Mental illness is one of the main causes for sickness absence and presenteeism within the UK and therefore has a significant impact on productivity within the workplace. The number of teachers reporting a mental health problem lasting longer than one year and using antidepressant medication is growing. There is a growing body of evidence that a substantial number of teaching staff within the UK are reporting work-related stress (Wettstein et al., 2020). Sadly, the department of education says that around 1/3 of new teachers resign within the first five years of completing their training, with contributing factors being reported as anxiety, mood and sleep disorders. (Jerrim et al., 2021).
Income and work are two important factors in mental wellbeing (Phillips et al., 2011), so why are teachers leaving a role which has numerous positive factors such as a good income, a sense of identity, social status, purpose and structure to one’s day; all elements conducive to positive wellbeing outcomes (Waddell and Burton 2006)? Conversely, the evidence available indicates that work can also be a source of stress and contribute to the onset and /or worsening of common mental health disorders (Waddell and Burton 2006) and therefore, alongside research, exploring case studies, undertaken by Occupational Health, may provide some additional information.
Referrals to Occupational Health (OH) are made by managers when concerns for health and wellbeing or advice relating to health are required. In these case studies, 25 management referrals carried out by an OH trainee advisor via telephone consultation during 2020-2021 were studied. The study subjects were limited to referrals of primary and secondary school teachers with mental health problems causing absence or concerns within the workplace. The severity of symptoms, length of an absence, support and medication were explored as well as any trends, similarities and/or disparities. Each teacher was assigned a number between 1 & 25 i.e., T-1. Validated screening tools used were the GAD7 (Generalized Anxiety Disorder 7) and PHQ9 (Patient Health Questionnaire 9-question instrument). Both are self-reported questionnaires that screen for the presence of, and severity of anxiety and depression, respectively (Swinson, 2006).
The most prominent issue (68% 17/25) reported by the referred teachers was work-related stress supporting Wettstein’s et al’s 2020 research. Upon assessment, only 2 teachers scored a range of severe anxiety / low mood (8%), the rest of the cohort scored within the mild-moderate ranges. Interestingly, the incidence of short term and long-term absences of those studies were similar with 7/25 (28%) and 9/25 (36%), short- and long-term absences, respectively. 32% of teachers remained at work despite reporting symptoms of work-related stress, anxiety and or depression. Interestingly, only 4 (16%) of the participants cited the covid 19 pandemic as the main cause of stress. Fear of contracting the virus due to working in proximity with pupils and difficulty with teaching remotely during lockdown appeared to be the cause of ‘Covid anxiety’ in the small proportion who reported this. Most of the participants denied self-harm/suicide ideation now or in the past, with only 2(8%) reporting issues with this in the past.
Following the OH assessment, participating individuals were signposted to either the EAP (Employee Assistant Programme), counselling, CBT, or other therapies by the OH practitioner. Only 40% had been referred for supportive mental health therapies by their GP with the reasons described as ‘GP appointments being difficult to obtain during the pandemic’ or that as it was work-related, they did not ‘want to bother their GP’.
This case study has a number of limitations but does reflect the general literature on this subject. 84% of those reporting work-related stress noted concerns relating to work were not COVID related. Mental health at work can be shaped by the interrelationship between the person, the type of work they do and their associated work environment (NICE, 2017). The Health and Safety Executive (HSE) identified six fundamental features of the working environment that can contribute to work-related stress and defined work-related stress as the “harmful reaction that people have to undue pressure and demands placed on them at work.”
As observed in this case study, teachers’ workload (demands), pupils challenging behaviour plus management issues (relationships at work) appear to be the main drivers for the work-related stress they experience (HSE, 2009).
