Public health and wellbeing professional Nina Fryer advises how clinics can implement positive mental health for employees
Most adults spend a large proportion of their lives in the workplace,1 so it is important that employees have a good experience. Employers and managers should also be attuned to recognising when a staff member is having a negative experience, and do what they can to promote positive mental health and wellbeing for their staff.
In 2008 The Black review was published to look into the health and wellbeing of the working age population.2 This, along with the subsequent government response,3 highlighted the need to change attitudes to health and work, promote wellbeing in the workplace and help more people get into work. The Institute of Directors, an organisation that represents and sets standards for business leaders nationwide, supports the view that having a healthy workforce is good for both the employee and the employer. This includes better attraction and retention of talent, higher staff engagement, reduced levels of absenteeism, reduced staffing costs in terms of turnover, higher levels of productivity, and the reputational benefits that come with being recognised as a ‘good’ employer.1
However, despite this increased awareness, evidence shows that mental ill-health is still one of the largest causes of absence from work.4 The recent Farmer/Stevenson 2017 review into mental health in the UK workplace highlighted that this topic is becoming an important agenda.4 The review found that although there is increasing awareness of the importance of supporting good mental health at work, the reality is that people with mental ill-health find it much more difficult to stay in the workplace. Additionally, the review found that around 15% of people at work have symptoms of mental ill-health. Figures from mental health charities such as Mind, suggest that this may be higher, affecting as many as one in four people over the course of their lifespan.5
This article will look at why aesthetic clinic owners and managers should focus on their employees’ mental health. It will also provide tips for how to ensure that aesthetic clinics have a positive environment to promote positive staff mental health and wellbeing.
Mental ill-health is estimated to cost employers between £33-42 billion.6 This is linked to sickness absence, the lost productivity due to presenteeism, where an employee with mental ill-health remains in the workplace but works less productively, and staff turnover. Staff turnover is a key consequence of the impact of mental ill-health on workplaces, which has a cost for both the employee and the employer. For the employer, losing valuable employee expertise often follows a period of extended employee absence, which may put a strain on other employees. For the employee, there are a range of negative health consequences which may spill over into their home life, including but not limited to, anxiety, depression and the financial consequences of being out of work.7
Legally, all employers have a duty of care to their employees,8 so they should take reasonable action to support their employees’ health and wellbeing – this includes mental health. Irrespective of whether the cause of mental ill-health is work related, employers have a responsibility to ensure that their work environment does not have a negative effect on their employees’ mental health. This is embedded with the Health and Safety Executives Stress Management Standards,4 which provide guidance to employers on the key causes of work-related stress and offer suggestions, case studies and toolkits to help identify and address issues that arise.
The Farmer/Stevenson Review9 makes a compelling argument to revise practice around mental health at an organisation level. It proposes a set of mental health core standards to provide a practical framework for employers which, the authors believe, will reduce mental ill-health in the workplace. The standards suggest six key actions that can be taken by employers, which are described below. I have also presented some practical suggestions for implementing these, drawing upon my own experience and evidence from across a range of workplaces.
Improving the culture and practice around mental health at work often begins with an employee taking initiative and instigating interventions and activities. However, whilst such interventions can be effective in the short-term, long-term cultural change is more likely if you have senior level support. Gaining support from senior parties has been shown to be effective in reducing the stigma of mental ill-health,10 and in creating the leverage needed for wellbeing action within an organisation.11 If done effectively, this creates the ability to dedicate staff and time resources towards a positive mental health agenda.
With senior level support, consider setting up a working group with relevant members from across the organisation who are passionate about achieving change and that can leverage financial and human resources. In an aesthetic clinic, this might involve the clinic manager along with line managers, or even the owner if they have the time. If possible, try to include somebody with communications expertise, such as your communications manager, to ensure that messages around mental health are presented in a way that colleagues can understand and support.
This working group can then be the driver around the creation of a mental health at work plan, drawing on supporting toolkits such as the Business in the Community Mental Health Toolkit for Employers,12 or the Mind Wellness Action Plan toolkit.13
Planning activities to coincide with national events, such as ‘Time to Talk Day’ in February,14 or Mental Health Awareness Week in May,15 can be a cost-effective way to ensure broader supporting resources are utilised. These events mean employers can request resources such as printed materials, and some charities also offer employer visits to coincide with these national events.
Mental health awareness is the ability to recognise signs of mental ill-health in both oneself and others. There is increasing evidence that interventions such as mindfulness training can be useful tools for enhancing personal mental health awareness.16 Mindfulness training is loosely based on a form of meditation that teaches you to notice your emotional reactions as they are happening, and to acknowledge that this influences how you feel and behave. By raising levels of awareness, the potential for your emotions to hijack your behaviour and to cause anxiety is reduced.17
Mental health first aid (MHFA) training is also effective at developing understanding of signs and symptoms in others. MHFA training teaches employees at all levels to spot the symptoms of mental health issues and how to offer initial help in terms of signposting that person to available support. This training does not teach employees to be therapists, but it does enable them to identify signs of mental ill-health and teaches skills for listening and responding.18
If these initiatives are accompanied with clear signposting to sources of support for mental ill-health, for instance in staff handbooks, posters/leaflets in staff communal areas, and as part of annual appraisal and staff development discussions, then you will be better equipped to create a supportive mental health culture.
