COVER STORY
MENTAL HEALTH: THE IMPORTANCE OF STAFF WELLBEING Nikki Brierley Specialist Dietitian and CBT Therapist Nikki has been a HCPC registered Dietitian for over 10 years and is also a BABCP accredited CBT Therapist. She works in a dual role within the Adult Community Eating Disorder Service at Cheshire & Wirral Partnership NHS Foundation Trust. She also works privately, providing one to one and group support.
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There is good evidence that happy staff are more compassionate and provide safer care. To be best placed to meet the needs of our patients/clients, we need to prioritise our own mental health and wellbeing and provide ourselves with care and support too.1 There is currently a national focus on productivity and the need to prioritise and increase the level of investment in mental health. The government review, Thriving at Work summarises the evidence and makes a very clear case for the value of improved workplace mental health and wellbeing.2 The review highlights the financial and human cost of mental health problems at work, with approximately 300,000 individuals with mental health difficulties leaving their jobs each year. There is a large estimated cost to employers associated with poor mental health in employees (£33 to £42 billion/ year), due to loss of productivity, sickness and staff turnover. There is a cost to the government also (estimated at £24 to £27 billion/year), which includes benefits, reduced tax revenue and the cost to the NHS. The largest cost, however, appears to be on the economy as a whole, with an estimated £74 to £99 billion/year lost due to reduced output.2 WHAT IS MENTAL HEALTH AND MENTAL WELLBEING?
Mental health and mental wellbeing can be difficult to define and can be interpreted differently by groups and individuals. The WHO describes good mental health as ‘a state of wellbeing, in which every individual realises his or her own potential, can cope 12
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with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’.3 Similarly, mental health can be described as a state of being that is not only free of mental ill health but encompasses a broader context of social, emotional and physical wellness.1 Mental health and mental wellbeing are also observed as dynamic, in that they are changeable from moment to moment, day to day, month to month and year to year. Good mental health and wellbeing are recognised as being fundamental to physical health, relationships, education/training, work and in reaching our potential.4 They are also associated with a range of better outcomes, regardless of age and/or background (see Table 1 overleaf). MENTAL ILLNESS
Poor mental health can lead to illness and mental ill health is very common, with one in four adults experiencing problems throughout their lives and many more experiencing mental health difficulties. Depression, anxiety disorders and phobias are common, with a UK prevalence of ~15%.6 Like physical health, mental health involves a complex interaction between the individual (their genetic, biological, neurodevelopment and other fundamental attributes) and
This material is for healthcare professionals only.
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HEALTH & WELLBEING Table 1: Associated benefits of improved mental health and mental wellbeing5 Improved physical health and life expectancy
Reduced risk of suicide
Better educational achievement
Increased enjoyment rates and productivity
Increased skills
Reduced antisocial behaviours and criminality
Reduced health risk behaviours (ie, smoking and alcohol misuse)
Higher levels of social interaction and participation
Table 2: Mental health core standards2 Produce, implement and communicate a ‘mental health at work’ plan.
Provide employees with good working conditions and ensure a healthy work-life balance and opportunities for development.
Develop mental health awareness among employees.
Promote effective people management through line managers and supervisors.
Encourage open conversations about mental health and the support available when employees are struggling.
Routinely monitor employee mental health and wellbeing.
their environment. As such, there are many opportunities to reduce the risk. The public health white paper, Healthy lives, healthy people7 was the first strategy to give equal weight to both physical and mental health by recognising the role that mental health plays in being central to the overall quality of life. With the ambition of mental health achieving an equal footing with physical health, NHS England published a 10-year forward view, with the aim of transforming mental health services by 2020.5 The Mental Health Task Force also published a five-year forward view, stating that mental health services are to benefit from additional investment of £1 billion/year by 2020/2021. MENTAL HEALTH IN THE WORKPLACE
A positive employment experience, where an individual feels supported and valued, can help to promote good mental and physical health. Recommendations to promote a positive employment experience include: • creating a supportive environment that allows employees to be proactive to protect and enhance their own health and wellbeing; 14
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• developing policies to support a workplace culture that respects a work-life balance.2 Conversely, a negative employment experience increases the risk of a reduction in both mental and physical health. Factors that are recognised as affecting mental and physical health in the workplace include: • fear of being judged, • stress, • lack of confidence and so an inability to disclose any problems, • not being able to face the stigma, as mental health issues are seen as a ‘weakness’. It is recognised that most individuals experience three phases at work – ‘thriving, struggling, or ill and possibly off work’ – and can move between these at different times.2 Worryingly, whilst figures suggests overall sickness rates have fallen by 15-20% since 2009, mental health sickness appears to have increased ~5%, and is currently one of the largest causes of sickness from work in the UK.2 It is suggested that that there are currently
HEALTH & WELLBEING
The Royal College of Nursing reports that 49% of staff have gone to work when unwell with stress and mental ill health problems and 79% of staff thought that staffing levels were not sufficient to meet patients’ needs.
