With pressure to reduce spending by £189m, supporting employees to stay healthy and productive is a key priority for Norfolk County Council. Paddy Lorenzen, Occupational Health and Well-Being Manager, describes how an evidence-based approach to resolving mental health-related absence delivered significant results.
As an organisation funded by the public, we have a particular responsibility to minimise any kind of unnecessary 'waste' – not least because of Government funding reductions requiring us to reduce our current spending by £189bn over the next three years – on top of the £140m cuts already delivered.
An important part of this is continually looking at ways we can keep our 22,000 employees as healthy and productive as possible. As part of our commitment to helping employees to reduce absence and stay in work, we introduced a fast-track physiotherapy programme (IPRS). This programme included functional assessments to identify what the employee was physically capable of doing. That sort of factual information has proved essential to making the right workplace adjustments, to keep employees affected by physical problems both healthy and working. It occurred to me that a similarly robust psychological assessment could be equally valuable for helping managers and employees deal with mental health conditions affecting work.
Previously, we found that a traditional referral to occupational health didn’t always give information that helped a manager and employee to address the situation. Even if the employee was being seen by a GP, they were usually only being prescribed anti-depressants to address the symptoms, but nothing was being done to deal with the underlying causes. Managers were left unsure if and how an employee, suffering from an issue like; stress, anxiety or depression, would return to work, while the employee remained in a state of limbo. Managers were also left unsure how to support individuals at work, but were experiencing mental health problems such as; Obsessive Compulsive Disorder (OCD) or depression, which resulted in them struggling to get through their workload or not performing or behaving adequately. Going forward, we wanted to get the factual insights required to understand, in what capacity, the employee could currently work and what was required to help them stay in work.
That kind of approach required specialist expertise and we also wanted to demonstrate to staff that we were making use of an external partner, with an entirely independent and confidential perspective. We were very impressed with Validium, our existing Employee Assistance Provider, because of the emotional and practical support provided to our extensive workforce since 2010. We were also impressed by the collaborative way they were already working with IPRS, to support employees with a physical injury, which also had a psychological component, such as fear of pain, rather than actual pain itself. They also had specific psychological health expertise and we were aware of the work they were doing with other well-known employers to rehabilitate absent employees, so we invited them to conduct a psychological assessment pilot with us.
After discussing the range of psychological assessments available, our HR department identified 21 cases that might benefit from a psychological assessment. Of these, two individuals refused to give their consent and four resigned prior to the referral being made. Of the 15 staff who went on to be referred, six had been off work for between three and 52 weeks, while the remaining nine had been at work, but were struggling to fulfil their duties. Six needed an extra five-to-ten hours of management time every month and four were doing 25-30 percent less than expected, which was affecting service delivery. The findings of the individual psychological assessments, carried out by chartered psychologists, were shared with the Council, only with the individual’s consent, and revealed a variety of personal and work-related issues preventing them from returning to work or performing effectively in their role. No one had a mental illness as such – instead they were struggling with typically long-standing, common mental health disorders, such as depression and anxiety, which had been triggered in some way.
We were provided with a clear picture of each individual’s psychological health in relation to their particular work duties and suggested adjustments for the employee, their manager and HR to sit down and talk through. In the event that the individual needed treatment to recover, we were also given a clear indication of costs and the likelihood of recovery. The psychological assessment gave those employees the opportunity to reflect on what they were and weren’t psychologically suited to do at work. Three individuals agreed to be redeployed into other areas of the council, one temporarily and two permanently. Their new roles enabled them to reduce their level of responsibility, along with a reduction in grade. All six employees who were absent returned and are now fully performing at work again. Two more participants resigned and another two were provided with treatment, which they were incredibly grateful for. One employee felt the psychologist provided was the first person to really understand what she was going through and essential to her recovery. Although people in the business had tried to empathise, the ability of the psychologist to use the right language to verbalise her symptoms and how they manifested, made a huge difference. Her manager reported that after just one session, it was clear she was so much better.
Two more participants were deemed so affected by depression they met the criteria for ill health retirement. We let them go, with the option to return to the workforce if and when they recovered. Two more met the criteria for ill health retirement. The remaining three were dismissed on the grounds of their capability, when the assessment showed they needed extensive treatment, with only a limited chance of recovery, which we considered to be an unreasonable adjustment. The clinical insights provided by the specialists enabled us to get over half of those taking part in the pilot back to full performance and concluded all the other cases. It has saved money being spent on wasted management time, and decreased replacement staff costs. As a result of the success of the pilot, we’re continuing to use psychological assessments to resolve other intractable mental health-related cases.
For us, the biggest benefit has been the creation of a process capable of generating the factual information required to make the right decisions when it comes to supporting our people, to attend and perform at work. Our pilot demonstrated that even in a highly-sensitive area, like mental health, a professional and evidence-based approach is of benefit to everyone concerned. The information and the facts made a huge difference and both HR and the manager were able to sit down with the employee and say: “This is what the report says, what can we do to get you back doing your duties”? It’s my belief that without the psychological assessment, most people wouldn’t have returned or got back to performing. It’s rare that people take the time to write thank you letters, but we’ve had some lovely letters from people taking part in the pilot, saying it transformed their life for the better. From the business perspective, revealing the hidden costs of an unresolved absence makes it easy to justify the business case for carrying out assessments and providing treatment.
Paddy Lorenzen, Occupational Health and Well-Being Manager
Norfolk County Council
