Protecting mental health at work

Employers underestimate the extent to which employees experience mental ill health. EOR reports on the support that is available to enable employers to deal with mental health issues at work and the action taken by BT and Devon Partnership NHS Trust.

KEY POINTS Most employers can expect a member of their workforce to be affected by mental health problems at some point and employers lose millions of working days each year due to stress, depression and anxiety. A minority of employers have a policy to deal with mental ill health in the workplace, although case law indicates they would be wise to do so. The government has launched a new three-year initiative encouraging employers to improve the way they deal with mental health in the workplace. It will provide guidance, advice and support to employers via eight regional teams. In partnership with its trade unions, BT has launched the biggest ever drive by a UK company to improve the mental health of its staff and claims it has made significant savings on staff absence as a result. Devon Partnership NHS Trust has publicly committed to working towards the Charter for Employers who are Positive about Mental Health, which is a commitment to improving the working lives of staff.

A new government campaign aims to help employers reduce the incidence and impact of mental health problems in the workplace. Statistics show that most employers can expect a member of their workforce to be affected by mental health problems at some point. According to MIND¹, one in four people will experience some form of mental ill health at some time in their lives. While the personal cost is incalculable, employers lose millions of working days each year due to stress, depression and anxiety. According to figures from the Shaw Trust, this costs employers an estimated £9 billion a year in sickness absence caused by stress-related illness - based solely on salary paid out.

People with mental health problems have the lowest employment rates of any of the main groups of disabled people - only around 20% of people with long-term mental health problems are employed, compared with 65% of people with disabilities. This is despite having the highest "want to work" rate, with up to 90% wanting to work, compared with 52% for disabled people generally. Even for people with more common types of mental health problems, such as depression and anxiety, only about half are in work.

Mental health ignored

Recent research from the Shaw Trust (the national charity that provides employment services to disabled people) found that employers seriously underestimate the extent to which employees and fellow managers are experiencing stress, anxiety, depression and other forms of mental ill health². The survey of 500 chief executives and directors plus 50 senior HR professionals found that almost half thought that none of their employees would be suffering any form of mental ill health.

Given this underestimation of the extent of mental health problems, it is perhaps not surprising that eight in 10 directors said their company had no policy to deal with stress and mental ill health in the workplace.

Even among companies employing more than 100 people, around half had no policy. Case law indicates that employers would be wise to have in place a stress management policy and to take note of any warning signs of mental ill health in their employees (see below ). However, the research found that around seven in 10 employers recognise that they do not know enough about their legal position and obligations relating to mental health in the workplace. This applies across all types of companies, irrespective of size.

Widespread discrimination

One in three employers thinks that people with any form of mental health problem are less reliable than other employees. Similarly, one-third of employers say that negative attitudes from workplace colleagues are a major barrier to employing people with any form of mental ill health. Around half of employers think that organisations take significant risks when employing people with mental health problems or keeping them in client-facing roles. This reinforces previous research, which found that one-third of people with mental health problems reported having been dismissed or forced to resign from their job³.

The Shaw Trust comments that the responses to its survey show a widespread lack of understanding of, and discrimination towards, people who are suffering or have suffered from mental ill health. It observes that the attitudes highlighted in its research might account for why so many employees risk exacerbating their situation by continuing to work with stress, depression and anxiety, rather than telling anyone about their problem. The trust says it is evident that those experiencing mental health problems naturally feel there is a stigma attached.

The research also highlights a problem regarding disclosure of mental health problems. Some eight out of 10 employers suggest that applicants should disclose any condition prior to being hired, yet fewer than four in 10 employers say they would consider employing someone with a history of mental health problems. These two findings give the impression that employers want to be informed so they can disqualify the candidate. A client of the Shaw Trust commented: "There is no incentive for a person to disclose their condition really - they would have to be heroic to do such a thing."

The Disability Rights Commission (DRC) recently asked employers if they felt that employees should reveal a mental health problem. Its survey of 849 small and medium-sized businesses found that 89% believed that current employees should reveal they had a mental health problem and 85% felt the same about potential employees⁴. Analysis revealed that almost one-third (31%) of those who felt employees should reveal a mental health problem said this was because the person would either be a health and safety risk to themselves or to others, or both.

