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