Poor mental health in the workplace - how do you deal with it?

Stas Lawicki

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We've just had mental health awareness week in the UK and if you haven't seen the stats on this monumental problem you might be surprised to learn some of them:

Cost to UK economy - up to £99billion pa
Cost to UK businesses - between £34 - 45billion pa
Number of employees resigning from work with long term conditions 300,000 pa
Number of top 100 companies being proactive about tackling the problem - 15%

The above is taken from a report commission by the PM in 2017 (Stevenson/Farmer - thriving at work)

Every single day I talk to friends, businesses, sometimes new acquaintances and the subject of workplace stress and poor mental health is never far from the conversation. It affects far more people than most realise - not to mention the knock-on effects on family and friends.

What are you doing about it? Have you got mental health 'first aiders' do they help or are they simply a tick-box for some businesses and leaders to give the illusion they are doing something, but are really not bothered about it in the slightest? Are we better to train leaders to treat people with kindness and in a human way rather than a commodity and resource that should be abused and used to some commercial aim or benefit?

I am really interested to hear your thoughts...!
 

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    I have a part time job in the civil service. We have mental health first aiders and people trained to help with stress problems. At the same time we have daily targets to meet and weekly reports on whether we, as individuals have met our personal targets and daily reports on whether the team met its target the day before. For some, that is a cause of considerable stress and the assistance available is seen as paying lip service to the problem instead of tackling one of its root causes.

    Are we better to train leaders to treat people with kindness and in a human rather than a commodity and resource that should be abused and used to some commercial aim or benefit?
    Yes, although, I would say train (or encourage) everyone to treat all their fellow human beings with dignity and respect.
     
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    Stas Lawicki

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    I have a part time job in the civil service. We have mental health first aiders and people trained to help with stress problems. At the same time we have daily targets to meet and weekly reports on whether we, as individuals have met our personal targets and daily reports on whether the team met its target the day before. For some, that is a cause of considerable stress and the assistance available is seen as paying lip service to the problem instead of tackling one of its root causes.


    Yes, although, I would say train (or encourage) everyone to treat all their fellow human beings with dignity and respect.

    Thanks, Cyndy. You are 100% right - it is a cultural change that would promote the organisation as a whole to treat each other equally, fairly, with consideration etc. This culture is stimulated and driven from the top down.

    But how do we get leaders to accept, or at least begin to think, that they are either part of the problem (not able to help with time management or manage resourcing, tasks, or perhaps allowing needless process to get in the way of people doing their jobs), or responsible for it. There are lots of dinosaurs around who seem to think MH doesn't exist or is a new-age millenial problem - of course, nothing could be further from the truth.
     
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    The problem clearly comes from the top. 'A fish rots from the head' as the old saying goes!

    If senior management is not committed to a caring and collegial atmosphere, no amount of discussion groups or special programmes will make things better. Yes, a certain amount of stress at work is inevitable, after all, we are trying to get shi1 done and we don't always succeed! But many managers deliberately seek out to increase that stress by enforcing a hierarchy where none is needed.

    Most organisations are IMO unnecessarily hierarchical. OK - deadlines are a part of life, as is uncertainty over whether individual projects are going to succeed, but employees who are stressed and fearful are unlikely to stay in their jobs or be productive in the long run.

    Many managers derive a lot of their status from their role within a hierarchy. That way organisations can reward high-achieving employees with a title and the ability to act 'superior' to others, as well as with extra money.

    But power is seductive. Peter Cappelli, HR professor at the Wharton Business School in Philadelphia, says that toxicity arises when "the boss acts like a dictator and actively punishes people who articulate different views or express disagreement."

    Amy Edmondson of Harvard Business School explains in her book, The Fearless Organisation, the ideal is to create an atmosphere of 'psychological safety' where workers can speak their minds and managers need to learn the art of respectful inquiry and ask employees questions and listen intently to the answers and act upon them.

    The solution (again, just my opinion!) is not bolting-on mental health schemes and initiatives to existing structures, but a total restructuring of the company and the workplace. You might call this philosophy 'Every Man an Emperor!'

    If every employee is responsible for the success or failure of their bit of the overall enterprise, a completely different atmosphere is created. This is however totally at odds with the structure of most companies!
     
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    Paul Norman

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    The problem clearly comes from the top. 'A fish rots from the head' as the old saying goes!

