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Mental Health First Aid Series

A Public Health initiative by

Employers Mental Health First Aid Kit

I alone cannot change the world, but I can cast

a stone across the waters to create many ripples.
- Mother Teresa

2014, Augmenta Health (P) Ltd

All rights reserved
Any unauthorized reprint or use of this book is prohibited. No part may be reproduced or
transmitted in any form or by any means, electronic or mechanical, including
photocopying, recording, or by any information storage and retrieval system without
express written permission of Augmenta Health (P) Ltd.
We would welcome any suggestions, clarifications and feedback.
Address for correspondence
Couch, Centre for New Beginning
Unit of Augmenta Health Private Limited
# 108, St Johns Road
Sivanachetty Garden P.O
Bangalore 560042.
Information in this book is neither intended to substitute medical advice nor replace
proper training. The content here in is the sole expression and opinion of its authors.
While best efforts have been taken in preparing this book, the authors make no
representations or warranties of any kind and assume no liabilities of any kind with respect
to the accuracy or completeness of the content. Every organization is different and the
advice and strategies contained herein may not be suitable for every situation. You should
consider seeking the services of a competent professional when necessary. The characters
and examples are fictional. Any resemblance to real persons, either living or dead, is
strictly coincidental.

About Mental Health First Aid Series (MHFAS)

First aid is the lifesaving and critical help given to an injured or

a sick person before medical or professional aid is made
available. Mental health first aid series aims to equip the public
at large to provide first aid for a mental health crisis, by
improving knowledge, eliminating stigma and empowering
people to be able to positively help a person in significant

The Key Objectives are

Early identification of Mental Health Emergency

Provide Mental Health First Aid

Reduce Stigma regarding Mental Health

Help People seek services earlier

Pave way for problems being nipped in the bud

Spread new hope through communities

Identify early stages of mental health problems

Know where and when to get help; and understand what types of help have been

Improved recognition of mental disorders

Increased confidence in providing help

Reduce gaps between distressed people and Mental Health Professionals

Addressing Myths and Misconceptions about Mental Health


Dr Sharmitha Krishnamurthy, BDS, MPH,

MBA, PGD Medical Law, PGD Clinical Research
is the Director and Head of ph, Public
Health division of Augmenta Health (P) Ltd.
She is specialized in the field of Public
Health Management, currently developing
in house Public Health initiatives in the area
of Mental Health.







(NIMHANS) is the Director and Consultant

Psychiatrist, Augmenta Health (P) Ltd. Known
for his exemplary teaching and training skills,
he has delivered numerous lectures on varied

of mental






Background ............................................................................................... 1

How to use this resource ............................................................................... 3

Identification of Distressed Worker ................................................................... 4


Is there a Distressed Worker in an Organization, at all? ......................................... 4


What is work-related stress and what are the possible causes? ................................ 5


What is the impact of a Distressed Worker on the Organization? ............................. 6


What if I just ignore and remain detached from the Distressed Worker? .................... 6


How do I identify a Distressed Worker? ............................................................. 7

3.5.1 Identifying early signs of distress .................................................................. 7

3.5.2 What are the possible signs of Psychiatric Emergency? ..................................... 8
3.5.3 Are all distressed workers, mentally ill? ........................................................... 8
3.5.4 I face special challenges while wanting to identify a Distressed Worker? ................. 9
3.5.5 Identifying a Suicidal Employee? ................................................................ 10

Providing help to a Distressed Worker ............................................................ 11


Decision to help a Distressed Worker ............................................................. 11

4.1.1 Prepare before the initial move? ................................................................ 11

4.1.2 Are you equipped to handle? .................................................................... 11
4.1.3 Are there any DONTs I should be aware off? ................................................ 12
4.1.4 I have decided to help. But tell me.!!! ........................................................ 12
4.1.5 Engaging with someone who is reluctant to talk ............................................. 13
4.1.6 Issues to raise with an employee who is distressed .......................................... 14
4.1.7 Managing an employee who becomes tearful and upset .................................. 16
4.1.8 Recognizing when professional/clinical help is needed ..................................... 16
4.1.9 To wait, To Provide, To Support or To Force. ................................................. 17

How do we really show that we do genuinely care for the distressed worker? ........... 17


We don't want any legal problems. ................................................................ 18

Supporting the Distressed Worker ................................................................. 19


Proactive health promotion.......................................................................... 19


Keeping in touch during sickness absence ....................................................... 19


When they come back? .............................................................................. 20


Returning to work ..................................................................................... 22


Managing reactions from colleagues and clients................................................ 24