The DRC points out that evidence shows that around six out of 10 people with severe and enduring mental health problems, such as bipolar disorder or schizophrenia, can work and/or study. So while employer fears about job performance and health and safety risks are real, they are based on inaccurate views of what people with mental health problems can do.

Support for employers

Respondents to both the Shaw Trust survey and the DRC poll wanted more support and help to deal with mental health in the workplace. Bert Massie, DRC chair, commented: "We need to recognise that mental ill health is now operating as a badge of exclusion from the labour market in the same way that race and gender once did.

"If employers had better advice and support they would have less fear about employing someone with a mental health problem - and employees in turn would be less fearful of disclosing their condition."

The Shaw Trust is seeking to develop a range of what it describes as "new and innovative support services that will offer the real solutions that business is asking for". These solutions will be developed under four main themes:

• awareness - to increase awareness of the scale and prevalence of mental ill health and implications for business;
• wellbeing - assistance in preventing the development of mental ill health and approaches to health promotion in the workplace;
• warning - systems that allow potential mental health issues to be identified and managed before they become too severe; and
• support - a range of innovative and effective services for employers and employees, including training and guidance for line managers, specialist occupational health support, vocational rehabilitation support and condition management programmes.

Action on Stigma

In October 2006, the government launched a three-year initiative encouraging employers to improve the way they deal with mental health in the workplace. Under the title of Action on Stigma, the campaign urges employers to sign up to a set of anti-stigma principles - for example, demonstrating that they have made changes in their employment practices to ensure that people with mental health problems are treated fairly (see box 1).

To assist organisations working towards these principles, the initiative will provide guidance, advice and support to employers via eight regional employment support teams. The project aims to increase the number of organisations and individuals who are prepared to work together in promoting mental health, and Action on Stigma wants to initiate discussion about how employers can be supported to adopt the principles. Organisations were given until 31 January 2007 to submit their views on the proposals and the kind of support employers will need to meet them.

The government believes that the NHS and other public services should be at the forefront of leading change in this area, especially given the disability equality duty that came into force in December 2006 (Disability equality duty: an EOR survey). It is hoped that industry will follow the example of the public sector and those businesses that have already taken a lead in this area.

Speaking at a conference to encourage the public sector to sign up to the initiative, Professor Appleby, the national director for mental health in the Department of Health, said: "We want the public sector to own this initiative and lead the way in transforming the working lives of people with mental health problems and their career opportunities.

"By doing this you will be setting an example to the private sector and be in the forefront of efforts to help a group of people often overlooked in the equalities debate. You will be helping tackle the last taboo - the stigma of mental illness."

The business case

Action on Stigma highlights the business case as a reason for employers to adopt the initiative. Arguments for the business case include:

• helping employers meet the legal obligations of the Disability Discrimination Act;
• reducing recruitment and training costs;
• reducing sickness levels;
• reducing staff turnover;
• improving productivity;
• making the workplace healthier and happier;
• showing others and your own staff that you are a good employer; and
• benefiting from the £50 billion annual spending power of people with disabilities.

Employers have a duty to ensure that their employees are not made ill by their work. They can also play a key role in changing the way their employees behave towards those who experience mental health problems. Employers can make a positive impact by committing to workplace practices that will:

• support and maintain mental wellbeing in staff and those with whom staff engage;
• provide mental health awareness training to staff;
• support employees if they develop a problem;
• make sure their employees understand mental health issues; and
• not discriminate against an employee or customer because they have a mental health problem.

Action by employers

As part of the initiative, the Department of Health published a document setting out six principles that will enable employers and organisations to reduce the incidence and impact of mental health problems (see box 1). The document points out that the first step to improving mental health and wellbeing in the workplace is to make staff more aware of the issues. When someone does develop a problem, they do not always recognise the danger signs and so do not seek help early enough. Making staff more aware will enable them both to help themselves and to be more sensitive to the needs of others.

Improving the mental wellbeing of employees also requires a work culture where everyone is treated with respect and dignity, and bullying and harassment is not tolerated. Promoting such a culture can reduce sickness absence, grievance and discrimination claims, and the incidence of mental health problems.