    If senior management is not committed to a caring and collegial atmosphere, no amount of discussion groups or special programmes will make things better. Yes, a certain amount of stress at work is inevitable, after all, we are trying to get shi1 done and we don't always succeed! But many managers deliberately seek out to increase that stress by enforcing a hierarchy where none is needed.

    Most organisations are IMO unnecessarily hierarchical. OK - deadlines are a part of life, as is uncertainty over whether individual projects are going to succeed, but employees who are stressed and fearful are unlikely to stay in their jobs or be productive in the long run.

    Many managers derive a lot of their status from their role within a hierarchy. That way organisations can reward high-achieving employees with a title and the ability to act 'superior' to others, as well as with extra money.

    But power is seductive. Peter Cappelli, HR professor at the Wharton Business School in Philadelphia, says that toxicity arises when "the boss acts like a dictator and actively punishes people who articulate different views or express disagreement."

    Amy Edmondson of Harvard Business School explains in her book, The Fearless Organisation, the ideal is to create an atmosphere of 'psychological safety' where workers can speak their minds and managers need to learn the art of respectful inquiry and ask employees questions and listen intently to the answers and act upon them.

    The solution (again, just my opinion!) is not bolting-on mental health schemes and initiatives to existing structures, but a total restructuring of the company and the workplace. You might call this philosophy 'Every Man an Emperor!'

    If every employee is responsible for the success or failure of their bit of the overall enterprise, a completely different atmosphere is created. This is however totally at odds with the structure of most companies!


    Pretty much this.

    A major cause of stress is untrained management.
     
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    Nico Albrecht

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    A major cause of stress is untrained management.
    I throw in a completely different perspective here how I see it and you try to blame at the wrong level in my opinion. Stress existed for 1000's of years.

    If you compare stress levels and complaints you will find a direct relation to obesity charts. The UK is right on track for becoming the most obese country in Europe by 2021.

    To fix stress you need to start to fix it at the lowest levels possible and that would be the body.

    Get staff healthy and stress can be very reduced significantly but people do not like to hear that and rather blame somebody else for their stress problems.

    Stop drinking alcohol, quite smoking, sleep 8 hours, eat proper food and exercise 5 times a week and medial research shows stress can be reduced but that would mean a person with stress would have to take ownership of their life, drop excuses. It is easier to just eat a snickers and complain about workload and management.
     
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    Mr D

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    I have a part time job in the civil service. We have mental health first aiders and people trained to help with stress problems. At the same time we have daily targets to meet and weekly reports on whether we, as individuals have met our personal targets and daily reports on whether the team met its target the day before. For some, that is a cause of considerable stress and the assistance available is seen as paying lip service to the problem instead of tackling one of its root causes.


    Yes, although, I would say train (or encourage) everyone to treat all their fellow human beings with dignity and respect.

    In my part of the civil service we didn't have mental health first aiders.

    Mental health was basically ignored.

    We did in most units have weekly targets to meet - and due to targets we couldn't do urgent stuff because we needed to meet the targets.
     
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    We've just had mental health awareness week in the UK and if you haven't seen the stats on this monumental problem you might be surprised to learn some of them:

    Cost to UK economy - up to £99billion pa
    Cost to UK businesses - between £34 - 45billion pa
    Number of employees resigning from work with long term conditions 300,000 pa
    Number of top 100 companies being proactive about tackling the problem - 15%

    The above is taken from a report commission by the PM in 2017 (Stevenson/Farmer - thriving at work)

    Are we reading the same report?

    https://www.gov.uk/government/publications/thriving-at-work-a-review-of-mental-health-and-employers

    Those figures don't match the report.

    Stress is good, too many people spend too much time and effort trying to avoid it.

    http://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend.html

    Stress may actually be correlated with longevity—if a person doesn’t view it as a negative

    The study: Researchers at the University of Wisconsin-Madison asked almost 29,000 people to rate their level of stress over the past year as well as how much they believed this stress influenced their health — a little, a moderate amount or a lot. Over the next eight years, public death records were used to record the passing of any subjects.

    The findings: People who reported having high levels of stress and who believed stress had a large impact on their health had a whopping 43% increased risk of death. On the other hand, those that experienced a lot of stress but did not perceive its effects as negative were amongst the least likely to die as compared to all other participants in the study.

