Becky is a stress and mental health risk specialist within the Health and Wellbeing Practice of Risk Management at Willis. Becky's focus is on supporting organisations managing risk to psychological health and safety, psychosocial risk. Becky has a particular interest in helping businesses implement a preventative strategy and action in line with ISO 45003 guidance.
She's a passionate trainer and advocate for workplace wellbeing as well as an approved mental health first aid instructor. Becky, it's really good to have you here. Welcome.
BECKY FORSTER: Thanks, Rachel. Good to be here.
RACHEL PHILLIPS: So Becky, the interesting subject. The UK government's recently announced proposals around immigration contain measures which will surely have an impact on a sector which is already navigating significant workforce challenges, including, of course, recruitment, retention, and wellbeing. And I hear a lot about psychological health and safety. So, Becky, what exactly is meant by this expression?
BECKY FORSTER: I think really you need to think of psychological health and safety in exactly the same way we do our physical health and safety. It's mental health, which I think is important to think about as to how we are. Essentially, it's how we think, how we feel, and how we behave. It's more than just mental illness, which is what is thought a lot of the time.
RACHEL PHILLIPS: Yes, and exactly. And I think it's ensuring that mental wellbeing, that good mental health, which is key. Why is it important, therefore, to prioritise, let's say, in health and social care environments? And what are the risks of neglecting it?
BECKY FORSTER: I mean, I think particularly in health and social care settings, we know that poor mental health and mental illness can be particularly prevalent due to the emotionally demanding nature of the work. If I think about high workloads, frequent exposure to distressing situations, for example. And then more broadly, if we think about health and social care and beyond, there are moral, legal and financial reasons for thinking about psychological health and safety at work. In fact, it's actually a focus area for the UK Health and Safety Regulator at the moment.
RACHEL PHILLIPS: Oh, that's interesting. We'll possibly come on to that in a little bit more detail. So I agree with you. I mean, it's a very difficult situation in which the teams working within health and social care are, and I think acknowledging that is really critical. And I'm sure providers go some way to acknowledge that already and to try to put in place some practices to help. Whose responsibility is it within an organisation?
BECKY FORSTER: I think everybody, just like with physical health and safety. Everybody has a responsibility here. Of course, we need to nominate somebody to have overall responsibility within the organisation, usually at senior management or board level. But then there are responsibilities for line managers.
You might have heard various bits of research that talk about a manager having more of an impact on somebody's mental health than their therapist or their doctor. But equally, we need to consider the mental health of managers, and employees themselves have a responsibility to take care of their own wellbeing and wellbeing of their colleagues as well.
RACHEL PHILLIPS: And I guess if they don't look after wellbeing of the team, then that potentially has an impact on other areas. So I guess basic, in terms of care provision and potential errors and omissions, would you agree?
BECKY FORSTER: Yes. Yeah, absolutely. And I think it's really key for employers to have mechanisms in place to monitor and measure perhaps the impact of stress and poor mental health on their workforce. When I talk to clients, I often hear people say, Oh, we don't have challenges around stress and mental health because we don't have people off sick, or we don't have stress claims. But like you just acknowledged, we need to look broader when we're thinking about this area.
And unfortunately, in society, you should have people off sick with these issues because they are extremely prevalent. One in four people is thought to experience a mental health issue at some point in their lifetime, and we know that stress claims and can be challenging to prove. But we also know that stress and poor mental health can have a negative impact on things like behavioural safety.
RACHEL PHILLIPS: Yes.
BECKY FORSTER: Leading to an increase in physical health and safety incidents. People are taking shortcuts, not following policies and procedures. Making mistakes, perhaps, which could ultimately lead to negligence claims.
RACHEL PHILLIPS: Yeah. And I think it's really an interesting point you raise around stress claims because I'm guessing even post-COVID, perhaps, it's less so now. You tell me, but I think people are probably reticent to talk about the fact that it was stress or nervous about that. So may actually put it down to being off sick for another reason, maybe.
BECKY FORSTER: Yeah, absolutely. And we see that when we look at absence statistics. I mean, according to the latest set of statistics released by the Health and Safety Executive (HSE), 46% of work-related absence was down to stress, anxiety, or depression. I would argue that, in reality, that figure is probably higher because, like you say, people don't always disclose the real reason for their absence. And we also know that poor mental health and physical illness or injury can coexist.
