Data from employers suggests that, in organisations without occupational health support (typically the smaller employers) there was greater reliance on the judgement of the employees’ GP. GPs generally provided employers with two things: advice regarding fitness to work at a particular time and a reason for absence, stating a diagnosis where relevant.
Small employers varied considerably in terms of the level of communication they had with an absent employee’s GP. Most did not query or request further information beyond statutory sickness certification. Some employers had approached GPs to obtain letters of consent (to release confidential information with the permission of the employee) and medical reports. Whether a manager working for a smaller employer sought this advice appeared to depend on their confidence, experience
and knowledge about absence management practice. There were some examples where expert medical assistance was needed urgently, such as when an employee was exhibiting alarming behaviour or in severe distress. In these cases, a human resources professional had taken the decision to send or take an employee directly to their GP. This had usually involved liaising with the employee’s family to ensure that they had somewhere safe to go after seeing their doctor.
Employers expressed a range of opinions about the input of GPs and the extent to which the information they provided was useful. There were some instances where employers had seen GPs in an adversarial role, particularly when they believed that they had no means of contesting a GP’s interpretation of an employee’s condition. Some employers were not convinced that GPs themselves always knew what was wrong with an employee. It was also commonly argued that GPs were too quick to ascribe symptoms of mental ill health to stress and that they wrote sick notes ‘to order’. Some employers believed that GPs tended to tell the employer ‘exactly what the employee has told them’. This was particularly frustrating if, for example, drug and alcohol problems were suspected. One employer had strongly suspected that an employee had a substance use problem but thought that the GP had been ‘fooled’ into believing that her difficulties at work were solely attributable to depression.
In another example, a human resources manager described a senior factory operator whom he had suspected for some time was a drug user. Several aspects of his behaviour had led the respondent to believe this: the employee’s attendance was erratic, when he was at work he was ‘constantly on the phone’ and he appeared to have debt problems despite being ‘well paid’. This belief was also shared by the employee’s colleagues. The respondent described the employee as ‘totally in denial’, and felt that the employee’s GP was hindering rather than helping the company to manage the situation.
We’ve actually got to the point now where he’s been telling us his GP won’t allow him back to work and his GP is getting the story from him that we’re not allowing him back to work.
(Human resources manager, large employer, manufacturing sector)
This was an ongoing problem. At the time of the research interview, the employee in question had been absent for several weeks and the human resources manager appeared at a loss as to how to move the situation forward.
A number of employers said that they would prefer to work more closely with GPs in identifying an employee’s condition and looking at ways to enable them to come back to work.
I think it is about working with employers and GPs because they are very often the biggest issues we have about keeping people with mental health conditions in work. It’s their GPs who are trying to keep them out of work and are telling them they will never work again.
(Head of human resources, engaged employer, large, manufacturing sector)
There were mixed opinions from these employers on how important it was to have a specific diagnosis for an employee’s mental health condition. Some employers had found this useful in helping them to respond appropriately, while others felt that this was not relevant or necessary. In general, employers preferred to focus on performance and behaviour and how best to adjust to assist this, rather than on obtaining a diagnosis. Several felt it was not helpful to label people.
We’re not experts in mental health, we’re here to produce and try and resolve issues that come up each day.
(Deputy manager, large employer, manufacturing sector)
Conversely, there were some cases where lack of a clear diagnosis had hindered management of employees with mental health conditions. One employer felt he had no choice but to invoke disciplinary procedures to deal with an employee with an apparent mental health condition, because his GP and psychiatrist did not provide a specific diagnosis. This was coupled with the fact that the individual concerned refused to accept they had a problem:
After they were temporarily sectioned, they were told there was no ongoing problem or mental health issue so we’ve been completely lost as to how we should deal with it. In the end they acted in such as way we had to protect other members of our workforce, which is very unfortunate.
(Workforce manager, medium-sized employer, health sector)
3.7
Conclusion
This chapter has presented a substantial amount of data on a range of themes relating to the way mental ill health at work is talked about, addressed and supported, and how it can impact on the work of individuals and others around them.
The research interviews with people who had experienced a mental health condition revealed a range of reasons why people may not mention this to their employer or others at work, including lack of personal insight, feelings of shame or weakness associated with mental ill health, or perceptions of stigma or discrimination by employers and colleagues. These factors were also recognised by employers in the study group. People who had experienced mental ill health at work also cited lack of opportunity or forum to talk about this, or a feeling that it had no bearing on their work, as reasons why they had not mentioned their condition to anybody. There were also people whose mental health condition was known about by others at work, but there was evidence that the extent and detail of this knowledge varied according to people’s own perceptions of their condition and how it had emerged. Notably, there were a number of instances where people at work were aware of traumatic circumstances that had occurred in a person’s work or personal life, but this may not, at the time, have been discussed or responded to specifically as a ‘mental health condition’.
The data also indicated that colleagues and employers could be similarly reluctant to raise the possibility that a person was experiencing some episode of mental distress, even when there was sometimes a compelling reason for thinking so. A fear of making things worse, of being wrong, of not knowing how to broach the subject all seemed to act to prevent people in this study from taking any sort of action.
Employers gave a wide range of examples of adjustments that they had either made for individual employees or would consider appropriate in some circumstances. Attitudes towards people experiencing some episode of mental ill health were largely constructive, with each employer using the resources and experience available to them as best they could. Clearly, the larger employers had access to far greater resources (such as human resources and occupational health staff) than smaller employers and this was reflected in the options open to them. Knowledge about how to respond, and who might be available to offer support, was much less in evidence among the medium and small employers in the sample. Some of the responses made were interesting for probably not falling within a definition of ‘adjustment’ under the DDA, for example encouraging other staff to take coffee breaks with people in need of some sort of immediate support in the workplace. It is possible to suggest therefore that there is scope for disseminating knowledge of these practices and examples of their effectiveness more widely among employers.
There were fewer examples from the employee data of adjustments being made to their role, perhaps influenced by the small number of people who had discussed their mental health condition in any depth with their employer. A few people reported constructive responses where some adjustments had been made. However, a perception that adjustments were not possible or not likely to be made had led some people to ‘struggle on’ in work without asking for support. In some cases, the adverse impact on work performance had led people to ‘choose’ to leave or to be dismissed, an important finding when considering employers’ job retention attempts.
Even when an employee and employer did share knowledge about a mental health condition, the employer data illustrated how tensions could be created for employers who needed to balance making some form of adjustment (for example, extra breaks, working at home, or discreet provision of training) with maintaining the confidentiality of the employee by not explaining those adjustments to work colleagues.
Awareness of the DDA and its application to mental health conditions was mixed among employers and very limited among the employee sample. Employers who were aware of the DDA (in relation to mental health) tended to view this as underpinning good practice, rather than their central reason for facilitating adjustments. In outlining the provisions of the DDA to participants in the employee sample, there was some scepticism about the extent to which this legislation could really be effective in the cases of people with mental health conditions.
Finally, it is worth reflecting on the evidence from this study of the limited role that GPs play in the relationship between people with mental ill health and their employers beyond the initial and continued provision of sickness certificates. There were relatively few examples of employees, employers and GPs working collaboratively to manage someone’s job retention, sickness absence or return to work, although some employers expressed the opinion that they would welcome closer collaboration. There was a common perception however that GPs were often cast in an adversarial role of providing justification for their patients not working rather than helping them to stay in or return to work.