Managing an on-going illness while at work ..................................................... 25


Supporting an employee who is off sick .......................................................... 25

5.7.1 Contact the distressed employees treating professional. .................................. 26

5.7.2 What to do if the person requests no contact ................................................ 26

Four big challenges which shall always remain! ................................................. 27

1 Background
Its a reality!
The World Health Organization estimates that by 2020 depression will become the
second most important cause of disability in the world. Whatever may be the cause of
increased mental illness, the reality is that, it has become so common and people at work
will inevitably have to deal with it in themselves, in their superiors or in those who report
to them.
Managers and colleagues in the front line can
make the biggest difference in the field of mental
health at work. Reacting appropriately to signs of
distress, maintaining contact with people who
may be plumbed into depths of despair and
constructing a practical return to work plans for
those recovering from mental illness are the
simple things that can prove job saving and, at times, even life saving.
Helping people through a difficult time can be enormously rewarding on a personal level.
However, for the organization, there is an even greater prize because those who receive
help will repay any investment many times over and those who are part of offering help
will feel more engaged and motivated. Raising the bar for mental wellbeing in a company
therefore promotes higher productivity, better customer service and, ultimately, increased
stakeholder value.
Employers Mental Health First Aid Kit has been developed by ph, the public health
division of Augmenta Health Private limited with three main intentions:

Promote mental health wellbeing at the workplace

Early identification, provision of timely help and supporting the recovery of the
distressed worker at a workplace

Reduce stigma, discrimination and enhance mental health seeking behavior at the

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Approximately, 3 out of 10 employees are said to go through the distress of varied levels
in a single year. It largely goes unnoticed. Even if the distress is noticed, it is mostly not
addressed or inappropriately addressed.
The impact of mental distress and illness is enormous on the individual, dependents and
the organization, from loss of life, livelihood, jobs, productivity and profits. Contrary to the
belief, the majority of mental distress and illness are treatable by pharmacological and
psychological interventions, leading to complete recovery and functioning.
The Workplace becomes important because a sensitive
employer can bridge the gaps between illness, treatment
and recovery by playing 3 crucial roles:
(1) Early identification of distress
(2) Provide adequate and appropriate help
(3) Support the recovering employee
An employer stands to gain in the process, like improved productivity, reduced sickness
absence, committed staff, better staff morale, etc.
Unfortunately, there is no template and one size fits all algorithm. Each individual is
unique, each scenario is unique and each success is unique too. So, decide do you want
to brush this hot and important issue under the carpet, or take it up your Sleeve.
Successes might be few, but positive impacts shall be plenty.

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How to use this resource

This source is a practical guide to address various dilemmas
employers will face while dealing with a distressed employee in an
organization. The challenge could be a simple stressful situation to
serious psychiatric illness. Our aim is primarily to address ignorance,
fear and stigma around engaging someone experiencing mental
health problems.

The key message is to keep the lines of communication open and healthy. Empirical steps
that the employer/manager and employees can take together are suggested so that:

Job requirements match with persons capabilities

Early identification and interventions happen

Environment of mutual care and support is created

Successful return to work is ensured

Long term illness and work is balanced

Support network is enhanced

Valid and useful information is shared

The resource is designed in a modular format that will ease identification of sections of
interest or need.

Please note this resource is NOT:

A diagnostic manual, helping you to make psychiatric diagnosis

A counselor or psychologist training manual

To be taken literally and practiced, as it is a not a guideline and each scenario may
demand more than the alternatives and ideas mentioned here.

Individual case to case discretion and judgment is warranted

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Identification of Distressed Worker

3.1 Is there a Distressed Worker in an Organization, at all?

We are all stressed and stress is a term abused so commonly that
we end up using this term for varied experiences, making it difficult to
comprehend the real meaning. Stress is a necessary part of everyday
life and some degree of stress called Eustress is considered healthy
which motivates us to continue working. Distress is the other part of
stress, creating an aversive state, in which our ability to adapt is
compromised, due to non-availability of resource, exhaustion of the
resource or an overwhelming situation.

Eustress, or positive stress, has the following characteristics:

Motivates, focuses energy
Is short-term
Is perceived as within our coping abilities
Feels exciting
Improves performance

In contrast, Distress, or negative stress, has the following characteristics:

Causes anxiety or concern

Can be short or long-term

Is perceived as outside of our coping abilities

Feels unpleasant

Decreases performance

Can lead to mental and physical problems

Understanding the difference between Stressor and Stress is important. Stressor is the
event or situation or any other trigger which brings about the stressful reaction. Stress is
the bodily reaction happening physically or psychologically following exposure to a
Anything and everything under the Sun, including the Sun, can become a stressor to an
individual. We are all familiar with negative stressors like the loss of a loved one, financial

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loss, diagnosis of major illness, etc. Interestingly, positive life events can also act as a
stressor. For example, promotions, birth of a child, on-site overseas travel etc.