RACHEL PHILLIPS: Yes.
BECKY FORSTER: You might have, for example, chronic or sustained stress contributing to frequent minor illnesses like coughs, colds, musculoskeletal issues, perhaps.
RACHEL PHILLIPS: Yeah, I agree. And if the government's proposed immigration policy comes in, surely that's going to exacerbate an issue the sector is already grappling with and I guess potentially further impact on wellbeing.
BECKY FORSTER: Yes, absolutely. And retention that can be an impact of stress and poor mental health, we didn't mention. I think what's most important with these government proposals is that we consider that change, or lack of communication about change, is one of the biggest causes of work-related stress. So I think it's so important that health and social care employers don't bury their heads in the sand. We want to be having empathetic conversations with our people about this area, perhaps using the HSE's talking toolkits for change and signposting people to support to help them with their emotional wellbeing.
RACHEL PHILLIPS: OK. That's interesting. I think we're going to come on. It'll be useful to actually to talk a little bit about in your experience, what works well and what doesn't work so well, including the toolkits. Have you got some practical tips, Becky, that you'd like to share?
BECKY FORSTER: Yeah, absolutely. And I think the biggest one is probably prevention is key. A lot of the time, when we're talking about psychological health and safety, we are providing people with support once they have already been harmed. That's not enough, and it's also not enough to meet our legal duty as well. So, if we're using things like the talking toolkits to have conversations about work-related stress, we want to do that proactively.
We don't want to wait until people are already showing signs of distress. And I think, importantly, we need to make sure that we have documented risk assessments in place for stress. That's a legal requirement that I often see organisations fall afoul of.
RACHEL PHILLIPS: And legal requirement, did you say under the Health and Safety at Work Act?
BECKY FORSTER: Yes, specifically the management of health and safety at work regulations. They impose a requirement on employers to risk assess for work-related stress. That means that we need to have a documented organisational stress risk assessment.
RACHEL PHILLIPS: I wonder how many providers are doing that and have recognised that. And I guess, it's not an area that has been highlighted in previous years, I guess, very much by the Health and Safety Executive, but did I hear that they are putting more attention to it at the moment and in the future, and trying to look at this area specifically?
BECKY FORSTER: Yes, absolutely. And it's a conversation you and I have been having for a while, isn't it, Rachel? But we are seeing several active investigations by the HSE in this area. There are a number of circumstances in which they will investigate. One of those is multiple reports of work-related stress, and I've actually seen a letter sent by the regulator to an organisation they are investing, and they are criticising that organisation around their management of work-related stress, because all of the control measures that organisation has in place are what's known as tertiary or support measures. So those measures, again, designed to help people once they're unwell.
RACHEL PHILLIPS: Yes.
BECKY FORSTER: We're not doing enough to prevent people from work-related stress in the first place.
RACHEL PHILLIPS: Yeah, in the first place. That's interesting. And I guess also what we don't want is organisations or providers that then discourage their teams from reporting stress because it then becomes highlighted to HSE, and in regardless of the legal imperative, we want them to have a moral. And you talked about this earlier, moral responsibility, because it makes good business sense for them to have a team that's got very positive mental health and feel valued and fulfilled, etcetera in their roles.
BECKY FORSTER: Yeah, absolutely. And I think the world of work is changing. So nobody expects to be made physically unwell by their work, do they?
RACHEL PHILLIPS: Yeah.
BECKY FORSTER: That's a moral expectation. I think we're in a situation where perhaps we have normalised harm to our psychological health and safety and an unhealthy level of stress, which is harmful to health. Stress itself is not harmful to health per se, but chronic or sustained stress is. But that's changing.
Generations entering the workforce now have a level of understanding about stress and mental health. A level of education that perhaps we didn't have, and therefore, they have different expectations of their employer when it comes to looking after their stress and mental health. Now, people do not expect to experience chronic or sustained stress. They do not expect to experience stress-related injury, which, again, is what we need to protect them from a legal perspective.
RACHEL PHILLIPS: That's a really interesting point actually, because you're right. We, different generations, I guess, have almost got used to that sometimes, in certain sectors, being just part of the job comes with a level of stress. And I do appreciate there's a difference between sustained pressure and chronic stress. The words are sometimes used in the same way, and I appreciate there is a difference.