Employers can help staff help themselves by providing information about mental health and access to services. Promotion of good mental health practices, such as operating flexible working hours so employees can balance the demands of home life with work, will bring about a positive working environment.

The document points out that the vast majority of people who experience mental health problems continue to work successfully. It states that the greatest barrier people face is not being given the chance to prove their effectiveness.

Employment rights

We provide a brief summary of the rights that arise under the Disability Discrimination Act 1995 (DDA), and those under the common law right to sue employers for negligence, particularly as they arise in relation to stress-related illnesses.

Disability discrimination

The DDA specifically includes "mental impairment" in the definition of disability. Since December 2005, a mental impairment is no longer required to be "clinically well-recognised", following changes introduced by the Disability Discrimination Act 2005 (Disability Discrimination Act 2005: an EOR guide). A claimant with a mental illness is now in the same position as a person with a physical impairment, and has to show that the impairment has a substantial and long-term effect on their normal day-to-day activities. This requires the claimant to show that the impairment has lasted, or is likely to last, 12 months.

The burden of showing the long-term effect of depression can be problematic for claimants. Although depression is a clinically well-recognised illness, the International Classification of Diseases states that the median length of a depressive episode is six months. This means that some claimants will have difficulty bringing their claim within the DDA's definition.

There are many different types of mental impairment that can lead to a disability, including: dementia; depression; learning disabilities; manic depression; obsessive compulsive disorder; and schizophrenia.

The DDA places a duty on employers to make reasonable adjustments to enable disabled people who are placed at a disadvantage to obtain and keep employment. A reasonable adjustment may be flexible working, part-time hours or a gradual build-up to full-time hours after a period of illness. What constitutes reasonable adjustment is judged by how far it deals with disadvantage, the cost of the adjustment, the resources of the employer and the availability of assistance or specialist help.

Key cases under the DDA

• The Department for Work & Pensions v Hall [2005] EAT/0012/05

This case illustrates the extent of an employer's duty to make reasonable adjustments once it is aware of an employee's poor mental health.

The EAT held that a tribunal was correct to conclude that an employer was in breach of the duty to make reasonable adjustments even though it accepted that there were no reasonable adjustments that could have worked because the employee refused to take her medication. The EAT found that the employer should have been aware of Ms Hall's mental disability because of her refusal to answer medical questions during recruitment, her volatile and disruptive behaviour, her application for disability tax credit and the fact that one of the interviewers had known her personally for some time. Once it was found that the employer should have known that she was a disabled person it followed that there had been discrimination in that the employer had failed to consider whether any reasonable adjustments could be made to accommodate her. However, as it was likely that no reasonable adjustment could have been made, the amount of compensation was limited.

• Edmund Nuttall Ltd v Butterfield [2005] IRLR 751 (In the courts)

The EAT found that an employee dismissed after his employer found out that he had committed offences of indecent exposure was not discriminated against by reason of a disability, as the reason for the dismissal was the claimant's "exhibitionism", which is an excluded condition under the DDA. Although the condition was a manifestation of a mental impairment, depression, and the fact that had he not had the mental illness the claimant would not have committed the criminal offences, it was held that the excluded condition was the reason for the dismissal.

The EAT acknowledged that a claimant may have both a legitimate impairment and an excluded condition. The key question, according to the EAT, is one of causation: what was the reason for the less favourable treatment? If the reason was the excluded condition and not the legitimate impairment, then the claim fails. Where both the legitimate impairment and an excluded condition form the employer's reason, if the legitimate impairment was an effective cause, then prima facie discrimination is made out. However, where the excluded condition is the reason for the less favourable treatment, the existence of an underlying legitimate medical impairment does not mean that disability is a reason for the less favourable treatment. That, said the EAT, would "render the effect of the Regulations nugatory". This seems to suggest that the claim will fall outside the exclusion only if the "legitimate impairment", eg clinical depression, was an independent cause leading to the employee being dismissed.

