Paul Litchfield, OBE, Chief Medical Officer at BT, gave a lecture entitled Mental Health at Work, at Warwick Medical School on March 17th. Largely self-congratulatory, the lecture outlined a collection of programmes with few clues to how they fit together, fit into the wider picture of public health or fit with the work of NHS mental health trusts.
Like the previous event at Warwick University, this one was introduced by a mysterious woman. There was a smaller audience of about three dozen people and I sat nearer the front hoping to hear better, so I am quite sure that she didn’t introduce herself this time. However, I did hear the speaker call her Sarah, so I am a little closer to solving the mystery.
BT, we were given to understand, tries to be an exemplary employer when it comes to the health of its workforce, and it has many programmes relating to mental health.
There are guidelines for good practice aimed at first-line managers and trades union officials, a framework for action (“Good Work — Good Health”), a People Strategy with five key themes, a BT Health & Wellbeing Passport scheme supporting vulnerable employees, a Mental Health First Aid programme, a data dashboard giving senior managers information about mental health in the company, an employee-assistance programme (EAP), and a stress-assessment program sampling a thousand employees a month. I may have missed some.
It was not clear, however, that all these programmes have arisen out of any kind of strategic plan. The EAP, for example, was said to have different perceptions of work-related mental health problems, the dashboard doesn’t apply to BT’s operations outside the UK, and the passport scheme (which seems stigmatizing, on the face of it) has had few takers.
One of the charts in the data dashboard was revealing of the thinking behind the whole lecture. It showed mental health problems reducing over the course of a few years, then rising again. The speaker’s explanation was:
We’d got it down, but then the recession hit.
That is to say, the point of all this was to show that when anything good happens BT can take the credit, but when anything bad happens it is the result of external forces.
Some general barriers to progress in workplace mental health were pointed out.
- There is only a weak evidence base for this kind of activity (although there is a NICE guideline about it).
- Smaller companies cannot do as much as a big organization like BT.
- Short-termism in business makes for a “brutal environment” in which it is hard to convince managers to give priority to health.
- There is a view that work is a mental health hazard, and this view needs to be reframed to recognize that worklessness is a much greater hazard.
- The tax system treats workplace mental health programmes as taxable benefits, which is absurd when they are saving the NHS money.
- The UK’s public sector provides no leadership in workplace mental health.
However, a sign of hope is that the Department for Work and Pensions and the Department of Health are beginning to work together.
A questioner in the audience asked why public sector sickness absence is higher than in the private sector. The reply, which was not just in relation to mental health:
We get people back to work faster and more effectively.
Another questioner asked how long is too long in relation to sickness absence. The answer: it depends. BT has 48 people who have been off for more than a year, but it tracks them all individually and first-line managers are encouraged to stay in touch with them.
Another asked how to convince management that mental health is important. The answer: tell them it costs money. They take more notice in tough times like these.
And another asked what are the big research questions. The answer: what works? No one knows what things are important. BT funds some research but it is careful to launder the funding through third parties so that no one knows BT is behind it.
My conclusion was that a lot of the activity described in this lecture is cosmetic and politically correct, aimed at making BT look good and avoiding blame. In the worst case, one might imagine that when BT management creates a bad situation and employees react badly to it, the employees can be removed temporarily on the grounds of “stress”. This changes the narrative from “we managers caused a problem” to “those workers have mental health issues”.
Back in the real world, mental health professionals take the opposite view. In a bad situation, feeling bad is a sign that you are mentally well, and stress is a normal healthy response to demands. Medicalizing these things for business purposes seems likely to reduce the resilience of BT’s workforce in the long term. It also seems likely to mask genuine mental illness, making it more difficult to differentiate from “stress” and treat early. I suspect those two effects might be costing the NHS money rather than saving it.
As a PR exercise, though, it is all quite impressive.