Often, when we look at accident statistics, we only look at those with external injuries. Those who slip and fall will sometimes have a mark to show they are in need of care. However, there is a sizeable portion of the UK population who bear invisible injuries. Injuries that do not bleed and are far more difficult to measure and treat for inclusion on a spreadsheet. According to the charity Mind, one in four of us will experience some kind of mental health problem each year in England. One in six will suffer from a common mental health problem each week. This can range from anxiety or depression to Post Traumatic Stress Disorder, Obsessive-Compulsive Disorder, and psychotic disorders. This not only effects those inflicted, but also those around them, and nowhere is this more evident than in a port environment. Week two of our “Protecting Quay People” campaign focuses on the Whole Person approach to Health and Safety and begins with the facet that can easily be overlooked, mental health. Wendy Freeman, Occupational Health Manager for Peel Ports, based in Liverpool, outlines what they are doing to deal with this unseen injury.
Working in such an environment as a busy port, the expectation would be that we would see mainly musculoskeletal issues given the nature of the environment and the labour-intensive aspect of many roles. Indeed, when I returned to the Port of Liverpool after first working here some 25 years ago, the presenting cases initially seemed to match those that I encountered first time around. As I became accepted back into the Port culture and developed the trust and relationships with our colleagues, it became increasingly evident that mental health was an area we needed to address. Most of us are now aware that the estimation is that 1 in 4 of us will have an issue with our mental wellbeing however this is particularly problematic with the NHS statistics showing that men aged 40-49 have the highest suicide rate in the UK given our workforce demographics.
Over the course of my first year, 26% of clients were seen as a direct result of mental health issues. However musculoskeletal issues were prevalent in causative factors for referrals into the Occupational Health service and a number of these had secondary mental health problems which impacted not only on their physical recovery but their ability to work without distraction as well as enthusiasm to return to work for those individuals who had to take sickness absence. Given the safety critical nature of many of our roles this, in itself, was cause for concern and a reason for action. It is well documented that work can play an important role in the recovery from mental health debility and that the work routine is vital in providing an individual with motivation to return to a fulfilled life however safety of themselves and others in often hazardous environments has to be paramount.
Many of our workforce were reticent to admit to a mental health problem for fear of a perception of weakness by colleagues and managers or they felt that there was a stigma attached so the challenge was how to address this to encourage people to reach out for support when needed.
I am fortunate in that I work for a company whose leaders acknowledge that our people are our greatest asset. Steps had already been put in place to make our ports not only safer but a better place to work. My employment and subsequent development of an in-house Occupational Health team was only a small part of the process of change that was needed as part of an overall organisational aspiration to improve working lives.
Historically, many of the workforce were employed as third-party labour. This changed in 2018 with a large transfer of employees into the company with improvement in terms and conditions. Much work has been put into altering shift patterns to facilitate a better work-life balance and whilst this is still work in progress, continuous improvements are being gradually introduced from slowly improving facilities to engaging more positively with employees and their representatives through reward and recognition. There is an annual Health & Safety Conference which has tackled mental health as part of the agenda for the past 2 years aiming to enhance our managers’ abilities to recognise mental health issues within the workplace and help to stamp out the associated stigma of discussing mental wellbeing.
The Occupational Health team has expanded with named Occupational Health Advisors for each area so as managers and colleagues know where to go for support via either management or self-referral. Managers have received clear guidance in urgent referral to Occupational Health in the event of a mental health issue so as immediate support can be provided to ensure a speedy response to prevent any further deterioration in an individual’s health.
A clear mental health plan has already been presented to the executive and whilst delivery of some aspects of this are delayed due to the current COVID-19 pandemic and the associated time constraints, much of this was placed in the Occupational Health Plan for 2020/21 and is gradually being delivered. We have already trained a number of mental health first aiders across many of our ports and alongside this have reviewed our Employee Assistance Programme, changing providers to offer a higher level of support with face to face counselling included as standard for all employees.
Mental Health is slowly started to be discussed more readily using communication channels such as a dedicated intranet Health Portal with signposts both into the Occupational Health Team but also to external support from both the EAP and local support agencies whether these be NHS, local council or mental health charities. For those employees without direct access to the intranet, a wellbeing app is available as well as information boards throughout the welfare facilities. In some areas, toolbox talks have already included mental health topics and support mechanisms.
