Over the past five years, a significant increase in mental health awareness has occurred. Shaw Trust (2018) reported it has doubled. Undoubtedly, we are all more aware of mental health than we were a decade ago. But is increasing awareness actually improving mental health?
Firstly, let us consider the key mental health outcome indicators. Here, we can consider two indicators, the suicide rate and the rate at which some of the more commonly occurring mental health conditions are being reported.
Having reached a twenty-year low in 2007, the UK suicide rate trend over the past decade or so is concerning as it is, generally speaking, upward (Figure 1.0).
Figure 1.0: UK suicide rate – all persons: deaths per 100,000 population
Source: ONS, online.
The 2019 suicide figure is due out in a few months, probably September 2020. If a high figure results, will it to show the low of 2017 was an aberration that masked a continuing and concerning long-term trend of deterioration? If a low figure results, will it indicate 2018 was the aberration, and that despite a few disappointing years, generally speaking, the long-term trend of lower rates is continuing? Whatever the 2019 suicide figure, the effects of current mental health interventions, including raising awareness, can be said to be patchy.
Looking beyond the suicide rate to the numbers of people reporting poor mental health, over the past thirty years, reports of stress, depression and anxiety appear to have doubled (Figure 2.0).
Figure 2.0: Rate of self-reported stress, depression or anxiety
Source: HSE, online.
Notably, there has been a particularly rapid increase in reported mental health conditions in the last five years, despite mental health awareness being at its height. Perhaps people with mental health issues feel more inclined to speak out because of increasing awareness? I’ll come back to this point later.
These two trends of an increasing suicide rate and an increased number of people reporting stress, depression and anxiety suggest mental health interventions, including raising awareness, may not be proving as effective as we all would have hoped.
In 2018, more mental health first aid training courses were delivered in the UK than in any prior year (Rice-Oxley, 2018). In 2018, UK suicides increased to their highest level for nearly sixteen years. Whilst not suggesting a link (although the examination of any such a link would be worthwhile), it is worrying that at a time of greatest mental health intervention, we see the highest suicide rate for sixteen years. The 2019 suicide rate may act as a vital indicator as to whether current interventions are helping or hindering.
Looking at the effects of raising awareness on employer attitudes towards mental health, the picture is no more encouraging. Shaw Trust (2018) found that:
half of employers view staff with mental health conditions as a ‘significant risk’ to their business, an increase of 10% since 2009
more than half of employers are reluctant to employ someone with a mental health condition due to a fear of that person being stigmatised by co-workers (56%, up from 51% in 2009)
in 2009, 90% of employers felt comfortable talking about mental health with their staff members; (in 2018) this figure was just 64%.
Perhaps part of the explanation for the deteriorating suicide trend and the upward trend in reported mental health issues is due to a hardening of employer attitudes.
If the workplace is becoming a more hostile environment for people living with mental health issues, it stands to reason that employees may begin to suffer with poor mental health where they did not before and those with existing mental health conditions may find their issues being exacerbated.
But why would employer attitudes towards mental health be hardening?
The change curve, developed by Elizabeth Kubler-Ross, is well known. It was developed to explain the emotions felt by the bereaved. It has seven phases: shock, denial, frustration, depression, experiment, decision and integration. The change curve has been adapted and applied to numerous settings, especially to change management. At its heart is the principle that things get worse before they get better.
In the context of mental health, perhaps it is the case that now, when presented with an increasing demand for attention to be given to mental health, society (including employers) is experiencing denial, rejection, frustration and even anger at having this change imposed upon it.
Sometimes, things that have hitherto been located in people’s subconscious minds move into their consciousness. In other words, people go from not really thinking about something to thinking about it. Raising awareness means mental health is going through this very transition.
Let us consider a simile in the form of Brexit. As the world watched, the UK population was asked whether it wanted to remain in or leave the EU. Yes or no? It was a binary decision. There were some people who saw this as a question of whether they wanted more or fewer immigrants in the country; a particular UKIP poster, ‘Breaking Point’, became infamous (Stewart and Mason, 2016). The result of the Brexit referendum is not fully understood. Perhaps it was anti-immigrant opinion that swayed the vote; perhaps it was not.
At the same time, UK nursing applicants from elsewhere in the EU were also forced to make a binary choice. They had to consider whether they wanted to live and work in a post-Brexit UK. Yes or no? ‘No’ was the resounding answer. The number of EU nursing applicants plummeted by more than 90%, contributing to the UK’s current nursing shortage (Siddique, 2017).
