Following the methodological approach discussed in the previous chapter, the Findings chapter will be presented as follows: the chapter will begin w

4. Findings

Following the methodological approach discussed in the previous chapter, the Findings chapter will be presented as follows: the chapter will begin with the outlining findings from the semi-structured interviews, representing employers perspectives, followed by findings discovered based on the analysis of online questionnaire, which represents employees perspectives.

4.1 Employers

You have to take steps to look at the bigger picture...you know, is it work that is part of the problem? And can we help provide a solution? (P3)

Areas covered in the interviews with employers served to find out, what employers perceptions around mental health are, how those perceptions affect their organizational culture and how does stigma tie into this discussion. Employers were asked about their actions and the role of HR and line management. Hence, in the following parts, the findings within each of these areas will be outlined in Tables 2-5 among with a discussion of the main themes that arose during the research.

4.1.1 Mental Health and Wellbeing Employers Perceptions Around Mental Health

Overall, all respondents appeared highly aware of mental health as something that affects every individual and similar themes arose throughout the interviews fulfillment, resilience and support being the main ones. Along with definitions of mental health, Table 2 outlines the findings regarding complexity of mental health, a theme picked up throughout other parts of the interviews. This section will also cover what mental health conditions interviewees have encountered in their workplace.

Themes Sub-themes Findings

Meaning of mental health and wellbeing Resilience Each employee can experience mental health-related challenges in the workplace.

Taking care of employees mental health as a way to help employees build up resilience and handle work demands in healthy way.

Taking care of employees mental health for them to live fulfilled lives, including happiness and engagement at work.

Today employers feel responsible to offer EAPs, be understanding and promote openness and support to employee wellbeing.

Consider all aspects of employee wellbeing (physical and mental) into account and address issues.

Employees challenged by their mental health considered a risk to their performance, attendance, capability.

As work impacts employee lives immensely, it is vital to acknowledge the importance of seeking support and improving balance.

Mental health can be encountered by every individual Corporate approach - EAP Holistic approach Work-life balance COVID-19 effect Complexity of mental health Private lives and professional lives Recognition that private life as well as work life influences employees health and can impact their mental health.

Recognition that mental health conditions affect people differently, even if people have the same condition.

To see destigmatizion of employee mental health as something positive to deepen inclusion and diversity practices.

Diversity of mental health conditions Mental health conditions as positive Table 2: Overview findings: mental health and wellbeing employers perceptions around mental health

Four interviewees spoke about the importance of providing adequate support not just for those suffering from mental health issues [...] but for everybody to avoid getting to that point where they then suffer from that kind of thing. (P8). Thus, recognizing their role within their organization to not only support employees with a mental health conditions but also take preventative measures.

The connection between general wellbeing and mental health was also recognized, hence portraying a more holistic corporate approach was mentioned by all interviewees. In addition to this, the importance between employees private and personal lives was mentioned in relation to finding the right work-life balance in order to have the best capability and mindset (P10) within the organization.

The complexity of mental health was largely recognized as many interviewees pointed out that mental health conditions affect different people in different ways and hence, each case needs to be handled individually. Interviewees highlighted that different factors attribute to someones mental health, as it does not happen in a vacuum (P4).

A new theme that arose was consideration of mental health conditions as something positive, as employees with a mental health challenges have a unique viewpoint on corporate practices which could improve EAPs. Having suffered from a mental health condition, one employer describes how it enabled them to console and support employees better. Similarly, one respondent describes how weve all learned from one persons journey and [...] were better at helping the general public now (P3).

4.1.1.1 Mental health conditions encountered in the workplace

Interviewees most commonly noted to have encountered stress. While seven participants said stress, two of them highlighted that it is not a mental health condition in itself but a cause thereof. Depression was encountered by two interviewees; anxiety by three and five people mentioned exhaustion/burnout. Three interviewees also noted having to deal with anger and two other interviewees pointed to the intersection of physical conditions and their mental health toll on employees. Eating disorder, bipolar disorder, trauma and substance abuse were each named once by different employees. While interviewees noted to have encountered around two mental health conditions on average, one interviewee has encountered all of the above-mentioned mental health conditions. Three interviewees noted to not have had encountered any mental health condition among employees in their workplace.

