Should we talk about it, 2015

 Work 52 (2015) 635–641 DOI:10.3233/WOR-152125

IOS Press

 

 

“Should we talk about it?”: A study of the experiences business leaders

have of employing people with mental health problems

Kaare Torgny Pettersen^∗ and Ragnhild Fugletveit

Department for Health and Social Science, Østfold University College, Halden, Norway

 

Received 13 June 2013

Accepted 12 June 2014

635

 

 

Abstract.

BACKGROUND: Job seekers with mental health problems are more at risk of being excluded from the labour market than those without such problems.

OBJECTIVE: Our aim has been to explore the experiences business leaders have of employing people with mental health problems and to investigatewhether they can suggest what might be done in order to include more job seekers with mental health problems in their companies.

METHODS: Our empirical sample consisted of in-depth interviews with ten business leaders who were recruited from five public and five private companies.

RESULTS: On the one hand business leaders want more openness in the hiring process in relation to any psychological problems job seekers have. On theother hand, employers were unsure whether job seekers would state that they have or have had mental health problems.

CONCLUSION: The study concludes that more attention must be focused on changing business leaders’ attitudes and changing unhealthy corporate cultures that create and sustain the idea that people with mental health problems are disabled. In order to reverse the trend of increasing numbers of peoplewith mental health problems being excluded from the labour market, it seems imperative that business leaders develop their understanding of how the workplace can accommodate employees who have a history of mental health problems.

 

Keywords: Job seekers, inclusion, openness

 

 

1.     Introduction

 

In Norway, several White Papers have focused on employment and measures among people with mental health problems. In 2001, NorwegianInclusive Work- ing Life Agreement [1] was established. The main goal in this agreement [1] is to improve the working envi-

 

^∗Address for correspondence: Kaare Torgny Pettersen, Østfold University College, Department for Health and Social Science, N-1757 Halden, Norway. E-mail:kaare.t.pettersen@hiof.no.

ronment, enhance presence at work, prevent and reduce sick leave and prevent exclusion and withdrawal from working life. In this agreement [1] one of the sub goals is to include persons with disabilities into the labour market. The National Strategic Plan for Work and Mental Health [2] emphasizes that people with mental health problems represent a significant unuti- lized resource in society. Furthermore the plan points out thatinclusion in the labour market provides people with an income, reduces poverty, creates opportuni- ties for positive working relationships, and promotes personal growth.

 

1051-9815/15/$35.00 © 2015 – IOS Press and the authors. All rights reserved

 

The definition of mental health used here is taken from the Norwegian National Strategic Plan for Work and Mental Health [2], which states:

“Mental health problems (troubles or difficulties): Severity of symptoms such as various levels of anx- iety, depression and insomnia. The severity of the symptom need not be diagnosed” (p. 7).

The National Strategic Plan for Work and Mental Health [2] has estimated that about 20 per cent of those receiving rehabilitation benefits suffer from some form of mental health problem. The Strategic Plan also cal- culates that every fourth applicant granted disability benefits, every thirdperson receiving social assistance, and every fifth person with sick leave from work, has mental health problems. Mental health problems range from mild to serious, some in combination with sub- stance abuse. In a Norwegian study by Ose et al. [3], it is argued that mental health problems are the sec- ond most common cause of sick leave and disability pension in Norway and that there are clear indications that the trend is moving in the wrong direction. Peo- ple with mental health problems remain unemployed despite the fact that it is government policy in Nor- way to include people with mental health problems in the ordinary labour market. Their study [3] combines national and international research on the topic of work and mental health and concludes that:

“In a labour market perspective, where the aim is to include as many as possible, reduce absenteeism and prevent as many as possible from falling out of the labour market, measures aimed at those with serious mental health problems (and who are rel- atively few in number) do not seem to have much effect. Measures must instead be directed towards the many with minor mental health problems, in order to prevent them developing serious mental health problems” (p. 88).