3.2 What is work-related stress and what are the possible causes?
Every workplace has its own demands and expectations set in. Not all workers are
equipped to handle the same. This leads to work-related stress, which happens when the
work demands and pressures that are not matched to the employee knowledge and
abilities, thereby challenging their ability to cope. The matters are worsened when
employees feel they have little support from supervisors and colleagues, as well as little
control over work processes.
Pressure at the workplace is unavoidable due to the demands of the contemporary work
environment. Pressure perceived as acceptable by an individual, may even keep workers
alert, motivated, able to work and learn, depending on the available resources and
personal characteristics. However, when that pressure becomes excessive or otherwise
unmanageable it leads to stress. Stress can damage an employees' health and the
business performance.
Work-related stress can be caused by:

Lack of control over work

Under-utilization of skills

Too high a workload, impossible deadlines

Too low a workload, no or few challenges

Low task variety

High uncertainty, e.g. due to poorly defined roles and

responsibilities, lack of clear priorities and targets

Job insecurity

Low pay

Poor working conditions, e.g. noise, overcrowding, excessive heat, inadequate


Low interpersonal support, e.g. inadequate or insensitive management, hostility

from colleagues

Undervalued social position.

Organizational structure

Leadership style and quality

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Demands of tasks and roles, balancing the efficiency of services with high quality

Increasing 24/7 mentality

Structural changes

Changes in business processes

Quality of communication throughout the organization.

It is important to remember that work stress can be perceived even due to factors outside
the workplace.
Example - An individual undergoing significant personal change like an ailing parent or ill
health of a spouse could find it difficult to cope with routine or limited work stress.

3.3 What is the impact of a Distressed Worker on the Organization?

There are distressed workers in every organization. It is estimated that
at least, 3 of every 10 employees will have a mental health problem of
some sort in any one year. More than decreased productivity of an
individual, impact of distressed workers can be in multiple ways, like
bringing down the morale of the team, increased pressure on other
colleagues, haste and error prone decisions, shrinking profits and
increased employee health expenses, etc.

It is a costly epidemic, as ailments related to stress are said to cost Indian exchequer
about 72000 crores, between 2009 and 2015.

3.4 What if I just ignore and remain detached from the Distressed Worker?
It appears easy option, only till a date when reality strikes you. It is
better to anticipate and handle at an earlier stage, which shall cost
lesser resources (time, people and money) with more satisfactory
outcomes for all involved stakeholders.

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3.5 How do I identify a Distressed Worker?

As a manager and a leader in the organization, you are in a
pivotal position to understand the employee beyond their work
abilities. The earlier you notice that an employee is experiencing
mental health difficulties the better for all concerned. Your early
actions can help prevent the employee becoming more unwell. As
a manager, you can and should play a key role in identifying and
addressing the barriers to normal working life the employee might
experience rather than trying to understand his or her diagnosis.

Identifying early signs of distress

Distress can be identified at the earliest by a manager who is sensitive to pick up the
changes happening in a particular employee and his associated team or colleagues. The
changes can be subliminal to supraliminal and the reasons being simple to complex.
Some changes which should alert any manager are:

Change in behavior of an employee, compared to his or her own previous self

Decreased work performance

Unexplained absenteeism

Significant lifestyle changes (Starting or increasing alcohol consumption, vivid gym

goer stopping the same, etc.)

Interpersonal problems with team or clients

Emotional outbursts


Multiple physical complaints, etc.

Gauge the teams stress Level by:

Recurrent disputes and complaints

Dissatisfaction amongst members

Decreased effective contribution

Dropouts and attrition rates

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What are the possible signs of Psychiatric Emergency?

Any symptom can later turn out to become an emergency, but the below mentioned
symptoms probably indicate the need for immediate mental health professional

Suicidal thoughts and attempts

Aggressive, argumentative and hostile behavior

Emotional outbursts of inappropriate nature and


Abnormal experiences or thoughts

Disinhibited behavior

Reckless behavior

Causing or threatening harm to self, others and property

Intoxication with substances, etc.


Are all distressed workers, mentally ill?