4.1.2 Organizational Culture and Stigma

When asked to describe their own organization culture in relation to mental health and wellbeing, most interviewees noted a challenge of dealing with organizational pressures as well ensuring inclusion and support. When it comes to stigmatizing attitudes within organizations, perceptions varied a little as many described there to be no stigma while others recognized it to exist, yet would overall describe their organizational culture as open in relation to mental health.

Themes Sub-themes Findings

Organizational culture Stressful Work environment in some organizations were described as stressful (heavy workloads, big demands and high pressure on employees performance) and brought the issue of employee over-commitment which can lead to mental health challenges (values-driven work, up-or-out environment).

EAPs promote inclusion for people with mental health conditions and creates awareness for everyones experience to be individual.

Foster teamwork and promote trust inside teams.

Recognition that work environment may interfere with employees mental health in a number of ways. Support employees so that they can perform well.

Importance of openness and honesty communication as key to inclusive and supportive culture.

Inclusion starts with leadership recognition that disclosure of mental health conditions in management increases acceptance.

Relationships with and among employees more important than supportive structures or processes.

Culture improving during COVID-19 discussion of mental health becoming more acceptable and more focus put on mental health conditions.

Workload, demands and pressures Diversity and inclusion Awareness and understanding Support Openness Communication Importance of relationships Improvements Stigmatizing attitudes

Despite high levels of awareness and actions, stigmatizing attitudes do exist in most organisations.

Mental health conditions among managers is commonly seen as a weakness.

Stigma noted to be lower, the more employees openly discussed their mental health in the workplace

Overall high levels of sympathy and understanding was expressed for employees suffering from mental health conditions.

Noted negative attitudes among employees when it comes to high pressures and stress and increased workloads on account of absence of affected employees.

Table 3. Overview findings: Organisational Culture and Stigmatizing Attitudes

Organizational culture was often described as stressful, some interviewees were pointing out over-commitment as for instance some of our employees will put the welfare of the people we support before their own wellbeing (P2). Such stress, workloads and demands were also linked to support, underlining that despite high levels of awareness and sympathy, managers are often pulled in different directions and we dont always get it right (P4). Yet, there was also a lot of emphasis on involving employees and supporting them in order to enable them to work hard and go the extra mile (P8).

Working in a high-pressure environment was also described in relation to employing employees with mental health conditions by several interviewees, who emphasized the importance of communication to support these employees as best as possible: I need to know if theyre not having a good day and I can try and re-organize the days work around that (P3).

Interestingly, one interviewee described their organizational culture as supportive and open but underlined my experience in my culture is that mental health challenges should be hidden (P3). This view was shared by one of the experts, who noted that while there are some examples of great organizational commitment, there is a problem with leadership as people are really not feeling supported most of the time (P5). Lack of managerial commitment is also to be visible in the fact that very rarely senior managers come along to EAPs learning and development courses. Speaking from their experience of working with different employers, another expert remarks that regardless of support processes and structures what it comes down to are relationships people have in their work environment (P9) and that mental health and wellbeing tends to overall be better in smaller organizations due to higher levels of autonomy and role clarity.

Employers who perceived no stigma to be attached to mental health conditions in the workplace often said this was the case because so many people are so open about their own mental health issues (P2), underlining that openness and discussion of the topic decreased stigma. The issue appeared to be more complex, however as within some intervieewed organizations, tensions within the workforce were mentioned in relation to employees who were frustrated when colleagues went off sick and they had to pick up the work and in those cases, negative comments or jokes may have been made stigmatizing the ones affected.

Recollecting previous work in the private sector, one interviewee notes, there was more fear there (P2). In support of that, another interviewee from within the private sector notes that people still do not feel comfortable opening up, citing problems getting people to sign up for a offered wellbeing programmes and in turn disclosing mental health condition, while overall emphasizing that culture is improving in this respect.

4.1.3. Experiences with disclosure

One of the main themes that arose from discussing experiences with disclosure of mental health conditions with employers was fear of stigma and discrimination, despite the fact that the majority of employers encouraged disclosure as a means to find an appropriate actions against stigmatization and manage their employees better.

