The Health and Safety (First-Aid) Regulations 1981 require employers to provide adequate and appropriate equipment, facilities and personnel to ensure their employees receive immediate attention if they are physically injured at work. The ratio is 25 employees to 1 first aider. To promote parity between mental and physical health, it should be encouraged as part of health and safety and wellbeing to have mental health TRIM and STRAW Practitioners in all public workplaces in every team and layer of each organisation.

TRIM is a trauma-focused peer support system designed to support the mental health of employees who have experienced a potentially traumatic event. TRIM was designed by Professor Greenberg, Occupational Psychiatrist who initially developed TRIM for the Royal Marines. It is now used by the Foreign and Commonwealth Office, UK Police Forces and a variety of organisations including the NHS in England in Scotland: Shetland.

STRAW is a Sustaining Resilience at Work peer support system which is designed to detect and prevent occupational mental health issues and boost an organisation’s psychological resilience. Unlike many other psychological first aid packages, STRAW is based on up-to-date scientific research, including the growing evidence base around peer support

TRIM and STRAW practitioners could help create psychological safety at work by encouraging employees to complete DATIX when they experience or witness any behaviour(s) that may affect the mental health of employees. Also, practitioners can provide assistance when a change in mental health is observed and offer risk assessments and follow up appropriate support. The TRIM and STRAW process does not interfere with any formal investigations.  TRIM is used by Police Scotland, NHS Grampian and 'Shetland Health Board for potentially traumatic incidents; whilst STRAW is used by NHS Trusts in England, UK Border Force and Cygnet Health Care.

‘’Early intervention could reduce suffering and costs to organisations and help create a safer more positive culture’’

Despite the fact that Mental health related absence is the most common cause of long-term sickness absence in the UK. work related absence in particular has increased 37%.  According to the CIPD and Simply Health and Well-being Survey, work-related stress, depression or anxiety accounts for 44% of work-related ill health and 54% of working days lost in 2018-9 (HSE, 2019). As well as sickness absence, poor mental health at work can lead to increased staff turnover, reduced engagement and presenteeism; with all the significant costs that are associated with these issues. In safety critical roles, such as drivers and healthcare staff, poor presenteeism can have dire consequences and in all occupations poor mental health is likely to affect profitability and service delivery.

Whilst these facts relate to a world pre-COVID-19; indications suggest that the pandemic (and measures taken by government to control it such as lockdowns and social distancing) will have a significant and negative impact upon the mental health of employees. It is very possible that these mental health implications will be felt for many months or even years. As early as two weeks into lockdown, employees were reporting a range of health effects including negative impacts on mental health and overall well-being.

People with mental health problems should be able to work in a safe and supportive environment.

The Mental Health Strategy 2017-2027 vision for mental health is for people to get the right help at the right time free from discrimination.

Did you know?

1.    Only 24% of employees said their company regularly engages with them on issues of mental health.

2.    Less than 1 in 10 would confide in their employer if they were suffering from a mental health condition.

3.    A staggering 14% of employees have experienced suicidal thoughts.

4.    Up to 45% of employees would look for alternative employment if their employer didn’t provide support in relation to mental health

To combat this employers, employees, students and young people need to learn the signs that someone has become unwell and learn how to respond.

People with chronic mental health problems are much more likely to die 15-20 years prematurely because of physical health issues.

People with mental health symptoms are more likely to wait up to four hours in an emergency department to be seen.

The Government's ten-year vision aims to promote parity between mental and physical health is predicated on ensuring equality of access to support. However, it is still not a legal requirement to have any mental health peer support systems in the workplace; despite the  legal requirement for physical first aid support.

Mental health problems can be triggered by both internal and external factors such as bullying in the workplace, which results in psychological injury. Bystanding should not be tolerated and those witnessing abuse should be held to account.

The costs of bullying

ACAS   estimates that bullying at work costs the UK economy £18 billion a year with £2.3 billion of those costs being incurred by workplace bullying in the NHS. This figure combines sickness-related absences (as a result of bullying), staff turnover and the reduction of productivity. Of course, there is much more to bullying than just the financial implications, with operational and human costs also being high.

While it's the financial aspects which might make the biggest impression on employers, workplace bullying can have a broader impact on how a business operates. The increase in sickness absence, for instance, can leave a department short-staffed and unable to meet demands. This can, in turn, increase the workloads of other employees who are having to pick up the slack. This could lead to lower company morale, higher stress levels and a drop in productivity.

All employees should attend a compulsory yearly ‘on line’ educational module to understand how their behaviour at work can trigger ill health in their colleagues to increase accountability. TRIM and STRAW Practitioners should be appointed at every level of organisations including the NHS. For evidence of the result of a bullying culture look up the public reports on NHS Highland and the costs. Prevention is better than cure. Bullying can trigger past trauma as most trauma is caused by interpersonal factors.

TRIM and STRAW promote stronger relationships. According to Harvard University the quality of our relationships can significantly protect people against both physical and mental ill-health. Increasing people's health and wellbeing will help improve work cultures and increase life span.

According to the Samaritan’s latest report, in 2018 there were 6507 suicides registered in the UK. This corresponds to a suicide rate of 11.2 deaths per 100,000 people (17.2 per 100,000 for men and 5.4 per 100,000 for women).

How many of these are work-related is not known While coroner inquests may decide that a suicide was work-related, these figures are not officially collated. Even the revised Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) does not now require the reporting of suicide on transport systems such as the railways.

The Laura Hyde Foundation has reported, according to its own investigations, at least 226 nurses across all settings had attempted suicide between 1 April 2020 and 31 April 2021.  Furthermore, it was reported in the Nursing Times in June 2021 that in just 6 years between 2011 and 2017, at least 307 NHS nurses took their own lives (figures released by the ONS); It should be noted that these are pre covid figures.

Additionally, government figures released by NHS (England) Digital in September 2021 show that anxiety, stress, depression and other psychiatric illnesses are consistently the most reported reason for sickness absence; this accounts for over 493,000 full-time equivalent days lost and almost 29% of all NHS sickness absence in May 2021.  Any figures released by NHS Scotland could be expected to be broadly similar.

  In Japan however, where work-related suicide is officially recognised and recorded, it is estimated that 5% of all suicides are directly work-related.

TRIM is a trauma-focused peer support system designed to support the mental health of employees who have experienced a potentially traumatic event. TRIM Practitioners have undergone specific training allowing them to understand the effects that traumatic events can have upon people and to be able to listen and offer practical advice and assistance to those exposed to trauma.

Sustaining Resilience at Work (STRAW) is also a peer support system which is designed to detect and prevent occupational mental health issues and boost an organisation’s psychological resilience. Unlike many other psychological first aid packages, STRAW is based on up-to-date scientific research, including the growing evidence base around peer support.  STRAW not only focuses specifically on mental health conditions and issues that are likely to affect the working population but also is unique in being designed as a comprehensive peer support system for use within high pressure organisations.

In summary:

The Government has a 10-year vision and a commitment to greater parity between mental and physical health provision.

Most trauma is a result pf interpersonal factors, not war or natural disasters. Peer support programmes can reduce conflict.

There is already a statutory provision for physical health related first aid to be available to employees within the workplace.

It is well recognised that mental health problems are a major contributor to absences from work, stresses within the workplace, poorer productivity and other factors with huge financial and health consequences, both to the employee and the employer.

It is already recognised that the effects of the Pandemic are likely to exacerbate this situation.

Now is the time to act on this:  please help by signing and sharing:

Play your part and end stigma and suicide.

Thank you former whistle blowers for the NHS

Fiona MacAulay, Tracy Boylin and Professor Malcolm Laing.