Wellness and Illness are the extreme ends of the varied and complex continuum of ones
being. As per WHO, Mental Health is defined as a state of well-being in which every
individual realizes his or her own potential, can cope with the normal stresses of life, can
work productively and fruitfully, and is able to make a contribution to her or his
For all practical conveniences, we can address the continuum in the following

Complete Mental Wellbeing (Ideal but not practical)

Significant Mental Wellbeing (Practical, can be worked upon)

Temporary or Mild Psychological or Emotional Distress (Might need

professional Support but many times recover spontaneously)

Chronic or Significant Psychological or Emotional Distress (Would

require professional Support)

Psychiatric Illness (Which can be further considered to be grouped as

treatable with complete recovery, treatable with significant recovery,
difficult to treat)

Note: In many scenarios, distress is produced by real or perceived problems, where in,
timely suggestions by near or dear ones might help the individual to circumvent the

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current crisis. This shall not mean professional help is all about problem solving or trouble
shooting alone; it is beyond all these, needing the professional to have the experience,
ability and qualification to handle the issue on hand.

I face special challenges while wanting to identify a Distressed Worker?

I am concerned how will they receive my views and help?

This mostly depends on your pre-existing relationship with the
specific individual and others in the team. The views and help
offered shall be received through three specific subjective filters:

Filter 1: The way they generally see and take others

views and help

Filter 2: The way they generally see you as a person

Filter 3: The psychological and emotional coloring due

to current distress

A significant distress or illness is suspected when the distress is affecting an

individual to the extent of causing prominent personal dissatisfaction about
their functioning, or affecting their biological functioning, physical or mental
wellbeing, or leading to persistent interpersonal problems or dissatisfactory
occupational functioning or overall functioning.

Remember, offering help remains with you, accepting help still remains with

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Identifying a Suicidal Employee?

Any distressed employee can be at risk of Suicide. It is better to ask
the person rather than assume that there is no risk. But, before
asking a distressed person, adequate precautions are to be taken to
ensure proper rapport is established, the employee has enough
trust to open up, feel empathized and then indirectly get into the
aspect of suicidal ideation. Even though it is a myth to believe that

by asking someone about suicidal ideas shall implant one in them, we need to avoid
direct and leading questions.
Two examples of the way of questioning could be:
I understand you are going through a lot. Have you ever wondered, with all the
problems on your hand, whats the point of life at all?
Sometimes when people go through significant stress like you, start wondering what the
purpose of life? Have you thought anything drastic?

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4 Providing help to a Distressed Worker

4.1 Decision to help a Distressed Worker
Some thought provoking questions!!!!

I dont want to worsen the distress by pressing the wrong


I already have enough on my table; I cant take more

than that.

Is there any initial preparation I need to do before I help?

We do have existing counseling/ Employee Assistance

Program (EAP) service, but why is the person, not
seeking help or using these existent services

Working your way through each section below may address these questions

Prepare before the initial move?

Before making the initial move, be clear within yourself about the following things.

Why do you feel there is a problem?

What do you feel about the Problem?

What are the resources available at your disposal?

What are the resources available, but the worker

has to take his/her own initiative?


How do you plan to help the distressed worker?

Why do you plan to help the distressed worker?

Are you equipped to handle?

Your willingness to help someone is well appreciated, it would be better if
you are trained in some basic counselling skills; so that your good intentions
shall more times lead to satisfactory outcomes. Be sensitive to the issue at
hand and be ready to address the possible resistance, challenges and issues
which might arise. Ensure that a list of available resources remain handy
with you.

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Be explicit to put across why you are concerned about the distressed worker as
an individual and moreover an organizational representative. It shall help the
other person to receive your help and views, with more clarity and less


Are there any DONTs I should be aware off?

Dont be judgmental

Dont threaten

Dont argue

Dont get involved in a blame game

Dont diagnose or treat

Dont cross boundaries

Dont decide for others

Dont solve their problems in your ways

Dont put in your values onto others

Dont prematurely promise

Dont promise what you cannot deliver

Dont take up responsibilities which are not exactly yours

Dont get to own the success or failure

Be aware and avoid boundary violations!


I have decided to help. But tell me.!!!

The magical one-liner which will make the Distressed

Worker to open up and share?!!!!!!!!!!!!!!!
There is NO magical one liner. But you can create one
which suits your situation and personality with certain
principles in the mind, which could help you most of the

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The sentences made should be based on these tenants:

Non authoritative





The earlier you notice that an employee is experiencing mental health difficulties, the
better for all concerned. Your early actions can help prevent the employee becoming
more unwell. As a manager, you can and should play a key role in identifying and
addressing the barriers to normal working life the employee might experience rather than
trying to understand his or her diagnosis. The longer you leave a situation like this, the
harder it is to solve the problem and indeed the employee might become more unwell.
Using ordinary management tools to identify problems and needs

Regular work planning sessions, appraisals or informal chats about progress

are all ordinary management processes which provide neutral and nonstigmatizing opportunities to find out about any problems an employee may
be having.

