Mental health in the workplace

Both personal circumstances and the workplace environment can contribute to how staff feel. 

Although it is often impossible to change external circumstances, workplaces can often help ease pressures through negating workplace risk factors and ensuring supportive practices and procedures. Educating staff about risk factors is the first step to achieving this. 

According to the WHO, these can include:

• poor communication and management practices
• lack of support for staff
• inflexible working hours
• unclear tasks or organisational objectives
• limited autonomy or decision-making power
• unclear job roles or organisational objectives.

In addition, burnout, loneliness and moral injury are recognised as risk factors that have significantly impacted the mental health of NHS staff, particularly in the height of the COVID-19 pandemic.

Moral injury is defined as persistent psychological distress which results from actions, or the lack of them, which strongly clash with a person’s moral or ethical code. It is commonly experienced by healthcare staff. 

Enduring highly traumatic experiences and feeling unprepared emotionally makes individuals more vulnerable to it.

NHS staff can experience feelings of moral distress within their jobs, which can lead to moral injury. This has been particularly evident during COVID-19. This has often resulted from staff being unable to deliver high-quality patient care due to understaffing, not received the required support needed for their work, a sense of failing to prevent or intervene (even when impossible) and witnessing ethically challenging incidents.

This has been coupled with frequent exposure to morally distressing incidents such as:

• staff being redeployed to work in other teams and carry out roles without receiving the appropriate training and induction to do the job to the best of their ability
• a lack of social contact in shift workers could be a risk. Whilst organisations cannot eliminate shift work, shift patterns that mitigate the risk and include flexibility could be considered
• seeing patients dying alone, not surrounded by loved ones.

The associated guilt and anger associated with the factors above often impact negatively on mental health. In addition, research by The King’s Centre for Military Health Research (KCMHR), King’s College London, shows that moral injury is a risk factor for post-traumatic stress disorder (PTSD), depression or experiencing suicidal thoughts. 

The experience of moral injury can lead to people having negative views of themselves, others and/or the world, which can have further impact on their mental wellbeing. Those experiencing moral injury tend to have fewer positive feelings in general, and often withdraw from those around them, which can reflect in how they undertake their duties.

• Raise the profile of moral injury in your organisation by including information about what it is on your staff intranet, notice boards, staff areas and calm rooms. Ensure you include details on how staff can access this support.
• Raise at board level to agree the approach to supporting staff with moral injury.
• Provide effective support through mental health hubs, your service (if you have one), and through signposting to your existing health and wellbeing offers.
• Currently the most effective way to support those who are dealing with moral injury is to help them make sense of what has happened to them, you can do this by encouraging your staff members to access psychological support.

• Ensuring suitable and sufficient risk assessments are undertaken on psychosocial hazards/causes of work-related stress. This should be done in partnership with trade unions. 
• Monitoring organisational data such as sickness absence and NHS Staff Survey data to identify any potential issues/areas of concern.
• Preparing staff who are likely to be exposed to potentially morally injurious experiences (intensive care units, A&E, trauma etc) and ensure that staff are made aware of the risk of working in these areas and are prepared for the reactions they may experience.
• Holding regular open and honest conversations about the nature of the tasks people face and how they may respond ideally before they are exposed to potentially morally injurious events (PMIEs). 
• Ensuring that all leaders role-model compassionate behaviour, including acknowledgment that moral injury may occur in difficult circumstances.

In response to an event where moral distress or moral injury may be a concern, managers and leaders can:

• access support themselves (if needed) and share experiences
• provide compassionate support in response to difficult experiences at work
• acknowledge potential moral challenges openly and honestly with the whole team, including ancillary/support staff who may have witnessed or been involved.  It is important to support your bank/agency/student staff too
• signpost to sources of further help and advice, including occupational health services, mental health hubs, trade unions and professional bodies
• encourage conversations outside of the organisation, such as with friends and family
• be open about the difficulties they have had which can lead to honest discussions and reparation. Support for senior leaders can be found via the NHS Leadership Academy and the Association of Clinical Psychologists
• organise reflective practice sessions, led by supervisors/managers, talking about the impact of the event, rather than what went right or wrong.

