Is it all in the mind?

In the week when all the news seems to be about EU referendums, the BBC has been running an excellent series of programmes about mental health that you may have missed called “In The Mind”.   The FT also ran an article called ‘Occupational Health: how employers can learn from Nordic countries”.  Two completely different subjects one may think, but actually they are both relevant to the really big topic de jour – Health in the Workplace.

Employers have long realised that Health and Safety in the workplace is important, complying with legislation, ensuring that surveillance is carried out in accordance with the law, and regularly reviewing process and procedures are all extremely vital to the wellbeing of an organisation.  But just as important is ensuring that the health and wellbeing of the employees is managed and cared for, particularly when things go wrong.  If one of the workforce goes off sick with a broken leg, with shingles or has a heart attack the symptoms are recognisable and the management of these overt health issues is relatively straightforward.  By ensuring that medical treatment is appropriate, is delivered in a timely manner and by working with the employer, the employee and the medical profession, a managed return to work programme can be very successfully implemented.   But how do you spot mental health issues, depression, bipolar etc., are you aware of the mental health issues that can result from a physical accident or illness – post cardiac surgery stress syndrome is just one example.

Best practice means that the Occupational Health team dealing with Health and Safety, performing the required testing programme and running the Health and Safety worksite processes should liaise with the specialist Absence Management Team.  Early intervention for Absence Management is a different discipline to the HSE Occupational Health Team.  The Absence Management Case Manager, frequently a nurse, should be trained in the biopsychosocial model of absence management.  Not only will he / she be evaluating physical issues they will also be looking at the barriers, often simply life events which have been medicalised, thus preventing a return to work.  Examples of such barriers can be home life, childcare, debt, colleague relationships and many more.

Research carried out by our non-executive Director, Professor Sir Mansel Aylward CB DSC FFPM FFOM FFPH FRCP, in his capacity as Director of the Centre for Psychological and Disability Research, School of Medicine, Cardiff University determined that the principal negative influences on return to work are:

Personal / psychological:

  • Catastrophising (even minor conditions)
  • Low self-efficacy
  • Belief that ‘stress’ is a causal factor


  • Lone parents / unstable relationships
  • ‘Victim’ of modern society
  • Rented or social housing


  • Job dissatisfaction
  • Limited attendance incentives (especially work colleagues)

Cognitive :

  • Minimal health literacy
  • Self-monitoring of symptom
  • False beliefs


  • Availability of alternative sources of income /support.

The corollary to this are the positive influences which include:

  • Respect for the employer
  • Jon satisfaction
  • Strong health literacy
  • A sense of moral obligation to ones work colleagues
  • Positive attendance incentives
  • Well managed chronic health conditions.

So, coming full circle, as the Nordic countries have found, engaging with employees is an important part of the Health and Safety strategy, and as the BBC programmes and research have found out mental health is an integral part of physical illness, health in the workplace and health in society.

Early intervention, and managing absence from the onset, can help prevent the medicalisation of illness, identify potential mental health issues and incorporate coping strategies such as talking therapies, engagement with an Employee Assistance Programme and pragmatic changes to the working environment.

It is well proven that work is good for us;  early intervention enables employees to remain in the workplace – understanding the nuance of the psychosocial inertia for this type of absence goes a surprisingly long way to optimising the absence (or disability claim) duration.




BBC in the Mind media release

BBC Radio 4 In the Mind programmes:

Financial Times – Occupational health: how employers can learn from Nordic countries :

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