A GMB GUIDE MEntAl hEAlth @WORK

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Mental health is one of the hardest issues for any GMB Workplace Organiser to have to deal with. Unlike physical hazards to health and safety, mental health is not easily identified, is often misunderstood, and can be extremely difficult to talk to employers, fellow GMB members and work colleagues about. this guide has been designed as a one-stop resource to provide information on mental health conditions; give basic advice on tackling the issues and providing solutions; and outline ways to organise around mental health as a workplace health and safety issue. We know only too well that there has been an explosion in mental health problems since the world wide recession of 2007 –08 and the austerity that has followed. Mental health issues have become more widespread in society. At any given time, one in four people have a mental illness or condition of some kind. As a result, GMB health and Safety Reps often assist members who are experiencing work- related stress, anxiety or depression. this is now the case across every sector in the UK economy and every section of GMB. All workplaces – from care to construction – now have workers suffering mental health conditions. We know well that most GMB members find it hard to talk about a mental health problem or request advice and support. there is still a lot of stigma surrounding these conditions, and members fear for their jobs, fear for their reputations and fear for their relationships with their work colleagues. no one wants to be judged negatively or laughed at. GMB health and Safety Reps play a vital role in challenging employers, representing GMB members and being that first sympathetic ear to make your colleague or friend comfortable enough to tell you about their mental health issues. GMB will never expect you to be an expert on mental health. Your role, whether you are a GMB health and Safety Representative, Shop Steward, Workplace Organiser or just the friendly face who has been approached, is to signpost the GMB member to the specialist support that they need, and if you are a GMB health and Safety Rep, to negotiate with the employer to protect the GMB member and improve their lot at work. this guide will help you to do just that. But if you need more advice or support, the whole GMB family will stand with you and behind you. the more that GMB can do to help GMB members talk to their GMB Workplace Organiser the sooner they can get the help they need at work, and the easier it will become for issues to be raised in the future. that work starts here, with you.

Tim Roache, GMB General Secretary 1 SECtIOn OnE: WhAt • Work (or lack of) IS MEntAl hEAlth? • Money AnD WhY IS It An • Housing ISSUE? • Physical condition • Education and training (or lack of) There are two very basic facts about mental health that explain why GMB • Family and relationships has to challenge practice in the • Cultural, religious and societal workplace: pressures • 1-in-4 people suffer from a mental • Medical treatment health issue in any one year. It is essential to understand that a • 1-in-6 people at work are diagnosis of a mental health condition experiencing a mental health issue does not mean someone will always be right now. suffering from that condition. A Everyone has mental health, just like person diagnosed with a serious we all have physical health. Sometimes mental health condition may have a we feel good and sometimes we feel very positive mental health state. poorly. Our mental health matters just Likewise, someone in a very poor as much as our physical health. Poor mental health state may not have mental health has a massive effect on been diagnosed. our ability to take part in our work Because of this, GMB takes a whole- and wider society. Mental health will person approach to mental health – rise and fall over our lifetime, with taking into account the many different factors affecting our circumstances, work environment and state of mind. social issues alongside the presence or Like all health, mental health doesn’t absence of a medical diagnosis. always stay the same but changes as The other key issue to overcome is the life and circumstances change. stigma surrounding mental health Everyone has times when they feel issues. At work, and in society stressed, in low spirits or scared. generally it is often hard and These are often temporary periods, uncomfortable to discuss how people but sometimes it can take much are feeling. This can make it very longer to recover. Some people who difficult to identify the condition(s) are diagnosed with mental health that a GMB member is experiencing, conditions have to learn to manage and therefore the right support or them for the rest of their lives. The key adjustments that need to be made in factors include: the workplace. 2 To make sure GMB Health and Safety than conditions with psychotic Reps can give the right advice and symptoms. support, we first need to understand • psychotic: which are related to what we mean by mental health issues perceptions of reality and which may or problems. include hallucinations, delusions or WhAt ARE MEntAl hEAlth paranoia, with the person seeing, pROBlEMS? hearing, smelling, feeling or We know that one in four people believing things that no one else experience mental health issues at does. These symptoms are also some point in their lives. These range known as ‘severe mental health from the everyday concerns that we problems’. all experience, to longer-term serious WhAt ARE thE MOSt COMMOn conditions. The majority of people who MEntAl hEAlth pROBlEMS? experience mental health problems COMMOn MenTal healTh PROBleMS can get over them or learn to live with inCluDe: them – just as with physical health 1. anxiety problems. About one in a hundred Everyone occasionally experiences people will experience severe mental anxiety – feelings of tension, illness. uncertainty and fear. The uneasy ‘Mental health problems’, ‘mental feeling can be short term and mild, or illness’ and ‘mental ill health’ refer a prolonged and severe. If the anxiety range of medically diagnosed clinical remains severe for a longer period the conditions, such as: person may feel like they have no control over their own life. This can • depression, lead to paranoia and panic attacks. • anxiety, One in ten people suffer from prolonged anxiety. • psychosis, Anxiety is the primary symptom of a • bipolar number of conditions, including: • Schizophrenia. • Generalised anxiety disorder: Traditionally health professionals have feeling anxious for a long time and split mental health symptoms into two often being fearful; not anxious groups: about anything specific. This broad condition affects people in different • neurotic: which are related to ways. depression, anxiety and panic, and are also known as ‘common mental • Obsessive compulsive disorder: health problems’, though this does which is detailed later in this not mean that they are less severe section; and 3 • Post-traumatic stress disorder: sadness and helplessness. It can developing strong feelings of happen to anyone with around 1-in-10 anxiety after experiencing or people suffering from depression at witnessing something very any time. Depression can develop into traumatic. PTSD can cause physical effects such as disturbed flashbacks, where the individual sleep, lethargy or feeling achy or sore. affected relives the negative Severe depression, known as clinical experience and feelings again and depression can be life threatening, as again. it can evolve into suicidal feelings. In many cases, people may not realise People with anxiety disorders can how depressed they are, especially if experience a range of symptoms: they have been feeling that way for a • feelings of fear or dread long while. • feeling tense or ‘jumpy’ There are some specific types of depression: • restlessness or irritability • Seasonal affective disorder: • dwelling on bad experiences Linked to darkness and light, this • being paranoid and expecting the develops in the autumn and winter, worst to happen when days are shorter and the sun is lower in the sky. • inability to concentrate or focus due to the mind racing • Post-natal depression: It is estimated that as many as 85% • sweating, tremors and twitches of mothers experience the ‘baby • headaches, tiredness and disturbed blues’. In most case this goes away in sleep a few days. Post-natal depression is much more severe. It can occur • a pounding or racing heart between two weeks and two years • shortness of breath after the birth, and affects around 1- in-10 mothers. • stomach upsets and diarrhoea • Bipolar disorder: • needing to urinate more frequently. See section later in this chapter. Treatment must be provided by a • Dysthymia/persistent depressive competent mental health professional. disorder: Treatment options include counselling/ This is longer term (2 years plus) talking therapies and medication. mild-to-moderate depression. 