Mental health: the last great taboo

Man staring out window and relaxing to illustrate mental health awareness

Mental health affects us all – as individuals and as business leaders, with related illnesses estimated to cost the UK almost five per cent of its GDP. So, asks Andy Silvester, when are we going to start talking about it?

Britain is not a place where it is always easy to talk about mental health. We are rightly proud of our fabled ‘stiff upper lip’ – that natural reserve and determination which seems to come almost preternaturally to those living here. In a tumultuous world, it will no doubt do us some good. But that reserve – that ‘don’t make a scene’ attitude – is less helpful in opening up a conversation around mental health. It was the man voted the greatest Briton of all time, Winston Churchill, who popularised the euphemism ‘the black dog’, as if talking in stark terms about depression were somehow un-British.

Mental health touches every one of us in some way; whether personally, professionally or through friends and family, the damage that can be caused from out-of-control stress, anxiety or indeed that black dog is never far from evident in the people around us.

The government has begun to acknowledge this. In recent years, a minister has been given responsibility for mental health, and another for mental health in the workplace. This is a step in the right direction, but alas it is only a step. The prime minister also deserves credit for making it the subject of one of her most substantial speeches to date. Diagnosis of mental health problems is improving, but treatment – and resources to provide it – is lacking. There are many campaign groups rightly putting the case that more needs to be done to ensure appropriate standards of care for those in need. But, while mental health is more than just a business issue, it certainly has a business impact.

Scale of the challenge

Official statistics suggest that 127 million hours of work were lost in 2015 due to mental health-related absence – the equivalent of around 75,000 individuals losing the entire year. The number of days taken off work with mental health problems has increased 25 per cent year on year, and stress, depression and anxiety together rank as the largest reason for absence in the workplace.

Even when poor mental health isn’t forcing individuals to take time off it’s affecting their work. More than six in 10 of the UK’s working population report that they’ve been kept awake at night by stress, leaving them unable to perform their duties as well as they might, according to the Mental Health Foundation. The OECD estimates that our failure to cope adequately with mental health issues costs the UK some 4.5 per cent of its GDP.

a man receiving counselling as part of mental health awareness

In short, something needs to change. The last real taboo, talking about mental health remains difficult – and the role of business leaders is going to be critically important in driving the cultural shift necessary to turn the corner.

With almost four million Brits working at least 48 hours a week – an increase of 350,000 from a decade ago – and the average employee in work for 40 hours, the time that employees spend at work is increasingly the largest single component of their lives; more than they spend at home or with family. That means that responsibility for mental health, whether employers like it or not, increasingly lies, at least in significant part, with those signing the cheques.

Since the dawn of paid work, good employers have been alive to the need for decent health and safety in the workplace. A report from 1540 describes the fate of a milliner who failed to take good care of a member of his staff:

“A yonge childe… standing neere to the whele of a horse myll… was by some mishap come within the swepe or compasse of the cogge whele and therewith was torn in peces and killed. And, upon inquisition taken, it was founde that the whele was the cause of the childes death, whereupon the myll was forthwith defaced and pulled down.”

Mercifully, most employers’ attitudes to health and safety have moved on since then. In truth, the UK should be exceptionally proud of the way in which regulators, legislators and business leaders have worked together to ensure that, for the vast majority of people, the workplace is essentially safe.

But physical health is a lot easier to plan and design for than its invisible cousin, mental health. As awareness of the latter has increased, however, some businesses have shown the way forward. Others still have plenty to do.

Recognising the business case

Unsurprisingly, given the recent uptick in awareness, IoD members are increasingly alert to the dangers poor mental health can pose in the workplace. Some 98 per cent of respondents to a 2016 survey agreed that a workforce with good mental health is important or very important to a business, and the consequences of poor mental health were also well understood (see chart below).

Graph illustrating consequences of poor mental health at work

Much has been written on the subject of boosting British productivity in recent years. Could it be that one of the easiest ways to do it is simply for individuals to be in a better frame of mind?

