The dangers of blanket policies on getting sick people back to work

Are policies aimed at getting people who are on long-term sickness leave back to work earlier or at reducing sick notes for those with mental illness a good idea? We asked occupational health expert Professor Gail Kinman.

silhouette of a person with grey paper scrunched up around to depict depression


Both Labour and the Conservatives have been the subject of recent reports about supporting people who are suffering from long-term health issues or mental illness back to work. The idea used to justify the policies is that the longer people are out of work the worse it is for their long-term wellbeing, but what are the broader implications? asked Professor Gail Kinman, Visiting Professor of Occupational Health Psychology and Director of the Council for Work and Health in the  Department of Organisational Psychology at the Clore Management Centre at Birkbeck University of London. Professor Kinman’s current research centres on a range of institutions including the NHS, the Ministry of Justice and the Prison Officers Association. There has been a lot in the news about mental health and getting people back to work through reducing sick notes and embedding employment support in medical settings. What do you think of that approach?

Professor Gail Kinman: Work can offer people many important psychological benefits, but there are many risks in ‘forcing’ people back to work for purely financial reasons. The wide-ranging risks of sickness presenteeism are recognised –  and although doing some work while not fully fit can rehabilitate employees back into the workplace, it is increasingly seen as a risky health behaviour. Returning to work too soon, or not taking enough time off to recover, can mean that health deteriorates further and people may end up taking even more time off in the future. Moreover, there can also be risks to colleagues and members of the public if somebody is working while unwell, especially where people are responsible for the wellbeing of others (for instance, in health and social care) and work in safety-critical industries (such as construction and driving).  It is crucial for the return to work process to be managed by occupational health professionals following best practice in partnership with organisations and the employee themselves.

In terms of embedding employment support in medical settings – who would be delivering this support? How would they be trained?  Different people have different rehabilitation needs and an in-depth understanding of the type of job they do and how their health problems restrict their abilities will be crucial – for example, somebody with musculoskeletal problems would struggle to go back to work on a building site, while somebody with mental health difficulties may find it difficult in an intensive customer-facing environment.

WMs: Do you see any significant difference between what the Conservatives are reported to be considering and what Labour has announced?

GK: I would rather not comment on political issues.  I think that such an important issue should be made with the extensive input of multidisciplinary teams who can communicate evidence-informed guidance. Unfortunately, such decisions tend to be made based on financial criteria by people with very little understanding of the challenges faced by ‘normal’ working people. 

WMs: While it is being spun as work being about addressing the mental health impacts of lack of employment, do you think this ignores the fact that work often contributes to mental health issues?

GK: Indeed.  Work is a common cause of mental health problems, or working conditions can exacerbate existing difficulties.  While work can benefit wellbeing in lots of ways, it needs to be good quality and people need to have sufficient time and opportunity to forget a healthy balance between their work and their personal life.  Many jobs are precarious and working conditions can be highly pressurised  – there is evidence that poor quality work can be more hazardous for health than unemployment.

WMs: There’s been a lot about employers having mental health first aiders and wellbeing policies [and a massive wellbeing industry], but do you sense that employers are reluctant to address how work can affect people’s mental health?

GK: Mental health first aid [MHFA] can raise awareness of mental health issues in organisations, but, unfortunately, the scheme can be used as a sticking plaster whereby colleagues who receive little training are expected to provide support.  A multi-level, holistic approach is needed to support mental health with interventions at the organisational level and the individual level. MHFA can be part of this, but should not be relied on in itself.

WMs: With the Employment Bill being shelved, have we lost sight of the good work issues that were at the heart of it?

GK: That is a major concern. People have worked long and hard to ensure that workers have the right to good quality, healthy work so seeing this eroded is a worry.  The people at most risk of unhealthy work tend to be those who are already vulnerable (those in precarious, low-paid work) which is likely to compound the difficulties they face with health.   It should be acknowledged that the people who make these decisions are the highest earners, who have little knowledge of the health risks that poor quality work can pose.

WMs: You work a lot in the public sector where pressure is huge and shortage of staff accentuate the pressures on individuals, do you see any examples of best practice when it comes to addressing workload issues in the absence of more staff?

GK: This is a challenging question!  The sectors I work in are facing considerable recruitment and retention problems.  Recent ONS statistics show that a high proportion are dropping out soon after qualification.  High numbers of people leaving will increase the pressure on those remaining, meaning that their health is likely to break down.  Some best practice can be identified (for example, increasing job control and support, ensuring roles are clear, improving the management of change and improving the quality of working relationships) and enhancing control and support and providing opportunities for flexible working can enable employees to manage their workload more effectively. Nonetheless, it is crucial to ensure that the workplace psychological safety climate is a healthy one and employees feel that their organisation takes their wellbeing seriously. In many cases, wellbeing can only be improved in a meaningful way if workload pressure is reduced and work-life balance is improved. This means that more staff is essential!

WMs: How much of a factor do you think workplace bullying is when it comes to mental health and do you think employers are really addressing this sufficiently or is the stress on line managers often making it worse?

GK: This is a key issue.  Most of what we know about workplace bullying comes from research on bullying between children. There are many similarities, though, and the culture in some organisations can be similar to that of the playground!  There are some people who are ‘natural’ bullies – this can be reinforced by such behaviour being rewarded with promotion, approval and just getting their own way.  Organisations can often overlook this – bullying can also be insidious, so is not easily detected. There is certainly evidence that employees who have mental health problems can feel targeted – bullying can  cause mental health problems in the first place, but also people with mental health difficulties can be at a greater risk of bullying.  We have found that minority groups of employees are more likely to report bullying, so this is a key focus for change.

The ‘bad apple’ approach to managing bullying is not usually effective and can encourage scapegoating when the institution itself is to blame.  An awareness of the organisational factors that can drive bullying is required and there should be an awareness that pressure on line managers can mean that bullying is hierarchical. It is a difficult task to manage relationships at work so appropriate and equitable policies are needed to ensure that accusations of bullying are managed properly and victims are not disadvantaged.

There is, however, also a risk in taking the view that bullying is a purely subjective experience (if you feel bullied you are). Employees need to be able to manage the ‘normal’ pressures of work without being unduly sensitive. Of course, if somebody is unhappy in their work and concerned about how they are being treated, they should speak to their line manager in the first instance to discuss the issue and any action that might be taken to improve things.

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