2. Depression People with dysthymia often have Depression is the development of symptoms for many years before ongoing feelings of hopelessness, seeking medical help. Often those 4 people believe that is just how life is 3. Mixed anxiety and depression for them, and never seek help or disorder advice as a result. This is the most common mental health condition in the UK. More than Common symptoms of depression 10% of the population will experience include: symptoms at some point. It is where • lethargy the person displays symptoms of both anxiety and depression, but not to the • sadness degree that a specific diagnosis of • lack of self-confidence and self- either a depressive disorder or an esteem anxiety disorder can be made. • inability to concentrate Many people suffering from work- related stress display the symptoms • inability to enjoy life associated with mixed anxiety and • feeling guilty or worthless without depression disorder. Treatment is good reason to typically medication to treat the depression, and counselling/talking • feeling helpless and/or hopeless therapies for the anxiety symptoms. • difficulty sleeping However, some new antidepressants can treat both depression and anxiety. • isolating yourself from others 4. Obsessive Compulsive Disorder • taking little interest in your work (OCD) • loss of appetite OCD is one of the most misunderstood of all mental health conditions. Most • loss of sex drive people associate the condition with • physical aches and pains excessive cleaning and an obsessive need for tidiness. In actual fact, this • increased use of tobacco, alcohol or involves upsetting and repetitive drugs thoughts that come into the person’s • suicidal thoughts mind regardless of how ridiculous they may seem and no matter how hard the • self-harm. person tries to block them. Unlike in Treatment can include counselling/ psychotic conditions, the person talking therapies, prescription knows that the thoughts are their medication, brain stimulation therapy own. OCD is relatively rare, with only and light therapy. around 3% of the population experiencing the condition. Compulsions are actions which people have to do frequently to reduce their 5 anxiety and stop the compulsive NHS estimates that 10 million people thoughts. Performing the compulsion in the UK have common phobias such usually stops the anxiety for a while, as heights or spiders, but that only though the anxiety may worsen if the around 2% of people go on to develop person is interrupted or believes they panic disorders. did not complete the act properly. There are three types of phobia: Common obsessions include: 1 Social or situational: Anxiety about how the person is • fear of contamination perceived by others, or the fear of • fear of causing harm to someone being publicly humiliated. Common else or themselves phobias in this group include fear of flying, going to the dentist, or • an urge to cause harm to someone entering tunnels. • fear of behaving unacceptably – this 2 Fears of specific things: may be in a sexual or religious way Common phobias include the fear of • the need for symmetry or animals such as spiders or snakes; exactness. fear of environment features such as heights or falling into water; and Common compulsions include: physical things such as blood or • checking sharp objects. • counting or repeating a specific 3 Complex phobias: word or phrase These are a combination of fears, often situational – fear of leaving • cleaning home, or of being alone, or of • dressing rituals. confined spaces. Such complex phobias tend to be more draining on Treatment for OCD is usually a mixture the sufferer than single phobias, as of counselling/talking therapies and they are often constantly present in prescription medication. their lives (unlike say the presence 5. Phobias and panic attacks of snakes). These are a range of disorders that People with phobias may experience result in people becoming anxious in panic attacks when they are exposed specific circumstances and situations, to the trigger for their phobia and albeit ones that are not dangerous. cannot easily immediately get away. The anxiety is disproportionate to the actual danger posed, but the situation Panic attacks and panic disorder is either completely avoided (such as A panic attack is a sudden, severe and fear of heights) or just about overwhelming attack of anxiety and tolerated (such as fear of spiders).The fear. Symptoms include: 6 • Heart palpitations Treatments depend on the severity of the condition. Phobias are usually • Sweating treated by counselling/talking • Trembling and feeling shaky therapies with panic attacks and disorders treated by medication. • Dry mouth Anyone suffering a severe panic attack • Hot flushes may need first aid provision, especially • Chills if they hyperventilate or faint. • Shortness of breath SeveRe MenTal healTh PROBleMS inCluDe: • Choking 1. Psychosis • Chest pain Psychosis is when a person experiences things that are not real, • Sickness and have altered perceptions about • Dizziness the environment around them. Symptoms include: • Numbness • Hallucinations: • Pins and needles Hearing, seeing, smelling, feeling or • Feeling faint tasting things don’t exist. • Fear of death • Delusions: believing things that are clearly and • Fear of insanity demonstrably imaginary. • Feelings of abnormality, of being • Mind racing: outside yourself. Thoughts jumping from idea to idea, Panic attacks often result in making connections between hyperventilation – breathing very fast, tangents and otherwise unlinked which can in turn cause the individual concepts. to faint. Once the person has become Psychosis is not in itself a mental unconscious their breathing will health condition. Rather it is caused by normally go back to usual. other conditions. These range from About one in fifty people go on to other mental health condition such as develop a panic disorder, where they severe depression or schizophrenia; frequently have serious panic attacks. physical illnesses such as brain disease As there is often no specific trigger or Parkinsons’ disease; or as a result of for the panic attacks, sufferers may drug and/or alcohol abuse. become embarrassed and stressed People experiencing psychotic about attacks occurring, especially at delusions usually do not believe that work or in public. 7 the thoughts and experiences they • Increased self-confidence and self- have are their own. This is in contrast importance to OCD sufferers, who know they are • Poor judgement having irrational thoughts but cannot easily control them. • Greater risk taking Psychotic episodes are very rare, with • Heightened sex drive less than half of 1% of people ever • Abusing drugs or alcohol experiencing one. Even then, in 75% of cases, the psychotic condition is only • Aggressive behaviour temporary. • Sharper senses than usual. Treatment is extremely specialised, The depression symptoms are similar and depends on both the type of to those detailed earlier in this psychosis and severity of symptoms. chapter. 