Themes Sub-themes Findings

Experience with disclosure

Time of disclosure (pre- or during employment) Employers only had few cases of disclosure prior to employment as people tend to test out environment before deciding to open up.

Disclosure can never be forced yet in cases, it can become inevitable when symptoms interfere with capability to work.

Disclosure recognized as a big issue.

Employers are aware that discrimination exists and understanding that this is the reason people choose not to disclose mental health conditions

Inability to offer support/help or manage situation without knowledge of mental health situation - communication as a key to enable understanding and make reasonable adjustments.

Learning from experience organisationd are notably becoming more aware after disclosure took place.

Employees must be empowered to share by signalizing openness and acceptance.

Trust, openness and supportive management structures as main factors increasing likelihood of disclosure while fear of discrimination, lack of trust and internalized stigma most likely to hinder it.

Most common work adjustments include: change in work pattern/time, changing teams, flexible leave, absence and return to work management, continuous communication.

People tend to wait until things get too bad/complicated.

Fear of discrimination Discussion enables solution against stigmatization Factors determining likelihood of disclosure of mental health conditions Work adjustments Table 4: Overview findings: experience with disclosure

The interviewees who have had employees disclose a mental health condition noted this to have happened largely during employment, not prior to it. Employers noted that questions around mental health are not part of their recruitment strategy, and if disclosure appeared prior to employment, this was voluntary.

Underlining the issue around stigma and discrimination, one expert spoke about their experience of working with people with MHCs, who were asked about gaps within a CV, which were the result of a mental illness, and upon disclosure were denied a job. Hence, people quite often wait; they suss the place out first before they feel that they know if they would get a bad or good reaction when theyre talking openly about their mental health (P1).

Another major theme that was mentioned by several interviewees was the perception that while it is their employees right to disclose or choose not to, employers cant help and cant be part of the solution unless I have the full information (P3). In addition to this, the aspect of disclosure becoming inevitable was picked up by recollections where employees MHCs have interfered with their work.

Employers explained high disclosure rates with high levels of support and particularly managers being open about their own MHCs, thus underlining the importance of openness when it comes to the likelihood of disclosure. One of the expert underlined this by stating that best practice organizations show a supportive management structure and visible examples to signal employees how things are enacted within their organizations.

4.1.4 Organisational practices and policies

In order to find out, what kind of support mechanisms employers have in place, interviewees were asked about their companys actions around mental health and wellbeing.

Only two interviewees noted that their organization has a specific mental health and wellbeing policy in place, while many participants noted mental health to be covered under health and safety, sickness and absence policies or a change management policy. Most interviewees said their organizational policies to have largely been drafted top-down with involvement of HR and top management, rarely line management. Some participants also noted their organizations policies to fall under overall wellbeing policy framework, and hence implementation true to intention cannot always be ensured (P9). Overall, policies were said to be frequently reviewed and updated.

Figure 4 lists the organizational practices around mental health and wellbeing mentioned by participants. This includes practices that were mentioned when adjustments for employees with a mental health conditions were discussed.

Figure 4. Overview: Organisational practices mentioned by employers

When it comes to the effectiveness of actions, most interviewees reported they had employee feedback mechanisms in place with the help of which they can assess their actions and offered options. Yet, while the opportunity for feedback may be there, one of the experts highlighted that trust is often a central issue and employees may not be as honest when they question the anonymity of feedback loops or services offered within organizations (P5).

Interviewees noted to receive feedback both formally (in the form of questionnaires for instance) and informally (many interviewees emphasized their open-door policy).

While the majority of respondents estimated their practices to be very effective, one respondent underlined that they need to be updated and we could certainly do better, adding later you know, you have your electricity test done every year, lets do something about mental health and wellbeing every year (P3).

4.1.4.1 Distinction between general wellbeing, mental health and stress

Interviewees were also asked how their organizations distinguish between general wellbeing, mental health and stress. Responses were mixed from distinguishing them clearly to understanding them as intertwined.

Those who underlined that they distinguish between these areas mostly said so because they understand that people need to be supported in different ways and that for instance, mental health is not always as straight forward as physical health problems (P8).

