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Line Managers'

MHFA England™ © 2016 MHFA. All rights reserved.

This Line Managers' Resource was originally developed by Shift,
the Department of Health’s programme to reduce the stigma and
discrimination surrounding people with mental ill health in England, in
partnership with the Department of Health, the Department of Work and
Pensions, the Health and Safety Executive, the Cross-Government Health
Work Wellbeing Delivery Unit and the Chartered Institute of Personnel and
Development. It was first published in 2007, and it built on an earlier guide,
the Mind Out for Mental Health Line Managers' Resource, which was
published in 2003.

Shift produced the 2007 guide as part of its Action on Stigma initiative,
which aimed to support employers in promoting good mental health and
reducing discrimination.

The Line Managers' Resource has been revised and updated over the past
ten years, including by Mental Health First Aid (MHFA) England in 2013.
MHFA England has also developed this new, fourth, edition (2016).
Line Managers’ Resource
Copyright © 2016, MHFA England CIC

ALL RIGHTS RESERVED. Any unauthorised reprint or use of this material

is prohibited. No part of this book may be reproduced or transmitted in any
form or by any means, electronic or mechanical, including photocopying,
recording, or by any information storage and retrieval system, without
express written permission from the author/publisher.


MHFA Line Managers' Resource

Shift, the government’s initiative to tackle We all have mental health, just as we all
stigma and discrimination surrounding have physical health, and in both cases
mental ill health in England, first we are on a continuum, where our health
published The Line Managers' Resource can vary day to day. It is estimated that
in 2007. Since then it has been regarded one in four people experience a mental
as an increasingly valuable tool for line health issue in any given year, and that
managers across the spectrum of private, one in six employees is depressed,
public and third–sector organisations. anxious or suffering from stress – related
Exceptionally practical, the resource problems at any one time. The bad news
offers a step-by-step framework for is that work can trigger or exacerbate
creating healthier workplaces, and has such issues; the good news is that
traditionally focused on key areas such as enlightened organisational practices
how to spot an employee experiencing and well-trained line managers play a
mental ill health, and how to manage and powerful role in fostering wellbeing and
support them at work, while they are off sustaining good mental health.
sick, and when they return after sickness
absence. The resource also provides The role of the line manager is key.
signposts to relevant employment The way they manage and interact
legislation and further sources of help for with their teams directly affects the
both the individual and the organisation. mental health of those teams – the old
adage that people join companies but
This new edition still does this, but the leave their managers still holds true.
focus has shifted towards prevention. And the relationship between manager
This reflects the new focus in our Mental and employee is under the spotlight as
Health First Aid (MHFA) England training never before: the requirement to 'do
courses, and the strides that have been more with less', a legacy of the post-
made over the past ten years in the recession era, has become 'business as
understanding of and attitudes towards usual'. As such, many employees are
mental health by both employers and struggling with bigger workloads, tighter
society as a whole. The good work done deadlines, tougher targets – and a sense
by a range of organisations, including of being out of control. The way they
MHFA England, Mind and Business in the are managed and supported at work in
Community, is helping to create parity order to sustain both their performance
between mental health and physical and their wellbeing has become a critical
health by removing the stigma and differentiator of successful organisations.
discrimination traditionally associated
with mental ill health. And it is largely
doing this by encouraging people to
talk about it. The evidence shows that if
people who are experiencing the early
symptoms of mental ill health feel able
to talk about them – particularly in the
workplace – it helps prevent the problem
escalating into a full-blown illness.

Foreword cont.

Awareness of mental health issues For too long stigma and taboos have
at work is growing, and employers fuelled fear and misunderstanding
are putting in place many positive around mental ill health and prevented
interventions – from healthy food in people from speaking out and seeking
the canteen, to gym membership, to help. The Line Managers' Resource is
resilience training – to help promote based on the understanding that mental
wellbeing. Mental ill health is typically health and wellbeing, like physical
caused by a range of factors, from health, can be sustained and improved
relationship problems, financial worries or through some simple yet effective steps.
poor housing, to poor management and/ Communication is vital. We know that if
or stress in the workplace. But whether someone experiencing a mental illness
the primary cause is 'home' or 'work'– has a line manager who is comfortable
related, a healthy working environment talking about mental health and knows
– and, in particular, managers who are what support to provide or signpost
skilled in spotting early signs of mental people to, that individual feels better
ill health and providing appropriate supported and is more likely to be able
support – plays a critical role in keeping to continue working successfully.
employees healthy and preventing full–
blown mental illness. Treating people as People who have or have had a mental
individuals is key – hence the pivotal role illness are working effectively at all
of line managers. No one knows their levels of seniority, in all sorts of different
people better than they do, which makes organisations. By using the clear,
them ideally placed to create a climate concise guidelines in The Line Managers'
that is conducive to the wellbeing of their Resource, organisations will help even
team and to spot changes in behaviour more people who have a mental health
or performance that could indicate an issue not just to remain in employment,
underlying mental health issue. Much of but also to flourish at work.
this comes down to good management
practice, but enlightened employers are
also training their managers specifically
in how to manage the mental and
emotional health of their teams.

MHFA Line Managers' Resource
MHFA England

MHFA England is a community interest

company and our social objective is to
increase the mental health literacy of
the whole population and, to this end,
to train one in ten adults in England.
MHFA England has worked tirelessly
since its inception in 2006 to increase
mental health literacy across England,
and when Shift closed in 2011 we were
proud to take on the responsibility
And finally, let's not forget that it is line for The Line Managers' Resource and
managers themselves who are often we remain proud of our continued
under the greatest pressure. They have association with it.
to do their own jobs, help their team to
do their jobs, and have a responsibility The resource complements the work
to look after the mental health and we do to train people in Mental Health
wellbeing of the people who work for First Aid. Thanks to our work there
them. We hope this resource will enable are thousands of Mental Health First
them to maintain their own wellbeing Aiders in England who are skilled in
and mental health as well as that of spotting the early signs of mental ill
their teams. health in their colleagues and confident
about their ability to point them
towards further sources of help and to
support them in their recovery.

For any organisation, providing

MHFA in the workplace is a matter
of enlightened self-interest: it is part
Poppy Jaman of being a responsible employer, but
Chief Executive Officer, it also builds employee engagement,
MHFA England CIC loyalty and productivity. There is also a
direct financial consequence. The cost
of mental ill health to UK business is
huge: estimates suggest that around
70 million working days are lost
every year because of mental health,
costing Britain between £70bn and
£100bn. (1) The cost of 'presenteeism'
– people who come to work but are
unproductive because they are unwell
– could be higher still.


MHFA Line Managers' Resource

1. The relationship between work and mental health and wellbeing 8
An explanation of mental health and wellbeing and how work
affects them in positive and negative ways.

2. Promoting wellbeing 16
Creating working conditions that foster good mental and
physical health helps to prevent mental ill health and addresses
some of the stigma and stereotypes associated with it.

3. Recruitment and promotion 21

How to manage the recruitment and promotion process
of someone who has or has had a mental health condition.

4. Identifying the early warning signs and talking at an early stage 24

Because they know their teams better than anyone, line managers
are ideally placed to spot changes in behaviour that could indicate
an underlying or incipient mental health problem.

5. Keeping in touch during sickness absence 38

Maintaining appropriate contact with people who are off work
because of their mental ill health is beneficial and essential.

6. Returning to work and reasonable adjustments 42

Effective planning by the employee and their line manager is essential
to their recovery and to their ability to resume work successfully.

7. Sources of further help and information 49

8. Appendix 52

1. The relationship between
work and mental health
and wellbeing
Facts and figures on mental health

- One in four people will experience a - In a Bupa poll in 2014, 94% of business
mental health issue in any given year. (2) leaders admitted to prejudice against
people with mental health issues in
- Between one in five and one in their organisation. (8)
six working age adults is depressed,
anxious or experiencing stress-related - In a survey of UK adults 56% said they
problems at any one time. (2–4) wouldn't hire someone with depression,
even if they were the best candidate for
- T
 he Chief Medical Officer estimates the job, according to a report by Unum
that around 70 million working days and the Mental Health Foundation. (9)
are lost every year because of mental ill
health, costing Britain between - W
 ork is beneficial to physical and
£70bn and £100bn. (1) mental health: periods out of work can
exacerbate a mental health condition
- In 2014/15 anxiety, depression and because people feel isolated, forgotten
stress accounted for 35% of all and purposeless. (10)
work-related ill health, and 43% of all
working days lost to ill health, according - A
 mental health issue is not a sign
to the Health and Safety Executive. (4) of weakness; in fact it can be just
the opposite. Determined, energetic,
- T
 he Centre for Mental Health purposeful high achievers can be the
estimates that presenteeism accounts most vulnerable, because they push
for 1.5 times more losses in productivity themselves so hard. Winston Churchill,
than absences. (5) Isaac Newton, Charles Dickens and
Ludwig van Beethoven all experienced
- One in five people take a day off due to mental health issues.
stress, yet up to 90% feel unable to be
honest about this being the reason for - Nine out of ten people with
their absence. (6) mental ill health experience stigma
and discrimination. (11)
- Research from Time to Change found
that 49% of respondents would feel - A
 report from Bupa, based on You Gov
uncomfortable talking to their employer research among 6,000 employees in a
about their mental health. (7) range of industries, found that one in
five middle managers had felt stressed
for more than a year and one in ten felt
close to breaking point. Half the
managers surveyed felt 'constantly
worried' and four in ten had
experienced depression as a
result of being stressed. (12)

The World Health Organisation defines Employers are constantly seeking ways

MHFA Line Managers' Resource

mental health as: "A state of wellbeing in to maximise the productivity of their
which every individual realises his or her employees, and the enlightened ones
own potential, can cope with the normal understand that the way to do this is not
stresses of life, can work productively to pile on the pressure, but to engage
and fruitfully, and is able to make a them and support them to work more
contribution to her or his community." effectively. Striking the balance between
higher productivity and robust mental
Wellbeing is rather more difficult to health is tricky, and it relies on strong
define, but there is consensus around the understanding by organisations, and by
following definition: "Being comfortable, well-trained line managers in particular,
healthy or happy." about how to create and maintain the
conditions that support and encourage
Work plays a strong role in our mental good mental health, and to recognise
health and wellbeing. There is a Maori signs of ill health and provide
proverb that 'work brings health' and appropriate support.
the Royal College of Psychiatrists claims
that work is central to many people's The stigma associated with mental health
happiness. Not only does work give us remains a major obstacle to the effective
the money we need to live, but it also diagnosis and treatment of mental health
provides social contacts and support, conditions. It can prevent employees
keeps us physically and mentally active, from talking to colleagues or managers
allows us to develop and use skills, gives about their problems because they fear
us social status, a sense of identity and discrimination. It may even prevent them
personal achievement, and provides a way from acknowledging to themselves that
for us to structure and occupy our time. they have a problem. This, combined
with a continuing lack of awareness and
However, work can also make us unwell. understanding among many organisations
Mental ill health is usually caused about how to tackle mental health in the
by a combination of work- and non- workplace, conspires against many of the
work-related factors: for example, the underlying issues being addressed.
pressure of ongoing change at work and
longer or more intense hours may be The MHFA England Line Managers'
exacerbated by financial pressures at Resource, in combination with MHFA
home, relationship problems and, given England training, provides just the kind of
the ageing population, greater caring practical guidance organisations need to
responsibilities. If the workplace is not overcome such obstacles. Both provide
supportive, it can trigger or exacerbate a practical step-by-step approach to
mental ill health, with anxiety, depression help organisations create a healthy
and stress-related disorders being environment, introduce awareness-
the most common issues. Poor work raising initiatives, identify the first signs
environments, typically characterised by of mental ill health and support staff
high demands, low levels of individual who are experiencing an issue. If there is
autonomy and poor support, can one key message we would emphasise,
undermine the health and wellbeing it is to create a climate where people
benefits that 'good' work brings. In some feel confident to talk openly about the
cases the effect is toxic. problems they are experiencing and
trust their employer to do the right
thing by them.

