In this section, the findings for both employees and employers will be compared and contrasted as well as set in the context of the literature discu
5. Discussion
In this section, the findings for both employees and employers will be compared and contrasted as well as set in the context of the literature discussed in Chapter 2. The discussion will begin with a comparative outline of levels of awareness among employees as well as employers when it comes to mental health conditions in the workplace. Then, organizational culture in relation to mental health will be discussed considering perceived support. Moreover, the role of stigma will be analyzed and experiences around disclosure will be assessed. Subsequently, impressions from both employers and employees will be examined in relation to organizational actions and their effectiveness. Furthermore, the importance of the managerial role along with training will be discussed. Finally, limitations and further research opportunities will be outlined.
5.1 MH and the Workplace
Research has shown that interviewed employers are increasingly focusing on mental health in the workplace as they realize not being able to adequately manage employees with mental health conditions not only costs them money but potentially talent (Henderson et al., 2013). As the majority of employers moreover noted to require more support in the area (Brohan et al., 2010), this study sought to find out how employers define mental health and wellbeing and how aware they are of the impact of poor employee mental health.
In contrast to findings by Henderson et al (2013), in which 1/3rd of employers noted that none of their employees suffered from a mental health condition, only one of the interviewees noted to never have encountered a mental health condition in the workplace, while the majority noted to employ people with a mental health condition. Their awareness of this was also mirrored in many respondents definitions of mental health and wellbeing as they spoke about the importance of building up resilience, living fulfilled lives with or without a diagnosis (P2) and largely recognizing that everyones mental health can be poor at times.
While depression was the most commonly encountered mental health condition which is consistent with research findings by Wheat et al. (2010) it is important to highlight that nearly 60% of respondents named stress as an encountered mental health condition. While two respondents did point out that stress is not a condition but a cause; this high number underlines that stress tends to be thought of first in relation to mental health. Interestingly, substance abuse, the third most common mental health condition (Wheat et al, 2010), was only mentioned once among with other common mental health conditions. This may be explained - as one respondent of the online survey highlighted because it may be easier to address stress than mental health because of stigma. Considering that stress has been covered more widely and the terminology is often used interchangeably (Shutler-Jones & Tideswell, 2011), it is also be possible to assume that employers are more likely to recognize and openly discuss stress than mental health condition.
Yet, these findings do not necessarily point to a lack of awareness considering that stress is strongly connected to the development of mental health conditions (Tennant, 2001) and job stressors may perhaps be more controllable from the employers perspective. Moreover, most interviewees recognized mental health as a complex matter that is affected by a number of different factors, most notably perhaps being the interplay between the private and professional sphere. As highlighted by Clark et al. (2012), both work and non-work stressors impact mental health conditions independently a finding that was mirrored in interviewees responses not only through the recognition of employees having pressures and responsibilities that interfere with their work-life but also in the majority of interviewees understanding it as the employers responsibility to create support mechanisms that comprise these factors.
Support mechanisms in relation to mental health are especially important considering that both stress and common mental health conditions are rooted in workload pressures and lack of support (HSE, 2015). Hence, the majority of interviewees emphasis on wanting to support employees as well as their recognition of mental health as complex, not only in relation to the interplay between private and work life but also the fact that mental health conditions look different for everybody, can be considered a reflection of Henderson et al.s (2013) findings of employers recognizing the need to focus on mental health.
Since existent literature has found a supportive environment to be connected to increased awareness and in effect protective of mental health (Schott, 1999; Iacovides et al., 2003; Stansfeld & Candy, 2006), it is also important to consider perceptions of organizational culture. Interviewees commonly talked about work pressures and stress in relation to support, indirectly underlining a balance of the two. Support of this was found when looking at employee responses as those who perceived their organizational culture as supportive on average also described their job as less stressful. Overall, employees perceptions of organizational support was relatively high on average, with some specifically pointing out that having a supportive and understanding management and culture is vital in relation to good mental health and wellbeing - hence, confirming existent researchs link between support and wellbeing.
In conclusion, the findings underline that employers participating in this study appear to be aware of employee mental health as an important factor as well as recognizing their responsibility regarding support mechanisms. It appears that employees participating in this study not only perceived high levels of support but both employers and employees moreover recognized it as a key factor ensuring good employee mental health.