Decreased emotional wellbeing among staff can contribute to increased mental health and stress concerns. It's therefore vital that staff understand the factors which affect mental health and have regular wellbeing conversations with their managers.

Managers must have the right skills to support these conversations and be able to respond compassionately to individual needs.

Leaders also have an important role in reinforcing positive attitudes around mental health and shaping organisational culture by encouraging positive behaviours.

While discussing physical health can be easier, emotional wellbeing can be more challenging. Organisations can help by:

• raising awareness of mental health 
• educating their people on this topic
• providing the right resources to encourage open conversations
• challenging the stigma about mental health.

The NHS Better Health, every mind matters hub has a free Your Mind Plan quiz. Use this for yourself or signpost to your colleagues. Answer five simple questions to get your personalised mental health action plan, with tips and advice to help you look after your mental health and wellbeing. 
 

Protective factors help negate the risk factors for poor mental health. Below, we have outlined what organisations can do to achieve this.

Create a healthy and supportive working environment

• Ensure the organisation’s culture does not stigmatise people with mental ill health. Do this by emphasising that honest mental health conversations are important, and through encouraging leaders to share personal experiences.
• Set up supportive peer networks where staff can share their views and connect with others who have similar experiences. This can help staff strengthen relationships in the workplace and increase staff engagement. It can also help combat loneliness, which can often lead to mental ill health.
• Recruit mental health first aiders and wellbeing champions into your organisation. It is important to provide them with the right support and supervision. Ensure working conditions promote good mental health where staff feel physically and psychologically safe and are able to perform their roles the best they can. That means making sure their basic wellbeing needs are being met, and they have the right equipment, training and development opportunities to support them.
• Develop a culture where open and honest communication is encouraged, bullying and harassment is not tolerated and people are treated with dignity and respect.
• Embed inclusive practices so that staff feel valued and able to bring their authentic self to work. Treat all staff consistently and fairly and provide positive feedback to staff when they do a good job.
• Recognise the heightened impact of factors such as chronic stress, burnout, loneliness and moral injury have on mental health. Focus your initiatives on tackling these issues. Read our beating burnout in the NHS guidance.
• Put preventative measures in place so that staff can maintain good mental health. Encourage mental health hubs and initiatives to be used by everyone – not just staff with mental ill health. Enable and encourage self-help and self-care and regular mental health maintenance training sessions.
• Policies and practices should encourage a good work/life balance, this will help ensure staff keep mentally healthy. Enabling staff to work flexibly can help facilitate this. Read our flexible working-enablers for change page.

Upskill line managers

• Training for line managers should cover how they can promote mental health and wellbeing and be aware of the signs and symptoms of poor mental health.
• Ensure managers know how to have effective regular conversations with their staff. See our wellbeing conversations guide.
• Managers should support mental ill health in the same honest and consistent way that physical health problems are supported. Ensure they understand and implement fairly the reasonable adjustments for mental health for example, changes to working hours, temporary redeployment, reduced duties.
• Acas have published guidance on reasonable adjustments for mental health at work to support employers and employees, including practical steps and considerations to be aware of. The Acas podcast, Mental health at work: reasonable adjustments, explores how employers can support staff by creating a healthy work culture and demonstrating a commitment to good practice. Speakers include Jo Yarker, Managing Partner at Affinity Health at Work, Julie Denning, Managing Director of Working To Wellbeing and Chair of the Vocational Rehabilitation Association and Francoise Woolley, Head of Mental Health and Wellbeing at Acas. 
• NHS Employers have published the Understanding workplace adjustments infographic where you can find out about the different types of workplace adjustments that can help support disabled staff in their roles.
• Encourage managers to be clear about job expectations from the start. Give them as much autonomy and control over how they deliver their work as possible.
• Upskill managers to effectively monitor the workload of staff (including those working from home) to ensure what they are expected to deliver is realistic within the timescales and resources available.

Listen, engage and inform

• Listen to your staff about the changes they want to see and how they wish to be supported. Ensure you follow up and inform them on how you will act on their requests.
• Have protected time when leaders and managers are available for staff to come and speak to them.
• Ensure staff understand their own objectives, their teams’ objectives and the organisation's objectives. This gives purpose to their work and helps increase a sense of belonging to the organisation.
• Keep members of staff informed of organisation or team changes. This includes providing a rationale for actions and decisions taken.
• Make staff aware of the internal resources that are available to them, such as occupational health or employee assistance programmes.