The relationship between work and
mental health and wellbeing cont.

What is mental ill health?

Organisational benefits of Mental ill health covers a variety of
improved mental health different conditions, ranging from
depression, anxiety and stress-
- C
 ompliance with legislation related disorders to schizophrenia and
such as the Equality Act 2010 and personality disorder. In the workplace
Management of Health and Safety the primary manifestations of mental ill
at Work Regulations 1999. health are anxiety, stress and depression
which, although they may not be
- R
 educed grievance and caused directly by work, are frequently
discrimination claims. exacerbated by it.

- D
 emonstrable corporate What do we mean by ‘stress’?
social responsibility. The Health and Safety Executive
(HSE) defines work-related stress as
- Reduced staff turnover. “the adverse reaction people have to
excessive pressures or other types of
- Reduced sickness absence. demand placed on them at work”.

- Reduced presenteeism. A certain level of pressure in a business

environment is desirable. Pressure helps
- A healthier workplace. to motivate people and boosts their
energy and productivity. But when the
- Better staff morale. pressure someone is under becomes too
much to cope with, that positive force
- More engaged and committed staff. turns negative and becomes stress. But
people can also feel stressed when too
- Better customer service few demands are made on them – when
they are bored, under-stimulated or feel
- Skills retention. undervalued. Stress is not technically a
medical condition, and most of us can
cope with short bursts of stress, but
research shows that prolonged stress is
linked to mental health conditions such
as anxiety and depression.

MHFA Line Managers' Resource
As we noted earlier, there is typically a
complex interplay between the pressures
people face at work and those they face What you can do to support your staff
at home. For example, someone who has
suffered a bereavement or a relationship - T
 he organisations that are leading
breakdown may be temporarily unable to the way in understanding, identifying
cope with a workload that under normal and supporting the need for good
circumstances they find eminently mental health in the workplace are
manageable. The line manager's investing in developing their managers.
attitude and approach to supporting MHFA training is one way to educate
that individual can have a significant managers and teams to spot the first
impact on their attendance, behaviour signs of mental ill health and give them
and performance. the knowledge and confidence to help
colleagues in distress.
How an individual copes with pressure
is determined by a variety of factors, - T
 he Health and Safety Executive
including support systems at home and (HSE) Management Standards use
work, and their own personality and a risk assessment process to help
coping mechanisms. What may be too organisations identify the extent and
much pressure for one person at one causes of employees’ work-related
particular time may not be too much for stress, and suggest ways that everyone
the same person at a different time or for in the organisation can work together
a different person at any time. to prevent and manage stress
more effectively.
Clearly, this resource is designed to help
line managers prevent and deal with - T
 he Health and Safety Executive (HSE),
a broad range of mental health issues, Chartered Institute of Personnel and
rather than stress per se, but the way Development (CIPD) and Investors in
you manage staff who are experiencing People have also developed a stress
pressures at home and/or at work will management 'competency indicator'
have a significant effect on their ability framework of tools to allow managers
to cope with it, on their resilience and to assess whether they currently
on their mental health. Management have the behaviours identified as
behaviour is often highlighted as a effective for preventing and
major factor by those suffering from reducing stress at work.
work-related stress. Employees whose
line managers have learnt good people
management skills are more likely to
develop healthier ways of coping with
the competing pressures on their time.
The result is higher levels of wellbeing
and resilience, which can help to prevent
more serious mental health issues.

The relationship between work and
mental health and wellbeing cont.
Mental ill health: a short guide Mental ill health affects different people
in different ways, including the length of
As a line manager, you're not expected to time they experience it for. In general, we
be a medical expert. But this short guide categorise mental ill health as temporary,
is intended to give you a quick insight into fluctuating or ongoing.
why and how people become mentally
unwell, and what they can do about it. - T
 emporary – the person experiences
the condition for a short time and
Anyone can develop mental ill health at recovers after treatment.
almost any time in their life, just as they - F
 luctuating – sometimes the person
can a physical illness. Mental ill health experiences the condition, and
is no respecter of age, background or sometimes they don't.
circumstances. It can be triggered by a
range of things – including ostensibly - O
 ngoing – the person experiences the
happy events like getting married, mental health condition all the time, but
having a baby, getting a new job or controls it through one or a combination
being promoted. of the following:

- Starting a new job and working - Medication

with new colleagues. - Talking therapies
- A first job. - Self-help
- A
 poor relationship with the - Practical support.
line manager or boss.
Common types of support are as follows.
- Getting married.
- M
 edication – prescribed by a GP or
- Coping with increased psychiatrist, this may, for example,
workload or promotion. alleviate depression or anxiety by
- Bereavement. calming people down or combating
sleeplessness or thought disturbance.
- Having children.
- T
 alking therapies – such as IAPT
- Health scares or physical illness. (Improving Access to Psychological
Therapies), counselling, cognitive
- Divorce or relationship breakdown. behavioural therapy (CBT) or
- Redundancy, or fear of redundancy. psychotherapy. A GP, the mental health
service or Employee Assistance Scheme
- A change in the business. may all afford access to these.
- S
 elf-help – including learning
Other things may cause mental ill health. mindfulness techniques and improving
wellbeing through diet and exercise.
- Trauma, neglect or abuse in childhood.
- A
 dditional practical support – such as
- Body chemistry. helping the individual to resolve financial
issues, advising them on lifestyle choices
- Substance misuse. (including diet and exercise) or pointing
them in the direction of relationship
advice or counselling.

MHFA Line Managers' Resource
Mind your language Usually, a GP will be involved in
Terminology is important when diagnosing conditions and in prescribing
talking about mental health or dealing or advising on treatment. But a clinical
with someone who is experiencing a diagnosis doesn't dictate what an
mental health condition. What may individual can or can't do; indeed, the
be appropriate language for clinicians way people experience and live with their
may be less helpful for employers or mental health, along with the level of
job seekers. For the purposes of this support they need, varies from person to
resource, we generally use the phrase person.
'mental ill health' or ‘mental health issue’
to describe the distress someone Everyone should have the opportunity
is experiencing. to work, whatever their mental health.
Mental ill health is common and most
We avoid the term 'mental health of us will either experience it, have
problems' deliberately: we don't want experienced it, or know someone else
to suggest to employers and others that who has experienced it. Mental ill health
someone experiencing mental ill health touches us all and should not be a barrier
is necessarily a problem to themselves to treating people fairly, with respect and
or to anyone else. Someone may have a understanding.
mental health condition, either chronic or
fleeting, but still enjoy wellbeing: the two The most helpful approach for a manager
are not incompatible. is to try to understand the mental
health issues an employee is facing, but
In this sense (as in most senses) our then put these in the context of their
mental health is no different from our strengths and capabilities. That involves
physical health. Someone with a lifelong, talking to them in order to get a clear
long-term or fluctuating mental health understanding of what they can do,
condition may experience an acute phase rather than what they can’t do – which is
that requires them to take time off from the same strengths-based approach you
work for treatment or recuperation. At would adopt for any employee.
this point we refer to them as 'unwell'.

Many more people experience symptoms

of distress – for example, sleeplessness,
irritability or poor concentration, loss
of or increased appetite, higher alcohol
consumption – without having a
diagnosable mental health condition.
The key differences between the two
categories are the severity and duration
of the symptoms and the impact they
have on everyday life.

The relationship between work and
mental health and wellbeing cont.
The law and mental health There are many different types of mental
health condition that can lead to a
disability, including:
Relevant legislation
- anxiety disorder
- H
 ealth and Safety at Work Act
1974 (HASWA) - bipolar disorder

- Human Rights Act 1998 (HRA) - depression

- M
 anagement of Health and Safety - eating disorder
at Work Regulations 1999
- obsessive compulsive disorder (OCD)
- Equality Act 2010
- personality disorder
- M
 ental Health (Discrimination) Act
2013. (This removed legislative bar- - post-traumatic stress disorder (PTSD)
riers to people with mental health
issues being company directors.) - postnatal depression

- schizophrenia

- self-harm.

The Equality Act 2010 If someone's mental health condition

The Equality Act 2010 consolidates means they are disabled it has a number
and replaces previous legislation of implications for their employer.
(such as the Equal Pay Act 1970, the
Race Relations Act 1976 and the - Y
 ou can't discriminate against them
Disability Discrimination Act 1995). It (under the Equality Act 2010).
was introduced to afford consistent
protection to nine different groups. - Y
 ou have to make 'reasonable
The 'protected characteristics' are age, adjustments' (see section 6) so that
disability, gender reassignment, marriage the individual is not disadvantaged
and civil partnership, pregnancy and compared to non-disabled people.
maternity, race, religion or belief, gender
and sexual orientation. - T
 hey may be entitled to Statutory Sick
Pay (SSP) up to 28 weeks and, if they
Under the Act a mental health condition aren't, or their illness continues for
is considered a disability if it has a long- longer than this, they can apply for
term effect on someone's normal day- relevant sickness benefits.
to-day activity. A condition is deemed
'long term’ if it lasts, or is likely to last, - Y
 ou can't dismiss them nor select them
for 12 months or more. ‘Normal day- for redundancy purely because they
to-day activity’ is defined as something are disabled.
someone does regularly in a normal day,
such as using a computer, working set
times or interacting with people.

