Mental health at work: reasonable adjustments

Chau Doan: Welcome to the Acas Podcast. I'm Chau Doan and in this episode we will be discussing reasonable adjustments for mental health, and how employers can support their staff with mental health and wellbeing at work. 

Joining me today is Dr. Jo Yarker, Managing Partner at Affinity Health at Work, Dr. Julie Denning, Chartered Health Psychologist and Chair of the Vocational Rehabilitation Association, and Francoise Woolley, Head of Mental Health and Wellbeing at Acas. Thank you everyone for joining me today.

Jo Yarker: Hi Chau.

Julie Denning: Hello.Hi.
 
Francoise Woolley: Thanks, Chau. Thanks for having us.

Chau: So I'd like to start this podcast first by asking what is reasonable adjustments in terms of mental health? So can I direct that at you first Jo?

Jo: Absolutely. So reasonable adjustments are really small changes that people can make to the way that they work to help them work well. So they might cover any aspect of work. They could be changes to the physical work environment. They could be changes to the way that their work is done, or to their work schedule. And they’re really unique to that individual, and also the job so they can be very varied in their nature. And hopefully, during today, we'll get to explore a whole range of different adjustments that people might use to stay well at work.

Chau: Can I then refer over to you, Francoise? So in terms of the law, so Jo mentioned that it can be different in that case, what is the law in regards to reasonable adjustments for mental health? So would they be similar to something that an employer might deal with in regards to a disability at work?

Francoise: Yes, absolutely Chau. So reasonable adjustments, the duty to put in place reasonable adjustments comes when someone fulfils the definition of having a disability under the Equality Act 2010. So the definition of disability there is 'a mental or physical impairment that has a substantial and long term adverse effect on a person's ability to carry out their day to day activities'. So some people might not actually recognise their mental health condition as a disability. But it's important that employers are aware that it could be. 

In terms of those elements that makes up a definition of a disability, physical or mental impairment is self explanatory. Adverse effect on a person's ability to do their normal day to day activities, so that could be anything from shopping, reading, writing, using the telephone. In work, it could be around interacting with colleagues or following instructions. 

The substantial element of it, so the substantial impact really it's quite a low threshold. So it's really more than minor or trivial, so quite a low standard there. And is the substantial effect long term. So what is looked at there is whether it lasts for 12 months or more, or likely to last for 12 months or more. And we know that some conditions such as depression, for example, can reoccur or come in episodes. So if you have a condition like that, you're treated as having a disability under the Equality Act, even if the adverse effects don't last for more than 12 months at a time. 

Chau: Can I then refer then over to you Julie? So we mentioned about reasonable adjustments, but are there any examples that employers could potentially take in regards to these reasonable adjustments? Or potentially what they can do to help any employees requesting it?

Julie: Yes, I think first of all, the sort of line manager needs to understand from the employee the struggles that they're having, and how their symptoms impact on their work. So I think it's definitely important the employer doesn't second guess that and ask questions. They might notice things like concentration seems to be flagging, or they might miss the deadlines aren't being met or the person is off camera when they come into meetings and they're normally on camera. 

So there's definitely something about noticing the symptoms that someone presents with or unusual behaviour, changes in behaviour. They may be out of the normal, they predict but they're making sure that they ask the individual what are the symptoms you are experiencing? How do they show up at work and what can we do? 

So it might be extending deadlines. It might be about clarifying exactly what you do want out of the individuals in terms of tasks to be achieved. It might be breaking down tasks so you make them more simple and easy to process and to work your way through. Because when, for example, someone has anxiety, or panic, it's very difficult to concentrate sometimes and really focus on problem solving, for example. So it's kind of breaking down tasks. 

It might be thinking about, if anxiety is related to the commute, some sort of challenging phobia or whatever about being able to get into work, maybe starting work later so you can avoid the commute. So there are any number of sort of adjustments that can be made, it's just really important that you speak to the individual to understand what symptoms they are experiencing. So how they show up in the workplace at work, in their working day.

Chau: So it sounds like communication is quite a key thing in regards to someone either requesting reasonable adjustments for their mental health or potentially for an employer to respond to as such. So can I then refer back to you Jo? So in terms of that then, does there have to be any medical diagnosis for employers to put in reasonable adjustments for mental health at all?

Jo: So we would often suggest that you don't wait for the diagnosis. What we can see is that so many people have a very long pathway to having their mental health condition diagnosed, and we know that there's such a pressure on the NHS to see people and to offer treatment as well. 

We also know from research that the earlier you can put things in place to help an employee to work well will increase their opportunity to stay at work, and also to maintain their mental health. So we would really recommend that we put things in place early and have those conversations early. And that just gives everybody the best chance to make small changes on an ongoing basis to really support the employee.

