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Recent by the Care Quality Commission has highlighted that the range of challenges faced by health and social care staff during the pandemic has impacted on their mental health and wellbeing. These have included: increased workload, witnessing serious illness and death at unprecedent levels, and feelings of guilt about not being able to do more. In June 2021, .

The impact of staff burnout, stress and staff leaving the profession can be seen in absence and recruitment data. The ONS show that workers in care had one of the highest rates of sickness absence at 3.8% (compared to 2.2% across all groups). Equally, at the end of June 2022 there were more than in the health and care sector, which was a vacancy rate of 9.7%, the highest it has been for 5 years. Further, mental health issues in the workplace are estimated to £1652 per employee per year.

Given these statistics it is important to consider what employers can do to spot, support, manage and help staff in a social care setting who are showing signs of suffering mental health issues.

The first step is to ensure that managers and HR colleagues are alive to the warning signs of poor mental health. Training managers to spot the warning signs which may include, uncharacteristic behaviour, lack of engagement, decreased productivity and withdrawal from social situations. Frequent and regular engagement with employees will also assist to help staff feel valued and supported as well as building rapport so that they are more likely to be open about any difficulties they may be experiencing.

Managers should also deal with concerns or issues that arise in a timely manner rather than letting them rumble on. Be sure that employees know who they can raise concerns or worries with and encourage managers to be more visible in the workplace. Managers also need to be proactive. Where there are concerns that staff are struggling due to poor mental health, consider a referral to occupational health at an early stage. There is often a temptation not to ask too many questions, but that approach is not helpful to the employer or the employee. The more an employer understands about an employee’s health and its impact on their ability to do their job, the more it can do to support that employee and prevent long-term absence from occurring.

Care home managers and owners should also have in mind that an employee’s mental health condition may be a disability, if it has a substantial and long-term adverse effect on the person’s ability to carry out their day-to-day activities (which is wider than work activities). Employers are under a duty to make reasonable adjustments for its disabled employees to remove disadvantages they may suffer in the workplace. Examples of adjustments may include changes to duties or working hours or working patterns. Engagement with the employee and with occupational health will be vital in knowing what support can be offered. If the employee is not disabled but struggling to manage a health condition, workplace adjustments might support them to stay in work or to return to work from periods of absence. It is in both the employer and the employee’s interests to find ways to help them remain at work.

Owners and managers should also consider the impact of mental health on an employee’s conduct and/or performance. The disruption and uncertainty of the pandemic, the cost of living crisis and ongoing staffing crisis in the care sector will have had impact on employee performance. Fatigue, anxiety and trauma are all contributing to the workforce being more vulnerable than it ever has been.

Where an employee’s performance or conduct slips, employers should consider all relevant factors before moving to a formal process. While employers need the workforce firing on all cylinders to minimise the impact of high vacancy numbers, it is important to recognise that many care home employees have been through a lot in the last three years and will need tolerance and understanding to avoid making a staffing crisis worse.

Where an employee is not performing or is behaving badly, employers should consider whether there are any external factors contributing to those issues. That is not to say that employers cannot expect their employees to perform and behave appropriately, but they should engage with the employee, obtain medical advice at an early stage and consider making reasonable adjustments before issuing sanctions. It is important to remember that there is a person at the end of the process. Therefore, if a formal process needs to be followed consider the wellbeing of the person concerned and asses what support will be required, such as extra time to reach objectives or allowing the person to be accompanied by their spouse/partner at any formal meetings.

Where an employee’s performance or conduct is impacted by poor mental health, there are no quick fixes and processes will take time. Care home managers should consider every decision and step in the context of the employee’s mental health condition and how it may be perceived or interpreted. Small actions can make a big difference to a vulnerable employee, so:

• consider training a pool of mental health ‘first aiders’ that can be the first port of call for those who are struggling with their mental health.
• offer a counselling line to employees or at least have a bank of useful resources to which employees can be signposted if they are in difficulty.
• if you do have to tackle performance or conduct issues, be compassionate in your approach. Consider whether it is essential to send letters/emails which might be difficult to receive on a Friday afternoon or just before a holiday – can it wait until the following week?
• consider venue and times of meetings – an employee with depression may find early morning meetings difficult, particularly if they have any distance to travel.
• Acknowledge that things may take longer, and you may have to agree to delays – while this will be frustrating, it is often difficult to justify months later why something had to be done and could not be postponed for a week/2 weeks/ a month

Ultimately by investing in employees’ wellbeing you will not only make employees feel valued and respected but will also build trust and engagement. This in turn may assist with retention and recruitment which given the current workforce crisis will be an important factor for any health and social care employer.