Ose et al. [3] question the use of an inordinately large proportion of resources on a small group of people who have serious mental problems with a serious risk of falling out of work repeatedly, whereas few resources are devoted to the large group of people with mild men- tal health problemswho have less risk for falling out of the labour market. They say furthermore that there is a serious lack of research about the issue of work and mental health in Norway and argue that national com- petence in the field is not a good basis for developing effective targeted solutions. Otherstudies, which have examined employment among people with severe men-

tal health problems, find other reasons for this hiring bias [4–7]. Ordinary work is considered meaningful, is economically profitable, increases social networking, improves confidence and increases satisfaction with leisure. The authors believe that it is important to exam- ine how employers view hiring persons with mental health problems [4–7].

International research shows that participation in the labour market is important for a person’s self-esteem because it offers recognition andrespect [8]. In western culture, mastery of life is largely linked to employ- ment. Many of those who are unemployed also need employment for economic reasons. Cook [8] argues that individuals with mental health problems are more at risk of being excluded from the labour market than those without such problems. She believes that there are a number of barriers that prevent people with men- tal health problems from being included in the labour market: educational level, dynamics within the labour market, productivity, suitable vocational and clinical services, discrimination, protective legislation, public policies, low income, health care policies, and inef- ficient work motivational programs. In many cases, employers are part of the problem. For example, in their study of employers’ attitudes towards job seek- ers with mental health problems,Biggs et al. [9] show that all of the employers who were interviewed had second thoughts about hiring them. Employers explain their hesitance to hire by pointing to their own need for more knowledge about mental health problems and their fear that the job itself may aggravate mentalhealth problems.

Oliver [10, 11] distinguishes between having a dis- ability and being disabled. Having a disability describes a characteristic of a person. The person may have a physical disability, a mental health problem, be intellec- tually disabled, or, for that matter, have social problems. A person isdisabled only when their disability prevents them from doing what they want to do or what society expects of them. Whether a person who has a disabil- ity is disabled or not will, in practice, depend on how society is organized.

Oliver [10, 11] argues that being disabled can be the result of a mismatch between what the individ- ual is actually able to do and the requirements society (directly or indirectly) imposes. The problem often lies in the different ways a workplace is standardized, result- ing in a standard that people with disabilities cannot comply with. If they are to participate in the labour market, it is essential that both the process of enter- ing the labour market and the specific ways in which

 

work is organized at the workplace to accommodate the needs of the employees. Conditions that promote or inhibit opportunities for active work participation fall into various categories. Generally, Oliver [10, 11] claims, there is a strong focus on physical adaptation of the environment for thedisabled, for example, remov- ing physical obstacles for wheelchair users. But full integration is more than just physical adaptation. It is alsoabout adapting to the specific needs of employees. Hearing-impaired people may be able to communicate easily with others through lip-reading,but failing to take into account their need for face-to-face communication can unnecessarily render them disabled. Oliver [10, 11] further states thatthe attitudes displayed towards a per- son, such as a lack of inclusion in the social community, unwillingness to place the same confidence in themas in others, lack of acceptance of the fact that some indi- viduals need more training than others to master a task, and so forth are all elements that turn a person with a disability into a disabled person.

1.1.     Objective

 

Due to the findings in Ose et al. [3], the objective of this research has been to explore the experi- ences Norwegian business leaders have of employing people with mental health problems. The authors’ pre- understanding was that job seekers with mental health problems have difficulties entering the labour market and the authors wanted therefore to investigate whether business leaders have suggestions about what can be done in order to include more job seekers with mental health problems in their companies.

 

2.     Methodology

 

A qualitative design and the use of interviews were employed in this study. The primary goal was to analyse in-depth interviews with employers about their expe- rience and social responsibility to include people with mentalhealthproblemsintotheirbusinesses. Thesetopic areaswere derived from a review of previous literature. The participants’ own descriptions about their expe- rience and their social responsibility according to the Norwegian Inclusive Working Life Agreement [1] was the focus of the study, and their understanding and inter- pretations wereidentified through interviews [12, 13]. All participants were informed of the objectives of the research and their right to withdrawn at any time.