Julie: I think that's quite an important point about the early part as well, because when we're working with line managers, we're often saying actually, you are the person who will see it early. Because you're with that person all the time. One spends more time at work with their colleagues than we do with our loved ones and our friends and partners. So, there is a greater likelihood that it will get picked up early at work if the line manager is tuned in and is kind of noticing what's going on. There's also about timely interventions. There’s early and then there's timely as well, making sure the right intervention is provided at the right time and the right sort of support.

Francoise: Yes, I was just to add to Jo and Julie's point really. We do find in Acas that people do get quite hung up on a specific diagnosis and whether something meets the definition of a disability under the Equality Act. And actually what we say is that actually good practice is that employers should make reasonable adjustments even if the issue isn't a disability. We would say, you know, why would you not? If someone is having difficulty, why would you not look at what you can do to support that employee and make them feel valued at work really. So really, employers should view reasonable adjustments as a way to support and retain valued employees rather than a challenge to overcome.

Julie: The sooner you intervene, the greater likelihood that someone stays at work as well, because actually, we don't want someone falling out of work. You know, the longer that someone is out of work, the harder it is to get back in. So we often think about reasonable adjustments and return to work planning, when someone's off sick.

Actually, what we want to try and do is prevent that absence, hence the early part. So sometimes you might need to just make a few adjustments, just temporarily, might be for a week or two, just to give someone some breathing space, while they're reaching out and practising the tools and techniques, maybe it's a flare up of their symptoms, or they need to access medical care. It doesn't always have to be an all or nothing thing. It's not an all or nothing thing. It's a review, and it could be a brief intervention, briefer than you think it's going to be, sometimes just a couple of weeks can do it. Sometimes not, of course.

Chau: Thanks for that Julie, I think that's a really valid point. So can I refer then back to you, Francoise? So you mentioned before about the Equality Act. So in terms of the law then, is there a legal right for an employee to have their request accepted? And also, what is the legal responsibility for the employer to actually respond to these requests as well then?

Francoise: We get asked this question actually quite a bit in Acas. So employers saying can I refuse a request to make reasonable adjustments? The Equality Act doesn't actually explicitly state that all reasonable adjustments for mental health requests must be accepted. And the law does recognise that there are kind of limits to the adjustments an employer could reasonably be expected to make. 

We know hence the word reasonable, this term 'reasonable' in employment law really. So it may be that actually something isn't reasonable to implement, it's not practical to make, it's not affordable by the employer or the business. In general, we would expect that the larger the employer, the more the kind of resources it has, and the more they're expected to do in order to meet the request. 

But it may be there are other considerations in terms of impact on the organisation and impact on the rest of the team as well, it could impact the health and safety of others, for example. So really, it's about what is reasonable? It is important that an employer understands that if they unreasonably fail to make adjustments, that it could be considered discrimination, disability discrimination in fact, under the Equality Act, so the question is really what does an employer need to do in order for a refusal to be considered non-discriminatory? 

So they have to really show, it's important to show that you've given a full consideration to the request, and that you feel that the changes are not reasonable, and that your actions are justified, and to really spell out why that is really, whether it's too costly, or it will disrupt other people at work. 

But the important thing is communication, you know we talk about this a lot in Acas really. So it's not just a black or white thing, a case of we cannot accept that reasonable adjustment, but actually having that constructive dialogue with an employee and talking about alternative options and whether there could be some sort of compromise is really important. And it's crucial also for the employer to note that actually an inability to put in place a specific adjustment doesn't exempt them from their duty to consider all reasonable adjustments under the Equality Act. So it's really about thinking about a reasonable solution that balances the needs of the employee and the limitations that are faced by the employer as well.

Julie: I think sometimes it's quite interesting, it works the other way around, that the employee's actually quite worried about disclosing. And that's a conversation we'd often have with what we refer to as our patients that are in our service is sort of say, well if your line manager or your employer doesn't know, what they don't know they can't do anything about. If you do let them know how it's affecting you and the symptoms, you don't necessarily have to go and describe the ins and outs, just say what you actually do need from someone, then they are obliged to help you. But if they don't know, the obligation isn't there in quite the same way. So, we're sort of saying it's up to you, you don't have to disclose. But it might help you quite significantly if you do, because then the employer has to think about what they can do to support you.

Chau: But I was wondering as well then, perhaps I can direct this at you Jo, in regards to the employer itself, what would be the benefit of them to implement reasonable adjustments for the employees?

