For someone who is depressed, the simple act of getting up in the morning can be one of the hardest things to manage. The idea of then going to work only to face service users who may well be suffering similarly from depression or another form of mental distress might easily feel too overwhelming to bear.

But clearly, just as people often continue to work through physical illness, social workers may work through times of mental ill health. Mental illness covers a wide spectrum from anxiety, depression, phobias and panic attacks, through to severe and enduring illnesses such as schizophrenia and manic depression.

The critical question for a social services line manager is this: if professionals who are vulnerable in terms of their mental health are dealing with individual service users who are vulnerable in the same way, how are decisions taken about when it is appropriate for that social worker to carry on?

No specific national guidelines exist as yet detailing how social services managers should deal with staff who develop mental health problems. Nor is there any national guidance specifically directed at this sector to help managers judge whether such a staff member should continue with a caseload that will almost inevitably include service users with mental health needs of their own.

Mike Evans, chief officer for adult services at Leeds Council, emphasises that, "a line manager's responsibility must first of all be to service users. The challenge is to maintain that focus and support their worker at the same time".

He points out that social workers operate in supportive teams, with regular and detailed supervisions embedded in their professional culture. If somebody developed a mental health problem, whether that was work-related stress or a more serious medical diagnosis, structures would already be in place to identify the issue early on and allow support mechanisms to kick in.

"I don't think it's necessarily relevant that they may be working with clients with mental health problems - social workers work with clients with a range of needs. There may be occasions where there are some features of a particular case that are too close to home for a worker. But each situation is unique and you have to judge each one as it comes up," he says.

"If there are concerns that a worker doesn't have sufficient insight we have a system agreed with the trade unions which can temporarily involve the worker in different responsibilities and that removes the risk to service users."

Creating a workplace in which a staff member suffering mental distress feels comfortable in disclosing their problem to a line manager is a crucial element in managing your team's mental well-being, says Tina Ball, director of psychological health at Sheffield Care Trust, which delivers mental health services in partnership with Sheffield social services department.

"Ideally it should start before someone gets ill. As a manager you'd start thinking preventively. We know that the NHS and social care can be very stressful places to work in, so we'd be looking at supporting staff before the problem arose.

"If it's a specific illness that someone has already had, you can talk to them while they're well about what to do when they become unwell. People are often good at monitoring themselves. If they weren't, I'd look for trusted individuals who would be asked to notice changes."

Confidential counselling services that are separate from line management are cited by managers as useful avenues of support, although Ball notes: "You need the service to be skilled enough to be able to distinguish between stress and psychosis, so they know to tell the worker it's time to go to the doctor."

Acknowledging the need to remove the deep stigma that persists around mental illness, Hampshire Council's social services is participating in an initiative called Exemplar Employer, in partnership with the local NHS trust and consultants from the Sainsbury Centre for Mental Health.

Ruth Dixon, county manager for mental health operations, says: "We used to have an old-fashioned approach - if somebody needed specialist mental health help, they'd be shipped off to London or Oxford for treatment. The thinking was that it was too stigmatising for a social worker to be treated in their own area. That's completely changed in the past couple of years. We have recognised that mental health difficulties are the second highest reason for staff absence, and there is now an explicit commitment to changing the culture.

"Through the Exemplar Employer project, we'll be looking at whether we need to employ specialist mentors and what extra training we should give to line managers in this area. That's for our current staff. Then, we need to look at how we attract workers who have experience of mental health problems. We are keen to attract them and that is part of developing culture change within the organisation. It means we're not operating a dual standard by saying to users 'we believe in recovery and hope and aspirations' and then failing to employ people who demonstrate in their own lives that positive outcomes are possible in the field of mental health."

Many managers emphasise that the unique understanding brought by social care professionals who have themselves been mental health service users can be immensely helpful in working with clients suffering mental distress. At Lancashire Council, the social services department has just begun an advertising campaign to recruit workers into its mental health teams who have either experienced mental illness or have cared for someone with a mental health problem.

And in the London Borough of Brent, David Dunkley, head of mental health services, is a passionate supporter of the contribution made by a member of his team who has suffered periods of mental illness. Her role is specifically to advocate within the department on behalf of service users, bringing a personal perspective to her professional input into team discussions.

Recalling his time as a line manager, Toby Williamson, policy director of the Mental Health Foundation says: "People who have personal experiences of mental illness can often bring a different kind of knowledge and understanding of which mental health services are appropriate, and especially of those that may not be.

"In a previous job I managed a mental health outreach team. Some staff had had mental health problems, and it gave them enormous empathy and insight into mental distress. It gave them a greater degree of expertise. As a manager I valued that."

- More information on the Mental Health and Social Exclusion Report, June 2004, from www.socialexclusionunit.gov.uk. NHS Guidelines: Mental Health and Employment in the NHS, published by the Department of Health, 2002. Line Managers Resource Pack, published by the Mind Out for Mental Health campaign, from 0870 443 0930 or mindout@codestorm.net

Protect and survive   

• Any concerns about an employee's mental health should be discussed with them in a supportive and respectful way. 
• Employers have duties to employees under the Disability Discrimination Act 1995 and health and safety legislation. Even if an employee does not meet the definition of a disabled person under the DDA, it would be good practice to look at what adjustments can be made if needed.   
• Adjustments can take different forms, for example flexibility over hours, part-time working, reassignment of some duties, or use of technology to help people manage work.  
• If people want support from their employer, including DDA adjustments, then someone with relevant authority needs to be aware of their needs. However this does not mean that their colleagues need to know about their mental health issues. 
• As well as treating people fairly, employers need to ensure that working conditions are not making their employees ill. Under health and safety regulations employers must address risks to mental as well as physical health.  The Health and Safety Executive (www.hse.gov.uk) has published guidance to help employers assess working conditions for risk of stress and to address the risks that are identified.  

Source: Mind, www.mind.org.uk