Awareness of initiatives

Ensure all staff are made aware of and have access to initiatives, this could include:

• flexible/ agile working
• peer support groups
• stress management exercises
• mindfulness training
• physical activity initiatives
• sleep and healthy eating advice.

Employers have a legal duty to assess the risk of stress-related ill health arising from work activities. The Health and Safety Executive (HSE) has produced the HSE Management Standards which provides information on how to assess and control the risk of stress.  They have also developed guidance on how to implement the management standards.

The Mental Health Foundation reports strong links between loneliness and mental health. Gallup’s State of the Global Workplace Report (2024) demonstrates that workplace loneliness is harmful to both employees and employers and can negatively impact staff engagement. For further details, read the government’s Employers and loneliness guidance.   

Organisations can help combat workplace loneliness by actively ensuring staff can form healthy, long-term relationships with their co-workers. The Campaign to End Loneliness advises five key factors which can help achieve this:

Culture and infrastructure - Organisational values, embedding loneliness within wellbeing activities. This includes creating a culture that supports healthy social interactions and relationships between all staff, regardless of seniority, background and job role. 

Management - Enabling managers to identify those experiencing loneliness. Upskill managers to enable them to have honest wellbeing conversations to understand how employees are feeling both in and outside the workplace. Read the enabling and supporting staff to work from home web page for tips on supporting staff working from home.  

People and networks - Implementing networks to support remote working. Ensure there is a healthy mixture of work-related and social activities that are inclusive and accessible to all staff. This could be through encouraging team work on projects, regular social check-ins, and establishing staff networks covering a range of interests. It is also about creating opportunities for staff to connect one-to-one. Mentor/mentee programmes can often help staff establish meaningful relationships with colleagues.  

Work and workplace design - Use tools and systems to promote connections.  

Wider role in the community - Tackling loneliness beyond the immediate workforce. Personal circumstances are important to consider, and the issue of loneliness should be addressed holistically. Does your organisation provide the flexibility and work-life balance for employers to socialise outside of work? 

• The NHS Long Term Workforce Plan has emphasised the importance of retaining our valued NHS workforce. Employers should be looking at their wellbeing offer and critically evaluating the experience of staff through all stages of their careers. A positive staff experience and a rounded support offer are vital to encouraging staff to remain in the workplace.
• Mental health in the workplace infographic: Our downloadable infographic provides statistics and facts around mental wellbeing in the workplace. Employers can use the infographic to raise awareness of the importance of positive mental wellbeing at work, or as part of a business case to further your workforce mental wellbeing agenda. 
• Supporting the wellbeing needs of NHS staff | NHS Employers: This guidance supports NHS health and wellbeing, and staff experience leads to prioritise and meet staff wellbeing needs.
• Hierarchy of NHS staff needs: A downloadable Hierarchy of NHS staff needs poster that helps employers prioritise staff wellbeing.
• Access to Work Mental Health Support Service
• Anxiety UK website
• Better Health, Every Mind Matters
• Deloitte UK, Mental health and employers: the case for employers to invest in supporting working parents and a mentally healthy workplace, 2024
• End stigma and discrimination in mental health toolkit, World Health Organisation
• NHS Employers, Understanding workplace adjustments infographic
• NHS England, Looking after your team’s health and wellbeing guide
• NHS Practitioner Health
• Nurse Lifeline listening service
• Sickness Absence Toolkit
• SOM, Ten top tips for line managers in tackling work-related mental health
• Staff mental health and wellbeing hubs
• Suicide prevention and postvention
• Supporting mental health at work
• The Everything App - Free Fitness & Wellbeing for NHS Workers
• The Mental Health at Work Commitment
• The value of Occupational Health and Human Resources in supporting mental health and wellbeing in the workplace
• Thriving at work – The Stevenson/Farmer review of mental health of employers
• Unmind app
• Wellbeing at work, The Chartered Institute of Personnel and Development
• Wellbeing Toolkit
• Where next for workplace mental health: putting science to work