Other key legislation and strategic - Match job requirements with an

MHFA Line Managers' Resource

guidance relating to mental health employee’s capabilities

The Five-Year Forward View for - T

 alk when an employee shows
Mental Health (2016) - strategic signs of distress
guidance by the Mental Health
Taskforce, set up in 2015 - Keep in touch during sickness
absence to offer support and plan for
Crisis Care Concordat (2014) the return to work

Health and Social Care Act (2012) - Achieve a successful return to work

Preventing Suicide in England (2012) - Support an employee to manage a

long-term illness while staying in work
No health without mental health (2011)
- a cross-departmental government - A
 ccess sources of support and
strategy designed to improve mental information.
health outcomes for people of all ages.
The resource provides the
In most cases people's mental health following things:
issues derive from a combination of work
and non-work related issues. Because it - A
 dvice and information on how best
is impossible to disentangle the impact to promote and sustain the mental
of various factors on mental health, it is wellbeing of employees
in employers' interests to support their
employees whatever the original cause or - Practical guidance on how best
trigger. Treating staff well not only keeps to manage situations arising from
them productive, it also increases their episodes of mental ill health
engagement with the organisation.
- Strategies to combat the fear
and lack of understanding around
engaging with someone experiencing
How to use this resource mental ill health.
This resource is written for managers.
We recognise that workplace settings Employer and employees have a joint
are very diverse, but much of this responsibility to safeguard employees'
guide is universally relevant. It offers mental wellbeing. We recommend,
managers practical advice on managing therefore, that both managers and their
and supporting all staff, not just those teams attend an MHFA training course
who are experiencing anxiety and in order to better understand how to
stress-related disorders, two of the most support themselves as well as others.
common workplace manifestations of As we noted above, line managers are
mental ill health. arguably the most vulnerable when
it comes to experiencing anxiety and
We have designed the resource in stress-related disorders, because they
modules so that you can go directly are squeezed from above and below.
to the section that is most useful. MHFA-trained teams are healthier and
Underpinning everything is the more resilient because team members
importance of open, trusting dialogue. are mutually supportive.
The resource suggests practical steps
that managers and employees can take
together to do the following:

2. Promoting wellbeing
By tackling the issue of mental health in managers in promoting the mental
the workplace from the starting point of wellbeing of employees through
promoting wellbeing you may find that supportive leadership styles and
in itself begins to address some of the management practices. This would
stigma and stereotypes associated with involve the following.
mental ill health, and achieve early buy-in
from staff. If employees are more aware - Promoting a management style
of what 'wellbeing' is, what the benefits that encourages participation,
are, and how they can achieve it, they delegation, constructive feedback,
will be better equipped to look after mentoring and coaching.
themselves and be more sensitive
to the needs of others. - Ensuring that policies for the
recruitment, selection, training
Much of this comes down to good and development of managers
general line management skills, as recognise and promote these skills.
guidance from the National Institute
for Health and Care Excellence (NICE) - Ensuring that managers are able to
in 2009 indicates. The guidance aims to motivate employees and provide
help employers to promote wellbeing them with the training and
through productive and healthy support they need to develop their
working conditions. performance and job satisfaction.

The five recommendations cover, among - Increasing understanding of how

other things, the role of line managers, management style and practices
and flexible working. Among other things, can help to promote the mental
they advise employers to wellbeing of employees and keep
do the following. their stress to a minimum.

- Promote a culture of participation, - Ensuring that managers are able to

equality and fairness that is based on identify and respond with sensitivity to
open communication and inclusion employees' emotional concerns, and
symptoms of mental health issues.
- Use frameworks such as Health
and Safety Executive Management - Ensuring that managers understand
Standards for work-related stress when it is necessary to refer an
(see section 1) to promote and protect employee to occupational health
employee mental wellbeing services or other sources of
help and support.
- Consider particular models of
flexible working that recognise the - Considering the stress management
distinct characteristics of micro, competency indicator framework
small and medium-sized businesses developed by the Chartered Institute
and organisations. of Personnel and Development (CIPD),
the Health and Safety Executive
The recommendation governing the role and Investors in People as a tool for
of line managers is particularly pertinent management development
to the Line Managers' Resource. (see section 1).

NICE recommends that organisations

should strengthen the role of line

MHFA Line Managers' Resource
Full NICE guidance ‘Mental wellbeing at Everyone feels under pressure at some
work’ is available at: www.nice.org.uk/ time, and pressure can be a spur to
guidance/PH22 perform. It is sustained, unrelenting
pressure that creates the stress
Line managers should pay close attention associated with mental ill health.
to these guidelines, given the fact that
they are invariably seen as the cause of
much workplace stress and anxiety. But
in addition to improving their practice Tips for supporting the
generally, they need to focus specifically wellbeing of your team
on other ways of boosting the wellbeing
of their teams. They are not expected to - D
 evelop a work culture where
have specialist knowledge of mental ill everyone is treated with respect
health, but they are well placed to help and dignity and issues such as
all of their team by providing information bullying and harassment are
on how they can look after their mental not tolerated.
wellbeing and where to access
services and support. - D
 evelop a culture where open
and honest communication is
One of the easiest first steps encouraged and support and
towards improving the mental health mutual respect are the norm.
of your workforce is to discuss with them Encouraging an ethos whereby
issues that might affect their wellbeing. staff know that it's OK to talk
These may or may not be purely work about mental health and that it is
related. For example, sometimes people safe to disclose their experiences
don't know that making healthy choices, will help to reduce the stigma and
like eating a balanced diet, taking stereotypes associated with it. It
exercise and having a sensible will also allow staff to tell inform
work-life balance, can protect their you of any adaptations you need to
mental health in the same way that it make to working practice to help
does their physical health. them do their job.

Running wellbeing events, creating space - G

 ive employees more control
in team meetings and supervisions or over their work and how they do it.
appraisals to talk about how everyone is Lack of autonomy is a major
feeling, and ensuring key messages about cause of stress.
wellbeing are reinforced throughout
the organisation – especially by senior - E
 nsure that the employee has the
management – all show a genuine right level of skills for the job.
commitment to investing in a healthier
work environment. Wellbeing Champions - M
 ake sure that staff have a
and Health and Wellbeing teams within manageable workload.
organisations can also focus on leading
improvements in the workplace. - O
 perate flexible working hours so
that employees can balance the
But arguably the most important thing demands of home life with work.
you should do as a manager to promote
and safeguard the wellbeing of your - A
 udit the work environment for
team is to ensure that despite mounting physical stressors such as flickering
pressure to 'achieve more with less' no lights, and eliminate them.
one feels overwhelmed, and that you
provide the help and support they might
need to mitigate this pressure.

2. Promoting wellbeing cont.

Five Ways to Wellbeing

3. Take notice. “Be curious. Catch sight
As part of the government’s 2008 of the beautiful. Remark on the unusual,”
Foresight Project on Mental Capital advises NEF. “Notice the changing
and Wellbeing, the New Economics seasons. Savour the moment, whether
Foundation (NEF) researched and you are walking to work, eating lunch or
developed what it calls 'The Five Ways talking to friends.” Being aware of the
to Wellbeing' - a set of evidence-based, world around us and what we are feeling
everyday actions that can boost our is at the heart of what has come to be
wellbeing. They are a deceptively simple known as mindfulness'. And if we can
recipe for improving mental health, and as reflect on our experiences it helps us to
relevant to line managers themselves as appreciate what matters to us. 
they are to their teams.
4. Keep learning. Trying something new,
1. Connect. Evidence shows that picking up an old interest or signing up for
feeling close to and valued by others, a course we've been thinking about for a
whether at home, work, school or in while provides the kind of stimulus that
the local community, is a basic human is essential for wellbeing. At work that
need. So connecting with family, friends, might mean taking on a new responsibility
colleagues and neighbours is essential or role or doing some training. At home
to our wellbeing. NEF advises people to it could be learning how to fix a bike,
think of these as the cornerstones of their experimenting with a new recipe or
lives and to invest time in developing learning to play an instrument. We need
relationships with them. The return on to set ourselves challenges that we will
that investment is a set of connections enjoy achieving. Learning new things is
that will support and enrich both enjoyable and confidence boosting.
people on a daily basis.
5. Give. Happiness research has found
2. Be active. Exercising makes us feel that doing an act of kindness once a
good, whether it's a walk or a run, playing week for six weeks is associated with an
a game, dancing, cycling or gardening. increase in wellbeing. And many of us will
The trick is to find activities that we enjoy have experienced the surge of wellbeing
and that are appropriate to our mobility that comes from doing a fundraising event
and fitness, and to build them into such as a run or cycle ride. Just thanking
our daily lives. someone or smiling at them is a form
of giving, and volunteering your time
can be incredibly rewarding. Giving also
creates connections with others - which
is an example of how these 'Five Ways to
Wellbeing' are linked.

MHFA Line Managers' Resource
A holistic approach to wellbeing at work the point they are first recruited, through
The chart below presents some ideas a mental ill health episode and then back
for a holistic approach to wellbeing. It into work.
is based around an employee’s journey
within an organisation and how their The chart recognises that each
experience can be positively shaped at employee’s journey is different and
an individual level by their line manager, that the support provided operates at
and also at an organisational level, from different levels and in multiple ways.

Chart: An holistic approach to managing an individual

Organisational level

Individual level

o rk Re
cr u
to it m
Rehabilitation policy Organisational drivers

ur Retirement policy Corporate culture



‘Exit with dignity‘

Fair recruitment

Return plan Job/person fit
Active Clear induction

Early, active Management to employee
Support engagement processes e.g. wellbeing:
from - appraisal awareness-raising
internal and Plan for return - work planning activities and
external sources - training/ training e.g.
co-ordinated to Managing
development eg MHFA courses
Off s

meet individual rest of team

Spot signs early MHFA courses

needs - assessment Policies e.g.

At w

Discuss support/ - stress risk

Sickness adjustments

absence policy - flexible working

Monitor - childcare
- diversity

Workplace counselling/Employee Assistance

Programmes/links with Increasing Access to
Psychological Therapies programme

Occupational health, human resources

External support/information

We gratefully acknowledge the work of Heron and Teasdale which has informed this diagram.

2. Promoting wellbeing cont.

- A
 t the organisation level, for example, Again, most of the ideas presented here
it is good to have policies, structures are just good management practice.
and appropriate processes in place to But what enlightened organisations do
cope with an employee’s physical and/ is encompass mental wellbeing within
or mental ill health as it should arise. the boundaries of normal working life,
rather than focusing on it as 'out of
- But it is equally important that the ordinary' and therefore potentially
managers observe what is happening stigmatised.
at work on a day-to-day basis, and to
keep a close eye in particular on the The remaining sections of this guide
interaction between the employee explore in more detail how line managers
and their immediate manager and can support their employees
colleagues or team. through this journey.

3. Recruitment

MHFA Line Managers' Resource

and promotion
In this section we offer some practical
guidance to managers on how to manage Nailing some myths
the recruitment or promotion process for
someone who has or has had a mental Many people still assume that
health condition. Under discrimination someone experiencing mental ill
law, an employer has a duty to assess health won't be able to cope at
whether the candidate is the best person work, but neither a diagnosis nor
for the job on the basis of their skills, the severity of someone's symptoms
aptitudes and experience. As part of this, predict their ability to succeed in a
they must fairly assess the capability of job. The vast majority of people
a person with mental ill health to do the who have experienced, or are
job, taking into account any 'reasonable experiencing, mental ill health
adjustments' (see section 6) they will be can work successfully.
required to make.
Evidence also shows that employers
Some people are prepared to openly who, after a fair recruitment process,
acknowledge their experience of mental have appointed the right person
ill health, whereas others fear that doing for the right job, find no difference
so might jeopardise their current job, between the performance of
or future job prospects, and therefore people who have or have had a
don't declare it. Under the terms of the mental health condition and those
Equality Act 2010, they are under no who don't/haven't.
obligation to tell an employer about a
mental health condition, whether or not
it is classed as a 'disability'. Pre-employment questionnaires
Some organisations use a
pre-employment health questionnaire
as part of the recruitment process.
This often includes questions on mental
health status and/or asks for explanations
for long periods away from work.
We would strongly advise employers
not to do this. Under the terms of the
Equality Act 2010, the general position
is that it is unlawful for an employer to
ask any job applicant about their health
or disability unless and until the applicant
has been offered a job.

