A light in the dark

    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

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