Workplace wellbeing in a time of austerity
Therapy Today, December 2015, Volume 26 Issue 10

Bina Convey reports on a rising tide of workplace mental ill health and how employers are turning to counsellors to cut the costs of sickness absence.

Wellbeing is more than just a popular buzzword in the corporate world right now; it has become a fast-growing business in its own right, and one in which counsellors can play a key role.

A recent flurry of activity around mental health in the workplace includes last month’s Good Day at Work Conversation – an annual wellbeing conference for business leaders – where motivational speaker John McCarthy, kidnapped and held by Islamic jihad terrorists in the Lebanon from April 1986 to August 1991, talked about bullying, survival and resilience. Meanwhile Mind is to launch a Workplace Wellbeing Index in early 2016 in which it will publicly rank employers on their efforts to tackle what has become both a moral and an economic issue.

Numerous factors have contributed to increasingly pressurised work environments over the last decade. Despite an economic upturn in the last two years, an austerity-driven economic climate has led to cost-cutting in both the public and private sectors; doing more for less has become the norm, as has a culture of high expectations linked to performance targets. Technology has also played a part in blurring the lines between work and leisure, with smartphones ensuring employees remain constantly ‘logged on’ to work, with the effect that many find it difficult to mentally switch off.¹

There is nothing like an economic crisis to make business and government sit up and listen. A report published last year by the Chief Medical Officer Dame Sally Davies² put mental health issues at work firmly on the agenda and called for ‘urgent measures’. The report revealed that mental health-related absence in the workplace is rising, with the number of days lost to stress, depression and anxiety up by 24 per cent since 2009, at an annual estimated cost of £100 billion a year in working days lost to mental ill health.

The way employers view workplace wellbeing is evolving, according to Emma Mamo, Head of Workplace Wellbeing at Mind: ‘The focus is shifting from the reactive management of sickness absence to a more proactive effort around employee engagement and preventative initiatives.’ This, says Mamo, has led to a rapid increase in employers requesting training and resources – an area where counsellors can play a vital role.

The corporate world is playing catch-up with the public sector, which has long recognised the need for employee wellbeing policies, particularly in sectors with a high-stress element such as the NHS, police and social services. Unsurprisingly, stress in the public sector is being compounded by austerity measures, with poor sleep, headaches, stress-related mental health issues and digestive problems among the problems reported by over a third of public sector workers surveyed earlier this year.³

More private companies are promoting resilience measures, from city firms, such as Goldman Sachs and JP Morgan, investing in mindfulness training for their staff, to the increasing uptake of Employee Assistance Programmes (EAPs). An EAP offers employers a package of resources, including workshops and face-to-face, online and telephone counselling. The UK EAP market, worth over £69 million, has grown significantly. According to the UK Employee Assistance Professionals Association (EAPA), the number of employees with access to an EAP has grown from 8.2 million to 13.8 million in just five years. EAP providers argue that this increase reflects a change in organisations’ human resources strategies, rather than a surge in mental health problems in the workplace.

Andrew Kinder, Chief Psychologist at OH Assist and Chair of EAPA, says the human resources function with organisations has become less about people and more about transactions between departments: ‘HR has changed; HR departments have become more strategic business partners with business objectives and less about the human elements. They have outsourced this element to EAPs with 24-hour helplines, but there are also a lot of hybrids where you will have a counsellor that has a face within the organisation.’

There may be a lingering stigma surrounding mental illness, but there has been progress in the last decade. One view is that a greater willingness to talk about mental health has given rise to a sense of wellbeing as a human right: ‘There is no stress epidemic, there is just a growing sense that people want things to be OK and are less willing to cope with the slings and arrows of life,’ says Kevin Friery, Clinical Director of Right Management Workplace Wellness.

Research by Right Management Workplace Wellness found that the majority of cases of depression and anxiety among their clients’ workforces were due to personal reasons rather than work issues, although it is difficult to identify the extent to which work pressure can exacerbate a personal or family problem. However, this is immaterial, says Friery, because the result is the same: an unproductive worker who needs support to feel more motivated in life and in work.

Companies are also realising there is economic sense in being seen to do the right thing. Under the watchful eye of their shareholders, ticking the box marked ‘corporation morality’ is a must. They also need to offer an attractive package of benefits to employees that they need to retain, as well as to the talent they wish to attract.

Friery sees a host of opportunities for counsellors in the corporate environment, from delivering workshops on resilience to mediation and psychological training for managers.

But he feels that many counsellors need to change their attitude and engage with what he describes as a ‘different population’ from those seeking help from the NHS Improving Access to Psychological Therapies (IAPT) services, for instance.

‘The trade of a counsellor traditionally is you and me in the room. EAP counselling involves thinking outside the box and one of my frustrations is getting counsellors to think differently and look at how their skills can be used in other areas,’ he says.

When it comes to telephone, online and face-to-face counselling, workplace provision is a very different model to that used in private counselling. Sessions are often limited to six (and sometimes just six in any 12-month period), and counsellors are required to agree specific goals with the client and detail how their progress will be evaluated. If a particular method is considered suitable, such as CBT or solution-focused therapy, clients may request this and will be assigned to counsellors with that skill set.