2. Bipolar disorder A medical diagnosis of Bipolar disorder Bipolar disorder is a condition where is usually made after a minimum of people experience extreme mood two episodes in which a person’s frame changes, from euphoria and mania to of mind and activity levels are depression. Most people will generally significantly upset. Someone with have periods of stability between undiagnosed bipolar disorder will these highs and lows, but bipolar typically experience one to two cycles disorder can result in psychosis in a year. some cases. There are several types of bipolar Most people with bipolar disorder disorder: experience periods of tremendous energy during euphoric highs, and 1 Type I: extreme tiredness and lethargy during Primarily episodes of mania, with depressive lows. less frequent episodes of depression. People may experience one or more of the following manic symptoms: 2 Type II: Primarily episodes of depression, • Extreme happiness and positivity with less frequent periods of mania. • Urgency and agitation 3 Cyclothymia: • Extreme irritability Regular but less severe mood swings, but still affecting daily life. • Racing thoughts 4 Rapid cycling bipolar: • Being distracted easily This is usually diagnosed if a person • Little need to sleep has frequent episodes in a 12-month 8 period. In rare cases, the change Treatment is usually a combination of from mania to depression can occur antipsychotic medication, counselling/ monthly or even weekly. talking therapies and cognitive behaviour therapy (CBT). Bipolar disorder is primarily treated through medication, usually OTheR TyPeS OF MenTal healTh antidepressants and/or PROBleMS antipsychotics. Other treatments 1. Self-harming include counselling/talking therapies Self-harming is a sign of mental health and brain stimulation therapy. problems, rather than a mental condition in itself. Methods of self- 3. Schizophrenia harm include: Schizophrenia is a mental illness that upsets thought processes. It often • cutting and slashing skins manifests in people in their teens or • burning or scalding early twenties. A diagnosis of schizophrenia means a person have • banging or scratching the body shown symptoms for more than a • breaking bones month before they sought the help of a medical professional. These • hair pulling or picking skin symptoms are classed as either • self-strangulation ‘positive’ or ‘negative’. • self-poisoning Positive symptoms are unreal or fantastic, and mirror those manic • Taking excessive levels of alcohol symptoms suffered by people with and/or drugs to hurt themselves. Bipolar disorder. Self-harming behaviour is not Negative symptoms reduce enjoyment necessarily suicidal behaviour, but in life, and may include these those who self-harm regularly are depressive symptoms detailed earlier most likely to end their own life than in this chapter. someone who does not self-harm. Other notable negative symptoms are: Treatment for self-harming forms part of the overall approach to the person’s • lack of motivation wider mental health conditions. It • sluggish and lethargic usually centres on counselling/ talking therapies and cognitive behaviour • not washing or cleaning therapy (CBT). • becoming withdrawn and socially Further treatment may be needed to isolated address the physical effects of self- • low sex drive. harm, such as scarring or burn treatment. 9 2. eating disorders needed for any physical harm caused Eating disorders occur for many by the pattern of bingeing and reasons, usually centred on a person’s purging. self-perception of their weight and 3. attention deficit hyperactivity body shape. disorder (aDhD) The two most common eating Attention deficit hyperactivity disorders are: disorder (ADHD) is a relatively new condition. It is the collective name for 1 Anorexia: This is a severe mental a range of symptoms, including health illness, where people severely hyperactivity, impulsive behaviour and reduce their body weight by an inability to concentrate. There is no extreme dieting, obsessively consensus on whether ADHD is a exercising, and using laxatives. mental health or developmental Anorexia sufferers generally condition, though present-day experience a negative self-image thinking is that adults can only have and very low self-esteem, and do not ADHD if it developed when they were accept that they should eat more or children. There is no single definition gain weight. The combination of high of ADHD, and no one set of criteria for exercise levels and minimal food a diagnosis of ADHD. intake mean they are often very tired, and suffer poor physical Treatment for ADHD is currently health. primarily medication to control the hyperactivity, with behavioural therapy 2 Bulimia: this is one of the most provided where appropriate. common eating problems. Bulimia is typified by person overeating to 4. Drug and alcohol dependency excess (bingeing), then purging, Substance abuse is the misuse of any either through making themselves drug that severely affects a person’s vomit or taking laxatives. As a result, physical and mental health. Alcohol people with bulimia normally dependence is the most frequent form maintain their usual weight range, of substance misuse at work, but any so they can hide their behaviour drug including legal highs, glue, from others. People with bulimia anabolic steroids and aerosols falls believe they cannot control their into this category. eating, and have a negative self- Most forms of substance abuse give image centred on their weight and the person a short-term feeling of body size. happiness (‘high’), but all cause long Treatment for eating disorders term harm to physical and mental focuses on counselling/talking health. therapies and cognitive behaviour therapy (CBT). Medication may be 10 Substance abuse is often rooted in the 5. Dementia person using drink or drugs as a Dementia is a chronic and persistent ‘crutch’ or ‘prop’, to help them through condition that degrades memory, hard and emotionally difficult times. problem solving, perception and Work-related stress can often be a language. There may also be changes trigger, though dependency develops in behaviour, mood and personality. It over a longer period when the affects 5% of people over 65, and one situation doesn’t change and the in 1,000 of people aged under 65 in the negativity remains. UK. Dementia is caused by damage to parts of the brain that deal with There is clear linkage between thought processes, resulting in the substance abuse and wider mental death of brain cells. It depends on the health condition. More than 1 in 2 parts of the brain that are affected as adults with alcohol dependency issues to the symptoms that are displayed. also self-identify as having mental health problems. In addition, it is The damage could be the result of a estimated that between 1/2 and 1/3 of number of factors: all people with severe mental health • A medical condition such as a brain problems take mind-altering tumour, Parkinson’s disease or substances to problematic levels. Huntingdon’s Disease; Substance abuse issues are normally • A head injury; treated by specialist drug and alcohol rehabilitation services. Treatment for • Infection; substance abuse is complex and • Vitamin B deficiency; depends on the underlying issues that the person may have. This often • Excessive alcohol abuse. includes medication, particularly if the The most common form of dementia is person is withdrawing from an Alzheimer’s disease. This is primarily addiction; counselling/talking caused by the aging process, though therapies, both short and long term; no one knows exactly what causes and periodic monitoring to ensure dementia. It is known that vascular that progress is maintained. dementia, where reduced blood flow kills brain cells, is the key cause of most forms of dementia. As a result, most types of dementia cannot be cured. In some case, Vitamin B deficiency can be treated, and some serious head injuries do heal, but in most cases the effects are permanent.

