This guide contains information, practical advice and conversation checklists for managers to better support those experiencing stress and mental health issues.
The guide addresses all aspects of employment, from recruitment, managing mental health at work, to supporting return to work after a period of absence. It will help managers facilitate conversations and put in place support so employees can stay well and in work – meaning better performance and improved retention of talent and expertise. The guide also sets out the practical steps that employers can take to create a mentally healthy workplace.
Who is this guide for?
We know employers come in all shapes and sizes, with different working practices, workforces and working environments. This guide is designed to support anyone involved in managing people, from line managers in large organisations to owner-managers of small firms. We also hope it will be a useful professional resource for HR and occupational health teams.
While the contexts will differ, we hope the principles, checklists and practical advice will be useful across the board and easily adaptable for different workplace environments and relationships. The guide can be used both as a handy outline for individual managers to consult in their day-to-day roles and incorporated into HR policies and practices to be integrated across teams and organisations.
Please note that we are not providing legal advice, but practical guidance – employers may also need to obtain their own legal advice on the approach to take in any particular case.
|This guide has been jointly developed by mental health charity Mind and the CIPD|
- Useful definitions
- Introduction: purpose of this guide
- What is mental health?
- Why does good mental health matter? The business case
- Good practice in recruitment
- Prevention: helping people to stay well and manage stress
- Early intervention: spotting the signs of stress and poor mental health
- Encouraging people to talk about their mental health: supporting staff to stay well and in work
- Supporting people to return to work
- Managing performance
- Case studies
- Mental Health at Work Commitment
For the purpose of clarity, when we refer to ‘mental health’ in this guide, we are using it in the broadest possible sense. Some useful definitions are below:
Mental health: We all have mental health, just as we all have physical health. How we feel can vary from good mental wellbeing to difficult feelings and emotions, to severe mental health problems.
Mental wellbeing: Mental wellbeing is the ability to cope with the day-to-day stresses of life, work productively, interact positively with others and realise our own potential. When we talk about wellbeing, we are referring to mental wellbeing.
Poor mental health: Poor mental health is when people are struggling with low mood, stress or anxiety. This might mean we’re also coping with feeling restless, confused, short-tempered, upset or preoccupied. We all go through periods of experiencing poor mental health – mental health is a spectrum of moods and experiences, and we all have times when we feel better or worse.
Mental health problems: We all have times when we struggle with our mental health. A mental health problem is when difficult experiences or feelings go on for a long time and affect our ability to enjoy and live our lives in the way we want. You might receive a specific diagnosis from your doctor, or just feel more generally that you are experiencing a prolonged period of poor mental health.
Common mental health problems: These include depression, anxiety, phobias and obsessive-compulsive disorder (OCD). These make up the majority of the problems that lead to one in four people experiencing a mental health problem in any given year. Symptoms can range from the comparatively mild to very severe.
Severe mental health problems: These include conditions, such as schizophrenia and bipolar disorder, which are less common. They can have very varied symptoms and affect everyday life to different degrees and may require more complex and/or long-term treatments.
Work-related stress: Work-related stress is defined by the UK Health and Safety Executive as the adverse reaction people have to excessive pressure or other types of demand placed on them at work. Stress, including work-related stress, can be a significant cause of illness. It is known to be linked with high levels of sickness absence, staff turnover and other issues such as increased capacity for error. Stress is not a medical diagnosis, but severe stress that continues for a long time may lead to a diagnosis of depression or anxiety, or other mental health problems.
Burnout: Burnout is a term used to describe a collection of experiences caused by long-term, unmanageable stress at work. Burnout can make people feel exhausted or unmotivated. People may start to feel distanced from or negative about their job. And they may worry that they’re not achieving enough at work. Burnout can affect mental and physical health. It can also impact work performance.
Stigma: Stigma is the perception that a certain attribute makes a person unacceptably different from others, leading to prejudice and discrimination against them.
Self-stigma: Self-stigma is where a person with a mental health problem becomes aware of public stigma, agrees with those stereotypes and internalises them by applying them to the self
Purpose of this guide
Awareness of the scale and impact of poor mental health at work is increasing. In 2022, the CIPD found that poor mental health was the most common cause of long-term sickness absence in UK workplaces, while Mind’s 2020/21 Workplace Wellbeing Index found that 14% of employees rated their current mental health as poor or very poor.
However, there is more that can be done. The CIPD Good Work Index 2022 found that just over half (56%) of respondents said their organisation is supportive of people’s mental health, while only 52% said their organisation encourages staff to talk openly about mental health problems. Mind’s 2020/21 Workplace Wellbeing Index found that only 58% of those who experienced poor mental health while working at their current employer felt confident they would be supported if they disclosed this. And 46% of people who did disclose their mental health problem to their employer felt that their situation stayed the same afterwards.
While CIPD research shows mental health is the top focus of most employers’ wellbeing activity, with just over two-thirds of HR professionals (68%) agreeing their organisation actively promotes good mental wellbeing, a similar amount (66%) are concerned about the impact of the pandemic. While it’s encouraging that the vast majority (81%) of organisations increased their focus on mental health in response to the pandemic, less than half (48%) believe their organisation has been effective at identifying and managing the mental health risks arising from COVID-19.
The lack of strong leadership on this issue is also disappointing; just over two-fifths (42%) agree that senior leaders encourage a focus on mental health through their actions and behaviour. Respondents also remain negative regarding the skills and confidence of managers to support people’s mental health, with well under half (38%) agreeing that managers are confident to have sensitive discussions and signpost people to expert sources of help. Even fewer (29%) say managers are confident and competent to spot the early warning signs of mental ill health.
This shows that many organisations still need to develop more effective approaches to support good mental health outcomes. Many employees are still reluctant to raise the subject, for fear of discrimination, while managers often shy away from the subject, afraid of saying the wrong thing and making matters worse or provoking legal consequences. This culture of silence means undetected mental health issues can spiral into a crisis, resulting in sickness absence, higher levels of presenteeism and increased staff turnover.
Mind and the CIPD have jointly developed this guide to help managers overcome these challenges. The guide addresses the whole lifecycle of employment, from recruitment, through managing mental health at work, to supporting people to return to work after a period of absence. It contains information and practical advice to help managers facilitate conversations about stress and mental health issues and put in place support so employees can stay well and in work – meaning they perform at their best for the business while the employer retains talent and expertise.
What is mental health?
We all have mental health, just as we have physical health. Mental health, like physical health, can fluctuate on a spectrum from good to poor. Poor mental health can therefore affect any of us irrespective of age, personality or background.
Mental health problems can appear as a result of experiences in both our personal and working lives – or they can just happen. Approximately one in four people in the UK will experience a mental health problem each year 1, and in England, one in six people report experiencing a common mental health problem (such as anxiety and depression) in any given week 2. Employees may be affected directly or indirectly, if partners, dependants or other family members have poor mental health, which in turn impacts on the employee’s own health.
Poor mental health can affect the way people think, feel or behave. In some cases, this can seriously limit a person’s ability to cope with day-to-day life, which can impact relationships, work and quality of life. However, many people effectively manage their mental health condition alongside the demands of a job and daily life, sometimes with treatment and support.
Mental wellbeing describes our ability to cope with the day-to-day stresses of life, work productively, interact positively with others and realise our own potential. When we talk about wellbeing, we are referring to mental wellbeing. Our wellbeing can fluctuate day-to-day, hour-by-hour and is influenced by many things in our lives, personal or professional. People with mental health problems can still have high levels of general mental wellbeing, while those without mental health problems can experience periods of low levels of mental wellbeing.
The crucial thing to remember is that everyone’s experience of poor mental health is different. Two people with the same condition may have entirely different symptoms and coping mechanisms. That’s why working with people on an individual basis is so important.
A common assumption is that mental health problems are just caused by issues at home, so some employers feel it is not appropriate – or indeed their responsibility – to intervene and support staff. However, CIPD research shows more than a quarter of UK employees (27%) say that work negatively impacts their mental health.
In fact, many people’s mental health issues are a combination of problems they face at work and outside work. For example, someone experiencing severe anxiety due to a debt problem might find that the demands of their job, which under normal circumstances are manageable, are now beyond them. Conversely, someone who is under prolonged stress at work might find challenges in their life outside work, such as caring responsibilities, become unmanageable. This can then create a negative feedback loop which further undermines their performance and puts greater pressure on them in the workplace.
It’s therefore impossible to disentangle the impact of various factors on someone’s mental health, and so it’s in employers’ interests to actively support staff with mental health issues, whatever the original cause or trigger. The benefits for the employer can be significant, as many people with a mental health problem can thrive at work if they have the right support in place, thus reducing potential sickness absence and increasing employee engagement.
Mental health is just like physical health: we all have it and we need to take care of it. Good mental health means being generally able to think, feel and react in the ways that you need and want to live your life. But a period of poor mental health might mean the ways you’re frequently thinking, feeling or reacting become difficult, or even impossible, to cope with. This can feel just as bad as a physical illness, or even worse. Mental health problems range from common problems, such as depression and anxiety, to less common problems, such as schizophrenia and bipolar disorder.