3. Recruitment and promotion cont.

There are, however, a few specific The Government Equalities Office

circumstances when employers can ask guidance is very clear.
questions about health and disability.
- A
 n employer cannot refer an
- T
 o establish whether the applicant applicant to an occupational health
can take part in an assessment to practitioner or ask an applicant to
determine their suitability for the job. fill in a questionnaire provided by an
occupational health practitioner before
- T
 o determine whether the employer a job offer is made.
needs to make reasonable adjustments
to enable a disabled person to - Questions about previous sickness
participate in an assessment during absence are classed a questions that
the recruitment process. relate to health or disability and must
not be asked.
- T
 o find out whether a job applicant
would be able to undertake a function - Employers must ensure that
that is intrinsic to the job. information on health or disability
obtained for the purpose of making
- T
 o monitor diversity reasonable adjustments during the
among job applicants. recruitment process does not form any
part of the decision-making process
- T
 o support 'positive action' in about whether or not to offer a job.
employment for disabled people.
- Employers should keep any information
- If there is an occupational requirement on disability and health that has been
for the person to be disabled. obtained for the purpose of making
reasonable adjustments during the
recruitment process separate from
other information.
More detailed information is available in
a report from the Government Equalities - A
 n employer cannot ask questions
Office called Equality Act 2010: What about whether any reasonable
do I need to know? A quick start guide to adjustments need to be made to carry
the ban on questions about health and out the job itself under after they have
disability during recruitment. actually offered the applicant a job.

The full guidance can be found at: Often the greatest barriers faced
https://www.gov.uk/government/ by people who are known to have
uploads/system/uploads/attachment_ experienced mental ill health is being
data/file/85013/employment-health- denied the opportunity to prove their
questions.pdf effectiveness. The Equality Act 2010
is designed to prevent this happening.
And because mental health conditions
and previous absences are not reliable
indicators of future illness, sickness
absence – or indeed, an individual's
ability to do a job – the Act also reduces
the chance that employers inadvertently
miss out on talent through discriminatory
recruitment practices.

MHFA Line Managers' Resource
By using the HSE Management Managers and occupational
Standards (see section 1) you can do a health advisers should not do
risk assessment for the job in respect of either of the following.
work-related stress. You can then review
this assessment should problems develop - A
 sk for information about treatment,
during employment, and use it as the the history of the illness, or any other
basis of a referral to occupational health information that is not relevant
or other health professionals. to the work situation.

What should you do when a - A

 ssume that a person with
potential employee discloses their mental ill health will be more
mental ill health after you've vulnerable to workplace stress
offered them the job? than any other employee.

It shouldn't really make any difference. Sometimes a potential employee

But at least if they tell you, you can won't tell you about their mental ill
make any necessary reasonable health. Indeed, some people with
adjustments to the workplace mental ill health are too frightened of
environment before they start work. discrimination to apply for jobs at all. It
A clinical diagnosis doesn't necessarily is vital, therefore, that employers make
indicate what a person can or can't do, every effort to create an environment
and the level of support, if any, they where potential new employees feel able
might need will vary from to communicate their individual needs
person to person. and abilities. Otherwise the organisation
could miss out on valuable talent, and
However, if you work in a larger talented individuals won't be able to
company an occupational health check fulfil their potential.
with the new employee may provide the
opportunity to discuss both reasonable - It is good practice to include a
adjustments and how to manage any positive statement about employing
future potential episodes of people with disabilities in job
mental ill health. advertisements in order to ensure
the recruitment process is fair.
If you don't have an occupational
health service, you should ask the - If a person with mental ill health fulfils
employee directly if they require any all the selection criteria, their health
kind of adjustment or additional help. should not be a barrier.
You can then seek advice if you need
further professional guidance. - Ensure that you can give fair and
truthful justification to a person with
mental ill health or a disability who is
turned down.

- Make sure you understand and have

policies and practices in place to
manage reasonable adjustments.

4. Identifying the early
warning signs and talking
at an early stage

In essence there are four broad Line managers should know their team
categories of people in any workplace. better than anyone. They are therefore
ideally placed to spot the early warning
- People with a mental health diagnosis signs that someone is mentally unwell.
who are healthy and performing There will be times when you notice that
well because they are managing someone whom you manage is behaving
their condition through medication, out of character or seems unhappy.
counselling, support at work and so on. Some of the key things to look out for
are changes in an employee’s usual
- People with a diagnosis who are behaviour, such as poor performance,
unwell. tiredness or increased sickness absence.
You might notice they are smoking
- People with no diagnosis who are well. or drinking more, or taking drugs, or
experiencing problems with colleagues.
- People with no diagnosis but who are A normally punctual employee might
very unwell and may not even realise it, start turning up late, or, conversely,
but whose performance is likely to be they might start coming in much earlier
impaired. This group is at the highest and working later. Other signs might be
risk of suicide. tearfulness, headaches, loss of humour
and mood changes. See the box for a
more extensive checklist.

MHFA Line Managers' Resource
Early warning signs of mental ill health - Being adamant they are right.

- W
 orking too many hours – first in,
Here's a list of behaviours and warning last out/emailing out of hours or
signs to watch out for. while on holiday.

- Not getting things done – missing - Being louder or more exuberant

deadlines or forgetting tasks. than usual.

- Erratic or unacceptable behaviour.

- Irritability, aggression, tearfulness. Physical signs might include the following.

- Complaining about lack of - Constant tiredness.

management support.
- Sickness absence.
- Being fixated with fair treatment.
- Being run down and frequent
- Complaining about the workload. minor illnesses.

- Being withdrawn and not - Headaches.

participating in conversations or
out-of-work activities. - Difficulty sleeping.

- Increased consumption of caffeine, - Weight loss or gain.

alcohol, cigarettes and/or sedatives.
- Lack of care over their appearance.
- Inability to concentrate.
- Gastrointestinal disorders.
- Indecision.
- Rashes/eczema.
- Difficulty remembering things.

- Loss of confidence.

- Unplanned absences.

- Arguments/conflicts with others.

- Being quick to use

grievance procedures.

- Increased errors and/or accidents.

- T
 aking on too much work and
volunteering for every new project.

4. Identifying the early warning signs and
talking at an early stage cont.
One of the most important things
you can do as a line manager is know Presenteeism
your people – that way it's easier to
spot when something's wrong. If you Presenteeism is a term used to describe
do perceive a potential problem with someone at work who is not working to
an individual, try to establish whether their full capacity because of ill health.
certain tasks, work environments, times A report in 2010 from The Work
of the day or particular team dynamics Foundation, Why do employees come to
are contributing to their distress. If the work when ill? found that the reasons for
problem persists for more than a few presenteeism include the following.
days, find a way to talk to them about
it. Be aware that the employee him – or - P
 ressure from managers and colleagues,
herself may not even recognise what's especially in environments where
happening to them, pretend it's not attendance management policies
happening, or feel anxious (which are designed to reduce
about seeking help. sickness absence) are in place.

Recognising colleagues' difficulties at - Stress.

an early stage makes it easier to help
them and provide appropriate support. - Personal financial difficulties.
Investing time and effort in promoting
the mental and physical wellbeing (the - A
 sense of responsibility for their work
two are linked) of your staff will be and to their team – factors that are
repaid many times over in terms of compounded by having no one to cover
enhanced morale, engagement, their workload in their absence.
loyalty and productivity.
Presenteeism, whatever the reason for it,
may be a sign of mental distress which,
left unchecked, could lead to even more
damaging (and costly) stress and mental
health-related problems.

Successive Absence Management

reports from the Chartered Institute
of Personnel and Development (CIPD)
indicate that presenteeism is on the rise,
and that the cost to employers is already
much higher than that of absenteeism.

Taking no sickness absence has

traditionally been seen as a virtue.
Instead it is contributing to mental ill
health. Instead of attempting to
'crack down' on sickness absence, line
managers need to look at the reasons for
it and talk to people who are coming
to work ill. Both absenteeism and
presenteeism could be early warning
signs of mental ill health.

MHFA Line Managers' Resource
Using everyday management - A
 sk for a private meeting at a mutually
procedures to identify problems convenient time and give yourself
and needs plenty of time so you don't have to
rush or are perceived to be in a hurry.
If any employee is experiencing mental
ill health at work, ideally they should - Meeting outside the office – in a
feel able to raise this with you, as coffee shop, for example – might feel
their manager. Regular work planning more private and less intimidating.
sessions, appraisals or informal
chats about progress are the kind of - Back up your concerns over particular
everyday management processes that behaviours or performance with
provide neutral and non-stigmatising concrete examples, dates and times
opportunities to talk about any problems
they may be experiencing. But if they - Y
 ou don't want to be disturbed, so turn
don't bring up an issue, and you have your phone off or onto silent.
noticed a change in their behaviour
that you think might indicate they are - W
 hen you ask them how they are,
becoming unwell, you need to find a way don't take 'I'm fine' for an answer. Be
of broaching it. prepared for them to be evasive or
defensive. Use specific examples to
Be aware that a sudden dip in underpin your concern and move the
performance or punctuality are likely to conversation forward.
be signs of a deeper underlying problem,
so it is inappropriate and unhelpful to - Mind your language. Say 'I' not 'we'
take a hard line approach. You clearly to avoid the employee getting the
need to talk about the issue at an early impression that 'everyone is talking
stage, but ask questions in an open, about them'.
exploratory and non-judgemental way.
For example: "I’ve noticed that you’ve - Reassure them that you are there to
been arriving late recently and wondered help them, not censure. This is not a
how you are?" That gives the employee disciplinary meeting and they aren't in
the opportunity to express their concerns trouble. If they get upset, let them take
in their own way. their time, and resist the temptation
to offer water or tissues as they may
If you listen and are empathetic, perceive that as an attempt to stop
positive and supportive, an employee will them. They will tell you when they are
feel more able to open up and be honest ready to continue.
with you, which then makes it easier
for you to offer the help they need. - Listen to them in a non-judgemental
Frame the conversation in the context way (see panel/box).
of exploring the issues and working out
how you can help. - Don't be tempted to rush into action.
Tell the employee you need to reflect
Sometimes your concerns may be such on what you've heard. Thank them for
that you need to have a conversation talking to you, reassure them that you
outside the regular informal chats. Think will sort it out between you and fix
carefully about how, when and where to another time to talk. Switching to the
have the conversation. pronoun 'we' at this stage is helpful,
because it includes them.

4. Identifying the early warning signs and
talking at an early stage cont.

Non-judgemental listening - Listen to the words and

the tone of voice and observe
The listener uses verbal and the body language.
non-verbal listening skills to:
- Check you understand what the person
- Hear and understand exactly is saying by restating it.
what's being said.
- Summarise facts and feelings.
- A
 llow the person to speak freely and
comfortably without feeling judged. - Use minimal prompts
('Mmm', 'Ah', or 'I see') to keep
the conversation moving.
It requires three key attributes.
- Don't worry about pauses or silences,
- A
 cceptance – respecting the person's as the person may be simply thinking or
feelings, experiences and values temporarily
although they may be different from lost for words.
yours. Not judging or criticising because
of your own beliefs and attitudes. You - A
 void the temptation to fill the silences
accept them as they are. as you may break their train of thought
or the rapport between you.
- Genuineness – showing that you
accept the person and their values Non-verbal
by what you say and do. You don't
make a moral judgement. - Be attentive.

- Empathy – the ability to place yourself - Keep appropriate eye contact (don't
in the other person's shoes and stare or avoid their eyes).
demonstrate to them that you hear and
understand what they are saying and - Maintain an open body position.
feeling. You get on their wavelength.
- Sit down even if the other
It requires a combination of person is standing, to make you seem
verbal and non-verbal skills. less threatening.

Verbal - T
 ry not to sit directly opposite
the other person, which can
- Listen without interrupting. seem confrontational.