All interviews were recorded and transcribed. The transcriptions were anonymized, both in terms of

employment and geographical location. The design and implementation of the project was performed under the approval of the Norwegian Social Science Data Ser- vices (NSD). NSD is the Data Protection Official for Research for all the Norwegian universities and univer- sity colleges and is responsible for assessing research projects in relation to the Personal Data Act and Health Register Act.

Interviews were completed in a semi-structured for- mat allowing the researcher to investigate key topic areas surrounding the process of eliciting the partici- pants’ descriptions of their experiences of people with mental health problems. The qualitative approach cre- ates depth,insight and a more holistic understanding of employer’s subjective reality [12, 13].

Our research questions was thematic formulated to what kind of experience the business leaders had with employing persons with mental health problems and their emphasis on including and social responsibility into their workplace. The participants were also pre- sented with a case to ascertain how employers might concretely evaluate a potentially well-qualified job seeker who had openly disclosed in a job interviewthat he/she had been admitted to a mental health care cen- tre for six months but now considered her/himself to be well functioning. Using a specific example helped to elucidate the employers’ immediate attitudes to the problem. At the end of the interviews, an open ques- tion wasasked to allow the business leaders to express perspectives they felt were relevant for our topic. This approach permitted the employers to reflectfreely and openly on topics and issues. They were interviewed individually for between 45 and 90 minutes each.

The analysis was carried out in four steps (12). The first step involved letting the participants describe freely, without interpretation or explanations, their opinions. The second step involved discussions where the participants were asked questions in order to clarify or to deepentheir opinions. New elements could arise during this step that the participants might not have been aware of before. In the third step, the interviewer started to arrange the material in meaningful categories, based on themes that came forth during the interviews. This can beunderstood as a condensation of meaning (12), an interpretation process that was done together with the participants. This step involves a continuous flow of interpretations together with a simultaneous confir- mation or rejection from the participants. The fourth step involved transcription of all the interviews that have been recorded and structuring the written mate- rial for further analysis in arrays of defined rowsand

 

columns (14) using the interaction between our presup- position and the trends given in the written material

(13). This led to categories with subcategories. In the analysis, the categories were illustrated by using the participants’ own words in a narrative reconstruction. Quotations have been chosen to give meaning to topics that were discussed. The main tools used in the analysis are therefore: condensation of meaning; categorization; restructuration of stories; and interpretation (12). All citations were recorded and transcribed in Norwegian and translated into English in the writing of this article.

 

3.     Participants

 

The empirical sample consisted of ten business lead- ers who were recruited from five public and five private companies. Participants werecontacted first by e-mail and then by telephone. Our sample consisted of eight women and two men, leaders responsible for recruit- ment, aged between 45 and 65 years. Nine of the participants were drawn up from an opportunity sam- ple obtained from the Norwegian Labour and Welfare Administration (NAV) located in Ostfold, Norway. The last one of the participants was recruited through a Norwegian national network for psychicalHealth, also located in Norway. The major criterion for participa- tion in the study was that all leaders were members of the Norwegian InclusiveWorking Life Agreement [1]. The rationale for the criterion was that such member- ship made employers more aware of their responsibility forincluding people with mental health problems into their workforce.

 

4.     Results and discussion

 

Our main finding in this study focuses on knowl- edge of mental health problems. Employers interpreted it on the one hand as referring to the hiring process; they desired more knowledge from job applicants with regards to psychological problems. On the other hand, employers were unsure whether job seekers would actu- ally freely confide that they have or have had mental health problems. The interviews also show us that employers focused on individual psychological diag- noses when they explained how they understood mental health problems. Despite that there is little focus onhir- ing people with mental health problems amongst the participants, the employers in our study were focused on preventing mental health problems in their com- panies. The study revealed a paradox, with two main

findings: the desire for more knowledge about mental health problems and the difficulties involved in employ- ing people with mental health problems.

Most of the employers interviewed were concerned about openness in relation to mental health problems regarding both job seekers and employees. They wanted more knowledge from their employees about their men- tal health problems but found it difficult to create the necessary openness in their companies’ working envi- ronments. One of the employers expressed it as follows:

"It is a very great challenge to create openness to mental health problems within a business environ- ment".