The terms used to diagnose conditions are sometimes words that are in everyday use, such as ‘depression’ or ‘anxiety’. Although this can make them seem easier to understand, their familiarity may lead to confusion. For example, be mindful of the difference between clinically diagnosed depression and the use of ‘depressed’ to describe feeling a bit down.
There are many different mental health problems. Some of them have similar symptoms, so people may experience the symptoms of more than one mental health problem, or be given several diagnoses at once. Or people might not have any particular diagnosis, but still be finding things very difficult. Everyone’s experience is different and can change at different times. When supporting staff, it’s important not to label people by focusing on a diagnosis. Instead, talk to them about how it impacts on their work and the actions and support they would find helpful.
Below are some commonly diagnosed forms of mental health problems with examples of some of their symptoms. This is not an exhaustive list, as people will react and respond differently, but the links provided to the Mind website offer more information.
Depression is a low mood that lasts for a long time and affects everyday life. In its mildest form, depression can mean just being in low spirits. It doesn’t stop people leading a normal life but makes everything harder to do and seem less worthwhile. At its most severe, depression can be life-threatening because it can make someone feel suicidal.
Anxiety is what we feel when we are worried, tense or afraid – particularly about things that are about to happen, or which we think could happen in the future. Anxiety is a natural human response when we feel that we are under threat, but if feelings of anxiety are very strong, or last for a long time, they can be overwhelming.
Panic attacks are a type of fear response. They’re an exaggeration of the body’s normal response to danger, stress or excitement.
Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. The term is often misused in daily conversation – for example, people may talk about being ‘a bit OCD’, if they like things to be neat and tidy. But the reality of this disorder is a lot more complex and serious. OCD has two main parts: obsessions (unwelcome thoughts, images, urges, worries or doubts that repeatedly appear in your mind), and compulsions (repetitive activities that you feel you do to reduce the anxiety caused by the obsession).
A phobia is a type of anxiety disorder. It is an extreme form of fear or anxiety triggered by a particular situation or object, even when it’s very unlikely to be dangerous. A fear becomes a phobia if the fear is out of proportion to the danger, it lasts for more than six months, and has a significant impact on day-to-day life.
Bipolar disorder (once called manic depression) is a mental health problem that mainly affects mood. With this diagnosis someone is likely to have times when they experience: manic or hypomanic episodes (feeling high); depressive episodes (feeling low); and potentially some psychotic symptoms during manic or depressed episodes.
Schizophrenia is a complicated mental health problem related to psychosis. There’s lots of misconceptions about it and even mental health professionals don’t all agree about it, but about 1 in every 100 people get this diagnosis at some point in their life. Many experiences and behaviours can be part of schizophrenia. They can start suddenly, or they might develop gradually over time. Each person’s experience is unique.
Our personality is the collection of thoughts, feelings and behaviours that makes each of us the individuals we are. We don’t always think, feel and behave in exactly the same way, but significant difficulties in relating to yourself and others and problems coping day to day may be diagnosed as a personality disorder.
There are ongoing debates about the diagnosis of personality disorders. Some find a diagnosis helpful or validating. Some find it unhelpful, upsetting or stigmatising. There is no right or wrong way to understand or describe our own experiences. The important thing to remember is that we all deserve support and understanding.
Psychosis (also called a psychotic experience or psychotic episode) is when people perceive or interpret reality in a very different way. The most common types of psychotic experiences are hallucinations, delusions and disorganised thinking and speech. People might experience psychosis once, have short episodes throughout their life, or live with it most of the time.
We all know what it’s like to feel stressed, but it’s not easy to pin down exactly what stress means. When someone says things like ‘this is stressful’ or ‘I’m stressed’, they might be talking about:
- situations or events that put pressure on them (for example, times where they have lots to do and think about)
- the reaction to being placed under pressure (the feelings they get when they have demands placed on them that they find difficult to cope with).
There’s no medical definition of stress, and healthcare professionals often disagree over whether stress is the cause of problems or the result of them. This can make it difficult for people to work out what causes their feelings of stress, or how to deal with them.
The HSE defines stress as “the adverse reaction people have to excessive pressure or other types of demand placed upon them”. Of course, a certain level of pressure in a business environment is desirable. Pressure can help to motivate people and may boost their energy and productivity levels.
Figure 2 illustrates the relationship between pressure and performance.
With little or no pressure on us, we can feel unchallenged and experience boredom, leading to very low or poor performance.
As pressure increases, our performance can also increase and there is a level of pressure that we might term our ‘comfort zone’, where we feel easily able to carry out our duties.
Beyond this comfort zone we might begin feeling stretched. In a workplace context this might be a new project, a piece of work requiring new skills or an extension of current responsibilities. It is in this area that we achieve maximum performance, focused and energised by a new challenge.
We thrive where we are able to move between the comfort and stretch zones, recharging our batteries with activities we are comfortable with after completing a challenging piece of work. However, if we are unable to recharge and if pressure continues to grow, there is a debilitating effect, where we experience strain. The increased pressure can impact the way we perform, by affecting our concentration, our decision-making abilities and our effectiveness. It is here we might first experience stress.
Where this pressure continues to be sustained or build, the pressure will exceed our ability to cope, becomes unmanageable and we reach a point of crisis. It is at this stage of crisis that a person might also consider themselves to be experiencing ‘burnout’.
Unmanageable stress can have physical, psychological and behavioural symptoms that, if not addressed, can lead to or worsen mental health problems.
Whatever the personal definition of stress is, it’s likely that someone can learn to manage stress better by:
- identifying the current triggers of stress in their life (whether these are frequent work situations, one-off events or ongoing issues such as bullying) and putting a plan in place to address or better manage the stress associated with these
- building emotional resilience and better understanding what supports their mental health and wellbeing at work so they’re better at coping with tough situations when they do happen.
Stress can be linked to physical ill health, including heart disease and back pain. Stress isn’t a psychiatric diagnosis, but it’s closely linked to mental health in two important ways:
- Stress can cause mental health problems, and make existing problems worse. For example, if someone often struggles to manage feelings of stress, they might develop a mental health problem such as anxiety or depression.
- Mental health problems can cause stress. Someone might find coping with the day-today symptoms of a mental health problem, as well as potentially needing to manage medication, healthcare appointments or treatments, can become extra sources of stress.
More detailed information on the signs and symptoms of stress is available from Mind.
Managing stress effectively is a crucial part of a preventative approach to supporting mental health in the workplace, and organisations need to develop an organisational framework for managing the risks to people’s health from stress. This should include carrying out a stress risk assessment or audit. Further guidance is also available in the CIPD’s guide on managing and preventing stress at work.
People with mental health conditions who are treated unfavourably may be able to challenge their treatment by claiming discrimination. In the UK, the Equality Act 2010 gives protection to people who can show that their mental health condition counts as a ‘disability’ within the special meaning under the Act.
Poor mental health is often a ‘hidden’ disability and as people are often reluctant to disclose their condition, it is good practice for an employer to make adjustments for someone experiencing poor mental health even if the definition of a disability under the Equality Act may not be made out. For example, a fluctuating mental health condition may not meet the Equality Act’s definition of a disability requiring the condition to be ‘long term’, meaning 12 months or more, but people may still need appropriate support and adjustments at work.
Organisations that are public authorities also have special legal obligations under the public sector equality duty. More information on the duty is available from the Equality and Human Rights Commission (EHRC).
Employers also have duties under health and safety legislation to assess the risk of stress-related poor mental health arising from work activities and to take measures to control that risk. The UK Health and Safety Executive’s (HSE) Management Standards are designed to facilitate this.
Why does good mental health matter? The business case
“When I returned to work on a graduated return, the positive way the company treated me meant that I felt even more engaged and energised than before, which meant I was more productive than ever. I was made to feel valued and given time and support to get back to firing on all cylinders. Even without knowing the figures, this made the business case for investing in staff wellbeing crystal clear to me.”
Managing and supporting people’s mental health at work is a critical and growing challenge for employers. Promoting good health and wellbeing is a core element of providing good work for people and improving their working lives.
Equally important are the positive business reasons for supporting staff mental health: positively managing mental health can reap rewards in terms of staff engagement, performance and loyalty.
It’s estimated that mental health problems cost the UK economy £117.9 billion annually. Thriving at Work: The Stevenson-Farmer review of mental health and employers highlighted the significant costs to employers of mental health illness. Deloitte has subsequently published biannual updates to this analysis, with the March 2022 report finding costs to employers amounting to £56 billion a year. This is made up of:
- absenteeism cost: £6.1 billion
- presenteeism cost: £24.8 billion to £27.6 billion
- staff turnover: £22.4 billion.
Stress and other mental health problems are the biggest cause of absence from work. The CIPD found that poor mental health is consistently the number one cause of long-term sickness absence (four weeks or longer) across the UK workforce, while stress is the third top cause. These are also among the most common causes of short-term absence.
The cost to business of poor mental health is not just related to absence. Some people with poor mental health come to work when they are unwell, which can undermine performance. This is not a sign of a healthy workplace.
CIPD research shows that ‘presenteeism’ (working when ill) remains prevalent. However, fewer HR respondents report observing it in the workplace (2022: 65%; 2021: 75%), although more report observing it among those working from home (2022: 81%; 2021: 77%).
