Breaking the stigma: why every office needs a Mental Health First Aider

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Elizabeth D'Arcy-Malone
CIPD Level 5Learning & Development Tutor
AVADO
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Depression, anxiety, stress - mental health issues in the workplace are cause for concern for many employers. 

According to the HSE stress, depression or anxiety accounted for 9.9 million days lost to work related ill health between 2014/2015.

If absenteeism is having an impact on organisations, consider the impact of presenteeism to the organisation’s bottom line - and that’s before we even start to throw leaveism into the equation!

As a person who has ‘suffered’(and I use the word suffer deliberately, as this is not just a case of feeling a bit down, or “having an off day”), my experiences of how my illness has been dealt with/supported during my working life has varied greatly.

A vicious circle

As someone who has been in Learning & Development for the majority of my working life, I know all too well how difficult it is to deliver training when it has taken all of your energy to just get out of bed.  

To stand in front of a group of eager and enthusiastic students/learners/delegates and not let them see how much anguish and torment you are experiencing is no mean feat, I can tell you! Sometimes it’s just not do-able. So then you decide to ring in sick; this exacerbates the feelings of worthlessness, and makes you question your abilities and adds to the feelings of guilt (which is a constant companion).  

Self loathing and self hatred are emotions I have felt on many an occasion, as I questioned my ability to perform my role and also agonised over how my colleagues perceive me due to my depression. Whilst compassion and empathy for physical illness are often plentiful, this is often not the case when people are dealing with mental ill health. 

People often just don’t know what to do for fear of making someone feel worse

I remember receiving a bouquet of flowers after having a hip replacement, when I was off with depression, not so much as a ‘we’re thinking about you’ card which would have made me feel much less isolated and also cared for by my colleagues.

However, I am not apportioning blame as I have seen this all too frequently. Unfortunately there is still so much stigma which accompanies mental ill health; people often just don’t know what to do for fear of making someone feel worse. So, here lies the rub…..people don’t know what to say, and there is still the perception (in some cases) that depression is an easy excuse for someone who may wish to swing the lead for a few days. 

I remember someone commenting that ‘back-pain’ was the go-to excuse for ‘pulling a sickie’ but this has now been replaced by ‘depression/anxiety/stress’. As professionals we need to challenge these perceptions and look at how we can address them.

A lack of understanding

In my last role, I worked with organisations to help them assess themselves against standards in the Workplace Wellbeing Charter (a framework to see how they performed in terms of workplace health and wellbeing against eight standards, including mental health).  

An issue which came up time after time was the lack of understanding by line managers around mental illness. Employees were often scared and anxious about making that telephone call to say they just couldn’t make it in to the workplace. Once the phone call had been made, some absence policies and procedures stipulated that the employee had to phone their line manager every day which can exacerbate the anxiety which is already felt by the individual. 

The ‘return to work’ interview is often construed as a 'checking up on me' interview

Following that, the ‘return to work’ interview is often construed as a 'checking up on me' interview, and coupled with policies which may invoke disciplinary proceedings, if you have had more than a certain number of periods of sickness, this does nothing to quell the distress. 

Again a greater understanding of mental ill health and how to support individuals is paramount in helping the individual eliminate anxiety caused by being absent. Some organisations use Wellness Recovery Action Plans, which can be of great help to both individual and business when someone has a recurring illness (this isn’t confined to purely mental ill health).

The confidence to support

I first attended Mental Health First Aid training in 2010 and was fascinated by the concept. Why do we have First Aid trainers in organisations to support people who may have had an accident and are in distress or need attention but for anyone who may be experiencing mental distress, their needs aren’t addressed?

Fast forward six years and I am now a MHFA Trainer which allows me to use my training skills and my experience of depression to inform and educate people around Mental Health. What’s the point I hear you ask, surely any compassionate member of a team would go to help a colleague if they were distressed? Well of course, in an ideal world that would happen. However, is everyone in your workforce equipped to deal with someone who may be having a psychotic episode?

Mental Health First Aid equips individuals with skills to feel confident in supporting someone who is experiencing distress

If you spot cigarette burns on the arms of your line manager, would you feel comfortable having that conversation? Your team leader is stressed and tired because their teenage son is behaving erratically and is saying he is being watched by M15 and he is hearing voices. Could you deal with that? Mental Health First Aid equips individuals with knowledge and skills to feel confident in supporting someone who is experiencing distress and can offer techniques to support that person until professional help is accessed.

This isn’t about being a counsellor, and this is made blatantly clear on the course, the same way that undertaking a First Aid at Work course does not make you an A&E doctor. It is about being there in those first moments of distress when, to the person experiencing anguish their world is crashing down around them.

These skills are not just confined to the workplace either as  I know I can call on them at any time. However, this is also about educating people about the impact mental ill health can have on not just the individual themselves, but also their loved ones, colleagues, friends etc. It’s about understanding that we’re not just 'swinging the lead' we’re not 'mardy arses' we can’t just "pull ourselves together” whilst hoisting our chins up. If only it were that simple! 

So a call to arms. Please help break the stigma. Consider equipping your teams, co-workers, colleagues and line managers with the knowledge, confidence and skills to support those in distress. You wouldn’t believe the difference you could make to someone. Surely that’s worth it?

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22nd Nov 2016 10:47

Elizabeth, I commend you for this article. The MHFA as you rightly point out gives people confidence in responding to someone in acute distress which is extremely important. In my experience, however, the support thereafter to the HR team is often lacking.