5.2 Mental Health Stigma
As discussed in Chapter 2, the stigma significantly impacts peoples quality of life as they experience exclusion as the general public is showing a desire for social distance as most commonly found discriminatory behavior (Corrigan et al., 2001; Angermeyer & Matschinger, 2003). In relation to the workplace, research has found that those employers who hire employees with mental health conditions, while showing greater awareness through experience, still largely express concerns over symptomatology, performance and work personality (Brohan et al., 2010).
Yet, within this study, only one of the interviewees mentioned concerns about performance and capability while with the majority, the focus lay on treating mental health conditions as something that occurs and needs to be dealt with in a supportive manner. Thus, overall stigmatizing attitudes on sides of managers and HR appeared to be very low, with several mentions of showing employees that having a mental health condition is normal on accounts of openness about personal experiences. When interviewees described their workplaces to have low stigma, they explained this through openness and one respondent emphasizing that their small team has learned from one persons journey (P3). These findings appear consistent with research finding familiarity with mental health conditions to be the key determinant in decreasing stigma (Corrigan et al., 2002; Bizub et al., 2011). Similarly to Brohan et als (2010) findings, awareness appeared to increase immensely with experience yet contrary to their findings, instead of concerns over capability and performance, a stronger desire to support employees proactively was expressed which in turn emphasized part of the responsibility to lie with the employer.
The positive link between familiarity and decreased stigma was also found in employees responses, hence supporting existent research findings. It is important to point out that overall, employees noted to be very accepting of colleagues or even a leader with a mental health condition in the workplace. While these findings rely on self-reporting, these results nevertheless point to very low levels of stigmatisation, which perhaps is most evident in the fact that the vast majority of 84% of respondents claimed they would feel comfortable speaking up about a mental health in their workplace (which will be discussed in more detail in the next section).
However, employers as well as experts interviewed mentioned having different experiences in other organizations and underlined that when it comes to support of mental health, there appears to be a lack of leadership and organizational commitment. Although stigma has been recognized by most interviewees, only one respondent (from the private sector) openly acknowledged stigma hindering discussion of mental health in their workplace, while emphasizing that focus on mental health is increasing. Other interviewees highlighted having an inclusive and supportive culture despite recollecting tensions among employees on account of mental health related sickness absences, which underlines the complexity of stigma as it appeared conditions were considered acceptable in the workplace unless they interfered with colleagues workloads.
To conclude, the association between familiarity with mental health conditions and increased acceptance as well as decreased stigma, as noted in existent research, has been confirmed in this study. Moreover, while both employers and employees participating in this research project appeared to have little stigma attached to mental health, they did recognize it to exist.
5.2.1 Discussion of MH and Disclosure of MHCs
As the discussion around stigmatization of mental health in Chapter 2 has outlined, people with a mental health condition not only experience discrimination but in turn, also often choose to conceal their condition in the workplace with a recent study by the CIPD (2016) confirming that less than half of UK employees (43%) who reported having poor mental health disclosed this information to their employers.
Considering Brohan et al.s (2012) model of disclosure, findings of this research show that the majority of employers experienced voluntary, full disclosure during employment. While it is of course difficult to generalize these findings considering that interviewees were also only able to refer to the cases they were aware of and disclosure of conditions to colleagues may be more common than noticed by HR managers. The fact that disclosure took place more commonly during employment is in accord with other research findings by Wheat et al (2011) and Brohan et al (2012), which found that discriminatory tends to be lower in relation to disclosure during employment to see how their employer would react to disclosure. Employees responses were highly consistent with these perceptions as 82% of respondents who have disclosed a mental health condition, did so during employment.
Similarly to findings by Henderson et al (2013), the majority of interviewed employers encouraged disclosure while recognizing its employees right to choose not to. The main argument for disclosure on the side of interviewees has been their inability to adequately support employees. This view is very much consistent with existent literature, which stresses the increased psychological burden of concealing a mental health condition (Wheat et al., 2010). Looking at the employees perspective - as mentioned above interestingly, the majority of respondents (82%) noted that they would feel comfortable discussing mental health in the workplace, which can be considered a positive result in connection to employers desire for disclosure in order to address issues in a timely manner. This result stands in contrast to the CIPDs (2016) finding of disclosure comfort being at 42%. This, however, may be explained considering that some respondents replied hypothetically and moreover because respondents were potentially more aware of mental health than the general public.