Jo: So I suppose the ultimate benefit is that they're much more likely to be able to keep their employee in work and the costs of recruiting a new employee, the costs of lost labour are significant. And we all know that there's a huge demand for talent at the moment. So given that, we want to do all we can, alongside our moral obligation to look after our workforce, to really keep people at work and producing and being productive at work. So I think the benefits for the employer are just multiple because you not only have that productivity element, but also I think it signals to the rest of the workforce that you care. 

And I think what we do see is where employers don't show a duty of care, where they're not looking after their employees in a way that feels safe to others as well, psychologically safe, then they're much more likely to have people want to leave and look for other jobs as well. So it's not only in the benefit of the employee who is requesting reasonable adjustments, but it's actually in terms of a good positive work culture, a healthy, mentally healthy work culture is a fantastic thing as well.

Chau: I was wondering as well then, so in regards to an employee putting forward that request, I think it can be quite a daunting situation to do that. I mean, we talk about it quite openly here to say, oh yes, just put in a request. But as we mentioned, it can be a quite difficult thing for them to do. So, then can I refer back to you then Francoise? So in terms of that, how can an employee essentially go about putting that request to the employer? How can they approach that situation if they feel that it's quite a sensitive subject or something that they feel a bit nervous about doing?

Francoise: Thanks Chau. I think well Jo mentioned earlier about that bigger picture of a healthy working culture, really. And I think employees are more likely to come forward and talk about it if there is a culture where they feel that there aren't going to be repercussions, or they won't be demoted or actually they will be looked after as an employee. So it's really important, that bigger picture piece, I think, in terms of kind of creating that environment where people can come forward.

Jo: I think one of the things that we often expect people to do is have all the answers just because they're the ones that need the help. And it can be so confusing. If you're off work, or you're working and trying to struggle through, you often don't really know what you need, and what might be helpful. And so one of the things that we would recommend everybody do to start with is almost map out, whether it's on a piece of paper or chatting with a friend, chatting with a family member or trusted colleague, is to think what's going on for me? Where am I struggling in my work? Where am I struggling in my work day? What might be helpful? And really map that out so you've got something tangible to work with. 

And then practise it, because often we go into really important conversations without really having said those words before. And so if we can practise a conversation, and just sound out what does it feel like when I'm asking for these things, so that you can try and get rid of some of the emotion that's associated with it, and feel a bit more confident about voicing your needs, then that's something that often people find really helpful. I'm sure Julie, you've coached a number of people through that first step as well.

Julie: Yes, and I think it does take a lot of courage. I think sometimes it's almost realising that you do have a problem, because I think sometimes you're in your own bubble with stuff and you're finding it harder and harder and harder. And you don't always realise it until you're like oh, hang on a minute, and you're hitting that sort of almost brick wall. And then you're off work so I think it's about the dialogue with someone because it does get it sort of out in the open and like you say, it allows you to cognitively process what's going on for you but given your cognition is probably going to be a bit offline because you're experiencing mental ill health. 

And it is, I agree with you, talking to someone that you trust and you feel very comfortable with, as a way of testing out that and sort of just saying I think there's something going on here, I'm not quite sure, you know, it feels really uncomfortable, I'm having these palpitations or having all these thoughts whirling around my head, just to kind of to get those ideas out there with a trusted person. 

But it might be using resources like mental health champions in the workplace. You know, a lot of workplaces have resources like that now. And seeking out those people as someone who is totally neutral in the individual's life, because sometimes it's quite hard admitting it to friends and family that you're struggling too. Whereas talking to someone who isn't in your life and isn't in your day to day working life either, so someone like a mental health champion, can actually be very helpful because it does bring a completely different slant because often people don't want to worry their loved ones. I don't want to tell them you know, this happened before and it ended up really badly. 

Any number of thoughts will go through someone's head as to why they have concerns about sharing with a loved one and if they don't feel comfortable doing that, talking to someone who is more objective and might help and things like the EAP programmes, for example, could be quite useful. So it's kind of interesting to think about useful, rather to think about what the employer is providing as part of their benefits package and admittedly that might be with larger organisations, but using those resources in order to be able to start to talk, because as much as the line manager needs to listen, the person needs to be comfortable starting to talk.

Chau: I think that's a really valid point there. You mentioned about the different support that people can get and obviously, it's a daunting thing. And I think maybe it's the case that we should be aware of line managers as well, essentially the support that they might require, in relation to that. I think it’s the case that they might not have all the answers as well. 

So you mentioned there about mental health champions, employee assistance programmes as well. But then, can I then refer over to you Francoise, so in terms of things that the employer could do. So for example, if they've got policies in place, should they be potentially reviewing that? Or is there any guidance that they can refer to help them with that as well then?