11 Treatment for dementia therefore some kind. There are GMB members in centres on adjusting to the symptoms. every branch and at every workplace There is no medication that will affected by mental health problems. reverse the symptoms, though some Understanding the issues facing medicines may slow the onset of people with mental health problems, symptoms, especially in the early and the need for employers to make stages. reasonable adjustments in the A 2014 report by the Alzheimer’s workplace to accommodate them is Society found that nearly 90% of vital for GMB Health and Safety employers anticipate dealing with Representatives. increasing dementia at work as GMB members with mental health retirement ages rise. However, the conditions may: report also showed that employers are unlikely to make reasonable • Encounter discrimination at work adjustments to allow those with • Be perceived negatively because of dementia to keep working. Instead, their condition (mental health most employers would either seek stigma) termination of employment on capability grounds, or offer early • Feel unable to tell their employer, retirement. colleagues or GMB about their condition WhAt MAKES MEntAl hEAlth A GMB ISSUE? • Not understand their rights at work Mental health is an issue that cuts • Need help in negotiating across a whole range of GMB adjustments to their work activities: • Be bullied or harassed because of • health and safety; these issues • equality issues; In all of these instances, GMB is there • ill health; to ensure that GMB members are not alone in dealing with their issues at • learning and training; work. There may be common issues • conduct; arising which can create a collective campaign to raise awareness of • performance management; mental health conditions, and fight • workplace relationships; against discriminatory behaviours where they exist. GMB members with • workplace democracy mental health conditions and issues Almost all of us will know someone at will feel more supported if there is work with a mental health condition of open support from their GMB Health 12 and Safety Representative and their GMB branch to tackling mental health SECtIOn tWO: WhAt at work. DOES thE lAW SAY? GMB is continually campaigning for There are two specific pieces of better policies on sickness absence legislation that cover mental health management and disability, regular at work. The equality act 2010; and monitoring of mental health levels, the health and Safety at Work act mental health and stress risk 1974. The equality act 2010 protects assessments and proper joint training people from being discriminated for managers and GMB members on against due to disability; the health mental health issues. It is critical that and Safety at Work act 1974 places a GMB is there to represent and win for duty on the employer to protect the GMB members with mental health mental health of anyone who works issues who want to keep working but for them. face huge challenges in doing so. Mental health problems are covered by GMB also has a vital role to play in disability under the Equality Act. In resisting Government austerity Northern Ireland, it is the Disability policies that result in increased stress Discrimination Act 2008 (DDA) that is and mental health issues whilst in force, rather than the Equality Act. cutting back on mental healthcare This guide will only cover the Equality provision. As the NHS budget is cut in Act and Health and Safety at Work Act. real terms each year, Mental Health Detailed advice and guidance on the Trusts are losing specialist nurses with situation in Northern Ireland should the vacancies never filled. These are be sought from GMB’s North West and critical roles that need specialised Irish Region. training, so each nurse who moves on leaves a number of patients with 1. thE EqUAlItY ACt 2010 complex mental health issues who will The Equality Act 2010 protects people not get the support that they need. who have or have had a disability in the past. This includes protection where they are perceived to have a disability or are associated with a disabled person. Under the Act, a person is deemed to have a disability if they have physical or mental impairment which has “a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities”.