With increased competition in the EAP market comes the need for more efficiency measures. One counsellor with five years’ experience of working for EAPs, who asked not to be named, said that counsellors are being asked by one of the UK’s largest EAPs to try to reduce the number of sessions. ‘We received an email which asked us to finish as quickly as possible, less than the usual six sessions. It was implied that those of us who finished quicker would get more referrals.’

Whether competition is driving down quality is a moot point. ‘There is a lot of discussion about the number of sessions but what is really important is the client’s readiness to change and their motivation. It is often a view based on clinical need where you may say: “Let’s work for three sessions and then review it” rather than give six sessions,’ says Kinder.

Workplace counsellors are uniquely in a triangular relationship – with the client and with the employer, and there may also be some crossover with occupational health, when the counselling work takes as its focus how to help the client get back to work.

Being ‘organisationally aware’ is important, according to the EAPA’s Counsellor’s Guide to Working with EAPs,⁴ and Kinder emphasises this: ‘I do think there is a gap with some private practitioners who don’t understand the corporate world. Counsellors are in their own business and self-employed; it is vital to have some experience of working in an organisation.’

In the workplace, each employee is a commodity; it may seem harsh that cost is a major factor when it comes to wellbeing but cost may not be the only factor. A rise in telephone and online counselling in this market can also introduce a new potential client group to counselling. Says Kinder: ‘It can be about accessibility and having different ways to support people. Having a chat online and computerised Cognitive Behavioural Therapy (cCBT) opens it up to a new audience. People find it useful, not just those in crisis, but as a preventative measure.’

Psychodynamic psychotherapist Teresa Mulvena has worked as a staff counsellor and mediator in the NHS since 2008. Resilience and preventative training play a large part in her role as staff counsellor.

Mulvena believes that, no matter what the stressors are, measures can be taken to prevent stress and burnout: ‘The most effective things an individual can do is have a sense of meaning and purpose outside work and have strong connections with others. These two things make the stress of work feel smaller. At work the most effective thing to prevent burnout is the support of your immediate supervisor. So someone who listens and sees their needs is important.’ She adds: ‘It is empowering to tell people in resilience training and in counselling to focus on what they can influence and change and try not to get distressed about what is beyond their control. They might not be able to change many things about the organisation but we can all look at how we look after ourselves outside work – especially focusing on activities that really replenish you, and improving how we relate to others.’

Educating managers on the impact of stress on their workers is also a vital part of the work for therapists working in an organisation: ‘For instance, it’s useful for managers to know that support makes a high workload much less stressful,’ she says.

A firm understanding of organisation dynamics is also important, both from the aspect of how the counsellor works with the organisation and what might be going on for the client.

‘You always have to keep in mind the triangular relationship,’ explains Mulvena. ‘The organisation is also your client and this means you have to be very clear about what information is shared with whom. I think an understanding of organisational dynamics is very helpful for a counsellor. We all take our family dynamics with us and relate to colleagues like siblings and the way we react to authority is informed by our experience of our parents. Working in any organisation can make you feel like a child again having to obey the rules the adults set and this informs the counselling work too.’

Rick Hughes, BACP Lead Advisor, Workplace, says there are challenges and benefits for counsellors in the EAP market. ‘This is a tremendously rewarding sector. An EAP counsellor could typically have a huge variety of clients, from shop floor operatives to senior executives. The flexibility and adaptability required of a workplace counsellor is one of the benefits too. The feedback loop back into organisations means workplace counsellors really feel much more engaged with how and what the organisation can do to effect lasting, positive changes to the work experience of the client.

‘There can be session limits imposed on some contracts or clients, but that’s the nature of time-limited workplace counselling. Counsellors can only really work with what is clinically appropriate in the session limit given. So they need to have a good understanding of the contraindications to time-limited counselling. In some cases therapeutic assignments might be more about assessment, containment and referral on, rather than going into any real depth.

The amount of referrals can fluctuate and the fee rates haven’t really risen in over a decade. While this is reflective of competitiveness within the EAP industry, it can also be symptomatic of the demand and supply of workplace counsellors. The healthcare sector has benefited from the Agenda for Change policy which helped to set pay bands for counsellors. It would be helpful for the workplace to have this too. EAPs want good and effective workplace counsellors but they’re commercial organisations and EAP providers need to strike the right balance.’

References

1. Arlinghaus A, Nachreiner F. When work calls. Chronobiology International 2013; 30(9): 1197–1202.
2. Department of Health. Annual report of the Chief Medical Officer, 2013. London: Department of Health; 2009.
3. Dudman J, Isaac A, Johnson S. Revealed: how the stress of working in public services is taking its toll on staff. Guardian; 10 June, 2015. www.theguardian.com/society/2015/jun/10/stress-working-public-services-survey (accessed 26 November 2015).
4. Employee Assistance Professionals Association. Counsellor’s guide to working with EAPs. Derby: EAPA; 2014.