More than half of IoD members have been approached by a member of staff wanting to speak about their mental health and levels of stress. Considering the negative factors associated with the issue, that means more than half of businesses in the UK could well be suffering from employees making poor decisions, producing low-quality work and being prone to conflict. In a world in which productivity – or indeed agility, the ability to adapt quickly to a changing technological world – is so vital such a significant figure cannot be ignored.

Large organisations have adapted to the challenge. It is difficult to find a large corporation without a wellbeing strategy or formal mental health policy. Some large companies in particularly high-pressure jobs, often in financial services, now employ in-house therapists and psychologists to allow their staff the time and space they need to ‘get their head right’. Those large organisations are also more likely to offer wellbeing perks; giving paid time off for volunteering, spa days and so forth. Some even offer unlimited paid time off.

Now, while psychologists on staff might be appropriate for large firms, clearly such services are impossible for smaller ones to implement. And that’s a problem; small and medium-sized businesses account for some 99 per cent of firms in the UK, and total employment in SMEs in 2015 was 15.6 million, accounting for 60 per cent of all private sector jobs across the economy. Such businesses often have overstretched HR departments, assuming they haven’t outsourced it altogether or left it to the already overworked company leader. There are many firms in which ‘human resources’ simply means navigating the myriad employment regulations that government imposes on small businesses. Against that background, is it any wonder some struggle to know where to turn for advice?

Some firms have responded by building formal mental health policies. At the very least, this gives employees the message that their mental health is important, and they should be open and honest if they feel that stress or personal circumstances are beginning to affect their health. Alas, many do not have such policies in place – more than four in five IoD members, in fact (see chart below).

Pie chart illustrating if companies have a mental health policy

Perhaps this is one reason why, according to a Business in the Community study, only 11 per cent of employees are happy to discuss their mental health issues with their line manager, and only a quarter feel comfortable talking to anyone at work about problems they are having. Even in the City, where many firms are putting real effort into mental health programmes, seven in 10 believe that asking for help or support for their mental health would ‘look weak’ and hit their career.2

The way forward

If we’ve established that the scourge of poor mental health is a serious issue for British businesses today, then the outlook for tomorrow is perhaps even more interesting.

Studies abound on the needs of millennials coming into the workplace – an increased focus on work that ‘gives back’ to society, a desire to be at a firm that works with charities, even entrepreneurs beginning businesses not to strike out on their own or because they believe they’re set for financial reward, but because they want to make a difference in their communities.

How does that relate to mental health? More than one Deloitte study of millennials has shown job loyalty is declining and young skilled workers are more aware of their opportunities and more willing to switch jobs to further their careers. In short, they believe the perfect job does exist, and are willing to chase it.

That perfect job clearly includes a good work-life balance and wellbeing support. IoD members continually state that the skills shortage is one of their most significant challenges in the modern workplace, and with adult education still not as good as it might be, many of those skills gaps will have to be filled by young workers. With emerging skills such as coding becoming ever more important too, those digital natives will be looking for firms who take their mental health and wellbeing seriously.

And of course, it’s also important to reflect on wider trends. The world is a better place to live in 2017 than it was in 2016, or 2010, or 2000, or 1950 or 1900. Life expectancy continues to increase, food becomes more readily available, prosperity too increases in general terms. But whether it’s people leading increasingly isolated lives, the rise in social media, political turmoil or myriad other factors, it’s clear that large proportions of the public don’t feel it’s improving for them. If ‘rational optimists’ are in short supply, to borrow a phrase from the author Matt Ridley, their opposites are not; nearly 70 per cent of people think Britain has become a less happy place than a year ago.

two women discussing mental health

That may or may not be true, but it is beholden to all of us to recognise that the vote to leave the EU will have profound effects on people. Even those who are optimistic about Britain’s future outside the EU – like this author – must recognise that it has thrown the UK and the population into a period of significant uncertainty, not least for those born abroad and still seeking, at the time of writing, clarity on their status once Britain has left. It is not just the new trade opportunities and political dealmaking that business leaders
will need to keep an eye on in the coming years.