13 The Act does not define impairment To help decide this, the Tribunal but it can include the effects of or identified five questions: symptoms of any condition or illness, 1 Was there an impairment at some including the side effects of any stage? medication or treatment. 2 Did the impairment have a The other key word in the law is substantial adverse effect on the “substantial”. This means it is more applicant’s ability to carry out than trivial, and therefore has a normal day-to-day activities? pronounced effect on the ability to do daily tasks. Working out whether the 3 Did the impairment cease to have a impairment has a substantial adverse substantial adverse effect on the effect means comparing the way the applicant's ability to carry out person carries out an activity with the normal day-to-day activities, and if impairment and the way they would so, when? carry out the activity without the 4 What was the substantial adverse impairment. It is about their effect? capability, not a comparison with any other person. 5 Is that substantial adverse effect likely to recur? “Long-term” is also defined, and means likely to or has lasted for 12 The UK Government Office for months or more. This can include Disability Issues Guidance lists the unstable or periodic conditions such following specific mental health as depression. conditions as being covered by the Act: Day-to-day is not defined in the Act, nor is there a list of capacities that • Anxiety may be affected. What should be • Low mood assessed is what the person cannot do, not what they can do. • Panic attacks An Employment Appeal Tribunal case • Phobias in 2004 identified that the question is • Unshared perceptions not whether the illness is likely to recur but whether at some stage the • Eating disorders substantial adverse effect on normal • Bipolar affective disorders daily activities will recur. • Obsessive compulsive disorders • Personality disorders • Post-traumatic stress disorder

14 • Some self-harming behaviour • Indirect – where an employer applies a policy, procedure or practice that • Depression is discriminates against anyone with • Schizophrenia disabilities. The employer can legally justify indirect discrimination if it is The Act does not cover addiction to a “proportionate means of achieving drugs or alcohol, aside from where a legitimate aim”. There is no addiction to prescription medication definition of legitimate aim in the results from treatment of a condition Act but it could include: listed above. GMB Health and Safety Representatives will therefore need to • the health and safety of staff or ensure that drug and alcohol abuse is people using a service covered in any mental health policy • the business needs of the negotiated. employer or service RiGhTS anD DuTieS unDeR The • needing to make a profit. equaliTy aCT 2010 It is illegal under the Act to: Proportionate means that there should be a fair balance between the • discriminate against a worker employer’s needs and the rights of the because of a mental disability or disabled person. The burden is on the • fail to make reasonable adjustments employer to show that the to accommodate a worker with a unfavourable treatment was disability. objectively justified. The Act defines a number of types of DiSCRiMinaTiOn aRiSinG FROM discrimination: DiSaBiliTy This is where a disabled person is given • Direct – where an employer, because adverse treatment because of of someone’s disability, treats them something connected to their worse than they treat or would treat disability. As with indirect others. discrimination, the employer can claim The unfavourable treatment does not that the treatment was ‘proportionate have to just be connected to a to achieving a legitimate aim’. The person’s own disability; it could be employer can also claim in their because someone is associated with a defence that they didn’t know (or person with disability, such as a carer. couldn’t reasonably be expected to know) that the person was disabled. The unfavourable treatment does not However, the employer should take have to just be connected to a reasonable steps to explore with the person’s own disability; it could be worker whether any difficulties are because the employer believes that they are disabled even if they are not. 15 because of the consequence of a haRaSSMenT disability. This is unwanted behaviour relating to a person with a disability. The FailuRe TO Make ReaSOnaBle behaviour results in creating an aDJuSTMenTS environment which is: An employer has a duty to make ‘reasonable adjustments’ – changes • hostile, that make it easier for the disabled • intimidating, person. The Act does not provide a specific list of adjustments, but • offensive, common changes include: • humiliating or • changing equipment • degrading • providing aids – including extra The behaviour therefore violates the support and equipment dignity of the person with a disability. • changing the location of work viCTiMiSaTiOn • changing policies and procedures The Act protects people from being victimised if they make allegations • allowing extra time off work about discrimination. The protections • allowing flexible working extend to anyone who supports them in making their allegations, such as a • changing the worker’s role or parts GMB Health and Safety Representative. of the workers’ role A detriment is defined as ‘something • offering counselling/talking that the individual affected might therapies or mentoring. reasonably consider changes their position for the worse’. When deciding what is reasonable, an employer can take into account: 2. thE hEAlth AnD SAfEtY At WORK ACt 1974 • the size of the organisation and its Section 2 of the Health and Safety at financial situation Work Act 1974 places a duty on the • the cost of making the change employer to protect the health and safety of anyone who works for them. • how helpful the adjustment would be This includes both physical and mental to the individual health, though it is only the risks • how practical it is to make the caused by work activity that the change. employer can and must control. In practice, the employer will primarily The employer cannot charge the be concerned with managing work- worker for making the changes. related stress.

16 WORk-RelaTeD STReSS anD The laW 3 the employer’s actions actually There is no specific legislation caused any injury; covering stress at work, though GMB 4 the harm from the actions was has long campaigned for specific foreseeable; and regulations covering stress management. 5 the negligence resulted in actual physical, mental or financial A 2010 employment appeal tribunal damages to the person. ruling determined that stress itself does not fall under the disability The Safety Representatives and Health criteria in the Equality Act 2010, due and Safety Committee Regulations to the short length of the ill health. In 1977 give safety reps the right to practice this means that adverse investigate and tackle workplace reactions will need to be ‘long term’ – stress. This includes the right to: more than 12 months before falling • inspect the workplace under the Equality Act 2010. • investigate potential hazards However, the Management of Health and Safety at Work Regulations 1999 • talk to GMB members requires employers to carry out • be consulted about the employer’s suitable and sufficient risk health and safety arrangements. assessments. The employer must then identify and implement actions to prevent or to reduce risks. This includes risks to mental health. The Enterprise and Regulatory Reform Act 2013 amended the Health and Safety at Work Act 1974 so employees now have to prove that the employer was negligent and that the negligence caused the injury. To prove negligence, the GMB member will need to demonstrate their claim passes five key tests: 1 the employer had a duty of care towards them; 2 the employer did not take reasonable care to fulfil the duty;