• Talbot v WAGN Railways 2005 UKEAT/0770/04 (Case digest)

Mr Talbot suffered post-traumatic stress disorder after a member of the public jumped under a train Mr Talbot was driving. He was then given a job on the ticket barrier, but after an altercation with a customer, the occupational health physician stated he should have a role with limited contact with the public. He was transferred to the customer relations department. When restructuring took place soon after this move, Mr Talbot failed to get any of the jobs through the competitive process owing to his limited experience in customer relations.

An employment tribunal originally decided that the dismissal was justified, but the EAT found that failure to retain Mr Talbot in the customer relations department was a breach of the duty to make reasonable adjustments under the DDA. The employer should have transferred him to a role in that department and considered adjustments to enable him to take up that role in the long term. However, the employment tribunal reduced the compensation awarded for loss of earnings by 25%, to take account of the possibility that the respondent's attempts to find a role for the claimant might have failed.

Personal injury

An employee can bring a claim for negligence against their employer where it is alleged that the employer has failed in its duty to take reasonable steps to ensure an employee's safety and to protect him or her from reasonably foreseeable risks.

In such a claim, an employee can recover unlimited damages for personal injury, including illness, loss of earnings, pain and suffering and loss of amenity (for example, loss of enjoyment of hobbies).

• Walker v Northumberland County Council [1995] IRLR 35 HC

The High Court held that, where it is known or is reasonably foreseeable that an employee is being exposed to the risk of serious mental illness, unless the employer takes sufficient steps to alleviate the situation, it will be in breach of the implied duty to provide a safe working environment and may be liable for any mental injury sustained by the employee.

• Sutherland v Hatton and others [2002] IRLR 263

In this case, the Court of Appeal laid down clear guidance as to how the county court and the High Court should deal with claims in negligence for psychiatric injury. It gave guidance on the way in which stress at work claims should be dealt with in the form of 16 "practical propositions". The following general principles arise: there are no occupations that are intrinsically dangerous to mental health; employers can usually assume that an employee can tolerate the normal pressure of work, unless the employer knows of a particular problem or vulnerability; an employer may be liable if it does not take notice of warning signs of harm to health; the claimant must show that breach of duty has caused or materially contributed to the harm suffered - it is not enough that occupational stress caused the harm; and employers should consider offering a confidential advice service.

• Barber v Somerset County Council [2004] IRLR 475

This House of Lords decision re-states the principles that apply to cases of workplace stress. It concluded that the mental breakdown Mr Barber suffered had been brought about by the pressures and stresses of his workload and that his employer was in breach of its duty to protect his health and safety. The House of Lords said the senior management team should have made "sympathetic enquiries" about his condition, taken steps such as reducing his workload to ease the pressure on him, and monitored the situation.

Lord Justice Walker said that the best statement of general principle remains that in Stokes v Guest, Keen and Nettleford (Bolts & Nuts) Ltd [1968] 1 WLR 1776, namely that "the overall test is still the conduct of the reasonable and prudent employer taking positive thought for the safety of his workers in the light of what he knows or ought to know" and "that where there is developing knowledge, he must keep reasonably abreast of it and not be too slow to apply it".

• Hartman v South Essex Mental Health and Community Care NHS Trust [2005] IRLR 293

In six linked cases, the Court of Appeal confirmed the 16 principles in Hatton, but it also emphasised that the principles do not set out statutory duties, and every case of work-related stress must be dealt with on the basis of that particular employer's duty of care to its employees in general and that particular employee. Some of the points raised in the judgment are:

• the fact that an employee does not take up counselling offered by the employer does not necessarily absolve the employer of responsibility;
• if an employer foresees that an employee or group of employees might suff er psychiatric illness but does nothing about it, it cannot later argue that it did not foresee the illness;
• the fact that an employer offers an occupational health service does not mean that it has foreseen that employees might suffer psychiatric illness.

• Daw v Intel Corporation [2006] EWHR 1097 (QB)

An employer that offered a counselling service was still found liable for breach of duty of care resulting in personal injury. In this case, the High Court commented that "whether in any case the counselling service provided will be enough to discharge the reasonable employer's duty must depend on the facts of each case … [Mrs Daw] cannot reasonably be criticised for not using it. A short-term counselling service could not have done anything to ameliorate that risk or help Mrs Daw cope with it. It could not reduce her workload. The most it could have done was to advise her to see her doctor. It does not seem to me that on the facts of this case, the service provided was a sufficient discharge of the defendant's duty."