    Further reading: Check out this paper, “Does the perception that stress affects health matter?” And these two similar studies back up the idea: (1) “Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: the Whitehall II prospective cohort study” (2) “Meta-analysis of perceived stress and its association with incident coronary heart disease.”

    http://www.ncbi.nlm.nih.gov/pubmed/22201278
    http://eurheartj.oxfordjournals.org/content/early/2013/06/20/eurheartj.eht216
    http://www.ncbi.nlm.nih.gov/pubmed/22975465

    A stress-is-enhancing mindset may have lasting effects

    The study: Employees at a financial institution were asked to take a test on their stress mindset before and after watching three videos over the course of a week that either presented stress as enhancing or harmful. In a second study, students who had previously taken a survey on their stress mindset were told in class that five of them would be randomly selected to give a speech that would also be videotaped. For each student, mouth swabs were taken to measure cortisol levels. Each was also asked to decide, if chosen to speak, whether or not they would receive feedback from their peers and business school experts who watched the footage.

    The findings: In the first study, not only were many people influenced by the message of the videos. Those that viewed the video that approached stress as enhancing reported better work performance as well as less psychological complications. As for the students, those who naturally saw stress as helpful had a more moderate cortisol response upon hearing about the speech possibility — and they were more likely to request feedback.

    Further reading: “Rethinking stress: the role of mindsets in determining the stress response”

    http://www.ncbi.nlm.nih.gov/pubmed/...f+mindsets+in+determining+the+stress+response
     
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    Stress always will and always has existed.

    Working in a company where you boss is a dictator and you fear going into work...how will being fit help?

    Fit people are more likely to find a new job than unfit people.

    On average, fit people are also better workers, meaning the boss is likely to be happier with them.
     
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    Mr D

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    Fit people are more likely to find a new job than unfit people.

    On average, fit people are also better workers, meaning the boss is likely to be happier with them.

    Some jobs have stress built in and staff cope differently with it.
    Have been in places where multiple staff a day were going home upset or crying. Have been in places where a dozen or more staff would be off with stress at any one time.

    Most stressful has been in my experience having own business - far more stress. However its not external stress, no manager imposing it on you so some of us can handle much bigger stresses without breaking. Not everyone can handle that kind of stress.
     
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    Stas Lawicki

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    @NickGrogan - yes, the figures are paraphrased from the same report. They are certainly in there ;)

    Interesting range of opinions. I am interested to see how stress can be turned into a positive influence, I suspect this is on a case by case basis and assumes this stress doesn't spill over into other every day matters. I'll have a look at the reports. Thanks for sharing.

    People are sometimes promoted into positions of responsibility for no other reason other than being a top salesperson or perhaps a favoured colleague of the promoting 'manager'. I have seen examples of this in every single place I was in until I started my own business. And what training are people given? How to set targets and ask certain questions - without any knowledge or training on what to do with the responses. When I took my first management role for a large corporate, we had some basic training on dealing with people, but 99% of it was on sales. The same BS countless managers before and after me were trained on.

    Has anybody tried anything that worked for them/their business/team when trying to tackle or prevent the problem?
     
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    And what training are people given? How to set targets and ask certain questions - without any knowledge or training on what to do with the responses.
    Exactly!

    Part of the task of the management is to improve equity - and not just financial equity, but the well-being of the workforce. The moral and social equity, if you like!

    Has anybody tried anything that worked for them/their business/team when trying to tackle or prevent the problem?
    Yes. Get rid of hierarchies! Or at least make the structures and attitudes to work as flat and as non-hierarchical as possible.

    Team leader? Foreman? Site supervisor? Department head? If you feel that these roles MUST be a strict part of your company structure, then (IMO) your company structure is wrong!

    That does not mean that one member of a team is not the most senior, but that person should not be laying down the law to all the others. For example, if one member of a team has the task of technical documentation, that his/her job and others should not interfere or tell them how to do it.

    Combine that with payment by results and watch the transformation!
     
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    Mr D

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    @NickGrogan - yes, the figures are paraphrased from the same report. They are certainly in there ;)

    Interesting range of opinions. I am interested to see how stress can be turned into a positive influence, I suspect this is on a case by case basis and assumes this stress doesn't spill over into other every day matters. I'll have a look at the reports. Thanks for sharing.