On the one hand, employers said they wished to coop- erate with their employees, but, on the other hand, said it was difficult for leaders/employers to create open- ness in a working environment. Several business leaders say that they needed assistance from experts outside the company in order to make this a focal point in the workplace. One of the employers said:

"We do not currently have an environment with transparency around mental health problems, but that’s just how it is: how do we get it on theagenda here? How do we make the issue of mental health problems less stigmatic? It’s very challenging to create openness. Here we hoped that a half-day seminar might be enough to put it on the agenda and focus more attention on this important sub- ject, making it less dangerous. We also hope that our approach allows employees to feel more confi- dent. But I believe that speaking openly about one’s mentalhealth problems is more difficult than that."

Several employers had good experience working with the Norwegian Labour and Welfare Administra- tion’s employment centre, which is essential in this context. The centre hosted themed evenings and courses that helped employees and employers become more aware of the topicand of how to create more openness and knowledge about mental health issues in the work- place. Nevertheless, several of the employers stated that they were the last to receive any information about their employees’ mental health problems. Employers found that most people who were employed said little about their mental health problems when they are hired. One of the employers stated that:

"I have hired people who said that they had a touch of fibromyalgia, but, as it later turns out, it’s a little more than that, it’s more aboutanxiety and

 

depression and that type of thing. It would have been much better for them if they had been open about all their problems during the interview. But whether I’d still have hired them is difficult to say. We are, after all, in the vocational business and have much more knowledgeabout this than an ordinary business. But it’s difficult."

This quote points out the paradox that existed in rela- tion to the employer’s need for knowledge about mental and physical conditions in thehiring process and how such openness might at the same time have had conse- quences for the job seeker’s chances of employment.

As mentioned earlier, the participants were asked about how they would have reacted if a job seeker revealed during the job interview that they had been admitted to psychiatric care for six months but had now recovered. Most of the business leaders in this study expressed uncertainty as to whether they would consider hiring such a person. One of the participants said:

"I think probably I would have focused on the job that had to be done and asked how they would mas- ter it. Also I think that we could try outthe person for a period and see, spend some time. But it is important that openness goes both ways."

The quote above assumes a desire from the job seeker to be open about mental health problems. Most employ- ers in our study had littleexperience of such openness among employees and/or job seekers. Only two of the ten business leaders in this study had experience of employees who were open about their mental health problems. In both cases, their openness led to a collec- tive effort with the workplace to takegood care of the employee. The participants were nonetheless reluctant to consider openness regarding mental health problems in a job interviewas solely positive. There seem to be few opportunities for job seekers who have spent six months in mental health treatment and the reason for this seems to be the uncertainty associated with the employee’s prognosis after psychiatric treatment.

Business leaders were also asked about how they, as employers, could facilitate matters to accommodate more people with mental healthproblems in the work- place. One of the managers answered the question as follows:

"It must be done with knowledge and openness about mental health problems. This is actually not very dangerous. But we have a way to go.It ought to be the case that having a mental health problem

is approached in the same manner as having a bad back. Having something to struggle with is OK. So what I mean is that, if you have a mental problem and people understand you, this need not develop into something serious, and you can actually con- tinue working. Weneed openness in talking about things. But it is clear that you cannot have an envi- ronment where everyone just sits and talks about this all the time and can also be quite a burden. Openness has its limits. There must be a balance."

The balance between talking too much or too little about mental health problems seemed to be a challenge for business leaders.

As mental health problems can be difficult to define and mean different things to different people, the par- ticipants were asked how theyunderstood the concept of mental health problems. One of the participants said:

"Yes, mental problems are psychological. We do not think that much about it really. We are so used to having it around us, we’ve had several employ- ees with psychological problems such as anxiety, depression, and things that are more difficult to actu- ally figure out. One colleague is very open about his diagnosis and problems. I think this is crucial for the working culture here. The fact that you are openabout what it is about and what the problems are."