Other CIPD research shows that 46% of employees said they had worked in their main job in the past three months despite not feeling well enough to perform their duties. There’s a clear link with workload: 65% who reported their workload was ‘too much’ said they had done so compared with 36% of employees who said their workload was ‘about right’.
Feeling the need to turn up to work when unwell can potentially make someone’s condition worse, depending on the individual case. This shows that managing and supporting people experiencing poor mental health when working is just as important as managing their absence and supporting their return to work.
Minimising the risk of losing valued employees, their skills and expertise is another reason to invest in managing mental health at work. The evidence shows that those with a long-term mental health condition lose their jobs every year at around double the rate of those without a mental health condition, and at a much higher rate than those with a physical health condition. This amounts to around 300,000 people dropping out of the labour market annually.
Stress and mental health problems can lead to costly and time-consuming conflict at work, but conflict at work can also be a significant cause of stress and poor mental wellbeing.
CIPD research shows the negative effects of conflict at work can be many and varied, and less than a quarter of employees report no impact on them. Some of the most common consequences are psychological or behavioural, with stress, a drop in motivation or commitment, and anxiety the top three. Individuals taking part in our research spoke of the mental health impacts, including stress causing sickness absence, not being able to sleep and even having heart palpitations and suicidal thoughts. Other impacts included low confidence and anxiety.
Employers who fail to manage mental health at work effectively risk damaging their employer brand in a number of ways. As well as adversely impacting people’s wellbeing and the organisation’s reputation as a good place to work, it could be more challenging to recruit and retain talent. According to a Deloitte report, 37% of employees think about their mental health more than prior to the pandemic and 31% expect more employer support for their mental health now. Employee morale and engagement levels could also suffer, as well as performance levels. There could even be costly and potentially high-profile litigation through the courts, through common law personal injury claims, unfair dismissal or discrimination claims, or as a result of breach of contract.
Conversely, embracing positive management of staff mental wellbeing can be part of a comprehensive corporate responsibility agenda and contribute to the organisation’s goals as an ethical and attractive employer.
Good practice in recruitment
“I was working when I had depression and I self-harmed. I had to leave my job. When I started applying for work again, I called it ‘stress’ to employers because of mental health stigma, but even then I think they declined to employ me because of the stigma around having stress. […] Out of nearly 90 jobs that I applied for, I was invited to only one interview, where I didn’t get the job. I felt worthless.”
Many job applicants will be fearful of disclosing information relating to their mental health problems because misunderstanding about poor mental health is still widespread. Under the UK Equality Act 2010, job candidates are not required to disclose they have a mental health condition to their prospective employer. Since the Act came into force, it is also unlawful for employers to ask candidates questions about health during recruitment, except in very limited circumstances. However, there are ways to facilitate disclosure lawfully to ensure people with a mental health condition have equal access to job opportunities, are offered any support they need to take up a post, and are not discriminated against during the recruitment process.
Outside the UK, check local legislation to understand the relevant provisions and your obligations as an employer.
Employing the right person for the job in the first place is crucial to help prevent stress and promote good wellbeing. A key source of work-related stress and poor mental health is a misfit between the individual and the role, or between the needs and values of the person and those of the work environment.
Selecting recruits based on competence and/or potential, combined with realistic job descriptions and person specifications, therefore, is not only important for performance, but also for managing and supporting mental health. Realistic job descriptions should encourage candidates to make a better-informed decision to continue the application process. As a result, they are more likely to be a good fit with the position.
Experience of poor mental health is not an indicator of poor performance, so it’s important that employers do not discriminate (consciously or unconsciously) against people on the basis of prejudiced and unjustified assumptions. This may be direct discrimination under the Equality Act, but it also doesn’t make good business sense to disregard someone who may have all of the valuable skills and talent needed for the position.
Recruitment should focus on hiring the most suitable candidate for the job. Therefore, appointment decisions should be objective and based on whether candidates have the necessary competence and potential required for the role.
Any concerns that do arise about whether health or disability may impact on a candidate’s ability to do the job must be assessed with reference to employers’ positive legal duty to make reasonable adjustments for people with a disability. These conversations may increase a candidate’s chances of securing a position, as employers must show they have only deselected candidates if their disability means they will be unable to perform ‘intrinsic’ functions of the job, even with adjustments in place.
Throughout the application and selection process, reasonable adjustments may need to be made. For example, as well as helping those with a physical disability, recruitment processes might be adapted for neurodivergent people. It’s good practice to be proactive in offering adjustments for anyone who needs them for their health, regardless of whether or not they meet the legal criteria for a disability.
For further information on recruitment, see the CIPD factsheet on recruitment and induction.
Distinguish carefully between essential and desirable requirements for the job. This means focusing on what is required to get the job done (for example knowledge or experience), not how it will be done (for example method of delivery), as this gives flexibility for achieving output in different ways.
Make clear what mental and emotional elements are required to meet the role requirements, but don’t overemphasise the need for a certain type of personality, for example:
- State the role requires ‘someone effective at networking’, not ‘you must be upbeat and sociable’ – this relies on personality, not ability.
- State ‘there may be a lot of pressure when events are taking place’, not ‘you must be able to work in a stressful environment’ – this takes away responsibility from the employer to manage pressure appropriately.
Communicate the organisation’s commitment to inclusion and diversity during the recruitment process, including in the job advert.
Provide guidelines and training for all staff to ensure that candidates are not discriminated against at any stage, including the risks of unconscious bias.
Make it clear in adverts and interviews that the organisation promotes good mental wellbeing and supports people if they experience poor mental health, as this sends a signal that sharing information about a mental health problem will not lead to discrimination. For example, include a statement such as: “As an employer, we are committed to promoting and protecting the physical and mental health and wellbeing of all our staff.”
State clearly that workplace adjustments are available – for the interview and the job itself – so applicants understand why sharing information about their mental health might be beneficial.
Ensure people can disclose a mental health problem confidentially and that any information about health or disability is kept separate from the application form, so the recruitment panel does not see it.
Section 60 of the UK Equality Act 2010 makes it unlawful to ask questions about disability and health before making a job offer, except in defined circumstances. The purpose is to ensure equal access to job opportunities by preventing disability or health information being used to sift out job applicants before they can show they have the skills to do the job. The EHRC can take legal action against employers where these requirements have been breached. If questions are asked before a job offer is made, it is also easier for job applicants to prove that discrimination has taken place as, under the Equality Act, employers will be assumed to have discriminated unless they can prove otherwise.
Questions about health and disability can be asked before a job offer only where necessary and if the following narrow exceptions apply. Questions may be asked to monitor the diversity of job applicants and to find out if a job applicant:
- can take part in any assessment to test the ability to do the job; or
- needs reasonable adjustments for the recruitment process, including assessments or interviews; or
- possesses a particular disability, where having that disability is a genuine occupational requirement of the job; or
- will be able to carry out a function that is intrinsic (or absolutely fundamental) to that job. ‘Intrinsic’ job requirements are very rare and must be objectively justifiable. The EHRC advises: “In practice, even if a function is intrinsic to the job, you should ask a question about a disabled person’s ability to do the job with reasonable adjustments in place. There will therefore be very few situations where a question about a person’s health or disability needs to be asked.”
If questions are asked for any of these purposes, they should be detached and kept separate from the application form, so any health information is not seen by the selection panel. Where all aspects of the recruitment process are handled by one person, for example in a small organisation, they must take every step to disregard this information in respect of shortlisting and selection to be compliant with section 60 of the Equality Act.
Table 1: Examples of appropriate and lawful health enquiries pre-job offer
Application form or equal opportunities form
Please contact us if you need the application form in an alternative format or if you require any reasonable adjustments to the selection process, including the interview (for example physical access, communication support, personal support).
Some of our roles require applicants to complete an online test. Please provide details below of any reasonable adjustments you would need in order to be able to complete these (for example extra time, online access, communication requirements).
Invitation to interview
Please respond to confirm your availability to attend at the time allocated and to indicate any reasonable adjustments you may require for the interview.
XX is an equal opportunities employer. The following information will be treated confidentially and will assist in monitoring XX’s equal opportunities policy. Your application will not be affected by the information provided in this section, which will not be seen by the selection panel. Do you consider yourself to be disabled? (Yes/No)
An essential criterion for this project is experience of mental health services of an NHS trust from a service user’s perspective. This is an occupational requirement, so you will be asked about your knowledge of NHS mental health services during the recruitment process.
Many employers do not use health questionnaires at any stage of the recruitment or induction process, instead dealing with any health issues among employees as they arise or using other tools to encourage disclosure, such as wellness action plans. However, others find that routinely using health questionnaires following an offer of employment can provide useful information to help support new employees and enable them to do the job effectively.
If questionnaires are used, they should be applied to all new recruits, rather than singling people out because ill health or disability is suspected, to avoid discrimination claims. Moreover, this approach will help to encourage an inclusive and positive culture from the outset of employment and help people to feel less stigmatised.
A job offer might be conditional or unconditional, and an employer can make an offer conditional on medical checks and then ask health-related questions without breaking the law, but they would need to show that any reasons for withdrawing a job offer are not discriminatory. It is unlawful to discriminate on grounds of a mental-health-related disability, so if an offer is withdrawn at that stage, an unsuccessful applicant may be able to make a disability discrimination claim, as the withdrawal itself may be seen as evidence of discrimination.