Managers are actively encouraged to undertake stress risk assessments with colleagues who report work-related stress and many are increasingly becoming more skilled in using these assessments as a positive tool for addressing work pressures now the initial fear of a “risk assessment” has subsided They have now realised that it is merely a conduit for opening honest and frank discussions about individual perceptions, many of which can easily be remedied and have a positive effect on both interpersonal relationships but also job enrichment. On occasion it has been necessary to adjust roles and hours to facilitate recovery for a short time but this has been advantageous for both the organisation and the individual in that the affected individual has continued to contribute but in a far more effective and safe manner which ultimately often leads to greater motivation and appreciation of their role.
I mentioned that COVID-19 has delayed some aspects of the mental health plan however it has also brought the need for psychological support to the forefront with additional services being provided to our colleagues outside of normal working hours. The Occupational Health team are currently available 7 days per week and employees can speak to one of the nurses directly with regard to issues around the current pandemic. This ranges dealing with symptomatic or positive cases of COVID-19 of either employees or their families to providing support to those who have lost loved ones or who are trying to cope through very difficult or challenging times themselves, an area we are increasingly having to address given the lack of direct external support available due to COVID restrictions. Whilst many people are struggling with their mental health, a two-minute check-in call with an unwell employee often can make them feel valued and offers reassurance that their wellbeing matters.
As an Occupational Health professional, I am keen that we all work together to achieve industry-wide standards based upon best practice. The statistics I have gathered in the 2 years at Peel Ports shows the incidence of poor mental health fits into the greater national picture so is not merely a “ports” issue. Demographically, I am sure we all have a high proportion of employees who fall into the high-risk category of males aged 40-49 and preventing any ill-health has to be of the utmost importance whether it be physical or psychological.
The 2017 Stevenson/Farmer review of mental health and employers, “Thriving at Work”, gives a clear review of the issues faced nationally and also provides sensible direction for employers in supporting mental health of their employees. Peel Ports’ mental health plan is based upon the framework outlined by this review with the achievement of core standards and then aiming to meet enhanced standards.
Within PSS, I have been part of a Ports Human Resources working group who, until COVID-19 arrived, were making progress with developing a more unified industry-led approach. This involved sharing ideas and best-practice and I certainly have benefitted from understanding that the same issues are evident across all ports. I would like to see an industry-led agenda for change in tackling poor mental health in ports and work in collaboration to remove the stigma of mental health problems. This can be done in conjunction with Public Health and HSE initiatives and possibly consider having a pledge that all Ports can sign up to whether it be an existing one, or the creation of a port-specific pledge. There should be standards set for training managers in not only their own resilience but also in recognising red flags for someone who is struggling to cope and understanding how to address it positively and with sensitivity.
Finally, our team is still in its infancy however we are starting to see the benefits of our work to date. What has become evident from our statistics is that reported musculoskeletal issues are decreasing slowly as are accident rates. Mental Health referrals remain fairly static between 25% and 30% however these are responded to promptly and quick intervention is reducing the levels of associated debility previously seen. It is not my aim to reduce these referrals but rather enable our colleagues to feel comfortable in approaching the business for support and finding that when they do, it is with a positive outcome that improves their working lives.
If you are suffering from poor mental health, the important thing is to talk to someone and seek help. This is often easier said than done, but if you want to take that first step and feel unable to talk at work then there are avenues available to you.
CALM (Campaign Against Living Miserably) is a charity devoted to men with mental health challenges aged between fifteen and thirty-five. Mind, Sane, Samaritans, Rethink, and Men's Health Forum all offer support and confidential advice to any who want it, as well as their families struggling to understand more about their loved one's condition. PSS strongly recommends contacting these charities and your GP, because ultimately our role in the sector is not just about preventing accidents but saving lives.
CALM - 0900 58 58 58 (Daily, 5pm to midnight) / www.thecalmzone.net
Men's Health Forum - www.menshealthforum.org.uk
Mind - 0300 123 3393 (Monday to Friday, 9am to 6pm) / www.mind.org.uk
Samaritans - 116 123 (24-hour helpline) / www.samaritans.org.uk
Rethink Mental Illness - 0300 5000 927 / www.rethink.org