The statement also allows for the understanding of mental health problems as psychiatric diagnoses. The point of departure for the study was that psychologi- cal problems cannot be automatically interpreted in the context of psychiatric diagnoses. Participants were also asked about how their companies worked to prevent mental health problems. One of the business leaders said.

"We talk a lot about what the job with us involves and we are open for talking about private matters. We need to know about each other, but also to be able to work on the tough everyday things we do here. And I think it helps to prevent problems by talking about them. It’s important that we do not go home with bad experiences from work. We have openness here and talk about what has been difficult at work. Ifyou’ve had a tough time at work, we talk about it. And we experience really tough stuff in life anyway. Things like people dying and stufflike that. People you’ve been pretty close to and then they’re dead, and we need to talk a lot about it. That’s how we help people to get through tough times".

 

In spite of the fact that all of the business leaders in this study manage companies that were part of the offi- cial Inclusive Working Life Agreement[1], none of the employers had an active strategy for prioritizing peo- ple with mental health problems at their workplace or in employmentprocesses. Some companies, however, focused on mental health issues among their employ- ees both because of high absenteeism but also to retain them as employees. And several mentioned how indi- viduals had adapted in a positive way despite mental health problems. One of the businessleaders refered to employees who at times could not be at work but needed specialized psychiatric treatment. In the period when the employee wassick, the company tried to follow up and considered hiring a substitute who could take over their work tasks. They needed pragmatic solutions in suchsituations. Other business leaders arranged lunch breaks so that employees who did not want to partake or join in other activities during working hours could be alone, without offending the other employees. Such adjustments were important for the individuals con- cerned but also for the work environment itself. One of the business leaders expressed this as follows:

"And we think that we have to take care of her. But it is all about openness. The first thing that is important is that she is open about what kind of problems she has and what that means."

The findings of this research suggest that there is a need for employers to improve more accurate knowl- edge regarding mental health problems. Knowledge about mental health problems can improve openness from employees even in a hiring process. Knowledge in this context must as Oliver [10, 11] suggest rely upon both what the employers actually are able to do and the requirements society imposes. None of the leaders focused on the requirements society imposes though they all are members of the Inclusive Work- ing Life Agreement [1]. The participants did not refer to the agreement [1] when they hiring people into their workplace. They refered instead to individual requirements in sense of what the future employee actually was able to do in their company. The hir- ing process seems to result in “thinking twice” like Biggs et al. [9] puts it when it comes topersons with mental health problems. Though our sample con- sist of 10 leaders it is likely to believe that these arguments are common elsewhere in the Norwegian context. Ose et al. [3] confirms the same argument in their study. We need more research and focus on how to reduce the mismatchbetween individual and soci-

ety requirements in hiring persons with mental health problems.

 

5.     Conclusion

 

In this study, ten business leaders were interviewed about their experiences of employing people with men- tal health problems. The results from this study are that the business leaders that were interviewed, were, on the one hand, concerned about general knowledge and openness around mental health problems but, on the other hand, found it difficult to employ people with these problems in their companies, despite having signed Inclusive Working Life Agreement [1]. This may seem like a Catch 22 for people with mental health prob- lems. Should they or should they not be open about their mental health problems at job interviews? Although it is a political goal in Norway for everyone to have equal job opportunities and it is emphasized that peo- ple with mental health problems represent significant unutilized resources in society, it appears that open- ness about mental health in the workplace can be a double-edged sword. The government’s policy is that inclusion in the workplace creates the opportunity for positive working relationships, and promotes personal growth [2]. Despite this policy, it seems that the trend is movingin the wrong direction. The study supports the findings made by Ose et al. [3] who argue that people with mental health problems are considered by many companies to have a disability that will affect their effi- ciency in the company. The study suggests that more should be done to educate business leaders on men- tal health issues in order to change their attitudes and avoid unhealthy corporate cultures that create andsus- tain the idea that people with mental health problems are disabled. Today there is a focus on the individual treatment of mental health problems as psychological disorders. To reverse the trend of increasing numbers of people with mental health problems being excluded from thelabour market, it seems imperative to shift the focus towards educating leaders and improving corpo- rate culture in relation to mental health problems and employment.

 

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