Ensure that promotional materials relate directly to your employees. For example, there is evidence that men engage less in mental health discussions than women.12 Therefore, if you have male employees within your clinic, ensuring that they are represented in materials is especially important.
One natural consequence of raising awareness of mental ill-health, and challenging the culture of silence around mental ill-health, is likely to be an increase in the number of conversations about mental health. The BITC Mental Health Toolkit for employers suggests that supportive conversations include finding a place to speak which will be uninterrupted, both by people and by mobiles/emails.19 Questions could include ‘How are you doing at the moment?’, or ‘You’ve seemed a bit withdrawn lately, is anything the matter?’ Giving colleagues time to answer and listening carefully is important. If the conversation is between a manager and their staff member, agreeing to a plan of action and setting a follow-up meeting can give structure to the support. Finally, recommending appropriate internal or external support is helpful at this point.19 For example, if you find that your clinic staff member is struggling, you can signpost them to see a trained counsellor.
Providing training for your managers on how to initiate conversations about mental health within both normal working conversations, and, as part of leadership and review discussions, will enhance their confidence and the confidence of other staff in the organisation’s ability to support positive mental health.
For managers, being aware of the nature, scope and size of your staff’s job roles to ensure that it is achievable in the time available is an important way to create and manage realistic workloads
We know that physical activity can be effective at reducing mental ill-health.20 Physical activity can be promoted through things such as organising team sports events, provision of subsidised gym membership, and supporting active transport.21 For example, you can support the staff who cycle to your clinic by providing changing and storage facilities, or subsidised bike purchase schemes. It can also be modelling healthy behaviours such as taking a lunch break away from your desk, or, where appropriate, practically challenging unhealthy working cultures, such as long-hours, by encouraging staff to not work out of their normal working hours. Where this is necessary for the business and has been discussed and negotiated with the team member, consider ensuring that this is not just extending your employee’s workload by allowing flexible working time to accommodate for this. For example, in some clinics it may be necessary from time to time to treat patients, for example celebrities, outside of the normal working hours. For managers, being aware of the nature, scope and size of your staff’s job roles to ensure that it is achievable in the time available is an important way to create and manage realistic workloads. Initiate conversations about workloads as part of staff review and appraisal processes.
There is increasing evidence that interventions such as mindfulness training can be useful tools for enhancing personal mental health awareness
For many leaders and managers, the biggest barrier to supporting colleagues with mental ill-health is personal confidence in their own skills and knowledge about how to do this effectively. One tip for addressing this at the start of an employee’s journey is embedding mental health into line managers’ job descriptions, to make explicit the responsibility that line managers have for their staff. We also know that one major cause of work-related mental ill-health is when employees experience problems with working relationships.22 Enhancing line management expertise can help to reduce this, because all too often, staff are promoted because they are good at their current job, without considering whether they have any development needs related to managing others. Therefore, as part of promotion discussions, you could identify any training needs that the staff member has relating to line-management, or proactively embed this by offering training for all managers with line management responsibility.
Sickness absence recording can provide data for further analysis of your staff’s wellbeing and health. Creating a positive culture around mental health and mental ill-health support should mean that staff do not feel concerned if they disclose mental ill-health as the cause of their sickness absence, as they know they will be appropriately supported. Improving your sickness absence data also means that you can initiate conversations with staff who are taking time off work with mental ill-health, to reduce the possibility of recurrences.
Many employers routinely conduct staff surveys to gather information on issues that are within the workplace. The opportunity to include questions about mental wellbeing should not be missed here, as it will give a clear indication of organisational areas that may need further attention. The ‘Time To Change’ mini health check for employers23 suggests some questions that could be asked in staff surveys that concern individual mental health status, organisational culture, and management practice around mental health. I have used these questions in evaluations of mental health stigma reduction interventions to great effect.10
Have you experienced stress, low mood or mental health problems while in employment?
In your opinion, how well does your organisation support employees who experience mental health problems?
How confident do you feel in supporting people you line manage with mental wellbeing at work?
It is crucial that before asking these questions, a plan on timescales and resources for responding to issues raised, is drawn up.
Changing the cultures around mental health in your clinic, challenging stigmas of mental ill-health and creating positive work environments do not always need large scale, expensive interventions. It can begin with just one champion and it has the potential to make both immediate and longer-term improvements to working environments, benefiting employees and employers alike. With the new Farmer/Stevenson Review published, the challenge now is to for employers to engage positively with these standards and translate them into actions and policies in the workplace.