'Be at work and well, or don't be at all': The role of line management for the support of employees with mental health problems

The vast majority of research that examines the relationship between work and mental health emerges from occupational psychology and focuses on the characteristics of work that predict employee wellbeing (e.g. Warr, 1987, Kahn and Byosiere, 1991). This body of research has an implied agenda suggesting that the appropriate 'management' of mental health will maximise output and efficiently. There is however, a dearth of work looking at the real experience of employment for people with mental health problems and examining the barriers that they face and potential for support. In part, academic research is often driven by a critique of practitioner priorities and with Human Resource Management Programmes and publications distressingly deficient in their addressing of mental health there has been a limited impetus to undertake research in the area. The management of mental health is often argued to be the domain of Employee Assistance Programmes, yet the reality is that only larger employers have access to such facilities and even those that do often have low take up from people with mental health problems (Schott, 1999). All these factors have led to almost no research in the area from a labour process or sociological perspective. With a lifetime risk of mental health problems in the UK currently standing at 1 in 4, then the lack of research in the management of employees with mental health problems is remiss.

This paper will report on data from a project funded by the Scottish Association for Mental Health, consisting of 210 survey responses of individuals in employment who were suffering from, or have suffered, from mental health problems, and 38 semi-structured interviews of participants who had on-going mental health problems. Participants came from a wide range of employment sectors and crossed socio-economic groupings. The majority of participants in this study were affected by depression or anxiety disorders with just under 30% citing work as the (or a) causal factor of their illness. The focus of this paper is the role that line managers play in supporting or further immobilising people with mental health problems.

Our findings suggest that the process of disclosure at work was often viewed as a negative experience because of the hostility and inertia on the part of line management. As line management were generally cited as the first contact point for return to work, their handling of the situation was crucial in terms of the sustainability of employment. In some of the better cases, line managers were central to the success of formal initiatives such as time off for counselling appointments or the support for flexible working. However, in many situations, line managers were not only unsupportive of employees but used an individual's mental health problems to discriminate against them and in the worst case scenarios participants suggested that they had been dismissed because of their health problems. Line managers' reactions were frequently based on ignorance of mental health conditions and often led to inappropriate responses or avoidance of addressing the issue with employees. Recommendations arising from this research focus not just on improving awareness among and training for line managers, but also thinking about ways in which responsibilities can be shared, both with the employees themselves, and also with wider support mechanisms such as GPs and specialist mental health services.

The vast majority of research that examines the relationship between work and mental health emerges from occupational psychology and focuses on the characteristics of work that predict employee wellbeing (e.g. Warr, 1987, Kahn and Byosiere, 1991). This body of research has an implied agenda suggesting that the appropriate 'management' of mental health will maximise output and efficiently. There is however, a dearth of work looking at the real experience of employment for people with mental health problems and examining the barriers that they face and potential for support. In part, academic research is often driven by a critique of practitioner priorities and with Human Resource Management Programmes and publications distressingly deficient in their addressing of mental health there has been a limited impetus to undertake research in the area. The management of mental health is often argued to be the domain of Employee Assistance Programmes, yet the reality is that only larger employers have access to such facilities and even those that do often have low take up from people with mental health problems (Schott, 1999). All these factors have led to almost no research in the area from a labour process or sociological perspective. With a lifetime risk of mental health problems in the UK currently standing at 1 in 4, then the lack of research in the management of employees with mental health problems is remiss.

This paper will report on data from a project funded by the Scottish Association for Mental Health, consisting of 210 survey responses of individuals in employment who were suffering from, or have suffered, from mental health problems, and 38 semi-structured interviews of participants who had on-going mental health problems. Participants came from a wide range of employment sectors and crossed socio-economic groupings. The majority of participants in this study were affected by depression or anxiety disorders with just under 30% citing work as the (or a) causal factor of their illness. The focus of this paper is the role that line managers play in supporting or further immobilising people with mental health problems.

Our findings suggest that the process of disclosure at work was often viewed as a negative experience because of the hostility and inertia on the part of line management. As line management were generally cited as the first contact point for return to work, their handling of the situation was crucial in terms of the sustainability of employment. In some of the better cases, line managers were central to the success of formal initiatives such as time off for counselling appointments or the support for flexible working. However, in many situations, line managers were not only unsupportive of employees but used an individual's mental health problems to discriminate against them and in the worst case scenarios participants suggested that they had been dismissed because of their health problems. Line managers' reactions were frequently based on ignorance of mental health conditions and often led to inappropriate responses or avoidance of addressing the issue with employees. Recommendations arising from this research focus not just on improving awareness among and training for line managers, but also thinking about ways in which responsibilities can be shared, both with the employees themselves, and also with wider support mechanisms such as GPs and specialist mental health services.