Workplaces make a lot of noise about mental health, especially the big ones. But I wonder whether some of the central ways to improve mental health are being missed, through a misguided attempt to look good at the expense of real change.
The UK is still stuck in a kind of dark ages when it comes to managing mental health. We haven’t yet worked through several of its ethical dilemmas, I suspect for fear of being politically incorrect. The result is a strange mix of attitudes, hypocrisies and legal conundrums which leave employees and HR departments reeling.
THE BIG TENSIONS
Three tensions perhaps dominate when it comes to mental illness. If an organisation cannot work out its policies with regard to these tensions, then it will be stuck in limbo. Everyone involved will be left with an uncomfortable feeling that the right solution has not been found.
TENSION 1 – THE MEDICAL MODEL Vs EXISTENTIAL AWARENESS
An organisation that focuses on the medical model will find itself constantly asking for medical evidence of mental illness.
- This leads to further unhappiness in the employee, as they repeatedly return to doctors and hospitals to ensure that the right evidence is available
- It also encourages some employees to stereotype their symptoms in order to ‘achieve’ a recognised diagnosis
- Furthermore, it creates a problem if the employee recovers. At the point where illness recedes, the employee’s protection can disappear overnight. Sometimes this leads to a relapse, as it is the only way the employee can access further help
An organisation that focuses on an existential model has a better chance of providing consistent support. (By existential, I mean taking the employee’s valid human experience seriously at all times, regardless of diagnosis.) This is because:
- The employee’s subjectivity is respected, and to a large extent their view is treated as evidence in its own right
- Employees are allowed to be themselves, without having to conform to particular symptomatic rules
- The border between ‘ill’ and ‘well’ is soft rather than hard, meaning that care can be offered irrespective of the employee’s state
Even so, an existential model has its problems. Old-style administration does not work, as ‘illness’ cannot be ‘proven’ in the same ways. Organisations are terrified of being taken advantage of, and therefore are at a loss of how to invent new approval systems for, say, time off, without requiring medical opinion.
TENSION 2 – AN ILLNESS MODEL VERSUS AN ABILITY CONTINUUM
Most organisations still function on an illness model. If you’re ill, you take time off. If you’re well, you come back. Some organisation do offer flexibility, but it’s slightly clumsy.
- An illness model dehumanises employees with emotional difficulties, as it implies that they need to be ‘cured’, rather than perhaps changing the organisation itself to make space for different emotional responses
- An illness model can misdirect attention away from an unhealthy organisation, and scapegoat employees, who might be perfectly healthy if it weren’t for emotional toxicities in the organisation itself
Some organisations now operate on more of an ability continuum. This has some advantages:
- Employees are encouraged to be open about what they feel they cannot do. Focus can then be on finding ways to overcome the issue together, rather than forcing interpretation ‘inside’ the individual employee
- Organisations can become more flexible, as a problem solved for one employee can help thousands of others
Again, an ability continuum has some issues. Not least, it can be expensive to adapt an organisation to incorporate different abilities. It can feel inefficient. This is not a problem for me, because I think efficiency is overrated. But efficiency is still worshipped in many economies.
TENSION 3 – A PERFECT PUBLIC IMAGE VERSUS AN IMPERFECT PUBLIC IMAGE
This is the biggie. We still exist in a world where organisations try, prima facie, to portray a perfect image. Everything must be said right, everything must be seen to be done right. You can see it when scandal hits: heads roll, as though we could easily identify the ‘imperfect’ staff, and by sacking them suddenly make our organisation ‘perfect’ again.
Many organisations operate on the perfect public image model because the public expects them to. Particularly charities. The recent furore over Oxfam staff conduct is a case in point. A big ‘imperfect’ label has been plastered all over Oxfam. Now, it thinks, it must not stop until it can give itself a big ‘perfect’ label again.
- Being perfect is unrealistic. We are discovering that in personal lives: we now need to apply it to organisations. The perfect public image model can lead to good staff being sacked in order to appease, and to falsely reinventing the organisation as re-perfected
- Perfect public images are by nature oppressive to both employees and customers. Everybody has to be fake. A kind of fake-speak evolves to take care of the mythical perfection. Phrases like ‘we are doing everything we can’ are born, which essentially mean nothing, but sound perfect
- Information is withheld. On a perfect image model, no one can find out anything bad about the organisation. So staff are punished if they speak outside the organisation’s world, and everything difficult is referred to a legal department
However, some organisations have worked out that this is all an illusion. They go for the imperfect public image model. They allow themselves to make mistakes, and do not scapegoat those mistakes; they own them and discuss them.
