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In today's tough economic climate, the risk of stress and mental health problems is on the up. Making matters worse, with many facing the possibility of redundancy, employees are more likely to keep their problems under wraps for fear of making themselves an easy target.


"The threat of redundancy is like a dark cloud for many people. This can affect people in the workplace, whether it's their position that's at risk or that of their partner," says Eugene Farrell, business manager at Axa Icas. "This can significantly affect an employee's wellbeing and productivity."



As an example, Farrell says that recent research from the US has shown that the current economic climate has made people more concerned about their finances, with a worried employee likely to spend around 15 minutes a day dealing with their financial problems. "Over a month this is a huge loss in productivity," he explains, adding that calls to Axa Icas's financial helpline have doubled since last August.


When it comes to looking after employees' mental wellbeing, there are a number of options available. For many, greater awareness and openness among staff is the first line of defence. "I'm a great believer in the line manager's role," says Maxine Bauckham, vocational rehabilitation consultant at Unum. "If they know their staff, they can identify any changes that might indicate they are having problems."


All manner of changes can be an early indicator of a problem. These can include absence, lateness, acting irrationally, not meeting targets, working late, obsessive checking, changes in personal appearance and being more emotional. "If line managers have one-to-ones with their staff, this can be a good time to talk about these changes. Then, depending on the employer's policy on stress, they could refer them for further support," Bauckham adds.


Employee assistance programmes (EAPs) are a common tool that can be used for referral. These are 24 hour helplines that provide support and information on a range of problems that might be affecting employees' mental wellbeing. Some services are general but others have dedicated lines for problems such as debt, relationships and bereavement. Alex Marshall, national account manager for occupational health at Norwich Union, adds: "EAPs are a way to manage mental wellbeing and help employees take preventative action to avoid more complex mental health issues."


Promotion is key as employees can forget the EAP is there or simply not believe their problem would be appropriate for the service. "A lot of employers have EAPS bundled up with other services, for instance a cash plan, income protection or medical insurance, so they forget they're there," explains Mike Blake, group sales manager at PMI Health Group.


Average usage is fairly low with only around 4 per cent of employees using the service but there are ways to increase this figure. Regular desk drops, posters and emails promoting the service, or areas where it can help to remind employees that it's there. Likewise, training line managers so they refer employees to it can also be effective.


Marshall also recommends packaging the EAP in a positive way. "Rather than labelling the service as a stress helpline, employers should highlight the areas of support that are covered and the fact that it can be used by their family members too. If employees are encouraged to call and get help when their problems are small this will prevent things getting worse," he explains.


As well as providing support to employees, an EAP can also be a valuable management tool. Andrew Grigg, director of Jelf Wellbeing, says that line managers can use it for support when they have to deal with stressed employees. "These services can offer advice to line managers, outlining the legal requirements as well as helping them understand how to help employees that are having mental health problems," he explains.


The other big plus in EAP's favour is the cost. Priced at anything from £5 to £25 per employee a year depending on the breadth of service, research has shown that they usually save employers much more than they spend on them. "There's never been a single piece of research that showed an EAP was a cost to an employer. At worst the return on investment is 1:1 but most employers see a higher return in terms of improved absence levels and productivity," explains Farrell.


While an EAP will help to reduce serious mental health problems, where more intervention is required, products such as medical insurance and group income protection can come into play.


Psychiatric cover is included on most medical insurance schemes but while the level of cover can be flexed on larger group schemes, there tend to be limits on cover for smaller groups. "In terms of in-patient psychiatric cover, 28 days is the norm, although some schemes will include 45 days. On top of this there's often a limit on the out-patient cover, say £1,000 a year," explains Blake.


As well as limiting the cover, insurers tend to pay close attention to any psychiatric claims, as in-patient stays, and costs, can escalate. Every claim has to be preauthorised and most insurers will look to reassess the claim on a regular basis.


Although this can feel like micro-management, Grigg says it actually benefits the employee. "The nurses make sure any treatment is in the employee's best interests and, if they need further treatment that isn't covered by the policy they'll manage them into the NHS," he explains.


There can be shortcomings though. As an example Blake flags up policies that exclude addictive conditions such as alcoholism and drug dependence, as a mental health problem could be traced back to either of these. "Some employers prefer to self-fund the psychiatric side, buying in a course of counselling if required," he adds.


Group income protection is another option. According to Bauckham just under 50 per cent of referrals from employers are for mental health problems, either where it is the primary cause of absence or where it has developed from a physical health problem. "The earlier we can get involved the better," she says. "If we can get involved around four to six weeks into the problem the chances of the employee returning to work are much higher."


Whenever the income protection provider is notified of a mental health claim, it can play an important role in returning the employee to the workplace. Alexandra Freeman, claims rehabilitation manager at Canada Life, explains: "We can work as a facilitator between the employer and the employee to help them come back into work. This could include helping to resolve any issues that might have led to the employee's absence and putting strategies in place to make it easier for them to come back."


These could include moving to a less stressful role or working shorter hours. "It's important to take a holistic view and understand all the external factors," adds Bauckham. "Travel might be a problem so we might look at changing their hours so they don't have to travel in rush hour."


When tackling mental health, preventative measures are sensible too. Legally, employers should take steps to reduce stress levels in the workplace and tools such as stress audits and the management information from EAPs can help to identify hotspots.


But, as employees can bring problems into the workplace, training them to cope better in difficult situations can also be beneficial. Freeman says that employers can run sessions as part of wellness days to encourage participation. "An employer might want to run training to help employees to become more resilient but there could also be an underlying reason, such as a bereavement or employee illness, that is behind it," she says.


These types of preventative services are often available from the EAP providers. As an example Norwich Union Healthcare offers a host of bolt-ons to its EAP, including online coaching, onsite workshops, stress audits and online health assessments. Marshall adds: "All sorts of steps can be taken to help prevent employees suffering mental health problems. The more proactive an employer is along the way, the less likely it is of getting a claim."


The effectiveness of EAPs


Norwich Union Healthcare uses PPC Worldwide to provide its EAP. It recently undertook some research into the effectiveness of EAPs and face to face counselling, with the following results


Impact of counselling on absence. A total of 843 face to face referred cases were dealt with over a 12 month period. Employees were asked whether they were at work, or planning to return.


At first counselling session


Percentage of employees at work 66%

Percentage of employees not at work but planning to return 0.5%


At last counselling session


Percentage of employees at work 79%

Percentage of employees not at work but planning to return 8%


This represents an 61% reduction in the number of employees absent at the point of the first counselling session and with no plan to return to work.


Evidence of effectiveness of counselling


Employees who took part in a total of 1,300 face to face counselling sessions were asked how it had affected them.


Got better 74.70%

Got worse 1.65%

No change 23.65%



Sam Barrett

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