17 • you agree an action plan with the SECtIOn thREE: GMB members YOUR ROlE AS A GMB • you maintain detailed and REpRESEntAtIvE confidential case notes Representing GMB members with • you understand the GMB member’s mental health issues is one of the mental health condition and how it hardest things any GMB affects the way the case is handled representative can do. employers are • you negotiate reasonable often ignorant, aggressive in their adjustments needed to participate approach, or unhelpful in their in informal and formal meetings attitudes. The members themselves with your employer may be angry, upset and frightened. it can be emotional and challenging, • you discuss and agree any but the rewards of a job well done additional support for the GMB cannot be measured. member It is critically important to remember • you identify any external support your role as a GMB rep. You are there that may be available. to give representation to our 1 you notify your GMB Regional members on employment issues, and Organiser, as the issue may develop to signpost GMB members to qualified into a discrimination case. competent medical help, whether it is their GP, or specialist mental health provider. It is not your role to offer Your initial role should be to: counselling/talking therapies or • Listen and take note of the GMB medical advice. You cannot solve the members’ concerns, letting the GMB GMB members’ mental health issues, member guide the conversation. but you can help them to get the Offer initial advice only as the action specialist support that they need. they are seeking may not be immediately clear. CaSeS RelaTeD TO MenTal healTh • Outline how the issue can be taken iSSueS Can Be ChallenGinG. iT iS forward with the employer, either iMPORTanT ThaT: through existing grievance • Both you and your members procedures or health and safety understand your role – what you avenues. can and can’t do • Provide GMB representation at any • you agree who is involved in the formal or informal meetings the case and confidentiality boundaries GMB member has, particularly grievance or disciplinary hearings. 18 • Consider whether there is a wider that the GMB member urgently issue in your workplace that may receives specialist help. affect other GMB members. The mental health charity Mind • Involve others when needed. This provides guidance on how to help may include escalating the matter someone who is suicidal. The key to your GMB Regional Organiser or messages are: Regional Health and Safety Officer; • always take the threats seriously the employer’s occupational health provider or Employee Assistance • Try not to act shocked and actively Programme; or other external demonstrate that you are sources of assistance wherever concerned appropriate. • Try to identify where proper • Understand your limitations and support can be accessed – competence. Assess whether you encourage the GMB member to call need help from your GMB branch, the Samaritans (116 123), nhS Region or National Office. Direct (111), or contact their GP. if you are close to a hospital they can Sometimes the GMB member will not go to the accident and emergency want to take matters further, but will (a&e) Department. be glad to have spoken to GMB. This is perfectly within their rights, which is • Do not handle the situation by why discussion and consultation are so yourself important before agreeing on a you must make sure you inform course of action. In the same way, GMB someone else in the GMB branch or is not obligated to support GMB Regional/national Office as this is a members who reject competent difficult situation for you to handle advice offered in good faith. alone. hanDlinG exTReMe ReaCTiOnS lOOKInG AftER YOU AS A GMB it is very rare for GMB members to REpRESEntAtIvE react badly, but you should be It is perfectly natural for you to worry prepared for difficult conversations, about your GMB members’ health. You which may include threats to self- may well offer more support initially harm or for the GMB member to kill than you can manage in the longer themselves. term. You may want to share your personal contact details, but make it There is no easy way to deal with clear that there will be times when you situations like this, but the most are not available, such as evenings and important thing is to be weekends. compassionate, and to make sure 19 If the GMB member does self-harm or rep you can raise with the employer threaten suicide, you may feel a range any adjustments that may be needed. of emotions. It is natural to feel guilty, Be honest – if you do not know what to upset or angry with the person who is say to that person about their health considering ending their life. You may or how to respond – say so. No one can feel that what is going on for the expect you to be an expert on mental person is in some way your fault. If you health. It is much better to be upfront do feel like this, you must talk to about your competence and someone you trust about how you feel. limitations than raise false GMB will always give you the support expectations on what you can do. you need in such situations, so make sure you contact GMB to discuss your The GMB member needs to know you circumstances and to get help. are there to support them at work, but they may need to guide you in It’s understandable that you may understanding their condition and blame yourself, but there is only so issues. Don’t be afraid to talk to the much help, advice and support that GMB member about the language they you can give. Talking about how you want to use to describe their mental feel doesn’t make you a weak person. health. The member may well talk Not being able to resolve a GMB about themselves in ways that cause member’s mental health issues offence if said by others. This is often a doesn’t make you a bad method of coping with expected representative. You can only do your stigma from colleagues. Just because best. It is absolutely vital that you look someone describes themselves as after your own health. If you don’t ‘mad’, it doesn’t mean that they want want to speak to GMB about the other people to refer to them like emotions you may be experiencing, that. there are other options for support: It may be difficult for the GMB • talk to a friend or family member; member to explain what their issues • seeking professional advice or are, and what they want you and GMB counselling/talking therapies; to do. It may take time for you to listen and understand where they are • go to a support group or get coming from. Try to avoid leading the support from a carer’s organisation GMB member by suggesting or Your role is to ensure their issue is not defining what the problem is. This may being caused or made worse by work, undermine the GMB members’ and whether changes or reasonable confidence in the process. The crucial adjustment may enable them to thing is to listen to the GMB member continue to work. In your role as GMB and base your analysis on their responses, rather than making 20 assumptions on what their health well negotiated trade union facilities issues are from your own experience agreement should address these or what you have picked up from the issues, and GMB Health and Safety media. Representatives should have access to facilities such as a locked office space You must avoid giving advice or your and use of the employer’s network and opinion on the GMB member’s health email servers as part of their role. or the strength of their case. You are not in a position to judge their state Almost all casework will involve of mind. If the GMB member handling and processing data of some themselves states that they are not description, whether printed well, it is right to encourage them to materials or electronic documents. All seek medical advice. GMB Health and such records must be kept securely, Safety Representatives are not either in a locked cabinet, on an medical professionals, and it is not encrypted memory stick, or in a appropriate to offer direct medical password protected cloud storage diagnosis or advice. system such as DropBox. Bear in mind that some mental health REpRESEntInG GMB MEMBERS WIth conditions might make it hard for the MEntAl Ill ISSUES In GMB member to make consistent DISCIplInARY pROCEDURES decisions, or to consider options on an The development of a mental health even keel. However, not all condition may result in a GMB member disagreements will be due to their being disciplined at work. Under the mental health condition. It is Equality Act 2010, the employer must therefore vital to keep notes to not discriminate against a disabled outline and clarify decisions and next person in the way it develops any steps. procedure or follows