If employers do use health questionnaires, it should be emphasised that the purpose is to see whether new staff have any health issues that, without support, could affect their ability to fulfil the duties of their new role or place them at any risk in the workplace. It should also be explicit that the questionnaire will help the employer to ensure any health needs are met and identify reasonable adjustments or assistance to enable the new employee to do the job. Framing the use of the information in a positive way will encourage people to talk about their mental health. It will also help to reflect the right ethos, which should be to provide better support to the employee. The questionnaire should also specify who will see the information.
We have developed a template health questionnaire to help ensure that any health questionnaires don’t ask unnecessarily intrusive questions that might discourage new employees from disclosing important information about their mental health. Our recommended questions are deliberately:
- limited to health information in relation to the work/job role – all other details are personal, sensitive and of no concern to the employer
- open, to enable new employees to describe their health in their own words and give only as much information as they feel comfortable with
- non-prescriptive, so people are not forced to disclose a particular condition or detail symptoms and treatments.
Of course, for some specialist roles, specific health questions may be relevant – for example, people working with chemicals may need to disclose any skin conditions – and this would be lawful under the exception which permits questions relating to ‘intrinsic’ job functions. Employers in these sectors will be best placed to determine the types of questions they need to ask, so the template is limited to general questions employers may choose to ask about health following a job offer.
Your answers to this questionnaire will be CONFIDENTIAL to [HR/occupational health/your manager] and will not be given to anyone else without your written permission. Our aim is to support and maintain the physical and mental health of all people at work. The purpose of the questionnaire is to see whether you have any health problems that could affect your ability to undertake the duties of the post you have been offered or place you at any risk in the workplace. In consultation with you, we may recommend adjustments or assistance as a result of this assessment to enable you to do the job.
Template health questionnaire – post job offer
Your answers to this questionnaire will be CONFIDENTIAL to [HR/occupational health/your manager] and will not be given to anyone else without your written permission. Our aim is to support and maintain the physical and mental health of all people at work. The purpose of the questionnaire is to see whether you have any health problems that could affect your ability to undertake the duties of the post you have been offered or place you at any risk in the workplace. In consultation with you, we may recommend adjustments or assistance as a result of this assessment to enable you to do the job.
Do you have any (physical and/or mental) health condition(s) or disability which may affect you performing in this role (based on what you know from the job description, interview and any previous experience)?
Would you like to tell us about any past examples of (physical and/or mental) health condition(s) or disability that were caused or made worse by your work, so that we can explore any support you may need?
Do you think you may need any adjustments or assistance to help you to do the job? If so, please give suggestions so we can discuss suitable changes with you.
- Is there any history in your family of mental health issues?
- Do you suffer from, or have you ever experienced, any of the following? [With an exhaustive tick box list of conditions, for example depression, anxiety, bipolar disorder…]
- Are you taking any tablets or medications? If yes, please give details.
- Have you consulted a doctor in the last two years?
- Are you having or waiting for treatment (including medication) or investigations at present? If yes, please provide details of the condition, treatment and dates.
Prevention: helping people to stay well and manage stress
“My employer encourages an ethos that supports staff, by encouraging colleagues to look out for each other and by allowing work patterns to be flexible enough to account for individual needs.”
Some of the impacts associated with poor mental health at work occur because undetected problems are left unchecked and spiral into a crisis. Good communication and people management skills can help to prevent stress and poor mental health among employees – often it’s about a common-sense approach.
A good induction programme is important for all new, promoted or redeployed employees, as starting a new role can be an unsettling experience. A negative first few days in the job, in which people are given insufficient guidance about expectations and processes, can undermine people’s confidence and could trigger new or exacerbate existing problems. An effective induction for all employees contains the following elements:
- orientation (organisational) – how the employee fits into the team and how their role fits with the organisation’s strategy and goals
- one-to-one meeting(s) between the new starter and their line manager
- meetings with other key employees (either face-to-face or online)
- an awareness of other functions within the organisation
- health and safety information (this is a legal requirement)
- explanation of terms and conditions, as well as pay and benefits
- details of the organisation’s history, its products and services, its culture and values
- a clear outline of the job/role requirements and expectations
- health and wellbeing initiatives provided by the employer
- information about ways of working, for example flexitime, homeworking.
If your organisation is operating a hybrid working model, you will need to adapt the induction process accordingly. This includes using induction to guide new starters on how to work effectively in a hybrid and/or remote way. It also means building more time into the process for new employees to build working relationships, and ensuring introductory meetings with other colleagues are set up remotely if necessary. New hybrid workers will need additional support in the early stages of their employment to understand the culture. It’s essential that line managers give as much support as possible and regularly check in on the team members to see if they have any questions or concerns. A buddy or mentor can also help. See the CIPD-commissioned guide on hybrid working for the Flexible Working Taskforce for more detailed guidance on effective induction in a hybrid setting.
How people are treated and managed on a day-to-day basis is central to their mental wellbeing and engagement, as well as the level of trust in the employment relationship. Good line management is crucial in supporting wellbeing, spotting early signs of distress and initiating early intervention, while poor line management may exacerbate or even cause poor mental health.
Mind’s 2020/21 Workplace Wellbeing Index found only two-thirds (66%) of employees agreed that their manager supported their mental health. Of those who said their manager does not support their mental health, 72% had experienced anxiety on multiple occasions in the past month. This is 28% more than the proportion of those who felt their manager does support their mental health.
Meanwhile, CIPD research revealed that, according to HR professionals, management style is the third main cause of work-related stress, showing that how managers go about their role can have a direct impact on people’s mental wellbeing.
When managers manage well and build trust-based relationships with their team, they help to create an environment that is open, respectful and kind, in which people feel ‘psychologically safe’. This means individuals feel able to speak up about a health or work issue like mental health without fear of criticism and in the knowledge that they will be listened to and receive support and understanding.
Only support and strategic leadership from the top will create organisational cultures where a management style based on openness and mutual respect can flourish. The senior management team will influence how all managers understand their role and the extent to which they place a priority on people management.
Managers need to have a clear appreciation of the link between the strategic objectives of their organisation, their departmental or team objectives, and their day-to-day people management in areas such as:
- communication and consultation
- training and development
- performance and attendance management
- workplace pressure, stress or conflict.
Managers also need to be familiar with all HR policies to ensure consistent people management practice across the organisation. In addition, they should receive training on the key people management skills needed for their role. Mnagers supporting people with mental health problems may also need extra support themselves, as they might experience additional strain as a result.
Often it is about common sense. Managers who regularly ask staff how they are and take an interest in their lives outside work are more likely to build trust and prevent and manage stress at work. Conversely, managers who assume staff are okay, are indecisive and inconsistent, give mostly negative feedback and set unrealistic deadlines are likely to exacerbate stress. A common-sense approach extends to managers flexing their management style to suit each employee’s preferred working style – so be aware that some people will be less comfortable sharing details of their personal life than others.
The CIPD has created a range of support materials to help line managers adopt a management approach that supports good health, wellbeing and engagement in their teams.
As a manager it’s important to create the right culture within your team:
- Lead by example: Actively encourage your team to adopt healthier working habits by working sensible hours, taking full lunch breaks, taking annual leave and resting after busy periods. Maintain a good work–life balance and set boundaries between your work and home life, including guidance around accessing work devices or inboxes out of hours.
- Build your confidence on mental health: Familiarise yourself with your organisation’s mental health policies and practices and how staff can seek confidential advice and support. Visiting the Mind website and building your mental health literacy with key terms can also support your confidence in being able to have meaningful conversations around mental health and understand any mental health vocabulary used.
- Normalise mental health: Regularly check in with your employees to see how they’re getting on and think about what might be causing them stress. Create space for them to ask questions and raise issues, and give them permission to talk about home as well as work issues if they wish.
- Take stock: Include an agenda item at team meetings to discuss everyone’s wellbeing together, and what factors are affecting this. A planning session can look at the issues in detail and develop a team action plan to address these. If the organisation runs a staff survey, this could form the basis of the discussion.
- Be available for your staff: Regular one-to-ones and catch-ups can help to maintain good working relationships and build mutual trust. If you have staff working remotely, ensure they’re familiar with when and how best to get in contact with you, whether by email, phone or a digital platform.
- Treat people as individuals: Treat employees with respect, praise good work, offer support if there are skills gaps, and try to use a coaching style of management. Ask for feedback about the support you provide and what support they need to help them achieve their goals.
- Embed employee engagement: Promote a culture of open dialogue and involve employees in decisions about how the team is run and how they do their job. Make sure employees understand their role in the bigger picture and make clear their contribution to the organisation’s vision and aims.
- Create opportunities for coaching, learning and development: Make sure employees are confident, well equipped and supported to enable them to do their job to a high standard. You can help them gain confidence and skills by developing and rewarding their capabilities and by being available for regular work-related conversations as well as providing formal training.
- Promote positive work relationships: Support a culture of teamwork, collaboration and information-sharing, both within the team and across the organisation, and model these positive behaviours to staff.