Thanks (2)
to yourmind
23rd Nov 2016 09:48

Thank you, that's very kind of you to take the time to comment. I think ecucation for the HR Function and also Line Managers is crucial as often situations are handling insensitively simply because the HR/Line manager isn't quite sure how to handle the situation. They may worry about how to phrase something, or whether something they say will cause offence or exacerbate the situation. This is something which can be addressed in training sessions for managers. However, empathy and compassion are THE most important skills when supporting someone (in my humble opinion :-) ).

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By leti
22nd Nov 2016 11:19

I recognise that by writing this I risk exposing myself to allegations of bringing my organisation's name into disrepute but that is not my aim. I am not naming anyone, not wanting to point any fingers of blame but am writing this in the hope that it might throw light on to a condition that people fear and misunderstand. I am no monster, clients are utterly safe with me and I am a consummate professional. It's just that, behind the scenes, i am sometimes reduced to a tatty ragdoll after a tussle with a bulldog.

I live with Borderline Personality Disorder and i work as an Occupational Health Advisor. I have high standards and expectations of myself and of those with whom i work. I need to feel in control of my environment, particularly at work. I have been a sole trader for 16 years but have often shared this with being employed, mostly in fitness and wellbeing. So i am used to having to be responsible, in control, etc.

Numerous factors in this current job have left me feeling vulnerable, fearful and very anxious. Feeling overwhelmed recently i had to take time off work to recover. Although i had acknowledgement from members of our management committee that i was ill there was no communication from my line manager. No phone call, text or email. I was not in a state to pick up the phone myself. For days on end i was barely able to function at all. We are a tiny organisation with no paid management. All committee members are volunteers with other jobs and i recognise how limiting this is but an expectation was set up on the level of support.

I returned to work having missed only 7 working days (2.3 weeks as i am employed only 3 days per week). I emailed to inform the committee that i was back and my line manager told me that i should not be back without a return-to-work interview. I was both righteously indignant at this selective use of HSE guidance and fearful. When this was followed by an order not to see any clients until i had had the interview and a stress assessment i became very confused, upset and angry. There was no informal chat on the phone and no explanation. I do know that the emails could be read differently, ie they came from a place of caring about me but that tone was not the one i was able to access, hence the desire to have a phone call rather than email.

We finally met 2.3 weeks after my return (ie i had now been back as long as i had been off!) and another committee member joined us. I asked why the line manager had not been in touch while I was off. The closest to a response I got was that it was because i hadn't phoned them. So no apology, no recognition of the difficulties this caused, no acknowledgement - in fact, no discussion was to be entertained on this subject.

When stressed i can become dissociated, paranoid and feel very scared. This happened in the return-to-work interview. Firstly i pushed my chair away from the desk to give myself space but my line manager took hold of my hands and pulled me back in and then would not let go. I don't know a lot of what was said as i finally blanked out but I ended up crouching in the far corner of the office terrified and begging my line manager not to come anywhere near me. This line manager has apparently been doing some research into my condition. This felt invasive as there had been little discussion with me over the preceding months and i could not gauge where the research had come from - Wikipedia? Google? Musings of a psychiatrist?

I would describe what happens to me in a meltdown as the mental version of an epileptic seizure. I do not have the capacity to control it. [The recent evidence from brain research that BPD sufferers have an actual incapacity in the brain has been immensely helpful to my understanding but this has yet to filter through to popular media.] It has only happened a few times in my life as i am usually able to just get away to safety when i feel it starting to happen. I take mood stabilisers, do not drink alcohol, exercise regularly and have an incredibly supportive husband.

I really struggle to check reality when feeling vulnerable. Was it me who was being unreasonable? The committee member did nothing to stop what was happening, simply witnessed it and agreed that it proved how necessary the return-to-work interview was. How different would it have been if i had not disclosed my condition to them? How would they have treated me?

I am so grateful to you Elizabeth for sharing both your own story and also your professional wisdom. More training? Yes but even more crucial is listening, asking, caring. Being compassionate, not making assumptions. And there are no courses that can teach that if someone does not also seek to look within and allow humility and compassion to grow.

Thank you Elizabeth. Go gently but firmly...

Thanks (2)
to leti
23rd Nov 2016 09:53

Leti, thank you so much for posting. I absolutely agree with you the willingness and capacity of line manager/HR Managers to listen, ask, care, show compassion and empathise is absolutely crucial.

Your post is brilliant and highlights how a period of illness can be managed so badly.

Not sure if you are on Twitter but there is an excellent group whcih supports people woth BPD. Message me if you'd like more details.

Hope you are having a great day, and again, thank you. :-)

Thanks (2)
By Amy
22nd Nov 2016 13:10

It is worth it! The avoidance-factor - putting your head in the sand and hoping 'the problem' will go away - is still a big issue in business I believe. The more we can empathise, connect and take responsibility to do something when someone is unwell with mental ill-health, the healthier, happier we will be and the more productive the workplace will become.

Thanks (2)
By leti
to Amy
22nd Nov 2016 13:13

Hi Amy - many thanks for your words. Do you think what i have written in my reply is ok to leave there? Feeling a bit anxious and wondering if i should remove it.

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By Amy
to leti
22nd Nov 2016 14:46

Hi Leti,
I think what you've written is very powerful and sadly all too common. 'Compassion, not assumptions,' is a great message. I wouldn't be surprised if many people relate to your story. Only you can decide if you want to leave it here, it's a very individual decision. What's right for you?
All the best, Amy

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