Francoise: Yes, I think it's probably a good time to point out our new guidance on reasonable adjustments for mental health, which we did in collaboration with Jo and her team at Affinity Health at Work. 

So what we found as part of developing this guidance with Affinity, we surveyed 611 respondents and 61% of those were employees with mental health conditions. 32% were managers and 7% were people who supported an employee with a mental health condition. So a TU rep or other mental health advocate. And we found that actually, managers are absolutely crucial in terms of whether somebody can access mental health reasonable adjustments or not. And there's a lot of, I feel, pressure on managers now in terms of supporting staff in many different ways, but not necessarily as this research showed, the training and the support in place to help managers. 

It's really important that managers don't feel like they have to have all the answers. But it's important, I think, to mention our guidance in terms of a good tool for managers to have. So the guidance covers things like actually, from the employee perspective, how to request a reasonable adjustment as well. But also, how do you respond as an employer, as a manager. How do both employees and managers prepare for a meeting. 

We have letter templates there of requesting and responding to requests for reasonable adjustments. And how do you manage employees with reasonable adjustments for mental health in place. So I would really say to our listeners that please do look at that guidance, because I do think it's really practical. And it does fill what we felt was a gap in terms of the guidance that's out there to help managers, to help employees really kind of understand what reasonable adjustments could help them and how they go about putting them in place and reviewing them.

Julie: The thing that I noticed in practice, is that kind of understanding where you're at, I think you Jo mentioned it about boundaries, boundaries of what is your role and what isn't your role. I think sometimes line managers can sort of get very tied up in knots with that, what should I do? And when should I do it? And how should I do it, and there's a danger of slipping into that counselling role, and it's actually no, your role is just to notice, and then to signpost to resources. 

And if you say something like I'm available for you 24/7, expect the 3am call because you have given that permission to be contacted at any point, at any time, or you know if conversations start to become really quite complex, and it's all getting to a sense where you feel overwhelmed, you can check in, it's not your responsibility, you're not going to be able to solve this. 

There are clinicians who will be able to help that individual, and your role is thinking about how you're supporting that person at work and the resources the workplace might have to support that individual with their mental health. So it's being really kind of reassuring about that, and very compassionate that the line manager doesn't have to take on everything, by any stretch.

Chau: That's a really interesting point that you've both put across there. And I think, obviously, in an ideal world, an ideal situation that anyone who puts their reasonable requests through essentially gets it heard and essentially gets it accepted. 

But then can I then ask, you know, obviously we don't live in an ideal world and there are difficulties that come in place, especially for employers. 

So can I ask then you Jo, in terms of an employer who cannot facilitate a request. So for example if they are small business, or potentially that request might have a detrimental effect on the business itself. What can the employer then do in that situation then, if they feel that they might have exhausted all the options?

Jo: So I think it's quite an interesting thing you say there in terms of exhausted all the options, and I wonder whether it is worth just coming back to that idea of test and learning as well. And I know that not all small businesses, not all big businesses, will have capacity to be able to do that endlessly. But I think one thing that's very clear from the research that we've done, and people we've spoken to, is that often their needs will change over time, and what you might try first, and what you think you really want, and what will really be helpful, actually isn't helpful, and it doesn't make the difference that you want. 

So it really is a case of test, learning, keeping that conversation open, and trying things out. And so before giving up, before saying that something isn't actually feasible, what I'd really encourage people to think about is okay, what is the broad range of activities we could try? How long are we going to try them for? When do we agree that actually, we've tried, and we now need to stop trying, because it's not working and it's disadvantaging everybody? But really give that space because, like anything, you don't get it right first time. And it does take a few iterations to really find a pattern that works for the individual, but also for the team and for the line manager, and the organisation as a whole.

Julie: Yes I agree Jo, I think there is that flexibility and that change. Also when someone starts to recover, their needs will change. So I think, think about maybe someone who hasn't got a return to work plan, because they were never off. But you made those adjustments, perhaps it's about reviewing those adjustments regularly and having that weekly, fortnightly catch up just to make sure those adjustments still hold true. And whether they do actually need to change. 

It's not an all or nothing, none of this is all or nothing. It's all about being flexible. And that can be quite hard to do in an organisation that's got its own rigid processes and procedures and bottom lines and stuff they need to achieve. But it makes such a difference to the individual, if you can demonstrate that flexibility and that willingness to pivot and to change and say, and actually sometimes that vulnerability. If you're a line manager, you're expected to have that gravitas and I'm leading you and I'm really important to actually say, "You know what, I got that wrong". You know, that's actually quite a hard position to be in, and particularly when they might feel responsible for somebody's health and mental health particularly. 