- Pay attention.

- A
 sk appropriate questions to
make sure you are both clear about
what is being said.

MHFA Line Managers' Resource
Understanding patterns of absence If this employee has seen others with
similar problems being discriminated
If someone is having frequent short against, their caution is understandable.
bursts of sickness absence, giving
a variety of reasons such as stress, - Meet the person somewhere
migraines and back pain – or, indeed, if private – perhaps in a place of their
they give no reason – they may have an choosing, where they feel comfortable.
underlying, mental health issue that you
need to discuss with them. - A
 sk them if they'd like to bring an
advocate – maybe a trusted colleague,
But if you are going to look systematically friend or family member – to support
at patterns of absence for employees, them. Indeed some people might find
they need to be able to trust you, and it easier to talk to someone other than
feel reassured that your motive is not you in the first instance – someone of
to castigate them but to help them the same age, gender or ethnicity, or
work healthily. Therefore, once you're at least someone who is not their line
reviewed absence patterns you may need manager. Ask them who they
to communicate with staff what changes would choose.
you are going to make to improve people'
health and wellbeing at work generally. - In larger organisations you might
enlist the help of occupational health
(OH). However, the employee may be
reluctant to talk to OH. Whatever the
Engaging with someone who approach, you need to communicate
is reluctant to talk about their clearly with OH to ensure that
mental health contact with the employee is co-
ordinated and supportive.
Sometimes you have to work quite hard
to get an employee to open up the - A
 ll three parties must be clear
problems they are experiencing. This is about confidentiality boundaries
likely to mean that you need to step up and who will be told what.
the dialogue.
- Deal with hurtful gossip or bullying
- Reassure the employee that you promptly and effectively. You have a
will treat anything they tell you in legal duty to ensure that employees
confidence, except where there are are not bullied or harassed on account
issues that pose a health and safety of any disability or additional needs.
risk to either them or others.
- If the employee finds it too difficult to
- Consider why they might talk now, reassure them that your door
be reluctant to talk. is always open.

- A
 re they worried about being
judged, or that they might lose
their job?

- Is it really safe to be

open with you?

- W
 ill you treat any disclosures
they make sympathetically
and positively?

4. Identifying the early warning signs and
talking at an early stage cont.

Issues to raise with an employee - Is there any aspect of their medical
who is experiencing mental ill health care that it would help you to know
about? (For example, their medication
- A
 sk open questions about what is could have side-effects that affect their
happening, how they are feeling, what work.) While you have no right to this
the impact of the stress or mental ill information, they need to understand
health is. Ask them what solutions they that you can't make ‘reasonable
think there might be but appreciate adjustments’ if you don't understand
that they may not be able to think what the problem is.
clearly about solutions while
experiencing distress. - Do they have ideas themselves about
the kind of adjustments to their work –
- How long have they felt unwell? Is this either short- or long-term – that might
an ongoing issue or something that an be helpful?
immediate action could put right?
- Do they have any ongoing mental ill
- Discuss whether work has contributed health that it would help you to know
to their distress. Listen without passing about? If so, is it useful to discuss their
judgement and make sure you address established coping strategies and how
their concerns seriously. the organisation can support them?
(See section 6 for more information.)
- A
 re there any problems outside work It is up to them whether they want to
that they would like to talk about and/ reveal this, but again, you can explain
or it would be helpful for you to know that doing so will make it easier for you
about? However, don't put pressure to make reasonable adjustments.
on the employee to reveal external
problems if they appear reluctant. - Establish precisely what they want
their colleagues to know, and who will
- A
 re they aware of possible external communicate this. An inappropriate
sources of support, such as relationship breach of confidentiality or misuse of
or bereavement counselling, drugs/ the information they have told you
alcohol services/advice, legal or might constitute discrimination.
financial advice?
- A
 gree what will happen next and who
- A
 sk them if there is anything you will take what action.
can do to help, and make sure that
they are aware of any support that - Record all conversations accurately,
the organisation may provide, such and provide employees with a copy
as referral to occupational health, to ensure you both agree that it is
counselling, Employee Assistance an accurate record. This protects the
Programmes (EAP), brief psychological organisation and the employee and
therapies, health checks and so on. allows you to monitor progress
Make sure they know that if they take against agreed actions.
advantage of any of this help, it will be

MHFA Line Managers' Resource
higher level and another person to
Try to be sensitive to the level of underperform. What's motivating for one
information and support the employee is a hindrance for another.
can cope with at a given time. In the
midst of a crisis they may not be able Also, someone's ability to work
to think clearly or absorb information. under pressure may vary according to
The important points are to talk to what’s happening outside work. Most
them, reassure them their job is safe, people can cope with short bursts of
state positively that all help, assistance stress, but prolonged stress is linked to
and support will be offered, and affirm mental health conditions such as
that the discussion will continue at a anxiety and depression.
pace that suits them.
The employer has a legal duty to ensure
that work doesn't make employees ill.
Problems can build up over time and Failing to assess the risk of stress and
while you may feel the pressure to take mental ill health and to take steps to
action immediately, it might be better alleviate them could leave you open to
to reflect and consider the options. costly compensation claims. There is
Together with the employee in question, now considerable case law in this area.
try to distinguish between what's urgent
and what's important. Fortunately, employers are usually able
to make adjustments easily and relatively
You might also consider whether the cheaply: after all, most adjustments come
employee has been affected by an down to good management practice that
issue that may affect others in the will help others, not just the particular
team/organisation, such as the threat employee in question.
of redundancy. If this is the case you
need to carry out a stress risk audit and For more information about good
address any issues that emerge together management practice, including risk
with other departments, such as health assessment, on work-related stress, see
and safety or HR. the HS website (www.hse.gov.uk/stress).
You may also want to make use of the
Workplace Pressure Support Plan
Things to consider when an employee tool overleaf.
appears or says that they are ‘stressed’
But managing the mental health of your
The term ‘stress’ is not always helpful workforce is about much more than legal
as it means different things to different compliance. Investing now in ensuring
people. We all feel under pressure some your workforce is confident and able to
of the time but not everybody suffers support themselves and each other pays
the adverse reaction of stress, or off not just in financial terms, but also in
the same level of stress. We all react team morale, productivity and loyalty.
differently: the same amount of pressure
can spur one person to perform at a

4. Identifying the early warning signs and
talking at an early stage cont.

Managing an employee who - Respect their wishes. Once they have

becomes tearful and upset recovered sufficiently, they may want
to carry on working. Alternatively
Emotions are a natural part of life and they might want to take a break or
sooner or later it is likely that a member even go home.
of your staff will become upset. This
can happen for any number of reasons - Reassure them that you value
and can be connected to something at them and support them, because
work or outside work. When this they might feel embarrassed at
situation arises do the following. breaking down.

- Stay calm. - Don't ignore someone who's

upset, even if you're worried
- Reassure them that it is OK to be about how they will react to your
upset and that you are listening. In intervention. Doing nothing may
fact, the process of listening may make the situation worse.
provide an important space for both
you and the employee to gain insight
into the problem and possible actions
to help resolve it.

- A
 sk them if they would like you to
contact anyone or if they would like
someone to be with them.

- Make sure you give them an

appropriate space where they can
express emotion freely and compose
themselves in privacy.

- A
 lternatively, you might suggest
that you both leave the building for a
short time, and have a hot drink or a
short walk to give them time to
collect themselves. They may choose
to go on their own, but it is advisable
to accompany them – or have
someone else of their choosing to
accompany them – if they are still
very distressed.

MHFA Line Managers' Resource
Workplace Pressure Support Plan Of course, issues at home could also be
a problem and it’s important to recognise
If an employee tells you that they feel this may impact on the employee at work
‘stressed’, under too much pressure or if and offer support where possible.
you have noticed some signs that they
may be having some difficulties coping, Having a conversation need not be
you can use this action plan to help difficult or embarrassing and doing
structure a conversation and record any something about a problem doesn’t
suggested solutions or actions. need to be time consuming or expensive.
In fact, getting the issues out into the
Remember that what may feel like open and agreeing a way forward is the
a reasonable amount of pressure to most effective action. Putting support
one person could be overwhelming to in place early to deal with any issues
another. It is important to respect the could prevent the problem escalating
way someone tells you they feel and having a larger impact on both the
and treat any issues as real and individual and the team.
warranting support.
The action plan overleaf can be used
There are several key sources of pressure to record the issues raised, identify the
at work which could lead to stress either sources of the problem where possible,
individually or in combination. any actions agreed to help along with
timescales for review. This can be used
- Demands – workload, targets, to support an employee at work and
time pressures, working patterns, could be at an informal 1:1, return to
balance etc. work discussion or formal appraisal.
You can keep this record and review it
- Control – inability to have an with the employee as required.
adequate say over how a job is done

- Role – lack of clarity or understanding

how a job fits into the team and wider
organisation, lack of skills or training
needed for a job

- Relationships – negative working

relations or lack of support from
managers, customers, colleagues etc.

- Change – job insecurity, uncertainty or

relentless, fast-paced change

Employee concerns Impact at work Suggested solutions Action agreed Review

What does the employee How are the What could solve the What actions have been Review date of
believe are the main issues affecting the issues? (manager and agreed & why? (for manager actions in place
issues? employee at work? employee) and employee)
talking at an early stage cont.

By signing, the manager and employee Name of Line Manager Signed by employee
agree the notes are a true reflection of
the discussion and agree to complete Name of Employee Date
the agreed actions without
4. Identifying the early warning signs and

unreasonable delay. Signed by line manager Date

MHFA Line Managers' Resource
Managing the rest of the team Recognising when the individual needs
professional or clinical help
Be aware of the effect one employee’s
mental ill health could have on the rest of Someone does not have to be
the team. They may respond to: 100% well in order to work and, as
stated earlier, in general work is good
- T
 he person’s particular symptoms or for people's mental health. However, in
behaviour while unwell. some instances an employee is simply
not well enough to work. If someone
- A
 ny reasonable adjustments continues to show signs of distress
that are made. despite the reasonable adjustments and
support you have provided, you should
- A
 n increased workload as a seek advice from HR and/or refer them
result of the person not being to occupational health (OH). Sometimes
well enough to work. people refuse OH assessments, in which
case you could tell them that you want
them to see their GP before they come
back into work.
In these instances it would be
advisable to do the following: Similarly, if you work for an organisation
without an OH or HR department you
- Be as honest and open with the team can encourage people to see their own
as confidentiality issues allow. GP and ask them to refer them on for
appropriate help. It might be helpful to
- Identify working conditions that give the employee a letter for the GP
may have an adverse effect on the outlining what their job involves.
wellbeing of the team, and change
them where necessary. One in four people experience ‘mild to
moderate’ mental health issues, such as
- Create an environment where staff can anxiety and depression, in any given year.
air their concerns openly. This helps However, a much smaller percentage
prevent gossip about and resentment will experience episodes of more severe
towards the member of staff who is off anxiety or depression that may be
work due to mental ill health. associated with episodes of ‘highs’. Such
episodes may present as:
- T
 reat all staff fairly in order to sustain
their engagement. If you offer flexible - Extreme heightened activity, and/or
working hours as a 'reasonable
adjustment' for a member of staff - Loss of touch with reality,
experiencing mental ill health, for hallucinations, and distortion of
example, then it may be appropriate the senses – for example, seeing or
to offer the same to all staff. The smelling things that aren’t there.
wellbeing of the whole team is
paramount, and employees who feel
stable and supported, whatever their
mental or physical health, will be more
engaged, loyal and productive.