the disciplinary process. This includes an employer’s You must also maintain the GMB procedures for dealing with both members’ confidentiality at all times, conduct and capability. Changes to particularly if you receive any medical disciplinary procedures to information which the GMB member accommodate workers with mental may wish to share. Representing GMB health conditions would be a good members on mental health issues example of reasonable adjustments almost always involves handling under the Act. sensitive information which is given in strict confidence. When GMB members with mental health problems are subject to This raises a number of issues about disciplinary action, GMB handling any case, especially around representatives should ask a number storing information, and the location of key questions: of meetings of a sensitive nature. Any 21 • Is the member’s mental health misconduct deliberately and problem the true reason for knowingly, being fully aware of their disciplinary action? This could be actions and the consequences. The EAT direct discrimination. suggested that employers should ask “Does the employee’s mental health • Does the employer see the GMB problem affect their ability to control member’s behaviour as a their actions?”. disciplinary issue? The tribunal decision confirms that • Does the GMB member have employers should consider reasonable mitigating factors due to their adjustments to support people at mental health condition? work, even if their behaviour would • Does the employer accept that the normally be classed as gross GMB member has a mental health misconduct. condition, and as such is covered by GMB neGOTiaTinG On ReaSOnaBle the Equality Act 2010? aDJuSTMenTS • Is the GMB member being The starting point is to ask the GMB disciplined for attendance or member if they require any sickness absence issues due to their adjustments. It may not be obvious, mental health condition? and letting them explain what they want will help them to feel in control • Has the employer made reasonable of the process. adjustments? Do they actually benefit the GMB member? The GMB member does not legally have to tell the employer that they have a • Would the disciplinary process treat disability. However, if a GMB member the member differently if they did wants their employer to make not have a mental health condition? reasonable adjustments then the GMB This could be indirect member should inform the employer. discrimination. Otherwise, the employer can claim An employment appeal tribunal that they were not aware of any judgement in 2014 determined that disability. for an employer to dismiss on grounds Where the GMB member has identified of gross misconduct, there must be that they may need mental health blame on the part of the employee. It support, and has made the employer is important for employers to take aware, GMB representatives can ask mitigating circumstances into the employer to make reasonable account, such as the employee’s adjustments such as: mental health. • Providing specific or adapted The employer should question whether equipment the employee had committed the 22 • Adjusting working hours • occupational health provider; and • Allowing more frequent breaks than • other union reps, who may have others: examples of good practice. • Providing mentoring At all times, the duty to determine reasonable adjustments lies with the • Rearranging work duties, by giving employer. tasks to colleagues and assigning new work, so long as the member Changes to safety and or occupational agrees. health policies should include: • Giving additional training • Information regarding training of staff including those with • Redeployment into a different role management or oversight Any proposed adjustments must be responsibilities on managing endorsed by the GMB member before disability. This must identify they are put to the employer. Such behaviours which may indicate a changes need to be carefully mental health condition. negotiated to ensure that colleagues • Disability awareness training for all are not disadvantaged and any new employees. arrangement is agreed by all parties, particularly the GMB member. The neGOTiaTinG On WORk-RelaTeD adjustments do not need to be STReSS expensive or complicated, and may Your employer has a legal duty to only be needed temporarily. manage and reduce the risk to mental health caused by work-related stress. It is however crucial that specialist advice is sought when agreeing As there are no specific regulations on workplace adjustments, so that there managing stress, the employer has a is a good understanding of the free hand on how they tackle the individual’s specific requirements. issue. They must assess the risk to workers of developing stress, and Sources of advice and information on implement control measures to ensure what adjustments may be required the risk is reduce to the lowest level and for how long include: achievable with the resources that • the GMB member; they possess. • their GP, potentially through In practice, the best way to assess the information given in the Fit for Work issue is to use the HSE’s Stress Statement (‘Fit Note’); Management Standards. These are voluntary, but provide a clear • Specialist mental health support the framework for assessing causes of individual may be receiving; 23 stress and identifying concerns. The 3. Support six management standards are: This includes the encouragement, sponsorship and resources provided 1. Demands by the organisation including line This includes workload, work management and colleagues. environment and work patterns. Workers should be able to The accepted standard is that demonstrate that they receive employees indicate that they are able adequate information and support to cope with the demands of the job; from superiors and fellow workers; and and systems are in place, at a local systems are in place to deal with level, to respond to any individual individual concerns. concerns. To achieve this, your employer has To achieve this, your employer should policies and procedures in place to provide workers with adequate and properly support workers; systems are achievable demands in relation to the in place to enable and encourage agreed hours of work. It should ensure managers to support staff; systems that peoples’ skills and abilities are are in place to enable and encourage matched to the job demands and that workers to support their colleagues; jobs are designed to be within the workers know what support is available capabilities of the worker. and how and when to access it; Management should ensure that any workers know how to get the concerns that employees have on their necessary resource to do their job; work environment are addressed. and workers receive regular and 2. Control constructive feedback. In effect, how much say the worker 4. Relationships has in the way they do their job. This includes promoting positive The accepted standard is that a working attitudes to avoid conflict and worker can have a say about the way dealing with unacceptable behaviour. they do their work, and systems are in The accepted standard on this is that place to respond to their concerns. workers indicate that they are not To achieve this, where possible, subject to unacceptable behaviour, workers should have control of the such as bullying at work; and systems pace of work and employees are are in place to respond to individual or encouraged to use their skills and collective concerns. initiative when doing their job; workers To achieve this, your employer must are encouraged to develop new skills promote positive behaviour at work to to help them with challenging aspects avoid conflict and ensure fairness; of work; Workers are consulted over workers share information relevant to their work patterns, and have a say their work; The employer has agreed when breaks can be taken. 