The Court also held that although an employer is more likely to be aware that an employee is vulnerable to stress if they have suffered from work-related stress in the past, in Mrs Daw's case, knowledge of previous bouts of post-natal depression did not mean that a reasonable employer would have considered that her mental health was more at risk if she was placed under stress. Further, although an employer is not required to make probing enquiries, in Mrs Daw's case, her manager was put on alert. He had found her in tears, and read her account of what the problem was. If the manager did not understand what Mrs Daw was saying in her letter when she obliquely referred to previous episodes of depression, he should have asked her to explain, as she was clearly upset and under considerable stress.

The Court of Appeal has given permission for the employer to appeal on the grounds that the steps expected of the employer were excessive, and that the availability of the counselling service discharged the duty.

Employer action

These decisions point to various actions that employers need to take. Employers should:

• carry out a risk assessment of stress-related injury as part of their health and safety policy;
• take note of any warning signs of breakdown in their employees, for example, through higher than usual sickness absence;
• ensure that where an employee actually tells the employer that they cannot cope, that reasonable steps are taken to alleviate the stress;
• where appropriate, have in place a stress management programme or confi dential counselling services; and
• where the employee is a disabled, or potentially disabled, person, ensure that reasonable adjustments are put in place and recorded.

1. How common is mental distress? MIND, January 2005. Available at: www.mind.org.uk/Information/Factsheets/Statistics/Statisti+1.htm.

2. Mental health: the last workplace taboo, Shaw Trust, 2006, available at: www.shaw-trust.org.uk/mentalhealth/.

3. Action on mental health: a guide to promoting social inclusion, Social Exclusion Unit, Offi ce of the Deputy Prime Minister, 2004. Available at: www.socialexclusionunit.gov.uk/publications.asp?did=300.

4. Survey conducted by Gfk NOP. Further information available from: www.drc-gb.org.

This article was written by Kate Godwin, research officer, Equal Opportunities Review, kate.godwin@irseclipse.co.uk.

BOX 1: ACTION ON STIGMA PRINCIPLES Employers can demonstrate that employees are helped to look after their mental health by making them aware of the steps they can take to preserve and maintain their own and others' mental wellbeing. Employers promote a culture of respect and dignity for everyone, ensuring that staff are trained to recognise and be sensitive to mental distress or disability in others, whether they are workplace colleagues or customers. Employers encourage awareness of mental health issues, so that employees recognise the danger signs and understand the importance of seeking help early. Employers can demonstrate that no one is refused employment on the grounds of mental illness or disability. Employers can make reasonable adjustments to the work environment for people with mental health problems so that they can continue working. Employers can demonstrate that they take positive steps to ensure that people with mental health problems are not disadvantaged, in relation to the availability of their goods and services. Source: Action on stigma - Promoting mental health, ending discrimination at work.