4. Identifying the early warning signs and
talking at an early stage cont.

This behaviour may affect colleagues, Such episodes are rare, and when they
clients or customers, and you need to do occur it is not usually completely ‘out
be mindful of your responsibilities of the blue’. This is why it is so important
for all employees. to be alert to changes in behaviour and
to act promptly to pre-empt these
- T
 ry to take the person to a quiet more extreme manifestations of
place and speak to them calmly. mental ill health.

- Refer to the ‘advance statement’ Advance statements

(explained below) if one has
been written. Some people who have mental ill health
find it useful to draw up an ‘advance
- Suggest that you contact a friend or statement’ (sometimes know as a
relative or that they go home and WRAP®, or Wellness Recovery Action
contact their GP or a member of the Plan®), which explains how they wish
mental health team if appropriate. to be treated if they become unwell
at work. The statement can include
- Y
 ou might also be able to help them information on:
to make an appointment, and even
accompany them to the surgery if they - Signs that that they
feel that would help. are becoming unwell

- If someone is experiencing - W

 ho should be contacted or given
hallucinations or heightened senses, information (a close relative, care
they may not be able to take in what co-ordinator or GP, for example)
you are saying. In this case they may
need immediate medical help. - W
 hat sort of support is
- If an employee is disturbing others and
refuses to accept help, seek advice - Practical arrangements
from your OH provider if you have
one, or from the person’s GP if you - Treatment preferences.
know who that is. Otherwise contact
NHS 111, or, if the problem is really
urgent, the ambulance service.

MHFA Line Managers' Resource
If an employee draws up an advance
statement that is agreed with you, you Additional support for an
must put it into practice as agreed if/ employee who is distressed or
when they become unwell. develops mental ill health at work

Some organisations oblige all staff to Company-funded counselling schemes

prepare an advance statement on the and free NHS services can provide
following grounds: a safe space for staff to explore
emerging problems before they
- Anyone can become mentally unwell. become acute.

- A
 n inclusive process increases the The National Institute for Health
likelihood that people will complete the and Care Excellence (NICE) has shown
statement. that psychological therapies can help
people overcome depression and/or
- It makes people think about their own anxiety, and people are increasingly
and others' mental health. being offered 'talking treatments' as a
result of significant government
investment in the Improving Access
to Psychological Therapies (IAPT)
programme. The programme focuses
on cognitive behavioural therapy (CBT)
but over time will extend to the other
NICE-compliant treatments.

Employment advisers work alongside

therapists, providing information,
advice, and guidance to help people
suffering from mild to moderate
depression and anxiety to remain at or
return to work, or gain new work. For
more information go to www.iapt.nhs.
uk. Local IAPT services are also
searchable on the NHS Choices
website: www.nhs.uk

5. Keeping in touch
during sickness absence

Managers often worry that contacting If your company has access to

someone who is off sick will be seen as occupational health (OH) support, you
harassment, but the reverse is usually need to co-ordinate your approach to
true: lack of contact or involvement from the individual so as to create clarity
a manager can make an employee feel about your respective roles and the
less able to return. Most people who support you are offering. While being
have experienced distress agree that ‘out of sight, out of mind’ may be the
appropriate contact is not only last thing the individual wants, too much
beneficial, but essential. uncoordinated contact from different
people can overwhelm them.
Early, regular and sensitive contact with
employees during sickness absences In general it is best to treat someone
can therefore be a key factor in helping who is absent because of mental ill
them to return early – a fact endorsed health in much the same way you
by companies that have pioneered would treat anyone who's off sick – in
'active absence management'. If your an honest, matter-of-fact fashion. But
organisation has a written absence you need to be sensitive. So by all means
policy, discuss with the individual at send them a card, but check whether or
the start of their absence an not they would welcome visitors.
appropriate level of contact. Their wishes might change very quickly,
or over time. As their mental health
improves they might welcome more
contact, for example.

MHFA Line Managers' Resource
Tips on supporting an - Families often play a key role in
employee who is off sick supporting people when they are
unwell and helping them to recover.
- It is essential to keep in touch. If Their knowledge and understanding
there is little or no communication, is often unique and can be an
misunderstanding and barriers can important resource for employers to
quickly arise, the employee may feel tap into. Members of the family can
that they are not missed or valued act as valuable intermediaries and
and this can exacerbate their already potential partners in helping an
low self-esteem. Inviting them to so- employee back to work. You
cial events shows that you still think need to respect the employee's
of them as one of the team. confidentiality, but don’t assume that
they wouldn't want you to engage
- W
 hen they call in sick suggest and with their family – indeed, they might
agree a time they will call you or you be relieved that you have offered
will call them. At the end of each to do that.
exchange you can agree on the
timing of the next follow-up call. - Y
 ou might find it helpful to think
about the support you would offer to
- Y
 ou could explore different means someone with a physical condition.
of contact – phone, text, email or Is your approach to someone
face-to-face meetings in a neutral suffering from stress/distress
setting, for example. The employee different – and, if so, why? The
could ask someone of their choice to employee might appreciate hospital
accompany them to any meeting. visits, cards, flowers and so on – but
ask them first. The main thing is to
- A
 sk them who they would prefer as let them know they have not
their main contact. It might be you, been forgotten.
as their line manager, or it could be
another line manager, or an HR or - Y
 ou could ask them what, if any,
OH adviser. This may be particularly treatment they are having and the
important if the employee’s relation- effect this is having, but you must
ship with their primary contact is poor never put pressure on the person
or if that person contributed to their to divulge personal or medical
absence in the first place. information. It is up to them
whether or not they reveal it.
- Early intervention is key. The longer
someone is off work the harder it - A
 sk them if they feel able to do some
may be for them to return, so it is work despite their health issue, and
advisable to refer them to OH when they think might be able to
early on. return to work. However, timing is
critical: when someone is in crisis the
- If the employee is too unwell to be very thought of returning to work
contacted directly, find out whether could exacerbate the problem, and
someone else – a family member they may have no idea how long it
or friend, for example – can keep in will take them to recover. Here the
touch on their behalf. Switch back to input of their GP, in particular the ‘fit
direct contact as soon as the note’, will be helpful.
employee is well enough.

5. Keeping in touch during
sickness absence cont.

What to do if the person You may wish to revisit the contact

requests no contact question, tactfully, as the person begins
to recover.
Sometimes employees don't want
to be contacted. Don't accept this at You might also consider introducing a
face value and sever all contact with policy of regular ‘light touch’ contact
them because, as noted earlier, all for all people who are off sick. A person
the evidence shows that this hinders experiencing mental ill health is much
recovery and greatly reduces the chances more likely to react positively to this kind
of a successful return to work. People of neutral, non-stigmatising, inclusive
may request no contact because they way of engaging with people.
feel anxious, embarrassed or ashamed
about the way that they feel and are However, there are rights and
behaving. But sensitivity, sympathy and responsibilities on both parts when it
treating the person normally can comes to managing someone during
help to overcome that. a period of sickness absence and
rehabilitation. If you have made all
Sometimes an employee will request no reasonable efforts to communicate with
contact because they see you as part an employee and they refuse to stay
of the reason for their illness. If this is in contact with you, then they can't
the case, you need to offer different expect you to be able to anticipate what
options, including the services of another reasonable adjustments might help them
manager and/or making use of an return to work.
intermediary such as a colleague, family
member or trade union official. If work
issues (real or perceived) are part of the
reason, you must address these, and be
seen to address them, or the individual is
unlikely to return.

MHFA Line Managers' Resource
The role of GPs Occupational health

The GP’s role is to provide care and Occupational health (OH) provide
treatment and help people recognise impartial and confidential advice on
that getting back to work can be good fitness to work. Managers can refer
for recovery and health. They are helped employees to OH with their consent to
in this by the ‘fit note’, which, unlike obtain advice on the type of support
the old medical statement or certificate required and to ensure a successful
that it replaced in 2010, focuses on return to work. GPs may also prefer
what people can do rather than what to share information on an employee
they can’t do. The fit note helps to with other health professionals, rather
improve the flow of information between than with line managers. Therefore,
employers, individuals and GPs by if you have access to OH support, it
enabling patients to convey information would be sensible to refer the employee
to their employer about when the GP to them. OH, in turn, would write to
thinks they may be ready to return to the employee’s GP – again, with their
work and what adjustments might help written consent. It then becomes the
facilitate that. responsibility of OH to share with
the GP what the employer can
In addition to this, provided you have reasonably facilitate at work in the
the written consent of the employee, way of adjustments.
you could contact their GP highlighting
any factors that might have a bearing The advantage of involving OH at this
on the employee’s return to work stage is that their medical knowledge
that it would be useful for the GP to means they can ask the GP specific
know. Such factors might include the questions about the diagnosis and
nature of the work they do, a stress risk how it affects the individual, and the
assessment and/or information about the implications for the work the individual
organisation’s rehabilitation policies. You does, the prognosis and treatment issues.
could also propose specific options for
the employee such as adjustments The GP will send a confidential report
at work and/or a short-term to the OH practitioner, who then has
reduction of hours. to provide the employer with guidance/
recommendations on how best to
You should enclose a copy of the consent support the employee based on this
form with your letter to the GP. confidentially-held knowledge of their
medical background.
If the employee does not wish you to
contact their GP, that is their right and However, at some point, you, as the line
you must respect it. manager, will have to make decisions
about the employee based on the
information that you have.

6. Returning to work and
reasonable adjustments

Most people who experience an episode - Depending on the severity of the

of distress or mental ill health recover illness, explore whether it would be
completely and can resume work helpful to have a 'halfway house'
successfully. Effective planning by the between work and absence – such as
individual and the line manager will working for a couple of hours a day at
increase the likelihood of this happening, home for a period of time.
as will supporting and monitoring the
individual during the early stages of their - Plan a phased return to work as they
return. This is good news for both sides. become healthier.
Work helps to keep people mentally
healthy, and the employer retains skills - Discuss whether you could
and talent. What's more, given the realistically change or accommodate
investment the organisation has made in any of the work factors that
the individual, a planned return to work contributed to their absence.
is usually more cost effective than
early retirement. - Be honest about what you can
change and what you can’t. Some
In larger organisations managing organisational factors are out of your
someone's mental health and control, but look at whether you
employment, including their recovery, could mitigate them.
typically involves collaboration between
their line manager, HR, OH and the GP. - A
 gree how you will gauge their
In this section, we offer advice on how progress once they're back at work.
to plan someone's return to work and
to support and monitor them during the - Before they return, brief them on
first weeks and months of their return. what’s been happening – social life as
well as work developments.

- Y
 ou may want to encourage the
Planning the return individual to come into work informally
before their formal return.
You need to put various things in place
before the employee returns to work. - It's always good practice to have
a ‘return to work’ interview when
- Develop, in discussion with someone returns to work after an
the employee, a return-to-work absence. Even though this might be
action plan. just a quick informal chat, it gives you
the opportunity of finding out how
- Discuss whether you need to make they are and making them feel valued.
any adjustments to ease their return
(see below for some ideas).