An Education Support survey titled the ‘Teacher Wellbeing Index’ (Education Support, 2021) studied the mental wellbeing of staff working in the education sector. Of 3,000 staff members completing the survey in the UK, 77% reported stress or a common mental health disorder, citing work as a trigger. 46% remained in work even when unwell and 54% contemplated leaving the education sector, due to the impact work demands had on their mental health and wellbeing. (Scanlan and Savill-Smith, 2021)
This study included all staff and was not limited to primary and secondary school teachers. What they found was that education staff reporting psychological symptoms caused by work is higher than that observed in all workers across other employment sectors. (HSE 2020; Ofsted, 2019). Evidence indicates that workplaces that assign high demands on individuals, without sufficient control and support to achieve these demands, increase the likelihood of potential work-related stress and poorer mental wellbeing in employees. (Bagnall et al., 2016). Therefore, addressing perceived work concerns may very well reduce the likelihood of recurrence and as such, it is the managers’ responsibility to risk assess and action findings for employees who exhibit or report signs of perceived work stress. (HSE 2018).
Occupational health (OH) contributes to business and organisation success, by assisting in the creation and implementation of strategies and action plans to enhance employee wellbeing, promote and prevent ill health. Health promotion delivered by OH nurses is paramount in the; primary (prior to illness), secondary (after illness has begun) and tertiary (when illness is established) stages of mental illness prevention and treatment. (WHO 2015). With regards to support for teachers at an organisational level, evidence suggests that appropriate health and wellbeing policies, mental health first aiders, support from unions and mental health toolkits for employers are key components in the primary prevention for mental ill-health, within the workplace (Health Scotland, 2020).
Occupational Health (OH) can support with consultancy, advice and leadership to employers and therefore school and education management. Policies and procedures are, however, not effective in addressing the stress response of teachers reporting perceived work stress or anxiety and low mood that may have occurred. OH practitioners with clinical training are an essential tool in the management of employees’ mental health and wellbeing, and in this case teachers’ mental wellbeing. They are in a privileged position of having insight into the biological, psychological, and social factors of each employee we encounter. As such, OH is able to advise, refer and signpost employees to appropriate health services and other supportive agencies, (McDowell & Fossey, 2015; Steed et al., 2021) as well as supporting organisations in managing work-related stress. A recognised tool widely used in the UK for this is the HSE ‘Stress Risk assessment’ tool or The Management Standards, which helps to identify and manage stress within the workplace. To complement the stress risk assessment, the HSE has formulated a targeted guidance document in “talking toolkit – preventing work-related stress in schools” to further allow for open dialogue between management and teaching staff to combat work-related stress.
An additional supportive measure that OH practitioners are able to signpost and guide management to, is a Wellness Recovery Action Plan (WRAP). By developing this WRAP, employees can actively support their own mental health by reflecting on the causes, and by taking ownership of practical steps to help address these triggers. This process can also help open up dialogue between managers and employees, understand their needs and experiences and ultimately better support their mental health. (Ellen Copeland, 2006; Canacott, Moghaddam and Tickle, 2019). Overall, there is evidence to suggest early intervention from OH, is likely to aid improved mental health outcomes for employees (Institution of Occupational Safety and Health IOSH, 2016).
As OH practitioners, the main contact with teachers is through management referrals where individuals are then assessed using a bio-psycho-social model, which includes workplace contributors. OH not only provide fitness for work advice, education and support for those managing the employees but also allows OH practitioners to signpost employees to their GP, emergency services, the community mental health team and other supportive mental health charities and organisations (WHO 2015).
In conclusion, this case study supports literature indicating relationships (with management, colleagues and or children) and workload are major drivers for reported work-related stress in the teaching profession. Teachers’ mental wellbeing is important, not only on an individual level but also on a societal level as poor mental health outcomes in teachers can directly affect, the school experience and learning outcomes, of children and young people ((Health Scotland, 2020). OH are a valuable tool because they possess medical and workplace health, knowledge and skills and are versed in interdisciplinary working. Therefore OH not only assess and advise the individual but advise and lead organisations in preventing ill health. All of this contributes to employee wellbeing and helps to build a psychologically resilient workforce. (Weinberg et al., 2017).
Phina is an experienced nurse who is currently studying for a specialist community public health nursing qualification, focusing on Occupational health. She is particularly passionate about community health and is a trustee of a charity centred on tackling mental ill-health within the African / Caribbean communities – Baba Yangu foundation. She works for PAM group which she says has been instrumental in her growth as an OH practitioner.