BOX 2: CASE STUDY - BT Telecommunications giant BT has launched the Work Fit - Positive Mentality campaign, the biggest ever drive by a UK company to improve the mental health of its staff. The campaign has been drawn up by BT in collaboration with the trade unions CWU and Connect and with the support of the mental health charities the Sainsbury Centre for Mental Health and MIND. The 16-week Positive Mentality programme consists of eight modules and aims to demonstrate how regular exercise, healthy eating and good relationships with others can help to ward off depression, stress and anxiety. It is also intended to reduce the stigma of mental illness and promote the range of support services that BT provides. "We want to help people to help themselves," says Dr Paul Litchfield, BT's chief medical officer. "Our approach to health and safety is that the company doesn't do things to you, and increasingly it doesn't do things for you, but it does create the right environment and gives you the correct information to enable you to do things for yourself." The company has established a dedicated website for its mental health programme. The campaign is being publicised through emails and written materials issued by BT and the company is supporting the trade unions that are running a series of roadshows about the initiative. Unlike the company's programmes on physical fitness, employees do not have to register to take part in the online mental health programme. BT is monitoring the number of hits on the site, and it runs a quiz at the end of each fortnightly module to try and gauge the level of active participation and knowledge transfer. The company is encouraged to learn that the mental health site has received around 6,000 hits from its workforce - compared with 16,500 for physical fitness - and almost 2,500 people are completing each quiz. Litchfield explains that the company's mental health strategy has three strands: primary prevention, secondary intervention and tertiary rehabilitation. Primary prevention: BT wants to create a working environment that helps people avoid becoming ill. So while customers' needs are borne in mind, the company aims to give people as much control over their work patterns as possible. Similarly, attention is paid to workplace design. Secondary intervention: the company tries to identify both "hotspots" in the organisation and individuals who are under stress. To help deal with this, BT and the trade unions have jointly developed a computerised stress risk assessment tool, called STREAM. A research psychiatrist advised the company on the tool, which asks 30 "pressure" questions and 10 questions to gauge how stressed an individual is. The test places individuals in a red, amber or green zone, according to the risk factors present. To date, around 20,000 of the 102,000-strong workforce have completed STREAM, with around 5% being placed in the red zone. Litchfield says there was much debate with the trade unions on whether or not completion of the test should be confidential; but it was finally agreed that, if a risk is present, management needs to know so it can act. So before an individual does STREAM, they have to agree to the report that it generates being shared with their line manager or another manager they nominate. To enable managers to deal effectively and sensitively with staff with mental health problems, an online tool called STRIDE has been developed. Litchfield says that all managers are actively encouraged to complete the programme. Senior managers are given information about the mental health of their part of the business from data obtained from the sickness absence database, the occupational health database and the STREAM database. Litchfield points out that sickness absence can be directly translated into cash. "When we first rolled out our mental health strategy, the early adopters were contact centres and we could show that, in the first year of implementation, the cost to that part of the business had dropped by half-a-million pounds during the course of implementation." Tertiary rehabilitation: BT recognises that the incidence of mental health problems means that one in four of its employees could be affected. It has accordingly structured its support services, the advice it gives to its managers, its occupational health programme and its employee assistance programme to support people through a difficult time. BT line managers are expected to keep in touch with their staff when they are off sick. "It's not about pressuring them back to work but to encourage them to talk about everyday things and share office gossip and stop them becoming isolated," explains Litchfield. The aim is to get anyone who has been off work with a mental health problem onto a rehabilitation programme. Once someone is back at work their hours and performance targets will be reduced. "We'll give them short-term aims and objectives so they can see they have achieved something each week, as a characteristic of depression is that people lose their self-confidence." Litchfield advises other employers who are considering how best to tackle mental health to keep it simple and not to "medicalise" problems, as from the employer's perspective it is the work that matters. "It's about treating people as you would like to be treated. If someone gets a health problem it is far more likely to be a mental health problem than heart disease or cancer. Any of us could be there. And our figures show that the business case stacks up!"