Not only did statistical findings show that those employees who noted to perceive high levels of organizational support were also more likely to discuss mental health in the workplace, but this was also mirrored in employees responses who attributed their likeliness to discuss mental health in the workplace to having an open and supportive environment as well as approachable management. Along with the second most common theme attributed to discussion of mental health was to foster improvements and dispel stigma, these factors were in line with findings by Brohan et al. (2012) and may in turn contribute to the explanation of why employees wait to disclose their condition, as they are unable to determine whether or not the organization would be supportive prior to their employment.
The most common factor determining disclosure according to Brohan et al (2012) was fear of discrimination and stigma, which was also found as a main reason listed by participating employees, who noted they would not feel comfortable discussing mental health in their workplace. Albeit the minority of respondents, the reasons employees gave were not only overall harsh but resembled one of the experts perception of mental health condition being interpreted as a weakness by many.
When it comes to sector differences within the UK, research has found the private sector to be less supportive in relation to mental health than the public or third sector (CIPD, 2016), which is consistent with findings regarding interviewees perceptions. Yet, surprisingly, when looking at employees responses, results showed that employees from the private and third sector were more likely to say they feel comfortable discussing mental health in their workplace than in the public sector. Although it is vital to acknowledge this contrast, the result may in part be explained due to the high proportion of respondents from the third sector.
In conclusion, it has been found that both employers and employees participating in this study appeared to have a positive attitude towards discussing mental health in the workplace. Despite the majority of respondents noting they would feel comfortable discussing a mental health condition in their workplace, stigma still appeared the key determinant in hindering such discussion thus underlining the importance of openness and transparency around the topic in order to encourage a discussion of mental health and disclosure.
5.3 Practices and Policies
Research has claimed that many employers use the terms stress, wellbeing and mental health interchangeably and in turn fail to adequately address employee health issues (Shutler-Jones & Tideswell, 2011). While some interviewees were highly aware of distinguishing at least between physical and mental wellbeing, either explicitly in their policies or in the way they support their employees, some employers underlined not to distinguish in order to deal with every problem equally or because they believed them to be interconnected either way. While few employees supported the opinion of everything being interconnected, the majority believed that their employers did not distinguish adequately with many attributing this to a lack of awareness and understanding of mental health. Thus, these results indicate employers should emphasize the treatment of these issues as separate entities, as is suggested by Shutler-Jones & Tideswell (2011).
These findings can be related to Henderson et als (2013) findings, which not only suggested that UK employers require more support in this area but moreover that 80% of them did not have a formal policy on mental health. This result was in fact matched exactly by this study as only 2 out of 10 employers noted to have a specific mental health policy. Yet, this low number of specific policies may be explained as many interviewees emphasized with the embeddedness of mental health in health and safety or absence policies and in turn related back to the problem of lumping together physical and mental health as well as stress.
When it comes to what employees perceived to be the most effective practices, these were: flexible working arrangements, including working from home and flexible holiday leave. It was specifically underlined that they contribute to stress reduction and enable management of health conditions. Hence, while literature has largely pointed to these practices as most effective in relation to stress minimization (NICE, 2009), these findings may also support the claim that they are effective not only in protecting good mental health but also facilitate coping with a mental health condition.
Interestingly, flexible working was only mentioned two times by interviewees while several spoke of adjustment of work regarding management of employees with a mental health condition. Most interviewees noted to offer EAP, counseling or referral to occupational health when asked about specific actions around mental health and wellbeing. What is important to consider is that when it comes to EAP and counseling, employees, who have good mental health may be less likely to be aware of their existence as well as unable to evaluate their effectiveness. Hence, this may explain the contrast between employees emphasizing flexible working as it is something that is beneficial to all employees, while interviewees specifically noted to receive good feedback for EAP or counseling by employees who have been in need of these practices specifically targeting poor mental health.
Numbers of general mental health awareness trainings or initiatives were very low both among employees and employers despite literature underlining it as a common practice to promote inclusion (NICE, 2009; Henderson et al, 2013). Yet, considering that many employees emphasized the effectiveness of one-on-one reviews (which was also overall the second most listed practice) as it enabled them to discuss both different issues in an understanding and open environment, it may be possible to assume that these attribute to greater awareness in regards to employee mental health. While participating employers did not specifically name one-on-one reviews, many did emphasize their open door policy and recounted informal conversations, in which employees shared information about their mental health. Thus, it may be possible to conclude that regular one-on-one meetings as well as personal check-ins may not only attribute to greater awareness but also foster inclusion, as employees noted to feel encouraged to share as long as there is a culture of supporting people living with mental health issues and therefore overall improve mental health as proactive management is enabled. This furthermore can be linked to the finding that the management of mental health conditions in the workplace also has its limitations considering that as underlined by one interviewee managers and HR are not medical professionals and referral to such services may at some point become inevitable. Thus, it is possible to argue that increased awareness also increases the likeliness of employers to recognize when these steps are necessary.