So I think that flexibility and that test, test is certainly something we see in clinical practice. We’ll often be reviewing a return to work plan and saying things like, let's just pause it this week shall we? Let's not increase because things haven't quite changed as we thought they would or we can go back a week? Or actually, let's speed it up because things are going really well. You know, it's okay to do all of that.

Chau: And then I think on the flip side as well, so I think I asked before about what the employer can do, for example, if they couldn't accept a request from their employee or their worker. But then in terms of the employee then, what rights do they have, for example, if their request does get rejected? So what can they do in that situation then instead?

Francoise: So I think the first thing I would say is to seek further clarification. The employee can request a clear explanation from the employer regarding the reasons for the rejection of the requested adjustments. So understanding that employer perspective is really important. And it could help kind of identify those areas where you could compromise or find alternative solutions. 

I would say, it's really important to have those discussions with your manager, with HR and to be able to really sort of explain the importance of reasonable adjustments for supporting them with their mental health. It might be that actually, as an employee, you need to provide additional information or evidence, perhaps the decision has been made on the basis of insufficient information. 

It's important that other parties could perhaps become involved here. So whether it's getting information from your GP, whether it's from occupational health, to support your application, that may well need to happen. 

We at Acas obviously always say try and resolve things informally first. If the informal channels do not work, then you should have internal grievance procedures, which will provide a kind of structured approach to address any dispute including a dispute around reasonable adjustments for mental health to try and find a mutually agreeable solution. 

Of course, external advice, so coming to Acas to ask advice, coming to a trade union, legal advice around your employment rights and sort of advice around any potential legal recourse is also an option. If an employee got to a stage where they wanted to take their employer to tribunal for disability discrimination for example, they would have to notify Acas first and we would offer that early conciliation, which is a chance to resolve the dispute without it going to tribunal, which we know can be stressful and costly and all the rest of it.

Chau: So I think that's a really valid point you mentioned there. And I think with all the things that we've discussed today in the podcast, I think just reviewing everything, it feels like you know, we've talked about the employer being flexible themselves with the employee, to actually reviewing the situation, having that clear conversation and open dialogue within the workplace as well, but also potentially having that psychologically safe culture, to have those open dialogues with everyone and make people feel comfortable to talk about that as well. So can I ask then, just to wrap up things, can I ask everyone what's the main key thing that they would like our listeners to take away from this podcast episode?

Jo: I think there's so many things aren’t there? But really, to me, it's about being open and seeing it as a journey. So really, not just one conversation that will resolve everything. It's about starting an open conversation that's going to evolve over probably a few weeks, possibly a few months, maybe over a few years and the employee's lifespan in the organisation.

Julie: First one is flexibility. I think this whole process is to be really flexible. And the other one that's connected with that is about having a person-centred approach. If you know one person with anxiety, you know one person with anxiety. Everybody experiences it very differently. And the line manager or organisation needs to be aware of that. If you've got two people with anxiety in your organisation, they will be having very different needs. And that needs to be understood. So an individual, person-centred approach would be my takeaway.

Francoise: I think really, to focus on that bigger picture of reasonable adjustments. So to focus on the benefits of putting in place reasonable adjustments for mental health in your workplace for creating an environment where people can be their best at work and thrive at work, rather than focusing on you know, is this condition a disability, must I do this? So that's one thing. 

And the other thing, I think, really for employers and employees, is to please just look up the Acas guidance on reasonable adjustments to give those real sort of practical tools and tips to help you put reasonable adjustments in the workplace. And we do have some case studies, which again, we worked with Jo from Affinity and her team, which really show the kind of possibilities really in terms of what reasonable adjustments are possible and the roles of different people such as employer, manager, employee, occupational health, etc. So please do look at those.

Chau: Thank you for that. So I think what I'm getting from the episode today is the case of, like we mentioned about checking the guidance, the guidance that we have here at Acas, but also the support that people could access. And I found this conversation actually very insightful, and I hope our listeners will do as well. 

And I think it's important to keep these conversations going, and potentially make it less of a daunting thing within the workplace, but more of an open and accessible conversation that people can have. So I just like to thank everyone today for joining me on the podcast.

Jo: Thanks so much for having us.

Julie: Yes, thank you. Thanks very much.

Francoise: Thanks Chau. Thank you.

Chau: This has been the Acas Podcast. For more information on reasonable adjustments for mental health and supporting mental health and wellbeing at work, visit our website at acas.org.uk, including advice, guidance, case studies, resources and training. Further information is available in the episode notes. Thank you for listening.