- Openly imperfect organisations show themselves to be evolving
- Openly imperfect organisations enhance mental health by reducing the requirement to fake everything, which is a key cause of mental illness in its own right
- Being open about imperfection means that problems do not have to go into purdah while they are ‘resolved’. Think of the pain for families when the NHS has to keep quiet about a bad patient experience. Think of the pain of NHS employees who are told to keep quiet while ‘investigations’ are carried out. Openly imperfect organisations know that the truth does not need keeping quiet, except where respect demands specific discretion
SUMMARISING THE THREE TENSIONS
In general, we could divide the world of organisations into two types:
TYPE 1 – WE ARE PERFECT, AND WHEN SOMEONE IS ILL WE SIGN THEM OFF. THAT’S OUR DUTY DONE
You can see this through the eyes of those who are off work with stress. Often, there is little contact with the organisation. I remember during my counselling training, when my father was dying, I took time out. At exactly that point, when I asked what support would be available, the answer was: ‘While you are on interruption, and we will not be able to provide any contact, support or counselling.’ So there you are, even an organisation that existed to train counsellors, was unable to see its way to actively support those who needed time out. More than that, they saw it as their legal duty to dissociate.
Look out for organisations that insist on appearing to do everything perfectly. Governments do this. In the quest to appear to root out badness, they will sack individuals at a moment’s notice, and then blithely say they have got rid of the problem. High-performance organisations often do this: their message, to themselves and others, is: ‘We are all well; if someone is ill, they cease to be functionally part of our operation. So we remain well.’
The logic is undeniable, but so is the inhumanity.
TYPE 2 – WE ARE OPENLY IMPERFECT, IN AN IMPERFECT WORLD. WE LISTEN TO THE SUBJECTIVE EXPERIENCE OF EMPLOYEES, AND WE TRY TO MAKE NEW THINGS POSSIBLE TO HELP. OUR DUTY IS NEVER DONE.
In these organisations, the experience of the stressed can be different. Instead of ‘Come back when you are well’, the message is ‘How can we help you through?’ There is never a point at which the organisation disengages.
Look out for organisations that are open about their faults. Look out for leaders and managers who, instead of seeking fake perfection, get their hands dirty and are prepared to involve themselves in problem resolution. They are rare, but intensely valuable.
There is a humanity is such organisations which is not logical, but you will know it when you experience it. It feels warm, as though you are being allowed to make yourself at home.
Personally and professionally, to encourage mental health in all those around you, maybe try the following:
- Listen to, and accept, their personal account of their experience, and work with that
- Try not to divide people into those you feel are unworthy of their problems, and those who are having ‘real’ problems. It is arrogant to require some kind of certificate of authenticity for other people’s unhappiness
- Focus on how you can help individuals do their next thing. Adaptations might happen in you, in your joint environment, or in them, but it is unlikely that the only solution is for the other person to adapt. It makes no sense
- Be openly imperfect. Everyone can then breathe a sigh of relief, and get on with negotiating life calmly, without your frantic insistence that ‘everything is fine’, and your constant scapegoating when it is not
For organisations, in particular:
- Respect every employee’s personal experience. Don’t invent an ideal employee and only listen to them
- Let employees take time out when they decide; don’t always be requiring independent proof. You wouldn’t do it to your partner (I never heard anyone say to their partner ‘can I have a doctor’s certificate?’ when time out was requested!)
- Focus on enabling employees. Adapt, adapt, adapt
- Think about how, in your conduct and your publicity, you can quit being all perfect and patronising, and start being openly friendly and imperfect. The public will like you better that way anyway
IN A COUPLE OF SENTENCES
Companies, please ditch the constant requirement to appear perfect. Especially senior management. It’s not healthy, and it’s not even believed.
Instead, make a home for people where they can be themselves, and negotiate their empowerment with them as they go.