Supporting mental health needs in the nursing workforce

Introduction

Mental health issues can significantly impact people’s ability to perform while at work. Nurses are particularly at risk of experiencing mental health issues given the stressful nature of their jobs. A study by Babapour et al (2022) found that nursing was a particularly stressful role given the high expectations, complex job demands, high levels of responsibility and minimal authority.

A survey conducted by the Nursing Times found that, of nearly 1000 nurse respondents, 40% felt their mental health was ‘worse’ or ‘much worse’ now than in 2020 or 2021 (Ford, 2023). Respondents characterised their colleagues’ morale as ‘poor’ or ‘very poor’, and around 61% said that their mental health had worsened since the beginning of the pandemic, with 20% reporting symptoms of post-traumatic stress disorder.

The Royal College of Nursing also offers mental wellbeing support on their website. The Royal College of Nursing offers counselling, links to self-help and third-party websites and various self-care tips (Royal College of Nursing, 2024).

Advisory, Conciliation and Arbitration Service guidance

Part of the solution to dealing with mental health is tied to the actions of employers who may be unclear about what is expected of them when it comes to supporting employees. The UK government’s Advisory, Conciliation and Arbitration Service published guidance in 2023, Reasonable adjustments for mental health, which aims to help employers and employees handle requests for reasonable adjustments where mental health is an issue (Advisory, Conciliation and Arbitration Service, 2023).

The guidance covers what reasonable adjustments are, examples of adjustments that might be made for mental health and how requests for reasonable adjustments should be made and responded to. The guidance also suggests that employers review their current policies with mental health in mind.

Challenges for employers

Employers may encounter difficulties when identifying mental health issues among their employees. The lack of physical signs of most mental health issues makes it difficult for employers to identify and understand the extent of the employee’s issues and the adjustments needed. This is often compounded by a lack of awareness and understanding surrounding mental health among employers. Employers and colleagues may also not fully comprehend the impact of mental health issues on work or the nature of reasonable adjustments.

Those with mental health issues can have varying experiences and needs, meaning that there no ‘one size fits all’ solution. Therefore, mental health conditions require personalised adjustments that are tailored to the individual.

Nurses can fear discrimination, stigma or negative consequences from disclosing mental health issues, which can make staff reluctant to express their needs. The Nursing Times survey recorded that most hospitals are doing very little to alleviate nurses’ mental health issues (Ford, 2023). While 29% of respondents said that workplace mental health support had improved since the pandemic began, 49% stated that this support had not changed, and 21% said that this support had worsened (Ford, 2023).

The duty to make reasonable adjustments

Under the Equality Act 2010, if an employee’s mental health condition amounts to a disability, employers have a duty to make reasonable adjustments in order to overcome any disadvantages an employee may face because of their disability.

A person is considered to have a disability if they have a physical or mental impairment, which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities. Not everyone with a mental health condition will be considered as having a disability; this is determined on a case-by-case basis.

The duty to make reasonable adjustments arises when an employer becomes aware, or should reasonably be aware, that an employee is placed at a substantial disadvantage because of their disability compared with employees who do not have a disability. Employees may be disadvantaged by, for example:

• an employer’s provision, criterion or practice
• a physical feature of the employer’s premises
• an employer’s failure to provide an auxiliary aid. For example, a person with a neurodiverse condition may need a quiet area where they can undertake part of their work

Substantial means ‘more than minor or trivial’, which is a relatively low bar when determining whether a disability disadvantages an employee. It is imperative that nurses experiencing mental difficulties make their situation known to management, as they do not have an obligation to provide adjustments for issues that they are unaware of.

Mental health conditions can manifest differently in each individual, and their impact on work performance may vary. This subjectivity can make it difficult for employers to objectively evaluate the adjustments needed and ensure consistency in their approach.

Requesting reasonable adjustments: steps to take

Nurses experiencing issues with their mental health can make requests for reasonable adjustments. Common requests might include:

• Changes to absence reporting procedures. Nurses may feel unable to speak to someone to report their absence, so employers should allow them to email or text, or allow family members or a friend to contact the organisation on their behalf
• A nurse asking to move into a different role or department if their current job has a negative impact on their mental health
• Providing rest areas away from the main staff area to allow nursing staff to take private breaks

The Advisory, Conciliation and Arbitration Service guidance reminds employers that every job and employee is different, so what works in one situation or for one employee might not work in another. As mental health fluctuates over time, what works for an employee now might not work in the future (Advisory, Conciliation and Arbitration Service, 2023).

Conclusions

Fostering a workplace culture that promotes wellbeing can play a pivotal role in raising awareness and breaking down stigma that is often associated with mental health, which can result in employees not seeking the support they need.

Reasonable adjustments can benefit employers and employees, as well as patients receiving care. The key for nurses is to be mindful that mental health issues can be invisible and until management is made aware of it, they are under no obligation to make any reasonable adjustments.