‘significant mental health challenges at work’ and in order to address this, it is suggested that mental health core standards are implemented2 (see Table 2 opposite). If work-based stress is identified, NICE Guideline 139 recommends that six management aspects are considered and addressed: 1 Demands – work load, work pattern, work environment 2 Control – how much say the employee has in the way they do their work 3 Support – organisation, line manager and colleagues 4 Relationship – promoting positive working to avoid conflict 5 Role – if the employee understands their role 6 Change – how change is managed and communicated
• The Royal College of Nursing reports that 49% of staff have gone to work when unwell with stress and mental ill health problems and 79% of staff thought that staffing levels were not sufficient to meet patients’ needs. • One in three NHS workforce have felt unwell due to work-related stress and one in two staff members have attended work despite feeling unwell. • 350,000 staff left the NHS for reasons other than retirement over the past five years. • The additional cost in this deterioration in staff retention is approximately £1 million/ per annum. • Work-life balance is reported as a factor in 13% of NHS leavers (approximately 45,000 over a five-year period).
IN THE NHS WORKPLACE
Health Education England has recently published a report entitled: NHS Staff and Learners’ Mental Wellbeing Commission,10 which suggests that there is sufficient evidence to indicate that the NHS could do a much better job in supporting staff and that there is a real need for action to change the current risk of workplace stress, exhaustion, overwhelm
There are some startling facts and figures reported regarding the NHS working environment, including the following:10 • The Royal College of Physicians reports that 84% of doctors believe the workforce is ‘demoralised’, with 80% worried about the ability to deliver safe patient care.
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HEALTH & WELLBEING and burnout. It is recommended that primary interventions should seek to remove the source of distress and that these interventions yield the greatest effect on wellbeing, but require structural change in the workplace/ organisation. Secondary interventions aiming to increase an individual’s resilience and capacity to cope, are viewed as of limited benefit if primary interventions are not also in place (ie, training individuals to be resilient in a system that doesn’t support wellbeing will not effectively solve the problem).10 At the 2018 NHS International Practitioner Health Summit, entitled 'The Wounded Healer', Simon Stevens (NHS England’s Chief Executive) announced national funding to prioritise NHS doctors suffering from mental health problems, recognising that, “ultimately it will be patients and not just their doctors who will benefit”. There is also an NHS workforce implementation plan underway which is due to be published later this year as part of the NHS Long Term Plan that was published in January.11 The Long Term Plan suggests a new deal for staff, whereby all staff should feel supported, valued and respected. The Plan goes on to suggest that increased flexibility, enhanced wellbeing and career development is made available, alongside efforts to prevent discrimination, violence, bullying and harassment. It is hoped that this will allow the NHS to become a ‘consistently great place to work’. SUMMARY
Mental health and mental wellbeing are recognised as a fundamental part of overall health and great efforts are being made to place mental health on an equal footing with physical health. It is now well evidenced
and documented that the mental health of healthcare professionals impacts on patient care, with positive mental health associated with better patient outcomes. Reduced mental health in workplace settings appears to be increasing and the human and financial cost of this is significant. The reported difficulties within the NHS have recently been acknowledged (~38.4% of staff reporting to have felt unwell due to work-related stress), as has the responsibility of the NHS to ‘lessen the mental health impact on staff resulting from the work they do’.10 Recommendations have been published to improve working environments and it is hopeful that primary interventions to reduce workplace/ organisational factors that are causing distress will be implemented. Most individuals who work within the healthcare environment do so due to a desire to help, care, support and/or heal others. What is, unfortunately, now very evident is that sometimes this work can have a negative impact on health and wellbeing and that current working environments can further increase this risk. It seems essential that we recognise that working within healthcare can be challenging and that, as dietitians, our own mental and physical wellbeing needs to be protected; not only for our own benefit but also for our patients. It seems imperative that the values we seek to achieve for our patients (ie, kindness, compassion and professionalism) are the same values we demonstrate to ourselves and each other. Our awareness of the importance and value of promoting and protecting positive mental health and wellbeing needs to extend beyond our patients to ourselves, our colleagues and the wider workforce.
Mental Health Awareness Week 13th to 19th May 2019 www.mentalhealth.org.uk/campaigns/mental-health-awareness-week
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