In contrast to this, some employers noted to not distinguish, emphasizing they deal with all problems and dont want to put [them] in a box (P6) or stressing the interconnectedness between the areas.

4.1.5 Role of HR and Line Management

Themes Sub-themes Findings

Role of HR Knowledge of resources Involvement in formulation of practices and policies.

Offering support and knowing resources they can refer employees to.

Offer advice and training to management.

Monitor progress of sick employees supervision of (long-term) sickness absence, return to work as well as exit management.

Formulation of practices and policies and review Support for employees and management Progress Monitoring Role of Management Role-Modelling Role-modelling openness about mental health.

Management support vital for acceptance of mental health conditions in the workplace organisational commitment needs to be visible.

Proactive management seeing changes in employees and hence enabling early intervention to poor mental health.

Learning by doing managers learn how to deal with employees suffering from a mental health condition and are better equipped to handle next situation.

Training offered is not mandatory.

Training covers: awareness (ability to spot changes and warning signs), seminars on legal issues, focus on own mental health.

Specific courses: mental health first aid training, 2-day training certifying managers to become trainers in their organization.

Support Management Training Table 5. Overview findings: role of HR and line management

The main themes that arose in relation to what HRs role is in fostering employee wellbeing and mental health were that they knew the resources to refer employees to, formulated and reviewed actions and supported employees, for instance monitoring sickness absence and return-to-work processes. As one central theme was also training of management, HR was often mentioned as offering advice and coaching as to how to deal with employees with a mental health condition.

One interviewee interestingly pointed to the limitations within supporting employees, underlining that at the end of the day, were HR but were not medical professionals and we dont have all the answers for people, unfortunately hence, while acknowledging employers responsibility to care for their employees (mental) wellbeing, in the case of a mental health condition, the referral to other resources may be the most supportive initiative.

While most participants recognized management training as an important factor, those interviewees who said their organization is offering formal training for line managers said it was not mandatory. Apart from HR coaching, employers mentioned to offer awareness training, and specifically the mental health First Aid Course. Four interviewees noted not to offer any training, yet in part this was due to the small size of their organization. Two interviewees moreover took a note as this was something they said they need to look into.

When it comes to the role of management, a lot of it ties in with the discussion around organizational culture, disclosure and stigma as most interviewees remarked the importance of (top-level) management support and in a sense role-modeling openness by showing that it is acceptable within organizations to discuss mental health openly. In contrast, one of the experts discussed that many managers feel the stigma of a mental health condition being perceived as a weakness in their position.

While some interviewees evaluated experience more positively than training, many agreed on the importance of having an aware line manager, who is able to recognize changes in someones behavior in order to manage a possible mental health condition proactively and not reactively also came up.

4.2 Employees

The following outlines employees impressions around their employers efforts to increase employee wellbeing and mental health by looking at how employees evaluate organizational actions to destigmatize mental health to understand what is perceived most effective.

Subsequently, findings regarding respondents perceptions around their organizational culture, stigmatizing attitudes and experience with mental health conditions will be outlined in order to understand how these are interrelated as well as contrast employees perceptions with that of employers. Lastly, the discussion around disclosure will be analysed from the employees side to gain an understanding over what the main factors are in determining the likelihood of employees discussing a mental health condition in the workplace.

4.2.1 Preliminary findings demographic distribution

The questionnaire generated a total of 106 responses. It is important to note that no items were mandatory, hence not all data adds up to 106 responses.

See below the demographic distribution.

Figure 5. Gender distribution

Figure 6. Age distribution

Figure 7. Sector distribution

Figure 8. Size of organization

Figure 5-8. Preliminary findings: Demographic distribution of respondents

Independent samples T-tests have been applied to determine whether gender has made a difference in any of the responses discussed below, yet no significant relationship has been found.

4.2.2 Practices and policies and evaluation thereof

Figure 8. Overview over selected organizational practices and policies in percentages, based on responses to Q1.

Employees most commonly listed flexible working hours as a practice within their organizations, followed by one-to-one formal reviews and flexible holiday policy. Practices specifically targeting mental health issues were selected more rarely, with only 25,5% noting that their organization offers EAP and 42,5% ticking access to counseling. For the Others box, Mental Health First Aid Training was specified.