Reasonable adjustments If necessary you should obtain a report

MHFA Line Managers' Resource

from the employee’s GP or consultant,
Some adjustments to consider with their permission, and, where
relevant, ask the employee’s key worker/
Almost no-one is ever fully fit when care co-coordinator for their view on the
they return to work after an illness kind of adjustments that may be needed.
(physical or mental) and it takes some
time to recover speed, strength and If you work in a large organisation you
agility of both mind and body. So it's can refer the employee to occupational
unrealistic to wait for someone to be health for an assessment and ask HR
100% fit before allowing them back: for their advice on what potential
doing so not only unnecessarily prolongs adjustments it would be reasonable to
their absence, but may also compromise offer. But you should always include the
their future employability. individual in the discussion to ensure that
the adjustment is effective.
It therefore makes sense to adjust their
work pattern to make their transition Adjustments should be agreed, not
back to work after a long spell out as imposed, and they must work for
comfortable as possible. This will help everyone – the individual, the
them to make a full recovery while giving business, the rest of the team,
them time to adjust and get back and customers/clients.
up to speed.

In some cases you will be required to

make ‘reasonable adjustments’ to comply What is 'reasonable'?
with the Equality Act 2010.
What's 'reasonable' will be judged against
the following criteria.

What is a ‘reasonable adjustment’? - T

 he extent of any disruption that
an adjustment may cause to your
The Equality Act 2010 requires organisation or other employees.
employers to make changes to jobs
and workplaces to enable a ‘disabled - The cost and your budget.
person’ to carry out their functions as
an employee or to help someone get a - Practicality.
job with you. These changes are known
as ‘reasonable adjustments’, and their - T
 he effectiveness of the adjustment in
purpose is to ensure that everyone has helping the employee do their job.
equal opportunities when applying for
and staying in work. - T
 he availability of financial or other
assistance from schemes such as
Who is responsible for providing and the government's ‘Access to Work'
implementing the adjustments? programme (see box).

Most adjustments are made based on An adjustment won't be reasonable

common sense following a frank and unless it works for everyone. Given
open discussion between the manager that a non-visible disability may require
and the employee about what might visible adjustments, you might get
be helpful and what's possible. Every questions from other members of the
'reasonable adjustment' is unique to the team about why one person works
individual’s specific needs and abilities differently. Plan with the employee in
and the extent to which the employer question what they want the rest of the
can accommodate them. team to know and how you will both
deal with any questions.
6. Returning to work
and reasonable adjustments
- A
 llow time off to attend therapeutic
The Access to Work Programme sessions, treatment, assessment
and/or rehabilitation.
The Access to Work programme
offers help to people with a disability or - Change shift patterns or explore
health issues who are in or looking for different work options such as
work. It provides funding that is used part-time, job-share, flexible working.
to help remove the practical barriers
that may prevent them from work- - A
 lter working hours, either by
ing on equal terms. This government reducing the hours someone works
funding could therefore be used to pay or offering a later or earlier start so
for the costs associated with making they can avoid the rush hour, or to
reasonable adjustments. accommodate tiredness or the side
effects of medication.
The amount of funding provided
varies depending on need and is - A
 llow them to make private calls to a
reviewed every one to three years. friend or mental health professional.
For more information about Access
to Work go to www.direct.gov.uk - Look at the physical environment
the person works in to see what
adjustments might be beneficial.
For example, you could move them
Examples of reasonable adjustments away from a busy corridor, or allow
them to use headphones to block out
This following list is not exhaustive, but distracting noise.
outlines some reasonable adjustments
you could consider. - Offer them a quiet place to retreat
to if they feel anxious or stressed.
- A
 phased return to work if the person
has been on sickness absence, starting - Consider offering childcare
with part-time working and building up. support, if appropriate.

- Look at aspects of the job that the - Give them a mentor or buddy.
person finds particularly stressful and
rearrange responsibilities. - Give them time to exercise – so
longer lunch breaks to go to the
- A
 llocate some of an employee’s duties gym or have a run.
to another colleague and adjust the
content of the job. - Identify potential training needs and
consider developing the skills of the
- A
 llow the employee greater control individual and their colleagues. This
over how they plan and manage their might cover the specific requirements
time and workload. of the job the individual performs
and/or enhance skills such as
- Offer the option of working at home communication and time
for some, or even all, of the time. management for everyone.

MHFA Line Managers' Resource
- Consider transferring the employee to What to do when an
another role. This is usually a last resort employee returns to work
once all reasonable adjustments have
been fully explored in the individual’s Above all make sure you and the
existing role. team make the person feel genuinely
welcomed back into the workplace.
Most adjustments are simple, You might consider offering them a
inexpensive and need only be temporary. mentor - a colleague or manager from
Some mental ill health can be episodic elsewhere in the organisation - so that
and so it may be better to agree they can talk to someone who isn’t their
certain adjustments on an ad hoc basis manager. This will ease their transition
rather than introducing them all in a back into work.
blanket fashion. However, many of the
adjustments listed above could be seen Do...
as good management practice that will
benefit all employees. - Ensure the returning employee
doesn’t have to face an impossible
Remember the following. in-tray, thousands of emails or a
usurped workspace.
- Don’t make promises that you
can't keep – be realistic. - Be realistic about workloads – some
people will want to prove themselves
- If you're not sure what will help and may offer to take on too much.
someone, ask them. Instead, set achievable goals that make
them feel they are making progress.
- Review the adjustments regularly to
ensure they are still working or - Make the time to have frequent
still necessary. informal chats with them to give you
both the opportunity to discuss their
progress and/or problems in a non-
threatening context. However, be
careful not to make them feel that their
work and/or behaviour is being overly
monitored or scrutinised.


- Make the person feel they are a special

case as this can make both them and
their peers feel resentful.

- Fail to deal with their work while they

are away. If you discover that a backlog
of unfinished work has built up,
deal with it.

6. Returning to work
and reasonable adjustments

Managing reactions
Points to consider around from colleagues and clients
staff who are on medication
Fear, ignorance and hostility from
- T
 hey may experience distressing side colleagues and clients can be a source
effects, which they might or might of great distress. Many people who have
not want to discuss with you. experienced mental ill health describe
this as a particular area of stigma and
- Some side effects might look like discrimination. Communicating openly
manifestations of the illness the about mental health/ill health is critical to
medication is treating, and they may eliminating the discrimination and stigma
be short-lived. Therefore the ef- associated with it, and nowhere is this
fects on the individual's work may be more vital to the employee's recovery
temporary. They may also need the and rehabilitation than at the point that
medication for only a short time. they return to work.

- For people with a longer-term health Stigmatising behaviour typically arises

need, it may take doctors some time from fear and ignorance rather than ill
to establish the right medication and will. People are unsure what to say and
dosage, so the employee may not im- find it easier to avoid the individual, the
mediately know whether or not their issue, or both.
medication will affect their ability to
do their job. To encourage honest open
communication in the team or
- In either case, you need to make sure organisation, we advise the following.
that you consider any side effects
they experience against their job - T
 ry to talk to the employee and
requirements – particularly in jobs agree who will be told what, by whom
where there are potential and when. Think about the language
health and safety risks. you use. Be clear about confidentiality
and boundaries.
- It is important that the employee
continues with medication until - Be guided by the employee’s wishes.
they have discussed stopping it Some people are prepared to be more
with their doctor. open than others. Encourage the
person to talk if they wish but don’t
pressurise them to do so.

- T
 reat people returning from absence
due to mental ill health in the same
way as you would those returning
after physical ill health.

- W
 atch out for hostile reactions –
stamp out any hurtful gossip or
bullying promptly.

MHFA Line Managers' Resource
- T
 reat mental ill health in a matter-of- continue to treat the individual with
fact way – it is common and should respect and consideration, and help them
not be a source of office gossip or to move on with dignity. You should,
conjecture. of course, fully explore options such as
any health-related benefits they may be
- A
 fter a time, ask the employee how entitled to – including health-related
they are getting on with peers/clients. retirement and pension.
Review the support you're giving them,
and if you don't already have initiatives
in place to raise awareness of mental ill
health, consider introducing them. Managing an ongoing illness
while at work
Most people who have ongoing mental ill
- Shrouding the issue in secrecy health can continue to work successfully
with either minimal support or no
- Making assumptions about someone's support at all.
workload and their capacity to cope.
This section discusses how, where
someone does need support, they can
work with managers to ensure that
What happens if the return support is sufficiently flexible to suit what
to work is not successful? might be their varying health needs.

By ‘return’ here, we mean either return It is discriminatory to make assumptions

after a one-off absence, or successive about people’s capabilities, promotion
attempts to return by someone whose potential and the amount of sick leave
illness is ongoing. they are likely to take, on the basis of
their health. You must treat people with
If the return is unsuccessful, review mental ill health exactly the same as you
the process again to see if you could would any other member of staff, unless
make any further adjustments, and talk they ask for help or demonstrate through
further to the employee. If things really their performance or behaviour that they
aren't working, talk with the employee need help.
about the most realistic way to move
forward. For example, you may agree that
transferring them to another job is the
best option.

If the issue is one of performance,

attendance or conduct, rather than one
relating primarily to the individual's
health or disability, you should use
normal procedures. If you can't resolve
matters this way, then terminating
their contract may be the only option.
Whatever the outcome, you must

6. Returning to work
and reasonable adjustments

Using regular management Coping strategies

processes to monitor needs
Most individuals are encouraged to
If a person has had a period of sickness develop coping strategies as part of their
absence, discuss with them the format care. This often involves noting signs of a
of their return and reintegration before possible relapse and taking pre-emptive
they come back to work. It can be useful action to avoid it. Such actions might
to agree a documented plan, which include cutting down on work or social
might include how you can both identify activity, reducing or eliminating alcohol
when they have reached the stage of intake, taking exercise and finding time to
‘business as usual’. Once they've reached relax.
this point, you can revert to normal
management processes to review their It is important that you support the
performance, needs and work planning. employee at this first warning stage.
Small and inexpensive adjustments
may well prevent a more costly
period of illness.
Advance statements
It is worth noting that employees who
As we explained earlier, it is best practice have developed coping strategies are
for an employee to draw up an advance often better equipped to deal with
statement to which explains how they pressure than employees who have never
wish to be treated if they become experienced mental ill health.
unwell at work.
Supported work projects

There are many projects around the

country that offer support both to
employees who have experienced
mental ill health and to employers. These
projects have an excellent track record
in placing people in employment and in
supporting them to be effective in the
long term. In fact, many people require
only minimal support once they have
been given the opportunity to work.
They are also useful points of contact.

You can find information on supported

work schemes through the disability
employment adviser at your local
Job Centre Plus.

7. Sources of further

MHFA Line Managers' Resource

help and information
Helpful resources, campaigns DoH guidance on workplace
and guidance adjustments for mental health

ACAS (Advisory, Conciliation and Available from: www.nhshealthatwork.