    People are sometimes promoted into positions of responsibility for no other reason other than being a top salesperson or perhaps a favoured colleague of the promoting 'manager'. I have seen examples of this in every single place I was in until I started my own business. And what training are people given? How to set targets and ask certain questions - without any knowledge or training on what to do with the responses. When I took my first management role for a large corporate, we had some basic training on dealing with people, but 99% of it was on sales. The same BS countless managers before and after me were trained on.

    Has anybody tried anything that worked for them/their business/team when trying to tackle or prevent the problem?

    Multiple places I have worked have promoted to management based on ability to do their current job. Training is sitting with a manager a few days as various things get explained then dropped in the deep end.
    As you can imagine, not ideal.

    One of the better managers I had got a day's training but was a natural organiser, what we called in those days a single mum. She slowly learnt our jobs, personalities, strengths and weaknesses (we were all undertrained) to build one of the best teams in the unit.

    Had an incompetent manager once that we had to work around, promoted due to race alongside inability to do our level of jobs. So long as he didn't interfere the job went well, he eventually came to learn about people management. He just could not get the technical aspects of his job right.

    One of my more recent employers had both managers and deputy managers of each team. One manager and often two deputies.
    The deputies were trained by the manager and shadowed for a couple of weeks to start off with then any day or week the manager was off the senior deputy would cover and do the job, switching with the junior deputy a few times a year. And could move either to manage a team missing management at short notice.
    Also meant that a pool of candidates for promotion later on had experience and management could see how they had coped in the actual job.
     
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    Noah

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    Discussion seems to have drifted from mental health to stress. The title struck a chord with me because we have had major problems here with mental health due to external factors - that is, not directly arising from workplace stress.

    I don't know if there's much that can be done in that situation, especially in a small business.
     
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    Stas Lawicki

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    Discussion seems to have drifted from mental health to stress. The title struck a chord with me because we have had major problems here with mental health due to external factors - that is, not directly arising from workplace stress.

    I don't know if there's much that can be done in that situation, especially in a small business.

    There are so many things that can be done, from individuals to corporate companies and it doesn't have to be stress related. Do you mind sharing more? If not, of course no problem at all... perhaps somebody has gone through the same and can offer some help
     
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    If you define something as a problem, it becomes a problem and can never be seen as anything else.

    For example, I have Prosopagnosia (face blindness) and Aphantasia (no "minds" eye - I cannot visual anything).

    I recognise people by their voices and the way they walk. In a work situation, I try and remember where people sit. If they swap desks, I probably won't notice.

    So if I saw someone I work with away from their desk or worse still outside the office, it is highly unlikely that I'll recognise them.

    I have walked past my own wife and sons and not recognised them, and not recognised myself in mirrors/photographs. When I look at photos of my children, if they are alone I don't know which child I'm looking at.

    This can make managing people or teamwork hard, along with all social activities - everyone is always a stranger.

    You could see this as a problem, or an advantage.

    I can focus better on my work because I am not distracted by people around me.
     
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    Stas Lawicki

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    Not calling it a problem would be a good start.

    I will respectfully disagree. It is a problem, and a huge one. I am talking in general terms and overarching a number of issues, causes and effects. Problems can be overcome, prevented, ignored, understood. They can also become worse. The semantics of the definition are not important, the action to prevent and manage the causes and effects are what matters.

    Noah - there are external resources, I'm not sure where you are in the UK but I am sure you can get the right support you need.

    Nick - thank you for sharing your last post. It must incredibly difficult but you also clearly can focus and be successful despite the challenges. Have you/do you speak about this openly? I would like to understand more about it.
     
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    simon field

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    We are five blokes in a shed. One of them says he has mental health issues.
    He has 7 kids (five of his own and two of his GF's) He has some form of time off at least twice a month due to life in general and blames anxiety, stress, money, ex-wife, kids, etc.
    But like many people I have known who have / have had mental health issues, he drinks, smokes, and smokes weed also gets no exercise.

    He's a good worker, so we just suck it up really.

    So to answer the OP, we do nothing about it. Nada. Zilch.
     
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    Mr D

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    We are five blokes in a shed. One of them says he has mental health issues.
    He has 7 kids (five of his own and two of his GF's) He has some form of time off at least twice a month due to life in general and blames anxiety, stress, money, ex-wife, kids, etc.
    But like many people I have known who have / have had mental health issues, he drinks, smokes, and smokes weed also gets no exercise.

