Now the mind matters


Artykuł pochodzi z pisma "Guardian"

Many employers have a poor record of dealing with staff who have mental health problems. But, reports Colin Cottell, it is an issue that is finally being taken seriously in some quarters

Saturday January 31, 2004
The Guardian

When Richard Seale, a former sales manager, told his employers (now ex-employers) he had a history of mental illness, their response was not exactly sympathetic.
"They were happy to make me work 70 hours a week," says Mr Seale, of Ickenham, Middlesex. Eventually it led to manic depression, and a successful claim for unfair dismissal.
"Most employers haven't got the foggiest idea. They are still incredibly prejudiced," says Gillian Howard, a consultant with Howard & Howard, solicitors, which specialises in medico-legal cases. "People are very sympathetic if they see you with a broken arm, but not so sympathetic if they see you with a broken mind. They think you are loopy."
A survey by the Work Foundation in December backed this up. It showed that while almost half of employees would turn to their employer if they had a mental health problem, two thirds of managers rated themselves as novices when it came to mental health. Similarly, three-quarters of line managers admitted their organisation did not have adequate policies or procedures to deal with such problems.
However, not all employers are plain bad. Marks & Spencer, Rolls-Royce, and Asda have established reputations for the care with which they treat their staff. The Civil Service, the NHS, some charities, and trade unions on the other hand, are considered to have poor records in managing the mental health of their staff.
One sector where mental health is beginning to be taken seriously is the emergency services, where as recently as the late 1990s the stresses and strains of work in one fire authority contributed to 93% of employees retiring on grounds of ill health (though not all at once).
PC Jim Davison, from Greater Manchester Police, an officer for 24 years, remembers the not-so-good old days. The attitude was: "You are a police officer. You are paid to do a job. Get on with it." In those days his method of coping with incidents such as the Toxteth and Mosside riots was rudimentary. "I would pick up a bottle on the way home, hoping I would get over it," he says.
Eventually, PC Davison says that a combination of mental wear and tear and family bereavement took its toll. "Eventually it went bang ... like as if someone had taken the feet from under you, and you ended up on your back," he says.
But whereas in the past PC Davison would probably have been retired on medical grounds, today he is still working as an operational police officer, albeit no longer on the frontline. PC Davison believes that such an outcome is down to his employer's more enlightened attitude to mental health. "Today it is the flipside of the coin. These days if you see something tragic, you can be referred to see a counsellor in a matter of hours. It is counselling on call. It has changed dramatically in the past five years."
Across 24 of the UK's police forces such an approach is being championed by the National Service for Police Psychiatry, headed by Dr Nick Cooling, a consultant psychiatrist of the service, which began in 2001 is based on one established for West Midlands Police in 2000. The key features are fast access to a psychiatric assessment clinic, access to counselling service and a specialist psychotherapy service, says Dr Cooling.
"In mental health there is an under provision in the NHS in terms of psychotherapy and counselling, and all I am doing is plugging the gaps," he explains. "The problem is that at the primary health care level research shows that 50 per cent of all cases get missed ... and I think it makes sense to have a specialist treatment to pick up the cases missed by the NHS."
Matthew Hodgkinson, an Essex firefighter, had what he call "an old-fashioned breakdown". He describes his treatment under the NHS. "They were over-stretched, over-worked and under-resourced. It wasn't their fault, but they were rushed off their feet." Mr Hodgkinson says he saw five different psychiatrists.
The key is early intervention, says Laraine Williams, occupational health manager for West Midlands Police Authority. "Early intervention with a diagnosis means that people don't become ill. Until you see a diagnosis you don't know how to treat it. And that can only be done with a psychiatrist," she says.
Waiting for the NHS in the West Midlands can take three to six months, continues Ms Williams. But for those with mental health problems this can often be too late. "After three months it is very hard to get people back to work - they get out of the habit, and they get more depressed."
Other research shows that 50% of people signed off sick with mental illness for six months or more never work again. West Midlands "fast track" referral service ensures that people are normally seen by a psychiatrist, or a psychiatric nurse within a month, says Ms Williams.
However, some people can continue to suffer for years. James Lloyd-Roberts, aged 35, a firefighter from Colchester, suffered post-traumatic stress disorder after his girlfriend died 10 years ago. "I was a mess for quite a time," he says. "As a fireman, I thought that if I was there I would have been able to sort it out." He wasn't. "I felt guilty and responsible because I was with her."
He adds: "Afterwards, when we would go to an incident where we rescued someone, I'd get upset because I couldn't rescue her. And if they died, I would also get upset," he explains. "Eventually I got to the point where I was fed up feeling bad all the time." After anti-depressants, time off and various counselling, he was referred to Dr Cooling at the Priory Hospital in Roehampton. Today, Mr Lloyd still works as a firefighter.
Referring those with mental health problems to psychiatrists, or psychiatric nurses who specialise in dealing with one group of people seems to work. According to Ms Williams, the number of ill health retirements in West Midlands Force on the grounds of mental health dropped from 13 in 2002-2003 to seven in 2003-2004.
Having a decent service in place is also cost-effective. "It costs £276,000 a year to run the service," she says. This compares to savings of £1.2million in one year alone in the West Midlands. This comes from retiring people early and not having to pay out injury awards, says Ms Williams.
The NHS is still capable of providing a decent level of service, says Dr Stephen Lawrie, a consultant psychiatrist at the Royal Edinburgh Hospital. "In general it is good enough to rely on the NHS," he says.
"If someone needs seeing urgently, they will be seen urgently. And even for a routine complaint of anxiety or depression, most people would be able to see a psychiatrist within a month or two. The first port of call should be your GP."
However he accepts that getting the right treatment and support "is a bit of a lottery." He adds: "Some GPs are quite switched on to psychological, or psychiatric, and many are not." Similarly, "some psychiatrists are interested in these things, but many psychiatrists will see themselves as being too busy to have the time or opportunity to deal with these kind type of complaints, when they are dealing with more seriously ill people."
Dr Lawrie agrees that the National Service for Police Psychiatry is a good idea. And he recognises that there is a strong case for dedicated services to help "high risk" employees such as the police cope with traumatic situations in particular. "If they want it, there is pretty good evidence to suggest that early intervention in terms of dealing with these types of problems is desirable."
With employees increasingly going down the route of litigation, which opens employers up to the possibility of having to pay unlimited damages, it may only be a matter of time before other organisations follow suit.

assessment – ocena, oszacowanie
bereavement – utrata bliskiej osoby
to champion – bronić
claim – roszczenie
to cope – radzić sobie
counselor – pracownik poradni
decent – przyzwoity
dismissal – zwolnienie
early intervention – wczesna interwencja
GP = General Practicioner – lekarz pierwszego kontaktu
litigation – spór (prawny)
loopy – dziwny, głupi
manic depression – zespół maniakalno-depresyjny
NHS = National Health Service – służba zdrowia
novice – nowicjusz
over-stretched – przeciążony
PC = Police Constable - posterunkowy
to plug the gaps – dosł. Zatykać dziury, tu: uzupełniać braki
port of call – dosł. pośredni port podczas podróży
post-traumatic stress disorder – zespół stresu post-traumatycznego
prejudiced – uprzedzony
be referred – zostać skierowanym
rudimentary – podstawowy, elementarny
rushed off their feet – bardzo zajęty
to sign off – iść na zwolnienie
Staff – pracownicy
strain – obciążenie, stres
Sympathetic – współczujący
to take ones toll – dać się we znaki
provision – świadczenie usług
wear and tear – zużycie


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