But there's almost, it's interesting that there's a different expectation coming from the next generation of workforce, which actually can only be beneficial.
BECKY FORSTER: Yeah, absolutely. And look, I think it's important to acknowledge that our aim is not to eliminate all pressure or responsibility at work. That's not realistic. It's about achieving balance. So if I look, for example, at the six main causes of work-related stress, it's likely in many roles that we've got high demands and a lot of the time there's nothing as employees that we can reasonably do about that.
RACHEL PHILLIPS: Yes.
BECKY FORSTER: However, there's often something we can reasonably do about the other five areas. If I take control as an example, giving people more control, more autonomy over the way that they do their work, involving them in the design of things like policies, processes, and procedures, can really make a difference, as can support. And just taking time to ensure people are clear on their roles and responsibilities.
RACHEL PHILLIPS: That's interesting. And for those providers, because most organisations now have an employee assistance programme, often a helpline. How important are they as part of that? Obviously, not prevention necessarily, or possibly. I don't know. What are your thoughts? Do they have a place? Does that have a place in helping manage stress and wellbeing?
BECKY FORSTER: Yes. Yeah, absolutely. They can be used if used in the right way. They can be a preventative measure if people are reaching out before they become unwell. But just like any mechanism for psychological health and safety, there isn't a single solution. There isn't a one-size-fits-all. For example, most employee assistance programmes are for mild to moderate distress.
RACHEL PHILLIPS: Right.
BECKY FORSTER: And they don't take away the need for the employer to address hazards at source.
RACHEL PHILLIPS: Right.
BECKY FORSTER: So, for example, when I deliver line manager training, one of the things I often talk about is how typical responses from managers to someone disclosing distress are often, do you need some time off? And ring the employee assistance programme.
RACHEL PHILLIPS: Yes, yes, I agree.
BECKY FORSTER: The role of the line manager needs to be in ascertaining the cause of work-related stress and doing something about it. For example, by using those talking toolkits, and by putting in place a workplace pressure support plan.
RACHEL PHILLIPS: I find that really interesting about the line manager, because I think actually they're often maybe not the first line of defence, but certainly a second line of defence. And that signposting towards the EAP is often where it starts and stops. And I think that training of line managers to actually anticipate and spot the signs early of stress and mental ill health or wellbeing issues, but also then being able to manage those individuals through that process and back into the business is really critical. Would you agree?
BECKY FORSTER: Yeah, absolutely. So I think managers need to look at things like performance management procedures and return to work as an opportunity to, again, have empathetic conversations about psychological health and safety and use tools, like those talking toolkits, to support them again, rather than burying heads in the sand.
RACHEL PHILLIPS: Excellent. Well, thank you, Becky. I found that really fascinating, actually. I guess some takeaways for me from the conversation is that health and social care providers should ensure that they look at this area, that they have policies in place which are robust. And actually, the risk assessment element of that is critical for stress or wellbeing in and of itself, but the policies and procedures are being actively followed because that's often the case.
A policy is perhaps written, but not necessarily followed or enforced, to help ensure that the psychological health and safety of their employees is paramount, and particularly, in the sector, where there's already a leanness around staffing, some chat because of the challenges that they face. And having more the impact potentially of this policy could mean that the staffing levels are reduced even further, and therefore, there's going to be greater, as you've talked about and touched upon greater impact, potentially on a smaller number of staff.
And interestingly, you've signposted free resources to support managers to have these conversations with teams about change. For example including, you mentioned the Health and Safety Executive talking toolkits. So there is a free resource out there, but there's also support from individuals like yourself and others who are fully immersed in having these conversations all the time and can help provide that second pair of eyes at an independent, if you like, check and review on what's going on within a provider and whether they're doing enough.
BECKY FORSTER: To add one thing, Rachel, because I think it is so important in this area, and that's consultation. Consultation with employees is so important when it comes to this area because what we're finding is when we don't consult enough with employees, there is a disconnect. So there's a disconnect between how employees want to be supported in terms of their emotional wellbeing and what's being put in place.
RACHEL PHILLIPS: Interesting. That's a great place to end, Becky. It's been a pleasure chatting with you today on The Anatomy of Risk. Thank you for listening to this podcast from Willis at WTW business.
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