Article

Mental health in the workplace

Tools and resources to help you make positive improvements to mental wellbeing in the workplace.

15 August 2022

The World Health Organisation (WHO) defines mental health as a state of mental wellbeing that enables people to cope with the stresses of life, realise their abilities, learn well, work well and contribute to their community. Fluctuations in mental health during our lives is normal, and recovery from mental ill health is more likely when people receive the right help at the right time. According to NHS Digital, mental ill health accounts for over 20 per cent of sickness absence in the NHS. 

The British Medical Association (BMA) states 9 out of 10 people who experience mental health problems say they face stigma and discrimination as a result. NHS trusts should have supportive initiatives in place to ensure staff mental wellbeing in the workplace, and to maintain the quality of patient care.

This web page provides guidance on what organisations can do to tackle some of these issues. 

Facts and figures

Our infographic provides a range of up-to-date key statistics and facts about mental wellbeing in the workplace. Employers can download the infographic to raise awareness on the importance of positive mental wellbeing at work, or as part of their business case to further the workforce mental wellbeing agenda.

Supporting your staff

It is vital that staff understand the factors that affect mental health, and have regular wellbeing conversations with their managers. Managers must also have the right skills to support their staff and be able to respond compassionately to individual needs. In addition, leaders have an important role in reinforcing positive attitudes, shifting mindsets and influencing organisational culture through modelling positive behaviours. Organisations can help facilitate this by:

  • raising awareness
  • educating their people
  • having the right resources in place to encourage open conversations
  • beating the stigma about mental health.

Understand the risk factors to mental health

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 on the mental health of NHS staff, particularly in the height of the COVID-19 pandemic.

Embed protective factors

Protective factors help negate the risk factors to 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.
  • 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.

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.

Supporting our NHS people with moral injury

What is moral injury?

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. It can occur when staff feel they have done something they should not have done; did not do something they should have; or were betrayed by others (often a higher authority).

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 link between moral injury and poor mental health

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.

How can NHS organisations support their staff?

  • 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.

Ways leaders and line managers help reduce the risk of moral injury

  • 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.

Addressing workplace loneliness 

The Mental Health Foundation outlines that there are strong links between loneliness and mental health. Furthermore, research by Young et al (2021) demonstrates that workplace loneliness is harmful to both employees and employers, and can negatively impact on staff engagement. Organisations should actively ensure staff can form healthy long-term relationships with their co-workers. The Campaign to End Loneliness advises on five key factors to address to achieve this: 

  1. 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. 
  2. 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.  
  3. 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.  
  4. Work and workplace design - using tools and systems to promote connections.  
  5. 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? 

For further details, read the government's Employers and Loneliness Guidance.  

Further resources