In conclusion, having an open and supportive culture, along with flexible working arrangements and one-on-one meetings have been found to be most effective in relation to management of mental health and wellbeing. As the importance of managerial support in connection to this has not only been outlined in literature but also by participating employers and employees, it will be discussed in more detail below.
5.3.1 Relevance of the Managerial Role
It has been outlined that both HR and line management play a crucial role in shaping an inclusive, open and supportive organization in relation to employee mental health and wellbeing (Cunningham et al, 2004). While the findings support this idea with HR not only being largely involved in the drafting of actions but also in the management of employees with a mental health conditions especially in cases of sickness absence , research has also pointed to good line management as the key determinant in how these actions are implemented and in turn, how employee mental health is managed (Munir et al., 2009; Woodrow & Guest, 2014).
The discussion above concerning factors determining the likelihood of speaking about mental health in the workplace highlighted the significance of supportive management from employees perspectives. Looking at employers perceptions, the importance of having good (line) management was certainly mirrored with several interviewees underlining that good managers recognize changes in their employees and can hence intervene when they feel that mental health may be poor. Yet, interviewees also recognized that this is not always easy and hence highlighted communication and experience as key. This is not only consistent which existent literature, which stresses the advantages of an attentive and supportive management (Munir et al., 2009; NICE, 2009), but also in line of employees responses praising both their managers approachability as well as regular check-ins may they be formal or informal. Hence, this underlines that good management should consist of both, paying attention to employees in order to recognize changes while also enabling conversation to encourage sharing of possible mental health consitions.
Literature has outlined several reasons explaining managers inability to support employees with a mental health challenges. One interesting reason being the double pressure they perceive as they have to juggle performance and productivity standards while also caring for their employees wellbeing (Cunningham et al, 2004). This factor was mentioned directly by two interviewees, one pointing out that their managers may sometimes be pulled in different directions. Nevertheless, it appeared that participating employers recognized their responsibility in having to support employees in order for them to perform well.
Interestingly, the majority of HR personnel understood their role as an advisory or coaching role to management, with only five participants saying that they offered some form of training to managers yet none of them saying it was mandatory. These findings certainly tie into the CIPDs (2016) report of only 10% of UK employers noting to have specific line management training regarding management of employees with mental health conditions. While availability may thus be one criticism, findings of this research show that the trainings offered in fact target raising awareness with the mental health First Aid course in particular which stands in contrast to other research findings pointing to more procedural trainings (Woodrow & Guest, 2014).
It is therefore also interesting to consider one experts perception, who offers specific management training courses and who underlined a lack of organizational commitment is evident in the fact that only rarely senior managers come along to the trainings. This certainly is consistent with research findings by Woodrow & Guest (2014), who also attributed lack of training to lack of motivation as it appears to not be prioritized by mangers or the organization as a whole. This was also mirrored in other interviewees responses who stressed the importance of top-level commitment to combating mental health problems in the workplace.
To conclude, while this study has found several employers to have managers acting as great role-models, who encourage discussion of mental health in the workplace by being open about personal mental health problems, it is vital to acknowledge that not all managers have this personal experience to draw from. Although other interviewees stressed the value of experience in managing employees with a mental health condition, it may be possible to assume that training should be considered more of a priority of the organization as a whole to ensure management commitment and as one interviewee put it: It does pay and it probably will pay to invest in mental health a little more. (P3).
5.4. Limitations and Further Research Opportunities
First of all, time restraints did not allow for an extensive volume of data collection. Thus, a limited sample was drafted, affecting the vigor of qualitative data and in turn possibly the validity (Maxwell, 1992). Thus, a further study with a larger sample size is suggested to gain a better and more representative understanding of the issues discussed in this paper.
The concurrent mixed-methods approach may also be considered a limitation as collecting all data within one timeframe limited the opportunity to adjust research questions and as was not possible to analyse the impact of time upon the different measurable variables. Further research should therefore be undertaken to investigate changes in attitudes, employed P&Ps and other developments within the area.
