If consultants and advisers in the field of health and wellbeing wanted a validation that the products and services they recommend are value for money, the Stevenson/Farmer Thriving At Work Review of Mental Health and Employers is a pretty good place to look.
Commissioned by the Prime Minister, who has generally accepted all its recommendations, the 82-page report, published last Autumn, argues that when it comes to mental health, employers are best placed to make an impact and bring about lasting change. Not only does it describe the workplace as a key battleground in the fight to change attitudes, behaviour and outcomes, it highlights the return on investment that can be delivered by just the sorts of strategies corporate advisers are recommending to their clients on a regular basis.
Speaking to Mind chief executive Paul Farmer – who co-authored the report with mental health campaigner Lord Dennis Stevenson – one gets a clear sense that the goal of changing attitudes and practices in the workplace is an idea whose time has genuinely come, but that employers are going to need a lot of assistance to get there.
“What has surprised me is how genuinely positive people across the board have been about what we have set out to do. SMEs in particular are really hungry for information. There is an assumption that people aren’t engaged with this issue. I think they are engaged – they have limited bandwidth but they want to know what to do,” he says. ““I would hope the Thriving At Work review can be a calling card for people in your industry speaking to employers about workplace mental health.”
Crucially for advisers, the report corrals information about return on investment. Work carried out by Deloitte for the review team calculated that the average return per £1 spent on mental health was £4.20, with a range of outcomes between 40p and £9.
That said, one of Farmer and Stevenson’s recommendations was that the government should facilitate more research into ROI around mental health interventions. And it makes a specific call for greater transparency and comparability around employee assistance programmes (EAPs).
“Some employers can afford private medical care. Others have used EAPs. But the feedback we got was these were often poorly promoted, meaning they were underutilised,” he said. “We put in recommendations that encouraged a greater degree of transparency around EAPs and occupational health.”
Farmer and Stevenson asked the government to develop some sort of comparison tool for EAPs and occupation health service providers, to enable purchasers to understand the value of what was available and what likely impact it would have.
“It is up to the government whether they want to implement it. We published our report in November last year – the government broadly accepted our recommendations, but I am not sure whether that particular recommendation is being taken forward,” he says.
“Underpinning the whole review is the idea that we need increased transparency around mental health. We are hoping that over a period of time more organisations will become more transparent about what they are doing around mental health, and we are optimistic this will happen because people entering the workplace
are increasingly making choices about where
they want to work based on their approach to health
and wellbeing.
“The call to the industry is ‘treat mental health in the same way you have treated physical health over the last few years’. We are suggesting that insurers look at best practice in organisations and think how they incentivise these examples of best practice. Because it is in everybody’s interest,” he says.
But isn’t part of the problem that people like insurers are not even talking to SMEs? The insurance industry might argue that the Department for Work and Pensions and the Treasury are not really communicating with each other. While the DWP understands the good things that group income protection, occupational health and rehabilitation service providers offer, the Treasury has increased tax on GIP through salary sacrifice, where it has introduced a P11D charge. Similarly, employees are subject to a P11D charge for EAP services that support family members. While the government has already kicked the idea of fiscal incentives into the long grass, does Farmer not think some form of incentive to reach out to the SME market would be a good way to prime the pump?
“Around incentives we adopted a test approach. There is a relationship between government, employer and the individual which is worth further exploration,” says Farmer.
“The call to the industry is to respond to the growing sense that tackling mental health is a corporate responsibility. Organisations that take on board the core and enhanced standards will embed a more preventative culture,” he says. “If employers prioritise the mental health of their employees, this should reduce the risks for insurers. Insurers discount premiums based on safety measures or other efforts, such as burglar alarms which can reduce home insurance premiums. We recommend that insurers explore how they could support and reward employers, in particular SMEs, who adopt preventative policies and provide mental health support to their employees.”
Farmer is broadly supportive of the explosion of digital tools supporting mental health, but says they fall into two distinct types.
“There’s the cluster looking at prevention
approaches, of which mindfulness tools are the most common, and tools that encourage quicker, faster access to clinical interventions. We gave recommendations that we need better guidance from the NHS or Nice
to give people clarity around what good looks like.