Arbitration Service) co.uk/images/library/files/
Phone: 0300 123 1100 Adjustments_Guidance_May_2012.pdf
(Accessed 07/07/2016)
Website: www.acas.org.uk
The Department of Health
Acas provides free and impartial published this advice on providing
information and advice to employers and reasonable adjustments for mental
employees on all aspects of workplace health conditions, outlining examples
relations and employment law. Supports of adaptations and good practice on
good relationships between employers applying any adjustments.
and employees, but also provides
conciliation services to resolve
workplace problems.
FDF workplace wellbeing guidance

Available from:
BITC (Business in the Community) https://www.fdf.org.uk/publicgeneral/
Phone: 020 7566 8650 (Accessed 08/09/2016)

Email: info@bitc.org.uk This resource created by the Food and

Drink Federation provides a best practice
Website: www.bitc.org.uk guide of tools and case studies on
supporting wellbeing in the workplace.
Business in the Community is the
Prince’s Responsible Business Network.
Its members work together to tackle a
wide range of issues essential to building Fit For Work
a fairer society and more sustainable
future. BITC provide a range of services, Phone: 0800 032 6235
practical guidance and creative solutions
that help businesses review, improve, Website: www.fitforwork.org
measure and report. BITC has also
launched a toolkit resource, helpful for Fit for Work is a voluntary service that
all organisations that are exploring how offers the wider working population
to embed a wellbeing strategy into their access to occupational health (OH)
organisation. advice and support. Employers can refer
employees who've been off work for
Available here: http://wellbeing.bitc.org. four weeks or more a free 'fit for work'
uk/all-resources/toolkits/mental-health- assessment. On the website you will find
employers (Accessed 07/07/2016) more information, an employer's guide
and a stress risk assessment tool.

7. Sources of further help
and information cont.
Health in Construction Leadership Group Mental Health Foundation
workplace resources
Phone: 0113 261 5368
Website: www.mentalhealth.org.uk/tags/
Website: workplace
The Mental Health Foundation has
Health In Construction Leadership developed a range of resources aimed at
Group works with construction CEO’s to tackling mental health in the workplace.
improve health within the sector, with a This includes the helpful guide ‘Managing
current focus on mental health. mental health in the workplace’, produced
Brings together contractors, clients, with employee benefits specialist Unum.
the Health and Safety Executive, Available at the link above.
professional bodies, trade
associations and trade unions.

Mindful Employer

The City Mental Health Alliance Phone: 01392 677 064

Email: cmha@citymha.org.uk Email: info@mindfulemployer.net

Website: www.citmha.org.uk Website: www.mindfulemployer.net

The City Mental Health Alliance is a Mindful Employer aims to increase

coalition of organisations that have come awareness of mental health at work and
together to create an environment in the provides easily accessible information to
City of London where mental health is organisations and supports for staff who
discussed in the same way as physical experience stress, anxiety, depression or
health. Championed by senior business other mental health conditions.
leaders, it is closely supported by UK
mental health organisations MHFA
England and Mind.

Education Support Partnership

Phone: 0800 0562 561 (Freephone, 24

hours a day, 7 days a week)

Text: 07909 341 229

Email: support@edsupport.org.uk

Website: www.

Provides free confidential counselling for

teachers, including online chat services.

Mind’s guide to workplace mental health Time to Change’s guide to

MHFA Line Managers' Resource

workplace mental health
Website: www.mind.org.uk/workplace/
mental-health-at-work Website: http://www.time-to-change.
Mental health charity Mind’s dedicated involved/support-managers
website section on workplace mental
health provides guidance to help Anti-stigma campaign Time to Change
employers take care of themselves and has a dedicated website section
their staff. Mind has also published the providing guidance, tips and tricks on
Employers’ Guide to Mentally Healthy many aspects of dealing with mental
Workplaces, which discusses what poor health in the workplace, including legal
workplace wellbeing is, what a mentally guidance and onwards signposting to
healthy workplace looks like, and how additional resources.
to create mentally healthy workplaces.
Available from: www.mind.org.uk/
(Accessed 07/07/2016) Shaw Trust

Phone: 01225 716 300

Richmond Fellowship Website: www.shaw-trust.org.uk

Phone: 0207 697 3300 The Shaw Trust is the UK’s largest third
sector provider of employment services
Website: for disabled and disadvantaged people.

The Richmond Fellowships is one of the

largest voluntary sector organisations NICE is currently developing some new
providing support for people with quality standards - 'Healthy workplaces:
mental health problems. Its aim is to improving employee mental and physical
work towards a society that values health and wellbeing and lowering sickness
everyone with mental health issues, absence' - which are due to be published
through providing supported housing and in January 2017.
employment support services to help
people find work or stay in work.

This is Me

Website: www.thelordmayorsappeal.org/

A City wide mental health campaign,

first developed by Barclays as part of the
Lord Mayor’s 2016 Power of Diversity
programme, run in partnership with
Business Healthy and the City Mental
Health Alliance and supported by City
AM. Aims to reduce stigma around
mental health in the workplace and raise
awareness of wellbeing.

Appendix 1: due to work and has subsequently been
supported by her counsellor and the
MHFA training occupational health team, had a period
off work and has since had a successful
MHFA training courses give people managed phased return.”
the confidence and communication
skills to support colleagues and teams “The learnings from the Mental Health
experiencing mental health issues. First Aid course were useful when one of
Below is a selection of comments from my counselees was signed off work with
MHFA-trained line managers. depression a few months later. Knowing
what support was available and how
“A few months after I took the course, to access it meant that we got the
one of my counselees was diagnosed by individual into the appropriate care
their GP with depression. He came to pathway immediately, and having
tell me about it, as was advised by his attended the course I could be
GP. While it was still a new experience absolutely confident that my employer
for me to deal with, having attended the expected and wanted me to focus on
Mental Health First Aid training was a their personal needs rather than the
huge help. I knew what to say to him, needs of the organisation. Being clear
and what resources to point him to. about this priority made a difference to
More importantly, I knew to reassure how I approached the situation, and now
him that it does not stop his career from that the individual is back at work we
progressing and the firm will support him are able to have an honest and ongoing
through this challenge. After a course dialogue to try and prevent issues
of treatment and a few weeks off work, building again.”
things have improved for him. He is now
happy to be back at work. I am really glad “Having various close friends with
I had the training and had the knowledge depression, I had seen mental illness
and tools to be there for him.” close hand. I had used the internet to
find out more, and tried to help as best
“I have been more aware of my as I could, but the Mental Health First
own illness and have been able to Aid course gave me further insight,
acknowledge the impact that it can helped me deal better with my emotions,
have on my day-to-day life. I have had and allowed me to offer help in a more
the confidence to discuss this with useful way to my friends. In particular,
my counsellor and management team I learnt that my role as a friend was not
and to take steps to start identifying to 'fix' their depression, but rather to be
triggers and adapt my working pattern open for conversation, and to understand
and relationships in order to manage my that because I am not a professional I can
illness and begin to reduce the negative help guide them to the correct source
impact it has on my life.” of help. Furthermore, I found that the
difficult topic of suicide was discussed
“Someone called me deeply upset prior openly and skilfully, and I found it
to going into one of our offices (not her especially useful to be given guidance
home office). She felt she was having a on how to discuss suicide with someone
panic attack and reached out for support, who has been thinking of, or has
knowing I had attended the Mental attempted, suicide. It was refreshing to
Health First Aid training. I recalled how hear difficult subjects being approached
to provide immediate support. Long head-on, stripping away the taboos
story short, she was suffering from stress

MHFA Line Managers' Resource
associated with them, and allowing us Appendix 2:
to have a much better understanding
of what people with different types of The small things
mental illness go through and how we
can help.” The #smallthings campaign from Time to
Change highlights all the little ways you
“Following the MHFA course I have can help someone you know who has a
been able to help a colleague to seek the mental health issue. See the links below.
support needed in respect of a family
member suffering with an undiagnosed https://www.youtube.com/watch?v=46-
(at the time) psychotic illness who was 1Rv13gXQ&index=2&list=PLW8cG1kJhc
refusing help.” vemCxldyQ7XHv_BhtAHbOQl

“I have used the learning from the https://www.youtube.com/watch?v=ZPK

course to help my sister who currently 9RK2BdhE&list=PLW8cG1kJhcvemCxldy
has severe postnatal depression. I have Q7XHv_BhtAHbOQl&index=3
helped her think about coping strategies
and persuaded her to seek professional https://www.youtube.com/watch?v=_Jm
help.” uv2rffgA&list=PLW8cG1kJhcvemCxldyQ
“I took the MHFA course in 2015 in
order to more effectively support https://www.youtube.com/watch?v=BUy
my colleagues and friends in crisis or 2y9QLVDg&list=PLW8cG1kJhcvemCxldy
difficulty, and to learn more about my Q7XHv_BhtAHbOQl&index=5
own mental health and how to support
myself in difficult times. I found the https://www.youtube.com/watch?v=ZZLy
course very informative and directly OlfNy64&index=6&list=PLW8cG1kJhcve
useful in my daily work life and personal mCxldyQ7XHv_BhtAHbOQl
life. Personal difficulties and work
stress do affect our mental wellness
and learning the tools to better support
others at work and in our personal lives
is incredibly valuable. Being able to
honestly and compassionately deal with
adversity is key to resilience and overall

Appendix 3: References

(1) Davies SC. Annual Report (7) Attitudes to Mental Illness

of the Chief Medical Officer 2013, Public 2013 Research Report. Time to Change.
Mental Health Priorities: Investing in 2014. Available at: www.time-to-change.
the Evidence. Department of Health. org.uk/sites/default/files/121168_
2014. Available at: https://www.gov.uk/ Attitudes_to_mental_illness_2013_report.
government/uploads/system/uploads/ pdf (Accessed 07 July 2016)
web_doc.pdf (Accessed 10 April 2016) (8) Lovell, D. Mental health
stigma still an issue in business. Employee
(2) McManus S et al. Adult Benefits. 2014. Available at: http://
psychiatric morbidity in England, 2007. www.employeebenefits.co.uk/issues/
Results of a household survey. Health november-2014/mental-health-stigma-
and Social Information Centre, Social still-an-issue-in-business/ (Accessed 07
Care Statistics. 2009. Available at: http:// July 2016)
adul-psyc-morb-res-hou-sur-eng-2007- (9) Managing mental health
rep.pdf (Accessed 10 April 2016) in the workplace. Unum/Mental Health
Foundation. Available at: https://www.
(3) Beaumont J, Lofts H. mentalhealth.org.uk/sites/default/
Measuring National Well-being – files/CR00233_Ebook_dualbranded_
Health, 2013. Office for National interactive.pdf
Statistics. 2013. Available at: http://
webarchive.nationalarchives.gov. (10) Modini M et al. The mental
uk/20160105160709/http://www.ons. health benefits of employment: results of
gov.uk/ons/dcp171766_310300.pdf a systematic meta-review. Australasian
(Accessed 10 April 2016) Psychiatry. 2016.

(4) Labour Force Survey (LFS) (11) Stigma Shout. Time to

Health and Safety Statistics for Great Change. 2008. Available at: http://www.
Britain. Health and Safety Executive. time-to-change.org.uk/sites/default/files/
2015. Available at: http://www.hse.gov. Stigma%20Shout.pdf
(Accessed 07 July 2016) (12) Crawford R. Line managers
too stressed to help staff. Employee
(5) Parsonage M. Mental Benefits. 2013. Available at: http://
health at work: developing the business www.employeebenefits.co.uk/issues/
case. Sainsbury’s Centre for Mental november-online-2013/line-managers-
Health. 2007. Available at: http://www. too-stressed-to-help-staff/ (Accessed 07
centreformentalhealth.org.uk/mental- July 2016)
health-at-work (Accessed 07 July 2016)

(6) YouGov poll commissioned

by Mind. Mind. 2013. Available at: http://
peoples-lives/#.V35MZLgrK71 (Accessed
07 July 2016)

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