Both the scale of the challenge and the impact that poor mental health has on the economy is, at this point, broadly unquestioned. But that does not make it easier to deal with. The answer will come in large part by removing the stigma that attaches to this last great taboo; having open conversations in workplaces, schools, even down the Dog and Duck.

But government too must play its part, properly funding treatment and diagnosis, and giving employers the tools they need to equip line managers and staff to deal with a world that seems to move ever faster and be ever more demanding.

There are reasons for optimism. Employers large and small are beginning to get it. More and more people are confident enough to talk about their own mental health, be they entrepreneurs or in more established companies. It is no great stretch to say that securing good mental health will be one of the defining issues, not just for business, but for the developed world in years to come. If ever there was a cause behind which government, business, trade unions and charities can all come together, it is surely this one.

BITC launches its Suicide Prevention Toolkit for employers this spring. For info, visit

Andy Silvester is the IoD‘s head of campaigns and deputy director of policy @silvesterldn

Start-ups and suicide

a counsellor taking notes as part of a therapy session for mental healthIt’s like a man riding a lion. People look at him and think, this guy’s really got it together! He’s brave! But the man riding the lion is thinking, how the hell did I get on a lion, and how do I keep from getting eaten?” Toby Thomas, CEO, Ensite Solutions

Building a business from scratch is not easy, and setbacks can be found in every direction. Even the most successful entrepreneurs – those “riding the lion” – will have sometimes wondered whether the risk they’ve taken to start their business will pay off.

Such stresses are more common than ever. With bank funding rarely the main source of finance for new firms, many entrepreneurs are piling up personal debt on credit cards or borrowing from friends and family. The pressure of not just financing a firm but ensuring that people close to you don’t lose their shirt in the process, bearing in mind that the loan itself is often founded on trust, is significant.

The start-up ecosystem in the US has been shocked out of its complacency by a string of suicides in recent years. The popular entrepreneur Jody Sherman, founder and chief executive of EcoMom, killed himself in January 2013; though we don’t know the cause of Mr Sherman’s suicide, it coincided with the firm running into financial pressure. It was the first of three ‘start-up suicides’ in Las Vegas’s tech hub Downtown Project in just a year. It also followed the deaths of Ilya Zhitomirskiy, co-founder of Diaspora, two years earlier, and preceded that of Austen Heinz, the founder of successful science firm Cambrian Genomics, who killed himself in 2015. This is, regrettably, by no means an exhaustive list.

Perhaps it is no surprise that one of the first studies into mental health and entrepreneurs saw a marked difference between founders and the public at large, with some 49 per cent of the former reporting a mental health condition, compared to just 32 per cent of others, with depression being the most common condition.3 A similar survey in the UK suggests that a quarter of small business owners have taken time away from the office as a result of stress and burnout.4

As Britain’s start-up community continues to thrive and grow, with entrepreneurs founding some 80 businesses an hour in 2016, it is crucial that we attempt to learn the lessons from the US where we can. The first response of many in the entrepreneurial community has been both the easiest and the most difficult – talking, openly, about our problems.

If you would like to take part in Policy Voice surveys, visit

2 MetLife Employee Benefits Research, “Don’t talk about stress in the City”, October 2016.  Michael Freeman, “Are entrepreneurs touched with fire”, 2015. 4 Simply Business, “Work-life balance”, August 2015.

Interested in finding out more?

The IoD is committed to raising awareness of mental health issues in the workplace, with a particular focus on opening up the conversation for small-and medium-sized businesses. We have created a hub packed full of helpful advice, best practice and useful resources, as well as shared experiences from business leaders.

Visit our mental health in the workplace hub here and get involved in the conversationon Twitter #IoDMH

Mental health – read more

IoD calls for ‘a little more conversation’ on mental health

How is your mental health?

The IoD’s mental health hub (opens new page)

About author

Andy Silvester

Andy Silvester

Andy Silvester is the IoD’s head of campaigns

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