Employers can help employees cope with pressure and adversity in the workplace by focusing on building resilience or stress management techniques. Resilience can be defined as the ability to recover or bounce back in the face of adverse conditions, change or pressure. Successful approaches focus on building individual, team and organisational resilience, which are all interconnected. A focus on building resilience can help employees understand how they can manage and withstand pressure more effectively and also ensure that employers are taking steps to identify and prevent stress effectively.
Early intervention: spotting the signs of stress and poor mental health
“I’ve been fortunate to work in a team where the managers were attentive, proactive and sensitive enough to notice when things were going wrong. It’s normal behaviour for me to withdraw from everyone when I’m going through a bad patch, which inevitably ends up as a crisis. Having a manager who makes a point of looking out for everyone has changed my life.”
No matter how well employees are managed, some people will experience poor mental health in the workplace. Spotting the signs of stress or poor mental health at an early stage means managers can hopefully nip problems in the bud before they escalate into a crisis or sickness absence.
A key part of spotting the signs is managers being alert to the potential workplace triggers, such as:
- people working long hours and not taking breaks
- unrealistic expectations or deadlines
- high-pressure environments
- unmanageable workloads or lack of control over work
- negative relationships or poor communication
- an unsupportive workplace culture or lack of management support
- job insecurity or poor change management
- high-risk roles
- lone working.
External triggers may also have an effect on an employee’s mental health and wellbeing, such as:
- childhood abuse, trauma or neglect
- social isolation or loneliness
- experiencing discrimination and/or stigma
- social disadvantage, poverty or debt
- severe or long-term stress
- having a long-term physical health condition
- unemployment or losing your job
- homelessness or poor housing
- being a long-term carer for someone
- drug and alcohol misuse
- domestic violence, bullying or other abuse as an adult
- significant trauma as an adult, such as military combat, being involved in a serious incident in which someone fears for their life, or being the victim of a violent crime
- physical causes – for example, a head injury or a neurological condition such as epilepsy can have an impact on behaviour and mood. It’s important to rule out potential physical causes before seeking further treatment for a mental health problem.
Managers who know their staff and regularly hold catch-ups or supervision meetings to monitor work and wellbeing are well placed to spot any signs of stress or poor mental health at an early stage. Often the key is a change in typical behaviour. Symptoms will vary, as each person’s experience of poor mental health is different, but there are some potential indicators to look out for.
Table 2 is not exhaustive, but it offers some useful pointers. However, if one or more of these signs is observed, this does not automatically mean the employee has a mental health problem – it could be a sign of another health issue or something else entirely. Always take care not to make assumptions or listen to third-party gossip and talk to the person directly.
Table 2: Indicators of poor mental health
Anxiety or distress
Increased smoking and drinking
Indigestion or upset stomach
Using recreational drugs
Appetite and weight changes
Joint and back pain
Irritability, anger or aggression
Changes in sleep patterns
Loss of motivation
Over-excitement or euphoria
Visible tension or trembling
Loss of humour
Nervous, trembling speech
Lateness, leaving early or extended lunches
Chest or throat pain
Distraction or confusion
Working for longer hours
Intense or obsessive activity
Constantly feeling cold
Lapses in memory
Repetitive speech or activity
Illogical or irrational thought processes
Impaired or inconsistent performance
Difficulty taking information in
Responding to experiences, sensations or people not observable by others
Increased sickness absence
Increased suicidal thoughts
Uncharacteristic problems with colleagues
Apparent over-reaction to problems
Disruptive or anti-social behaviour
Encouraging people to talk about their mental health: supporting staff to stay well and in work
“What made a huge difference was being asked if I was okay – simple as that. I don’t seek out people to tell, it’s not in my introspective nature. Without being too drama queen about it, I would have left work by now without her support, and wouldn’t be going back to anything, and probably would be self-destructing right now.”
If poor mental health is suspected or disclosed, it’s crucial that managers facilitate an early conversation about the person’s needs, to identify and implement appropriate support or adjustments. Basic good people management and the use of empathy and common sense lie at the heart of effective management of mental health in the workplace. If an individual does not trust their manager, they are unlikely to want to discuss a sensitive issue such as mental health with them. Managers need to be approachable and listen when staff ask for help, supported by a workplace culture that’s open and inclusive about mental health.
While mental ill health is a sensitive and personal issue – like any health problem – most people prefer honest and open enquiries over reluctance to address the issue. Shying away from the subject can perpetuate fear of stigma and increase feelings of anxiety. Often employees will not feel confident in speaking up, so a manager making the first move to open up a dialogue can be really helpful. It’s important that they don’t make any assumptions, though.
Regular catch-ups or supervisions are an opportunity to start the conversation, which should always be in a private, confidential setting where the employee feels equal and at ease. Questions should be simple, open and non-judgemental to give the employee ample opportunity to explain the situation and their feelings in their own words. If there are specific grounds for concern, such as impaired performance, it’s important to address these at an early stage, but in all cases people should be treated in the same way as someone with a physical health condition – a good starting point is asking how they are
Questions to ask
- How are you doing at the moment?
- You seem to be a bit down/upset/under pressure/frustrated/angry. Is everything okay?
- I’ve noticed you’ve been arriving late recently and I wondered if you’re okay.
- I’ve noticed the reports are late when they usually are not. Is everything okay?
- Is there anything I can do to help?
- What would you like to happen? How?
- What support do you think might help?
- Have you spoken to your GP or looked for help anywhere else?
Questions to avoid
- You’re clearly struggling. What’s up?
- Why can’t you just get your act together?
- What do you expect me to do about it?
- Your performance is really unacceptable right now – what’s going on?
- Everyone else is in the same boat and they’re okay. Why aren’t you?
- Who do you expect to pick up all the work that you can’t manage?
Managers should explore how to address any difficulties which are work-related with any employee reporting a mental health issue. This might in turn help them to cope with any problems in other areas of their lives. Managers should encourage employees to see their GP as a first step and ensure they are aware of any support available either from their employer, for example by contacting the HR department, using a confidential employee assistance helpline, or from other sources, such as Mind’s telephone helplines or SANEline (see Useful resources).
Employers need to communicate clearly through policies on stress management and/or mental health that anyone with a mental health issue will be supported. Employers need to point out what help is available, as well as be clear with employees about relevant ill health procedures.
If you think a member of your team is experiencing poor mental health, or they tell you about it, it’s essential you have a sensitive and supportive conversation with them about their needs. This will help you to evaluate and introduce appropriate support or adjustments. To manage mental health at work effectively, you’ll need good people management skills, as well as empathy and common sense.
Choose an appropriate place
- It’s important to make people feel comfortable, so it’s good to have the conversation somewhere private and quiet.
- Sometimes a neutral space outside the workplace will help the person to feel equal and at ease.
- For remote workers, you can ask if they would like to meet you for a walk, or a chat if they are comfortable with that, or have the conversation virtually. If meeting virtually, you’ll want to ensure they have appropriate notice of the topic of your conversation; they might want to take the call in a private space away from other members of their household if working from home.
Avoid making assumptions
- It can be difficult for people to disclose information relating to their mental health, so make it easier by keeping an open mind and giving them space to talk it out.
- Avoid trying to guess what symptoms an employee might have and how these might affect their ability to do their job.
- Remember, many people are able to manage their condition and perform their role to a high standard, but may require support when going through a difficult period.
- People can understandably be anxious about disclosing, so be prepared to assume responsibility for some confidential and sensitive information.
- Understand your organisation’s policies about who should be made aware of the individual’s situation. This might be outlined in a safeguarding policy or mental health policy. As a rule, it should involve as few people as possible.
- Reassure the individual that any private information they disclose will not be leaked to their colleagues.
- Discuss with the individual any information they would like shared with team colleagues and how, as this can be very supportive for some people.
- In order to fulfil your duty of care to keep your staff members safe at work, you will be obliged to break confidentiality if they are experiencing a crisis. If you become aware that someone is at serious risk of harm, whether this is the employee or someone else, you should call the emergency services. When beginning a discussion about mental health, it is best to ensure they understand the circumstances under which you might be required to share information they disclose.
Encourage people to talk
- It’s important to have an open dialogue with employees when discussing their mental health.
- Remember, everyone’s experience of poor mental health is different, and how you deal with a disclosure should be entirely dependent on the individual.
- Follow the conversation checklist below to explore how the condition manifests itself, what the implications are and what support they need.
- Mental distress affects people in different ways and at different times in their lives, so be prepared to adapt your support to suit the individual.
- If it works for both of you, work with your employee to develop an individual wellness action plan.
- Remember, workplace adjustments for poor mental health need not be costly nor require huge changes – they can be simple, as shown below.
- Be aware of the steps to take if you’re concerned the employee may be having suicidal feelings – guide them to seek help from their GP or the Samaritans, and consult Mind’s advice or the CIPD’s guide on how to support people.
Develop an action plan
- Work with your team member to develop an individual action plan.
- It’s important that the plan identifies the signs of the individual’s mental health problem, triggers for stress, the possible impact on their work, who to contact in a crisis, and what support they need.
- The plan should include an agreed time to review the support measures to check if they have been effective or whether any further adjustments are needed.
- Include a date to follow up on this action plan and set up a subsequent meeting.