Now, thanks to mental health campaigns centred on raising awareness and speaking out, the UK population – including organisational leaders, managers and employees – are having to consciously think about mental health and answer another binary question: are you willing to work with a person with mental health issues? Yes or no? Brexit teaches us that if the future appears uncertain and potentially problematic, the decision-making trend appears to favour a cautious approach. If a binary response is required, we must expect a ‘no’ answer to the mental health question.
Shaw Trust (2018) found: ‘Although the majority of respondents stated that they were willing to work with someone with a mental health condition, it is concerning that 31% of senior managers would not be willing to do so’.
It is, perhaps, for this reason that speaking out about mental health should come after the population has been properly prepared for it, making people, including employers, receptive to the idea of mental health before thrusting it upon them.
The positive case for employing people with mental health issues has, perhaps, not yet been adequately made, at least, not in the eyes of some of those being asked to become more tolerant and understanding of mental health. The vast majority of effort to date has focused on trying to get people without mental health issues to accept those that have them, without any real explanation or justification. It’s like trying to trade on goodwill alone. But if you have not developed the basis for goodwill, you can’t expect to find much of it, hence attitudes towards those with mental health may harden – as they appear to have done.
Perhaps employees sense this hardening of employer attitudes. Returning to the point of whether increasing awareness of mental health is leading people to report their condition as they feel more inclined to do so, Business in the Community found that employees are no more comfortable talking to their line manager about their mental health than they were four years ago, despite awareness of mental health having increasing dramatically during that time (Figure 3.0).
Figure 3.0: Percentage of employees who feel comfortable talking to their line manager about their mental health
Source: Figures collated from BITC, 2016, 2017, 2018, 2019.
Employee inclination to speak out about mental ill-health does not seem to be improving, yet reported mental health conditions are on the rise; a worrying combination.
It appears the attitudes of leaders, managers and neurotypical employees are moving into the ‘trough’ stage of the change curve, in which denial and frustration takes place. This may mean those people being asked to accept neurologically atypical people are entering a phase of negative emotions and perceptions ahead of arriving at a more tolerant and understanding position.
If society (including employers) is entering a negative phase, which might involve worry, concern and uncertainty, raising awareness might lead to attitudes towards mental health getting worse before they get better.
References
Business in the Community (2016) Mental Health at Work 2016 Report: National Employee Mental Wellbeing Survey Findings 2016. Available at: https://www.basw.co.uk/resources/mental-health-work-report-2016 (accessed 6 February 2020).
Business in the Community (2017) Mental Health at Work 2017 Report: National Employee Mental Wellbeing Survey Findings 2017. Available at: https://www.uk.mercer.com/our-thinking/health/mental-health-at-work-2017-report.html (accessed 6 February 2020).
Business in the Community (2018) Mental Health at Work 2018 Report: Seizing the momentum. Available at: https://www.bitc.org.uk/wp-content/uploads/2019/10/bitc-wellbeing-report-mentalhealthatworkreport2018fullversion-oct2018.pdf (accessed 6 February 2020).
Business in the Community (2019) Mental Health at Work 2019: Time to take ownership. Available at: https://www.bitc.org.uk/report/mental-health-at-work-2019-time-to-take-ownership/ (accessed 22 November 2019).
Health and Safety Executive (online) Historical Picture Statistics in Great Britain, 2019 – Trends in work-related ill health and workplace injury. Available at: https://www.hse.gov.uk/statistics/history/index.htm# (accessed 18 April 2020).
Office for National Statistics (online). Suicides in the UK Statistical bulletins. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/previousReleases (accessed on 20 Feb 2020).
Rice-Oxley, M. (2019). UK training record number of mental health first aiders, The Guardian, 2 Sept. 2019 (online). Available at: https://www.theguardian.com/society/2019/sep/02/uk-training-record-number-of-mental-health-first-aiders (accessed 29 April 2020).
Shaw Trust (2018) Mental Health at Work: Still the last taboo. Available at: https://www.shaw-trust.org.uk/ShawTrustMediaLibraries/ShawTrust/ShawTrust/Documents/Shaw-Trust-Mental-Health-at-Work-Report-2018-full_1.pdf (accessed 29 November 2019).
Siddique, H. (2017) 96% drop in EU nurses registering to work in Britain since Brexit vote. The Guardian 12 June. Available at: https://www.theguardian.com/society/2017/jun/12/96-drop-in-eu-nurses-registering-to-work-in-britain-since-brexit-vote (accessed 9 March 2020).
Stewart, H. and Mason, R. (2016) Nigel Farage's anti-migrant poster reported to police, The Guardian, 16 June 2016 (online) Available at: https://www.theguardian.com/politics/2016/jun/16/nigel-farage-defends-ukip-breaking-point-poster-queue-of-migrants (accessed 29 April 2020).
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