Reflecting the high percentage visible in Fig. 8, a total of 80 respondents noted that they

found flexible working arrangements (flexible working hours and working from home) particularly helpful as it enabled them to fit my work and home life together; cater to care responsibilities and overall helps to maintain a balance and reduce stress. One respondent noted it has helped to manage my health condition.

15 respondents moreover found one-on-one review meetings to be very useful as they are most helpful in drawing out issues and finding solutions, yet only as long as there is a culture of supporting people living with mental health issues. Overall, the managers approachability has been noted several times and one respondent wrote: having an understanding manager has helped the most. In contrast, one respondent noted that meetings depend on the personality of manager and could be even threatening rather than supportive. Hence, underlining that while regular one-on-one review meetings offer a chance to allow conversations to deal with issues as they arise rather than building up noted to include issues in work and private lives their quality appears to depend both on the organizational culture and the manager.

In addition, four respondents stated to have taken up all of the practices and emphasize their overall added value to a healthy working environment while EAP and counseling were evaluated positively as they offered employer support, with one respondent noting it was hard to discover it was available. Gym memberships and yoga classes have been listed four times as helpful with stress management.

66,3% of respondents believed that actions did not adequately distinguish between stress; and wellbeing, whereas 33,7% thought they do. Many of those, who thought they did, attributed this to their employers openness and that different issues were addressed differently.

Some respondents also noted that the three should not be distinguished or treated separate but are all under one umbrella: Everyone needs to focus on their mental health which includes stress and impacts upon our general wellbeing.

As the majority said their organizations did not adequately distinguish, one of the main reasons listed was lack of awareness or understanding of mental health with respondents writing I think mental health is not well enough understood as a whole and its difficult for individuals to know how to tackle it or not enough emphasis has been placed on supporting mental health. Still very much under the radar.

Three respondents use the term to tick a box, questioning their organizations sincerity when it comes to these practices: There is little evidence of pro-active initiatives towards mental health.

Ten respondents addressed stigma, one writing there is stigma attached to asking about mental health and it is much easier to put it down to stress. One respondent also writes Far more sympathy given for cancer (yes I have had both). Another respondent describes a similar experience, writing about her cancer treatment, which was actually a benefit in disguise as it was my mental illness which was the worst while also noting they did not think they would have been promoted had they disclosed their mental health condition.

4.2.3 Organisational culture

Figure 9. Perceived levels of stress. Based on responses to Q4.

Only 10% of respondents noted their job to be extremely stressful while the majority (55%) it as somewhat stressful.

Overall, perceived organizational support was relatively high as the scale measuring supportive culture (5 = high, 1 = low) showed an overall mean of 3.6.

Relating levels of stress to perceived organizational support, a modest negative correlation has been found (r = -.225, p = .023). Hence, respondents who noted their jobs to be less stressful were more likely to describe their organizational culture as supportive.

Significant differences have been found in relation to perceived support and whether or not respondents would feel comfortable speaking up about mental health condition within their current organization (t = 4.310, p =.000). This result implies that respondents who perceive their organization and colleagues to be more supportive are also more likely to feel comfortable discussing mental health in the workplace. Those respondents noting they would feel comfortable on average scored higher when it comes to perceived support (M = 3.77, SD= .805).

4.2.4 Awareness of and familiarity with mental health conditions

Figure 10. Mental health conditions associated with the subject Mental health conditions in the workplace in percentages. Based on the responses to Q9.

In terms of frequency, anxiety was selected most commonly (90,6%), followed by stress (88,7%) and depression (86,8%). See Fig. 8 below for the total distribution of mental health conditions listed. Additional mental health conditions named by those participants who checked other were bullying and insomnia as well as two respondents noting all of the above.

Respondents on average checked 2.1 of the 7 possible mental health conditions (see Appendix A for detail). 65% of the total respondents stated they have mental health conditions/have encountered someone close to them with mental health condition, while only 1 pointed out no familiarity with mental health condition. The LCR mean was 7.9 (SD = 2.89), indicating overall high familiarity of respondents with mental health conditions.