- People should speak to their GP about available support from the NHS, such as talking therapies.
- If your organisation has an employee assistance programme, it may be able to arrange counselling. Your organisation might also have a range of additional support services available; be sure to familiarise yourself with how accessible these are to remote workers.
- The Mind Infoline can signpost people towards support, and the network of local Mind hubs across the UK can also help source advice and support.
- People may not always be ready to talk straight away, so it’s important that you outline what support is available.
- Reassure the individual that your door is always open, and they can speak to you as their manager at any time.
Seek advice if you need to
- If you’re still unsure, the person lacks insight or an issue is particularly complex, seek advice from expert organisations and encourage your employee to do the same. If available, employee assistance programmes can also help.
- Where workplace relationships are strained or confrontational, consider using workplace mediation to help resolve issues.
- Involving occupational health services, if available, can be useful, as they can support both employees and managers to discuss their situation and agree on effective support and/or adjustments.
- Remember that once aware of health or disability information, the employer also has a legal duty to consider making reasonable adjustments as well as a general duty of care and responsibility for employee health and preventing personal injury.
- Avoid interruptions – switch off phones, ensure colleagues can’t interrupt.
- Ask simple, open, non-judgemental questions.
- Avoid judgemental or patronising responses.
- Speak calmly.
- Maintain good eye contact.
- Listen actively and carefully.
- Encourage the employee to talk.
- Show empathy and understanding.
- Be prepared for some silences and be patient.
- Focus on the person, not the problem.
- Avoid making assumptions or being prescriptive.
- Follow up in writing, especially agreed actions or support.
Anna works for a local authority and was pleasantly surprised by the positive response from her manager when she disclosed her depression and borderline personality disorder.
“I really wasn’t sure about being honest at work as I’ve had previous poor experiences – such as being told that ‘people like you can’t help other people’.”
With her manager, Anna explored various options for staying in her existing team, such as part-time, compressed hours, a period of time off or completing a stress at work assessment. She felt her manager did everything possible to support her to stay in her existing role. However, in the end, they agreed she would take a healthier career step into a less front-line position, which she felt suited her circumstances. “It doesn’t feel like I’ve been punished for being depressed; it almost feels like I’ve been rewarded for being honest.”
See the CIPD guide to managing and supporting employees with long-term health conditions for information on key principles for creating a supportive workplace.
Given the high levels of stress and poor mental health we are seeing in the workplace, there is a growing demand for innovative and proactive ways of managing mental health at work. The Wellness Action Plan is inspired by Mary Ellen Copeland’s Wellness Recovery Action Plan (WRAP): an evidence-based system used worldwide by people to manage their mental health.
A Wellness Action Plan is a personalised, practical tool (that can be used whether someone has a mental health problem or not) to help identify what keeps people well at work, what causes people to become unwell, and the support they would like to receive to boost wellbeing or support a recovery.
As a manager, encouraging your staff to draw up a Wellness Action Plan gives them ownership of the practical steps needed to help them stay well at work or manage a mental health problem. It also opens up a dialogue with your team member, to help you better understand their needs and experiences and therefore better support their wellbeing. This in turn can lead to greater productivity, better performance and increased job satisfaction.
Employers who choose to introduce new starters to the Wellness Action Plan during the induction process are able to demonstrate their commitment to staff wellbeing from the very beginning, sending out a clear message that proactive management of the wellbeing of their workforce matters.
Wellness Action Plans are also particularly helpful during a return-to-work process as they provide a structure for conversations around what support and/or reasonable adjustments might be useful.
By giving your staff an opportunity to draw up a Wellness Action Plan, they will be able to plan in advance and gain an awareness of what works and what doesn’t work for them. A Wellness Action Plan can help employees to develop approaches to support their mental wellbeing, leading to a reduced likelihood of problems such as work-related stress.
By regularly reviewing the agreed, practical steps in the Wellness Action Plan, you can support your team member to adapt it to reflect their experiences or new approaches they find helpful. By allowing the individual to take ownership of the process and of the Wellness Action Plan itself, you will be empowering them to feel more in control.
What should a Wellness Action Plan cover?
- approaches the staff member can adopt to support their mental wellbeing
- early warning signs of poor mental health to look out for
- any workplace triggers for poor mental health or stress
- potential impact of poor mental health on performance, if any
- what support they need from you as their manager
- actions and positive steps you will both take if the staff member is experiencing stress or poor mental health
- an agreed time to review the Wellness Action Plan and any support measures that are in place
- anything else that the individual feels would be useful in supporting their mental health.
You can find Mind’s template Wellness Action Plans in addition to a manager’s guide in their use on the Mind website.
Various aspects of work and the workplace can cause substantial disadvantages for people with disabilities. The UK Equality Act 2010 says that employers must take reasonable steps to remove the disadvantage. The purpose of the law is to place a duty on employers to address the disadvantages encountered at work by people with disabilities, and the starting point for any consideration of reasonable adjustments should be what difficulties someone is experiencing in the workplace.
‘Reasonable adjustments’ for people with disabilities or health needs are commonly perceived as adaptations to the physical environment where this causes difficulties, such as wheelchair ramps, or communication assistance, such as sign language interpreters.
In relation to mental health, more often the obstacles are less tangible and relate to negotiating the social, rather than the physical, world of work. A requirement to work set hours, for example, or the practice of only having occasional supervision might cause a substantial disadvantage for someone with certain mental health problems. Effective adjustments can be simple, low-cost and are generally changes in practice or requirements, such as flexible working hours or increasing one-to-one supervision.
An employer is only under a duty to make adjustments that are reasonable, which will depend on the circumstances of the case. Potential adjustments should be considered on a case-by-case basis, but factors that may be helpful to consider include:
- the effectiveness of the adjustment in preventing the disadvantage
- the practicability of making the adjustment
- the extent to which making the adjustment would impact on service delivery
- financial and other costs – and any financial assistance, for example available under the Access to Work scheme (see below)
- the potential impact on colleagues.
It can be useful for managers to discuss the practical implications of any reasonable adjustment request, including what has been done before, the ease/difficulty of accommodation, any service delivery and team implications, as well as any other relevant issues. Both the employee and manager need to be clear about the considerations that will be taken into account in reviewing whether an adjustment is reasonable and practicable to implement.
However, employers should follow a flexible, rather than a rigid, approach to ‘reasonable adjustments’. Adjustments for mental health are often simple and it is good practice to offer support to all staff, whether or not they have a formal diagnosis or a disability according to the legal definition. Allowing staff flexibility in how and when they perform their role, where possible in line with business needs, can reap rewards in terms of loyalty, increased productivity and reduced absence, and can help normalise mental health and disability in the workplace.
The key point to remember is that everyone’s experience of poor mental health is different – so two people with the same diagnosis may have very different symptoms and need different adjustments. This may seem complex, but often the person will be the expert on their condition and know their own support needs. In essence this means managing the person as an individual.
Following a Wellness Action Plan approach and discussing with the employee about what adjustments might help is a straightforward way to identify what support managers need to put in place. Often this can be very simple: for example, one person with anxiety requested that her manager remembered to say thank you after she completed a piece of work to prevent self-esteem and paranoia issues spiralling into distress.
Below are some adjustments that may help to mitigate mental health symptoms and the impact on the employee’s performance at work. They are not prescriptive, but employees with a mental health condition have found some or all of these useful in their experience. It is important to always be guided by what the individual says – this list could act as a prompt for managers and employees to explore together.
While making 'reasonable adjustments' may not be a legally defined requirement for employers outside the UK, they may in any case find these guidelines useful as considerations. Be sure to check local legislation to understand the relevant provisions and any other obligations you may have as an employer.
Chloe, a charity worker in her 20s, was experiencing depression. Her boss had noticed her performance had slipped, but, with no information on Chloe’s health, put more pressure on her to perform. Chloe disclosed her condition and her boss did everything he could to support her, ranging from weekly catch-ups to prioritise her workload, flexible working hours and afternoon naps to cope with the side effects of medication. This aided Chloe’s speedy recovery and ability to stay in work.
- Flexible hours or change to start or finish times; change of workspace, for example quieter, more or fewer people around, dividing screens
- working from home at certain times or on certain days in a given period
- changes to break times
- provision of quiet rooms
- lightbox or seat with more natural light
- agreement to give an employee time off for appointments related to their mental health, such as therapy and counselling
- temporarily changing duties, for example changing the balance of desk work and customer-facing work, reducing caseloads, changing shift patterns
- reallocation of some tasks or amendments to the employee’s job description or duties
- redeployment to a more suitable role
- increased supervision or support from manager, buddy or mentor
- extra help with managing and negotiating workload
- debriefing sessions after difficult calls, customers or tasks
- mediation can help if there are difficulties between colleagues
- access to a mental health support group or disability network group
- identifying a ‘safe space’ in the workplace where the person can have some time out or access support
- provision of information to promote self-care
- encouraging employees to work on building up their resilience and doing things that support good mental health, such as exercise, meditation or eating healthily
- providing regular opportunities to discuss, review and reflect on people’s positive achievements – this can help people to build up positive self-esteem and develop skills to manage better their triggers for poor mental health.