24 procedures and policies in place to and systems are in place to respond to prevent or resolve unacceptable individual concerns. behaviour; systems are in place to To achieve this, the employer provides enable and encourage managers to workers with timely information to deal with unacceptable behaviour; and enable them to understand the systems are in place to enable and reasons for proposed changes; the encourage workers to report employer ensures adequate worker unacceptable behaviour. consultation on changes and provides 5. Role opportunities for workers to influence This is where people understand their proposals; workers are aware of any role within an organization, and possible impact of any changes to management ensures that there are their jobs. If necessary workers are no conflicting roles. given training to support any changes For this standard workers indicate to their job; workers are aware of that they understand their role and timetable for changes; and workers responsibilities; and systems are in have access to relevant support place to respond to individual during changes. concerns. GMB along with many other unions To achieve this, the organisation believes a seventh factor should also ensures that the different be measured. This is ‘Fairness’, which requirements it places on workers are tests the degree to which all workers compatible, and provides information are treated equally, and the to enable workers to understand their mechanisms by which justice at work role and responsibilities; the employer is decided and administered. ensures that, as far as possible, the GMB Health and Safety requirements it places upon workers Representatives should always are clear; and systems are in place to encourage their employers to use the enable workers to raise concerns Stress Management Standards as the about any uncertainties or conflicts basis for assessment. This gives a they have in their role and consistent approach which can be responsibilities. followed across businesses and 6. Change organisations. How organisational change is managed GMB must be involved in the and communicated in the introduction of the standards at every organisation. stage. Without proper consultation The accepted standard is workers and involvement from GMB the indicate that the organisation standards are unlikely to reduce work- engages them frequently when related stress. undergoing any organisational change; 25 neGOTiaTinG a MenTal healTh health issues. It is a three staged POliCy approach: Working with management and Stage One identifies the presence or Occupational Health staff to improve absence of known causes of workplace health and safety standards can be stress by interviewing a particularly beneficial when dealing representative sample of employees with mental health issues. A joint within the organisation using an audit committee off the main Health and tool. Safety Committee can assist with working together. Stage Two investigates in more detail the main areas of concern in order to If the employer does not believe that identify the specific risks to mental mental health is a workplace health health and generate practical risk and safety issue it will be difficult to reduction interventions. make any improvements. Even if there is a paper policy and risk assessments Stage Three evaluates the impact of these could just be paying ‘lip service'. the interventions and risk reduction Getting the employer to work with you strategies. can prove difficult. You need to find Audits can be done by in-house your allies within the workplace; these experts such as Occupational could include Occupational Health Psychologists however, most staff or even Human Resources – organisations do not have this in arrange to meet with these people to house expertise and may have to call discuss how to move forward on on external stress audit providers. mental health issues. Whilst a stress audit is not a legal There are a number of elements to requirement, it can be a useful tool to negotiating a mental health policy. establish the causes of workplace Your action plan should include stress and help employers comply with implementing a mental health and the legal requirements to carry out stress audit; developing specific stress risk assessments. and mental health policies; and stress risk assessments. If an audit is carried out, GMB Health and Safety Representatives should be a Mental health and Stress audit fully consulted on the implementation A mental health and/or stress audit is of such an audit. Audits should focus designed to measure levels of stress on the organisational factors which within a particular group of employees cause stress rather than individual or across the entire organisation. The factors. Audit is a tool used to identify and manage workplace stress and mental

26 Mental health/Stress Policy • An outline of the responsibilities for Workplace policies on stress and all levels of managers and mental health are a good starting supervisors within the organisation point. These can be two separate alongside a commitment to train all policies, or a single mental health managers and supervisors in good policy with a focus on stress. A good management techniques. policy should contain the following: • A commitment to that recruitment • A written commitment from the and selection activities will support employer stating that he/she and provide reasonable adjustments recognises mental health as a health for applicants with mental health and safety issue and is committed to issues. preventing workplace stress. • An outline of the role and functions • A clear definition of mental Health of GMB Health and Safety issues beyond stress and anxiety. Representatives and the Health and Safety Committee in relation to • Links to other policies and mental health issues. procedures, such as: • An outline of the role and • performance management responsibilities of Human Resources • disciplinary and Occupational Health in relation to managing mental health issues • capability and stress risks. • sickness absence • A list of key contacts internal and • grievance external to the employer, who can be contacted for advice or support. • drugs and alcohol • Be signed by the Employer. • bullying and harassment • Apply to everyone in the • flexible working organisation. • disability leave GMB Health and Safety • career breaks Representatives must be consulted on the contents of any stress policy and • training and development have the opportunity to comment and • An outline of systems in place to make suggestions for change. prevent and reduce mental health COlleCTive aCTiOn risks and workplace stress e.g. risk There are a number of things that you assessment and bullying and can do collectively in your workplace harassment policies, and compliance to take a stand on mental health with legislation. issues. Mental health and stress 27 referrals should be tracked by the workplace Health and Safety Committee, and increases should be raised for investigation. You should raise this collectively with the employer (being mindful of individual confidentiality), seeking to identify and tackle the root causes. You could also consider running a mental health awareness campaign. There are events each year such as World Mental Health Day, Mental Health Awareness Week, and European Depression Day that activities can be organised around.

28 GMB hEAlth AnD SAfEtY REpS ChECKlISt

Does management acknowledge that mental health □ Yes □ No is a workplace issue? Are there workplace policies on mental health and stress? □ Yes □ No Do risk assessments include stress risk assessments? □ Yes □ No Are GMB Health and Safety Reps involved in the risk assessments? □ Yes □ No Does management use the HSE Stress Management Standards? □ Yes □ No Is there an open and transparent procedure for raising concerns? □ Yes □ No Does the employer make reasonable adjustments for any □ Yes □ No worker with a mental health condition?

This list is not exhaustive and there may be a need to raise other concerns with management or involve your GMB Regional Health & Safety Officer.

29 GMB –EXPERTS IN THE WORLD OF WORK It can be as simple as a new manager, or a new way of working that causes you a problem at work. Guard against that day by joining GMB now. GMB membership covers you wherever you work. Only GMB members get GMB help. IF YOU WORK YOU NEED GMB@WORK Join now at www.gmb.org.uk/join or fill in the form below then hand it to your local GMB representative, or post it – simply write FREEPOST GMB on an envelope – you don't need a stamp or any other address details. If you have any questions contact GMB: email [email protected] or visit our website www.gmb.org.uk

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