    He's a good worker, so we just suck it up really.

    So to answer the OP, we do nothing about it. Nada. Zilch.

    There are some who have mental health issues who would say that drinking and smoking and exercise do not impact their mental health.

    The reasons they do or don't do those things may also be reasons why mental health is as it is - someone with ME or Fibromyalgia may well have depression and not exercise, the lack of exercise not a cause of depression - the ME / Fibro quite possibly would be.
     
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    The semantics of the definition are not important, the action to prevent and manage the causes and effects are what matters.

    Daniel Kahneman is a Nobel Prize winning psychologist, who spent his career studying happiness and human behaviour. He believes how/when/why/in what order you ask questions or make statements makes a huge difference.

    I suggest you read "Thinking, Fast and Slow" as a good starting point.

    It must incredibly difficult but you also clearly can focus and be successful despite the challenges.

    Why must it be difficult/challenging?

    Have you/do you speak about this openly? I would like to understand more about it.

    It's not something that I can hide, but I don't bring it into conversation much either.

    What would you like to know about it?
     
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    Stas Lawicki

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    Daniel Kahneman is a Nobel Prize winning psychologist, who spent his career studying happiness and human behaviour. He believes how/when/why/in what order you ask questions or make statements makes a huge difference.

    I suggest you read "Thinking, Fast and Slow" as a good starting point.



    Why must it be difficult/challenging?



    It's not something that I can hide, but I don't bring it into conversation much either.

    What would you like to know about it?


    What would I like to know, well, a lot more. Perhaps too much to do over this forum...
     
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    owas

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    Really interesting read here and interesting different input of opinions. I just wanted to point out, mental health comes in all shapes and sizes, and for all different reasons. If someone says they have anxiety and they are having a particular bad day, in my opinion and from experience this is an illness that should be treated just as equable as a person who feels suicidal.

    An example of this, someone very close to me suffers mental health issues. With the modern cliché of having to provide for his family he works long hard hours. His managers barely acknowledge his issues, and offer him no support what so ever. In work he tries his best, puts on a front and gets on with as best he can, even through some really bad days. At home he will cry for hours, he will contemplate suicide, which he has attempted several times.

    If someone is feeling crappy, no matter how trivial you think their issue is, just a little bit of support can make a big difference.

    On another note, I strongly recommend the book reasons to stay alive, it’s such an insightful read for not only those that suffer mental health but just to give a good understanding of what it feels like, I think if you want to raise awareness in the work place have a sit down with your colleagues and take some pointers from this book.
     
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    paulears

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    There are two sides to these discussions. I'm not segregating illness into any sub category - there's no need, sick is, well, sick. Broken brain or broken leg? Does it matter?

    From the sick persons perspective, they are not feeling well enough to go to work, individuals have different points at which they cannot go to work. They could be the type who walk two miles through snow when they have a broken foot, or they could be the type who have a day off because the have a runny nose. Ignoring the clear slackers using sickness as an excuse, if people get ill, in most cases it isn't their fault.

    From the employers perspective, sickness of any kind is a pain. It can cause general disruption, or possibly a business that suddenly grinds to a halt, or possibly even loses a customer because work promised doesn't happen.

    if somebody is ill, they may decide they have to leave. Or, the business might decide they must go being a liability. It boils down to the facts. If somebody is a constant thorn in the side because they can't do their job, then at some point, the gears have to turn and they get replaced with somebody else who can do the job. It takes systems and policies, but this needs to happen. Clearly, the sick person feels they are being fired for being ill - something beyond their control, and in most cases, this is exactly what is happening. Jobs are interviewed for, with carefully written contracts. A job has to be earned, and somebody with a poor health record is more of a hindrance than somebody who is healthy. This is countered with the reliable, healthy but troublesome person set up against the unreliable but always helpful and useful sick person.

    I've been in the position of having to get rid of a person with severe and frankly scary Schizophrenia. I've got no issues with mental illness, and I could have lived with it, difficult though it was. Imagine having a meeting with staff, designing and detailing a plan for the next day and then finding out it was wrecked because one person had no recollection of even being at the meeting, let alone doing what she said she would do? This person actually did something unforgivable, way above the usual gross misconduct - something with severe and perhaps irreversible implications for two other members of the team. She walked, immediately. However - I find the person on Facebook slagging me off for sacking her for being mentally ill!