BOX 3: CASE STUDY - DEVON PARTNERSHIP NHS TRUST Devon Partnership NHS Trust is one employer to host the Mindful Employer™ initiative, which aims to increase awareness of mental health at work and provides support for businesses in recruiting and retaining staff. The trust has publicly committed to working towards the Charter for Employers who are Positive about Mental Health, which has developed from the overall Mindful Employer initiative. The charter is a tangible display of commitment to improving the working lives of staff. Darren Armitage of the trust points out that it is different from Investors in People, the Two Ticks disability symbol and other accreditations, in that the charter recognises that policies and good practices are not necessarily already in place. It is a set of aims; something to work towards. The charter is a voluntary agreement that seeks to support organisations in working within the spirit of its positive approach. Armitage comments: "It is not legally enforceable and doesn't negate the need for you to get the right person with the right experience, qualifications and skills for the job. Whether you are a small, medium or large employer, the charter fully respects there will be many different priorities, policies and practices which influence the way you recruit and retain staff - you are the expert on your business." The trust has used Working Towards: an aid for businesses signing up to the Charter for Employers who are Positive about Mental Health to review and develop its existing approaches and has further developed policy and support mechanisms that will be present within most large organisations. These include: Prevention of stress policy. The policy aims to eliminate the causes of stress; to reduce the residual adverse effects of stress on staff to as low a level as reasonably practicable; to recognise the employer's responsibility in engendering a climate that promotes the management of stress; contribute to supporting staff in periods of change and promote, through education, stress management as a means of maintaining a healthy workplace. Absence management policy. This policy recognises that the value that the trust places on the health and welfare of its staff is of the utmost importance. In doing so it also recognises that some absence due to sickness is inevitable within any large organisation and sickness absence needs to be dealt with in a sympathetic and understanding way. However, it also recognises that absence can have an adverse affect on the quality of service provided by the trust and aims to enable optimum health and wellbeing of its workforce while providing a mechanism to deal with unacceptable levels of absence. More specifically, it requires managers to immediately refer cases of absence relating to stress, etc for occupational health review. The trust offers phased return-to-work programmes to support staff returning after episodes of absence. Grievance policy. The aim is to resolve any matters of dispute and anxiety as quickly and fairly as possible through informal or formal means in order to alleviate stress and rebuild healthy working relationships. Acceptable behaviour policy. This states that bullying and harassment will not be tolerated and gives support to employees and managers on how to deal with situations. The trust has trained support advisers and mediators to support staff and alleviate any stress. Recruitment policy. Ensures that a fair and transparent process is followed with regard to recruitment and selection of employees regardless of any disability. Equal opportunity. An assurance that the organisation is committed to all staff being treated in a fair and equitable manner regardless of any disability. Time off for medical/dental appointments. This ensures staff can access services easily with regard to their health and wellbeing. Service-user involvement/reimbursement policy. Recognises the value of getting mental health service users to share their experiences throughout the organisation, either as part of the induction programme for all new staff involving courses/lectures for staff, or to service users as part of their treatment. Single equality scheme. Specific commitments to staff covering employment and discrimination about disability more generally. Mindful Employer details and resources are available at: www.mindfulemployer.net.

BOX 4: FURTHER INFORMATION Helpful information for employers about the Disability Discrimination Act and the disability equality duty can be found on the Disability Rights Commission's website: www.drc-gb.org and from the Department for Work and Pensions: www.dwp.gov.uk/employers/dda/. The Employers' Forum on Disability has produced briefing papers designed to make it easier for employers both to comply with the DDA and to adopt best practice. They are intended for HR, occupational health, recruitment and training specialists and line managers. See: www.employers-forum.co.uk. Acas (www.acas.org.uk), the CIPD (www.cipd.co.uk/subjects/health) and the Health and Safety Executive (www.hse.gov.uk) have produced valuable resources on stress at work, health and employment and related legislation and good practice. Managing for mental health: The MIND employers resource pack is for employers that want to ensure best practice in mental health promotion at work. It includes sections on where to get help, employment policies and background information on mental illness. The pack can be ordered from MIND publications, tel: 0844 448 4448 or email: publications@mind.org.uk. Employer support The Shaw Trust offers support in matters such as employing disabled people, recruiting a diverse workforce, managing absence effectively and having an accessible website. This is a national organisation, with offices and projects around the UK. Tel: 01225 716350, website: www.shaw-trust.org.uk. Mindful Employer is an employer-led initiative that aims to increase awareness of mental health at work and provides ongoing support for employers who wish to improve their employment practices. Its website includes resources for employers, an online discussion forum, local contacts and a Charter for Employers who are Positive about Mental Health. There is no cost involved in the Mindful Employer initiative, which is open to any employer in the public, private or voluntary sector in the UK. Tel: 01392 208833, website: www.mindfulemployer.net. Action on Stigma has been set up to initiate discussion about how employers can be supported to adopt good practice principles in relation to mental health. The project aims to add to the knowledge base and increase the number of organisations and individuals who are prepared to work together on the issue. The website carries news of the regional events where employers and accredited employee organisations can hear about the principles and examples of good practice. It also has links to a number of documents, resources and other websites that may be of interest to people and organisations that are working to reduce the stigma and discrimination that surrounds mental health. Website: www.shift.org.uk/employment.