The Access to Work scheme is designed to provide advice and financial support for people with health problems or disabilities that impact on their job. It might provide expert advice for employers and employees or pay towards a support worker or equipment the employee needs at work.
Access to Work can be very helpful for people with a mental health condition, and someone doesn’t have to be diagnosed with a mental health condition to apply for support.
Encouraging employees to apply for Access to Work support can help employers to manage the potential costs of reasonable adjustments.
Their specialist advisers provide:
- tailored, work-focused mental health support for nine months
- suitable coping strategies
- a support plan to keep them in, or return to, work
- ideas for workplace adjustments to help them fulfil their role
- practical advice to support those with a mental health condition.
Erin is a senior leader in higher education and has general anxiety disorder. Her role is external-facing and often requires working unusual hours with significant socialising and international travel. Erin had a panic attack at the office after a period of extensive travel and had to attend A&E. Erin spoke with her manager and fully disclosed her anxiety disorders, which she hadn’t done in the past. It was important to Erin that she maintained her full responsibilities, including travel, and together they made adjustments, such as:
- increased flexibility with travel arrangements so she could arrive a day earlier or stay a day later to give her additional time to prepare and recover
- supporting ‘rest days’, so after long periods of external activities and/or travel, she felt empowered to block rest time in her diary
- increased communication with manager and colleagues through different channels (email, WhatsApp, text), so if she found herself struggling, especially when travelling, she could reach out quickly to ask for support and to chat
- additional team support so when she was travelling for long periods of time, she had the option to bring an additional team member to help manage the external engagements.
“My career is important to me. My biggest worry was that my manager and my team would think I was incapable of doing my job successfully. These adjustments made me feel that they trusted my abilities, believed the severity of my anxiety, and wanted me to be healthy and succeed.”
Supporting people to return to work
“My manager was in touch when I was off and reassured me that my job was safe. He let me know that I was “part of the team” and that I was wanted back. I came back gradually, building my hours up as I went along. It was crucial that there was that amount of flexibility at the heart of the support plan.”
Proactive management of absence is central to the effective management of people with a mental health issue – and again the role of the manager is critical. Sometimes an employee may be so unwell they need time off work to recover. The way organisations manage a period of sickness absence is key to shaping how effectively and how quickly people are able to return to work, and get back to peak performance.
An important time in managing and supporting someone with a mental health problem is when they are off sick for periods of two weeks or longer. It’s important that managers agree how often and how they communicate, for example by telephone, email or face-to-face visit. It’s useful to set out the importance of this contact in the absence management policy so managers and employees are clear about the need to maintain contact. In the event that the manager is the source of the individual’s distress, another member of staff or someone in HR should be the person that keeps in touch.
The CIPD guide Managing a return to work after long-term absence sets out the guiding principles to follow when navigating the key steps to managing an effective return to work:
- maintaining communication while absent
- preparing for a return to work
- supporting the employee and manager during the immediate return
- supporting the employee and manager on an ongoing basis on return.
Return-to-work interviews are consistently identified by CIPD research as an effective intervention for managing absence. An effective return-to-work interview can build trust and engagement and support a smooth and sustainable return to work. When the person is ready to return, the manager should arrange to meet up in a neutral and comfortable venue to discuss the details of the employee’s return.The employee should know in advance to expect a return-to-work interview and that this is a supportive process to help them make a successful and lasting return to the workplace, and address any ongoing health needs.
If the individual is not yet open about their mental health, a return-to-work interview is a great opportunity to explore what factors are contributing to their absence and identify if they have an underlying mental health problem. Effective return-to-work interviews can ensure mental health issues are identified at an early stage, before any work-related problems escalate and the individual’s condition worsens.
Access to occupational health services is identified as one of the most effective interventions for long-term absence. Also, NHS England’s Adult Improving Access to Psychological Therapies (IAPT) services – offering cognitive behavioural therapy, counselling and employment advice – may benefit employees, with referral usually through their GP. Employers can also build links with, and encourage employees to access support through, third sector organisations such as local Minds, which offer a range of mental health and employment or vocational support services. There is also a wealth of guidance online (see Useful contacts).
Whatever support is used, early intervention is vital. Some employers refer employees with mental health problems to occupational health on the first day of absence, recognising that these problems are likely to be recurrent or long term if not addressed promptly. By the time someone has been off sick for a month, the chance of a successful return to work is reduced, as they are likely to have lost confidence and started to become alienated from the workplace.
For further information on how to manage absence effectively, see the CIPD factsheet on absence management.
- Tell the employee they were missed.
- Ask the person how they’re feeling.
- Explain the return-to-work process/procedures.
- Reassure the employee that they aren’t expected to walk straight back into full-time hours, or manage a full-time workload.
- Use open questions that require more than just a ‘yes’ or ‘no’ answer and give people lots of space and time to talk.
- Listen and try to empathise with the employee.
- Ask if there are any problems at work that might be causing them stress.
- Discuss whether there are any difficulties outside work that might be contributing to their absence.
- Talk about the person’s mental health problem, if they have disclosed it, and its possible impact on their work.
- Discuss possible solutions and make sure you are aware of any sources of available support, whether internal or external.
- Discuss any worries the person has about returning to work, reassure them that these are normal, and agree how to address their concerns.
- Help the person to think about how they want to manage their return; for example, what they want to say to colleagues.
David has experienced depression and anxiety for a number of years. In his first job, he disclosed his mental health problems at the start, and after a year he experienced a severe episode of poor mental health resulting in absence from work. The employer supported David when he was ready to come back to work, providing a phased return to his job and assigning mentors to help him cope with his workload and to ensure he always had someone to talk to if needed. This enabled David to progress well and continue to succeed within his job. In the last couple of years he has been signed off for another three-month period. His manager has been a constant support. The occupational health team helped with his return to work and they meet with him on a regular basis to ensure they are providing the best support possible.
The first day back at work is very important, whether the employee is returning to a workplace or working from home. As a manager, you should try to make the event as trouble-free as possible for the returning employee. People are often very anxious about returning to work. They may feel self-conscious about something that happened before they went off sick, or feel they’ve let down colleagues. The manager and employee should decide together beforehand exactly what colleagues will be told about the situation. If based in a physical workplace, the individual may like to be met at the workplace door or travel in with you or a colleague. If the individual is working from home or in a hybrid way, give careful thought to how they will be supported remotely, for example by setting up virtual coffee breaks and catch-ups with colleagues. The aim is to gently reintegrate the returning employee into the routine of work while making sure they can catch up on any work or organisation developments.
Managers need to be proactive during the first few weeks of the individual’s return. It’s important to remember that an employee is unlikely to be fully fit when they return to work, and will need ongoing support as well as possible adjustments to their workload to help ease them back into their work routine, particularly if the absence has been long term.
Mind’s Workplace Wellbeing Index assesses the impact poor mental health has on performance. Its 2020/21 report found:
- 74% said their condition makes it difficult to concentrate and 51% said they found it more difficult juggling a number of tasks.
- 52% said it sometimes makes them put off challenging work, while 51% said it takes them longer to complete tasks.
- 40% said they have difficulty making decisions and a further 35% said they have difficulty learning new tasks.
- 14% said they are more likely to get into conflict with colleagues.
- 9% felt that when their mental health is poor, they rely more on colleagues to get work done.
Most employers will have policies and procedures in place for performance management, but where there are suspected or known health issues, these should also be explored, prior to any formal processes. If the root causes of poor performance are not addressed, any solutions are unlikely to fully resolve the issue, so problems can spiral into sickness absence.
Performance management should in essence be a positive and supportive process. It is in the organisation’s, as well as the employee’s, interest to discuss potential adjustments and support where appropriate, and help the individual perform to their full potential. Contrary to the myth about people with a mental health condition not being capable of performing to a high standard at work, many people with a mental health problem continue to go into work and thrive. There could be times when performance could be affected, particularly if they are afraid of disclosing their condition and accessing the support they might need at certain times. An effective performance management process should be responsive to people’s needs and take into account any health issues they may be experiencing.
It is important to ensure employees are given the opportunity to disclose any health condition that could potentially affect their performance. Managers should make it clear that any disclosure of a mental health condition will be dealt with in a supportive manner and not prompt disciplinary action. The 2019 BITC Mental Health at Work survey found that 9% of employees had faced dismissal, disciplinary action or demotion after disclosing a mental health condition.
Discussions or meetings about performance should concentrate on the individual’s work and how it is being impacted, but asking simple, open questions about how the employee is and whether anything is affecting their performance can encourage people to talk about any health issues. It is also useful to explore any other potential workplace issues, such as negative relationships with colleagues, which may be impacting on the employee’s wellbeing and, in turn, their performance. Managers should not force someone to disclose or suggest they are ill, but using the conversation tips can help explore this area in a way that is not intrusive or judgemental.
An effective performance management system should not consist of a one-off appraisal meeting but should include regular and constructive feedback and discussion. This informal dimension to performance management is crucial to encouraging a two-way dialogue and trust-based relationships. This will make it much easier to address any health issues, identify any extra support or coaching the person may benefit from and set timescales for improvements.
Each employee will need to be managed on a case-by-case basis, but the general rules of thumb are:
- Focus on the person, not the problem – don’t make assumptions about how mental health affects performance, because people with even a serious mental health condition can still thrive at work.