While no significant differences have been found in terms of participants levels of familiarity and how it affects their likelihood to discuss mental health in the workplace, the mean of familiarity for people who noted they did not feel comfortable speaking up about a mental health condition was slightly higher (M = 8.38, SD = 2.77) than that of participants who said they would feel comfortable speaking up (M =7.83, SD = 2.93).

4.2.5 Stigmatizing Attitudes

The majority of respondents (56%) agreed to recommend someone with a mental health condition for a job. Moreover, 43,1% strongly agreed and 48% agreed to the statement that they would not mind working with someone with a mental health condition. 32% of respondents strongly disagreed and 41,7% disagreed with the statement that mental health conditions should be concealed at work. When it comes to trusting a person with a mental health condition in a leadership position, the majority of respondents either agreed (49%) or strongly agreed (22%) with the statement.

A strong tendency to a significant correlation between the level of familiarity and stigmatizing attitudes has been found (p = .052) with a negative correlation of r= - .192. Hence, the more familiar respondents were with mental health conditions, the lower they scored on items measuring stigmatizing attitudes.

Overall, respondents showed low levels of stigmatizing attitudes since the scale measuring stigmatizing attitudes around mental health in the workplace showed a mean of 1.96 (SD = .6).

4.2.6 Disclosure and factors determining likelihood of discussing mental health in the workplace

33 respondents (34%) noted that they have disclosed a mental health condition, with only 6 people having disclosed prior to and 27 during employment.

82% (84) of respondents said that they would feel comfortable speaking up about a mental health condition within their current organization, while 18% said they would not. When testing for whether there is a significant relationship between the sectors respondents worked in and their likeliness to speak up about a mental health condition, a significant relationship has been found (. =13.19, p= .004). The results showed that participants from private and third sector were more likely to speak up about a possible mental condition than respondents from the public sector.

Respondents who said they felt comfortable speaking up about a mental health condition within their organizations most commonly explained that this was due to having an open and supportive organization culture, a safe environment, that enables them to share and discuss issues, with approachability of management being mentioned several times.

Another major reason listed by people who said they would feel comfortable speaking up is to increase awareness as a way to ensure improvements (If we ignore it, it gets worse) and dispel stigma around mental health. To banish myths and stereotypical attitudes [...] and to ensure anyone with poor mental health at any given time can still access mainstream and get the help and support they need, writes one respondent while another notes The more people know, the better they understand. Ignorance is a barrier. One respondent writes It affects so many people and might be a relief for those suffering in silence to see that they are normal, hence also underlining that mental health affect a lot of people, which was an argument picked up by many other respondents (Millions of others suffer and no one should feel like they have to suffer alone).

The minority that answered No largely attributed this to stigma and fear of discrimination. One respondent explains: would get laughed at by co-workers, another one: would be seen as sign of weakness, unreliability and typical female emotional. One respondent claims if I had depression I feel that it would be used against me. Similarly, others state that while they themselves would be supportive, they would not be comfortable opening up as it may cost them career opportunities albeit this would be done with good intentions.

4.3 Summary of key findings

The section above has outlined the main findings regarding employers and employees perspectives around mental health and wellbeing in the workplace.

Interviewees representing employers showed overall high levels of awareness and understanding of mental health as a complex matter and described their organizational cultures as supportive. No interviewee showed signs of stigmatizing attitudes and despite almost none having a formal mental health and wellbeing policy in place; there are actions covering the area. While the role of HR was portrayed largely a supportive one, line management appeared to be more complex with almost all interviewees recognizing the importance of proper training yet no one marking it to be mandatory.

Moreover, the most notable findings around employees perspectives have been that they perceive flexible working arrangements along with one-on-one meetings to be most effective as well as valuing the importance of openness and support within organizations. Perceived support was overall high, while levels of stress remained moderate. While respondents showed average levels of awareness of mental health conditions in the workplace, levels of familiarity appeared to be rather high. Respondents showed low levels of stigmatizing attitudes; yet the minority who claimed to not feel comfortable discussing mental health in the workplace commonly highlighted stigma as a reason. In line of this, a supportive and open environment was most commonly listed to enable discussion of mental health in the workplace.