    I've had people with limbs missing, very strange attitudes and some with clear physical illnesses undisclosed on interview. They've all done fine, and the small changes we made to cope with their oddness perfectly doable. what I want are people who can do what they say they can do. I've had broken limbs, phobias, allergic reactions and loads of physical and mental illnesses - and if they are genuine, everyone copes. Two of these people often described themselves as being a bit mad some days. No issues with people knowing when they're not quiet themselves. Do they work hard and would I hate them to leave? yes. I can put up with all kinds of things when these people are worth it.

    I cannot stand slackers or people who just don't even try to fit in.

    Nowadays, we have to pussy foot around. The person I had to sack who had a totally genuine mental illness actually said to me one day - "now I've told you about my mental illness, you n' get rid of me. I know I am rude, and upset everyone and I don't care - I have a mental illness. Oh, and by the way you cannot tell anyone I have it". Advice from HR was to put up with it for the length of the contract. If I needed to get an extra person to cover her, then that was fine - so effectively she got a get out of jail card. Hands tied. I don't mind admitting that when I had to get rid of her for her really serious incident, I didn't feel bad at all because of the seriousness of it. I didn't give her a bad reference. I didn't tell anyone what had happened apart from the person concerned who needed to know to fix the problem caused, and HR. none of the others knew I had fired her - until she told them all she'd been fired for being ill. At this point loads of people came to me to tell me of things she had done, that because of her condition, they'd all put up with. A terribly abrasive person, and not just to me but everyone in her team. Nobody shed a tear.

    I've had a quick count up and if you include conditions like ADHD, Asbergers, OCD and depression we have a bit like 50% physical and 50% mental illness in the team. A small team of males/females and we have thyroid, rheumatoid arthritis, damaged nerves, mild autism, lung degeneration/asthma with just one person having a clean bill of health at the moment. All of these are on repeat contracts, having completed them successfully and then coming back to do the same things again, year on year. however, in the past I've had loads of one contract wonders - useless people I do not offer a second one to. Not because of any illness, but because they take advantage, are skivers and wastes of space!
     
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    Stas Lawicki

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    Thanks again @NickGrogan - I've got a lot of reading to do. Thanks too to others who have contributed.

    I was told today that there are thousands of organisations, one man bands, corporates, start ups and charities in the UK that are focused on 'MH'. As complex as the area is, and indeed the various described 'cures' and fixes, the biggest issue would still appear to be leaders not taking the problem seriously enough. Workshops, first aid, resilience training, clinical interventions, yoga, fruit bowls are some examples of the services being touted as solutions - many fall short, some are ridiculous!

    Has anybody, in their workplace, had a comprehensive programme or range of solutions provided that made positive and lasting improvements?
     
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    LMN118

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    We've just had mental health awareness week in the UK...

    You probably already know but the following offers a general framework.

    Google HSE mental health, sorry can't post direct links.

    There is a link about half way down about pre-existing conditions but most of of it relates to work related stress. I.e. poor working conditions that directly impact employee health. This tends to be the focus currently judging by the number of emails and seminars I get sent.

    People generally are still clueless about stress/mental health and how it impacts health and productivity. Pretty much proven by comments here.

    I'm self employed so it doesn't really affect me and the H&S assessments I do are more specialised rather than company policymaking.
     
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    V

    Victoria_V

    No matter the size of your business—you can be a CEO of a huge company or a solo entrepreneur who only interacts with their clients, you should treat mental illness as such. Yes, the symptoms are not usually visible and it’s hard to tell when the person is struggling with even simple everyday tasks like getting out of bed every morning, but it’s still an illness and cannot and should not be disregarded. You can’t overestimate management training—for some reason top management quite often feels they’re above such things—but basic human decency and respect towards each other goes a long way as well. Not everyone has the same level of resilience and we’re all human so we should really start small: talk to your colleague (or a friend!), offer your help, give them emotional support, and maybe advise they go see a therapist.
     
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    Owesdr

    Free Member
    Nov 21, 2018
    49
    0
    This is a very good discussion on quite significant topic for contemporary society. In my opinion, if we treat only mental illness, then we might not make some progress, as the cause of it will still be there. We need to take into account full picture and deal with it
     
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