- Ask simple, open and non-judgemental questions.
- Consider health-related solutions, not just performance-based approaches.
- Make it clear that the organisation is prepared to put in place support or adjustments to help the individual perform to their full potential.
- Allow the employee to be supported in discussions or meetings, for example by an advocate or someone who understands their condition.
- Use mediation to resolve any conflict if necessary/appropriate.
Deloitte is a professional services firm, operating a hybrid working model for its 22,000 people, including over 1,100 partners, in key locations across the British Isles.
When our people thrive, so does Deloitte and everyone we work with. Deloitte offers its people the opportunity to choose where, when and how we work, alongside a range of support, resources, communities, and events to support the wellbeing of our people.
Deloitte’s Inclusion and Wellbeing Ways of Working Framework invites individuals at all grades to outline their backgrounds, strengths and preferred working styles.
Deloitte teams are encouraged to fill in the framework at the start of every project and to discuss this as a project team. In some cases, clients have also requested to fill in the framework and take part in the discussion with the Deloitte project team.
Teams are encouraged to regularly set up time to revisit the framework, to discuss where circumstances have changed. First piloted across Deloitte’s consulting practice in July 2020, the framework was adopted widely across Deloitte in September 2021 and has been made available as a free-source downloadable document, allowing other organisations and businesses to benefit from the template.
Our people leaders are at the heart of our approach – they are colleagues who are responsible for supporting their team members’ wellbeing, performance, and development. They do this through regular one-to-one check-in conversations. Our people leaders have access to a wide range of resources to support them in their role, including regular newsletters, webinars and learning modules.
We adopt a story-telling approach to our frequent internal communications campaigns around mental health, sharing the personal experiences of our own colleagues in written and video form. For Mental Health Awareness Week 2022, we have led a campaign of ‘real people, real experiences’ to destigmatise several mental health topics, including bipolar disorder, baby loss and the impact of disability on mental wellbeing.
Our well-established network of almost 100 trained Mental Health Champions is available as a confidential source of support, and we regularly promote the network as well as spotlighting individual champions. We also track, anonymously, the topics of conversations with champions to inform our future knowledge in building the community and developing our wellbeing strategy.
Our approach is further informed by our continuous listening approach. Through a variety of surveys, webinars, and sources of feedback, we review the input from our people and use this to inform future policy and practice.
Our resources and support underpin our approach, including occupational health, our employee assistance programme, learning pathways, regular webinars and events, multiple toolkits and information sources. To ensure that our people can find and access the information they need, it is hosted on our My Wellbeing intranet platform – a one-stop-shop for everything relating to wellbeing at Deloitte and the associated My Wellbeing app.
LSI Architects is an AJ100, award-winning architectural practice with over 70 people, including architects, technologists and support staff, based in London and Norwich. We seek to create sustainable, innovative, valuable and positive architecture that improves lives, builds communities and enhances society, or, as we put it – Life Touching Design.
The Mind Workplace Wellbeing Index has been the cornerstone of our work on mental health and wellbeing since we took part in the inaugural index in 2016. This provided us with a useful starting point as a means of consulting with our employees, and by using the feedback received from the survey, we were able to structure an appropriate and effective approach to workplace mental health and wellbeing.
Our focus has been on wellbeing and building resilience within our teams, alongside creating an open culture where mental health is viewed in the same way as physical health. We want our internal environment to be without stigma, and a place where people can be themselves and discuss their mental health with no concern over being judged.
Every employee has been provided with the opportunity to attend a series of informative workshops, provided initially by Mind, which offered simple strategies to understand and prevent the causes of poor mental health and promote positive wellbeing. These have since been developed into a video format, enabling our team to access resources when working from home and out of hours. Most of our team have changed something about their lifestyle to better support their mental health and wellbeing, including altering their work routines, diet, or exercise.
Training on coaching, mentoring and feedback has been provided in support of our one-to-one structure, where every employee has at least monthly one-to-ones with an assigned mentor, focusing on their performance, development, and wellbeing. These sessions also incorporate a wellness action plan.
Trained mental health champions are available to recognise when people may be struggling, and to signpost them to support, as well as championing our wellbeing agenda.
Through the surveys, we learned that our line managers did not feel capable of providing support to employees experiencing issues with their mental health, and as a result, we now provide training around how they can proactively support their team’s wellbeing and respond to trauma events.
During the pandemic, we worked hard to ensure that everyone still felt connected, with regular wellbeing calls from managers and HR. Regular leadership briefings also reassured people during a difficult time.
The practice provides employees with the opportunity to connect and support their wellbeing through multiple activity sessions, including weekly yoga and boot camp classes, five-a-side football, and a well-attended sketch club. An external specialist also provides private counselling, should employees wish to utilise the sessions available to them.
Commitment to improved employee mental health and wellbeing
In January 2017, the UK prime minister commissioned an independent review into how employers can better support the mental health of all people currently in employment, including those with mental health problems or poor wellbeing. The Thriving at Work review into workplace mental health was led by Lord Dennis Stevenson and Mind CEO Paul Farmer CBE.
Drawing on the accounts of over 200 employers, people with mental health problems and leading experts, Thriving at Work set out core principles and standards to which all employers, regardless of size or industry, should commit. These are captured in the Mental Health at Work Commitment.
The Mental Health at Work Commitment comprises six standards:
- Prioritise mental health in the workplace by developing and delivering a systematic programme of activity.
- Proactively ensure work design and organisational culture drive positive mental health outcomes.
- Promote an open culture around mental health.
- Increase organisational confidence and capability.
- Provide mental health tools and support.
- Increase transparency and accountability through internal and external reporting.
The Mental Health at Work Commitment is free to sign and signals the organisation’s supportive approach and prioritisation of employee mental health and wellbeing. To sign, visit www.mentalhealthatwork.org.uk/commitment
Visit the CIPD’s hub that supports the Mental Health at Work Commitment to access the CIPD content that will help you to meet the standards.
Useful contacts, advice and resources
Acas: free and impartial information, advice, and training to employers and employees, including a range of resources to support good mental health at work
Equality and Human Rights Commission
Health and Safety Executive advice on stress
PANDAS HR toolkit for businesses and organisations to support employees who may be affected by perinatal mental health conditions
Togetherall: a safe, online community where people support each other anonymously to improve mental health and wellbeing.
Telephone: 0300 123 3393
Mind provides confidential mental health information services. With support and understanding, Mind enables people to make informed choices. The Infoline gives information on types of mental distress, where to get help, drug treatments, alternative therapies and advocacy.
Side by Side, Mind’s online community
Side by Side is a supportive online community where you can feel at home talking about your mental health and connect with others who understand what you are going through. We all know what it’s like to struggle sometimes, but now there’s a safe place to listen, share and be heard.
Telephone: 116 123
Whatever you’re going through, Samaritans are there to listen – 24 hours a day, 365 days a year. Samaritans offer a safe place for you to talk any time you like, in your own way about whatever’s getting to you. They won’t judge or tell you what to do; they’ll listen to you.
Shout, text support
Text: SHOUT to 85258.
Shout is a free, confidential 24/7 text messaging support service for anyone who is struggling to cope. The service is anonymous and won’t appear on any phone bill.
Telephone: 0800 58 58 58
The CALM helpline is there for anyone who needs to talk confidentially about a tough time they are experiencing. Calls are taken by trained staff who are there to listen, support, inform and signpost you to further information. The helpline is open from 5pm to midnight every day, 365 days a year.
Telephone: 0300 304 7000
SANEline is a national out-of-hours mental health helpline offering specialist emotional support, guidance and information to anyone affected by mental illness, including family, friends and carers. It is normally open every day of the year from 4pm to 10pm.
Mind: mental health information and support
We won’t give up until everyone experiencing a mental health problem gets support and respect. We believe no one should have to face a mental health problem alone. We’ll listen, give you support and advice, and fight your corner.
When you’re experiencing a mental health problem, supportive and reliable information can change your life. That’s what we do. We empower people to understand their condition and the choices available to them through the following:
- our Infoline, which offers callers confidential help for the price of a local call
- our Legal Line, which provides information on mental-health-related law to the public, service users, family members/carers, mental health professionals and mental health advocates
- our award-winning information, certified by the PIF Tick.
Our local Minds provide help and support directly to those who need it most. There’s a network of around 125 local Minds across England and Wales that offer specialised support and care based on the needs of the communities they support.
We believe everyone with a mental health problem should be able to access excellent care and services. We also believe you should be treated fairly, positively and with respect.
We campaign on a range of issues that could affect anybody with a mental health problem. This includes health services, legislation, protection of legal rights, and employment. Join us to campaign for change.
Whether you’re an employee worried about your or a colleague’s mental health, a company looking for professional training or consultancy, or an HR professional who wants to improve mental wellbeing in your organisation, we’re here to help.
Mind’s workplace wellbeing services include:
We also offer a range of free resources and information for employers and employees.
Explore our collection of resources around legal issues surrounding stress and wellbeing in the workplace
Join our webinar to explore how you can normalise conversations about menstruation and menstrual health in the workplace to better support women at work.
What this practice is, why you should avoid it, and how to approach it if no other options are available