There are unquestionably good and bad propositions in the market. And the evidence base needs to be better.
“But we know on the preventative end the evidence base is still a work in progress. It is difficult to evidence the absence of a mental health problem as a result of something somebody has done. We recognise this is not an easy thing to do.
“The digital tools accelerating access to therapy are making a lot of difference for some people. The practicalities and the ease of being able to talk to a therapist online – you can do it at home, or in your lunch break.
“And the evidence is suggesting that that access is as effective as physical face to face approaches. We are encouraging that development. For lots of people it is about ease of access, particularly when in a working environment,” he says.
He also highlights the importance of financial wellbeing and resilience, seeing it as one of the three key factors likely to impact mental health.
“We know there are consistent factors that put your mental health at risk. Two of the most common are relationships and financial concerns. So there is some merit in employers being able to signpost people in these two areas – the third area is pressure through caring responsibilities, either children or parents,” he says.
“We did a campaign five years ago called In The Red, that tackled this. Financial worries can cause mental health and if you experience serious mental health, you have financial worries. And this is not a great marriage.
“There is a merit in helping people to have access to good quality and support about your finances. Because we are still living in a world where most people didn’t get basic financial education.”
Farmer believes it is important to understand that everyone has mental health, and that it can change all the time. His report categorises three groups – those thriving, those struggling but getting along, and those who are clearly unwell.
“If we think about the thriving, struggling to unwell groups, debt worries could tip you from thriving to struggling, and that could impact your relationships, and that in turn could impact you in the workplace. So these things are all interconnected,” he says.
Access to reliable information is a key theme for Farmer, which is why his organisation is co-ordinating a digital gateway – rather like the information portal proposed in the paper – for people wanting to improve workplace wellbeing.
“The feedback we got was there was an overwhelming desire for a clear pathway to where employers could go and get support. So at Mind we are developing a workplace wellbeing gateway for employers, to act as a first stop shop – effectively something akin to the portal we recommended in our report. This is being created in conjunction with Business In The Community, the Federation of Small Businesses and the Institute of Directors, and is funded by the Royal Foundation,
and is planned to launch in September. We would
love to hear from people who want to contribute
to this.”
Farmer says the concept of presenteeism – the at work sick – is poorly understood, yet incredibly important. “Where we see it at its strongest is inside the NHS, where we put people under a lot of pressure to do extraordinary things on a daily basis, If people are not fit for work, that is not good for the organisation.
“The other area where presenteeism is starting to have an impact is in the financial services sector. The data we saw from the research we did with Deloitte showed the costs per employee of mental health – finance, insurance and real estate – ranging from around £2,500 per person per year. That is a massive message. There is also a message for the insurance industry itself to make sure that it is looking after its own people. We know a lot of this cost is to do with presenteeism,” he says.
“As the stigma around mental health starts to recede we are only just beginning to see the scale of the problem. For far too long people have been suffering in silence with undiagnosed mental health issues and the costs of that are lost and ruined lives in far too many cases,” he says.
So what has Farmer, an expert with many years’ experience in mental health, learnt from conducting the review?
“The real surprise for me was the extent to which we are only scratching the surface. Organisations are only now starting to shift from awareness and recognition that they have got to do something about this, to action. Since the report has been published I have been really pleased that many organisations have come to us and said we don’t just want help doing the awareness – we are actually committing to changing our business culture.”
The Stevenson/Farmer report recommended core and enhanced standards that the government should promote amongst UK employers
Core standards
• Produce, implement and communicate a mental health
at work plan;
• Develop mental health awareness among employees;
• Encourage open conversations about mental health and the support available when employees are struggling;
• Provide employees with good working conditions and ensure they have a healthy work life balance and opportunities for development;
• Promote effective people management through line managers and supervisors;
• Routinely monitor employee mental health and wellbeing
Enhanced standards
• Increase transparency and accountability through internal and external reporting
• Demonstrate accountability
• Improve the disclosure process
• Ensure provision of tailored
in-house mental health support and signposting to clinical help