LibDem leader Nick Clegg’s decision to crown his party conference speech this autumn with a call for new waiting time targets for treatment for mental health conditions has pushed the issue of presenteeism further up the political agenda.
The media coverage garnered by Clegg’s comments has been broadly welcomed by group risk professionals as a step in the right direction. And although the new measures are not specifically aimed at the workplace, anything that can help break down the stigma associated with mental health has been backed by the industry.
Whilst there are published waiting times for physical health services there have previously been none for mental health services. Research results released in September by the We Need to Talk coalition of charities found that 9.6 per cent of mental health patients are waiting over a year between referral and assessment and 41 per cent are waiting over three months. The research showed that 16 per cent attempt suicide while waiting, a further 67 per cent have experienced suicidal thoughts and 40 per cent have harmed themselves.
With effect from April 2015, however, mental health will have its own NHS access and waiting time standards, which are to be fully implemented by April 2016. The aim is that at least 50 per cent of people experiencing their first episode of psychosis start to receive treatment within two weeks of referral, bringing them into line with treatment for cancer. Those needing talking therapies for conditions like depression will be subject to the same access standards as those suffering from most physical conditions. It is intended that 75 per cent receive access within six weeks and 95 per cent within 18 weeks.
Group risk providers should benefit both from de-stigmatisation resulting in earlier reportage of workplace mental health conditions and from being able to promote their ability to provide much quicker access to treatment than this NHS schedule.
Aviva head of group risk Steve Bridger says: “What is clear when claims come through is that a lot of people have flagged up the condition a lot later than they could have done. People have struggled on as they don’t want to be seen as struggling, and they still feel very uncomfortable talking about mental health.
“An 18 week waiting list is too long to get effective help and we would expect, if notified, to be following up on mental health issues within a few days. So I think this NHS timetable will be another factor highlighting how group risk can do better than the welfare state. It’s a similar opportunity to capitalise on as the unveiling of the government’s Fit For Work Service.”
Furthermore, research results released by Canada Life Group Insurance this October show that 93 per cent of employees come into work when ill, suggesting that employers should increasingly value private provision for its ability to combat presenteeism as well as absenteeism. According to Oliver Gray, managing director of employer wellbeing provider energiseYou, our performance on the day we go into work sick is often around one eighth or worse than our normal performance.
Presenteeism due to mental health, or indeed any other condition, is notoriously difficult to quantify but the Sainsbury Centre for Mental Health, in its 2007 policy paper Mental Health at Work: Developing the business case, found that it accounted for 1.5 timesas much working time lost as absenteeism. This seems to broadly tally with more recent anecdotal evidence.
JLT Employee Benefits principal, healthcare and group risk Nick Boyton says: “We have worked with health risk assessment providers who calculate presenteeism statistics and they always show at least the same cost of absence, if not higher. Some presenteeism is caused by personal issues like financial problems, as an employee may be worrying about how they are going to make their next mortgage payment.
“Even with the economy picking up in most industries we will start to see the other side of presenteeism occurring. As there become more opportunities to switch employers, a lot of people will become disengaged with their current firm because they are thinking of leaving or are working out their notice. They don’t feel the company cares about them and are not engaged with its culture.”
Group risk providers have for years prided themselves in their ability to help tackle presenteeism. This occurs through fast-tracked access to cognitive behavioural therapy (CBT) and other talking therapies via their rehabilition services, as well as by providing access to employee assistance programmes (EAPs) and other helplines offering HR and legal advice. Unum has a helpline that can assist with any queries people may have regarding colleagues who are struggling at work.
But providers have recently been upping their game in two important respects. One of these is in providing industry-specific claims statistics to flag up potential health issues that employers can tackle at an early stage.
Jelf Employee Benefits managing director, UK healthcare and group risk Iain Laws says: “Employers are sometimes using group risk data to see where claims are popping up and where to be proactive. Absenteeism data will show the causes and patterns of absence so, for example, things that originally seem to be gastric conditions and musculoskeletal problems can turn out to be psychological disorders. Insurers’ claims management services are evolving into risk management services.”
Perhaps more importantly still, there has been a noticeable trend in recent months for group risk providers to offer training to help tackle stress and other causes of presenteeism.
PSHPC head of wellness consulting Beate O’Neil says: “A lot of income protection providers now offer HR training, tailored mainly to mental health aspects. Some do line manager training, even if only for select clients, and others are doing resilience training for HR and line managers. Some will charge whilst others will offer a certain number of services free to larger clients but I think it will become a standard feature for all of the largest schemes in due course.
“Most of this activity has started in a major way during the last year as insurers have been increasingly realising that offering additional services can help attract and retain clients. A lot of presenteeism in certain companies is cultural and this training can help combat it by impacting on culture.”
Portus Consulting has been taking a number of group risk providers offering training services to see clients so they can sit down with HR personnel and line managers and explain exactly what they can do, particularly in terms of combating presenteeism via resilience training.
Portus Consulting director of consulting David Dolding says: “Employers realise they have a duty of care but with my more progressive clients I’m try to promote the idea that they should explain to employees that they too have a duty of care to tell employers if they have issues affecting their work, either inside or outside the workplace. The duty as an employer is to help deal with these issues so it’s a mutual responsibility.”
Nevertheless, despite so much forward thinking being in evidence from both providers and intermediaries, some wellbeing specialists feel that the group risk field still has a long way to go before it fully gets to grips with presenteeism. In particular, it is failing to adapt to changes in peoples’ attitudes, expectations and beliefs.
Pamela Gellatly, chief executive of risk management consultancy Healthcare RM, says: “People are just not coping as well as they used to and they have different social pressures at home like Facebook and Twitter. They tend to blame the government or their employers rather than taking personal responsibility for not being able to cope and this perceived injustice can affect performance and make them ill. It’s a social change, and older people cope a lot better because of the way they are brought up.
“It’s all about understanding that physical and psychological changes are caused by a range of things and they won’t just go away if you offer counselling. We need to change the way we treat all these things rather than put on the old-fashioned sticking plasters but a lot of the rehab providers are doing nothing different. Therapists need to take a multi-disciplined approach, including exercise, nutrition, weight management, and emotional resilience.”
PRESENTEEISM STAYS AT ALARMING LEVELS
Research results published by Canada Life Group Insurance last month show that 93 per cent of employees come into work whilst ill, a proportion that remains unchanged since 2013. Its research found 8 per cent of employees would only take sick leave if they were hospitalised or had no other choice while 21 per cent have gone into work when ill due to fear of redundancy or financial implications. Meanwhile, 29 per cent said that their workload was too great to allow time off, even if they felt unwell.
Worryingly, stress-related illnesses are only considered by employees to be as severe as minor illnesses such as headaches. Here, 23 per cent said they would take time off for a headache or migraine but only 21 per cent would take time off if suffering from a stress-related illness.
Canada Life Group Insurance sales and marketing director Paul Avis says: “Technology is advancing at a rate of knots and we are adapting our daily lives but the workplace isn’t adapting at the same rate. There is the ability to work from home or via Skype but these practices are not yet embedded in the workplace. The technology is there to change the workplace but we are still based on a culture of turning up to offices and going long distances to meetings.”