You might find it helpful to use open ended questions that allow the employee
maximum opportunity to express concerns in his or her own way. For example:

How is life going?

How are you doing at the moment?

Is there anything we can do to help?

If you have specific grounds for concern such as impaired

performance, it is important to talk about these at an early stage.

Ive noticed that youve sometimes been arriving late recently and
wondered if there was a problem.


Engaging with someone who is reluctant to talk

Reluctance to talk could be a normal reaction of people for

various underlying reasons, based on their individuality,
perception, culture of upbringing & workplace, and the person
asking them.

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Make it clear that the discussion will be absolutely confidential, and stick on to it. Give a
non-judgmental consideration to the employees reasoning. Be realistic, ensure
confidentiality and sound supportive. Sometimes having discussions outside work space
might be an option to get the employee to open up.
After you have spoken to them, if they still remain reluctant, respect their feelings and let
them know that you are still open to talk or discuss with them and the door is open for
them. This might turn around a reluctant person to open up as his views are being
respected and enough personal space is given to him.
Remember: Confidentiality is of at most importance, till a point that the confidential
information you have leads to further serious consequences to the distressed individual or
any other concerned in the matter. This is a delicate, dynamic and an important issue to
be remembered. Please understand the legal and policy implications of the confidential
information you carry.


Issues to raise with an employee who is distressed

Ensure you ask more of open questions during the initial discussion, aim to establish
rapport rather than collect information. Your aim of opening up a discussion with the
employee is to:

Identify if there is any distress? Gauge the severity of


Provide a platform to share their concerns or issues.

Provide help by providing Mental Health First Aid

Provide help by sharing some useful professional








challenges, being supportive, empathetic and one of the resource to bank on,
through their journey from illness to recovery.
The following issues are to be raised to understand the distress of the individual better:
a. Ask open questions about what is happening, how they are feeling, what
the impact of distress is on them and others concerned, what are the
possible solutions they are looking at?
b. How long have they felt this? Is this an on-going issue or something that an
immediate action could put right?

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c. Are there any problems outside work that they might like to talk about
and/or it would be helpful for you to know about?
(Never pressurize the person to reveal external problems)
d. Are they aware of possible sources of support such as: relationship,
bereavement counselling, drugs/alcohol services/advice, legal or financial
advice, Mental Health Professionals?
e. Are they aware of the support that the organization may provide such as
reference to Occupational health, Counselling, Employee Assistance
Program (EAP), Brief Therapies, and Health Checks?
f. Is there any aspect of their medical care that it would be helpful for you to
know about? (For example, side effects of medication that might impact on
their work).
g. Does the employee have ideas about any adjustments to their work that
may be helpful (Within the realm of the existing organizations Policies)?
These could be short or long term.
h. Do they have any on-going mental health problem that it would be helpful
for the manager to know about? If so, is it useful to discuss their established
coping strategies

and how the organisation can support them? It is the

employees choice whether to reveal this. But you cannot necessarily be

expected to make reasonable adjustments for a condition if you dont know
it exists

Establish precisely what they wish colleagues to be told and who will say
what. Any inappropriate breach of confidentiality or misuse of this
information might constitute discrimination.


Agree what will happen next and who will take what action.

k. You might also consider whether the employee has been affected by an
issue that may affect others in the team/organization? If the latter, then you
need to undertake a stress risk audit followed by team-based problem
It is important that you record all conversations accurately - not just to protect the
organisation and the employee, but also to show that the actions have been carried out

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Managing an employee who becomes tearful and upset

This can happen for any number of reasons and can be
connected to something at work or outside of work.
Reassure them that it is OK to be upset and that you are listening.
In fact, the process of listening may provide an important space
for both you and the employee to gain insight into the problem
and possible actions, and
Ask if they would like someone of their choice with them
Try to be sensitive to the level of information and support the
individual can cope with at a given time. In the midst of a crisis,
they may not be able to think clearly and take on board complex

information. The important points are talking to them, reassure them their job is safe;
state positively that all help, assistance and support will be offered, and affirm that
discussion will continue at a pace that suits them.
Try and be calm yourself!
Many problems build up over time and whilst you may feel the pressure to do something
NOW, it may be better to take some time to calm yourself and consider the options. Try
to distinguish, with the person, between what is urgent and what is important.
You may also need support in managing this kind of situation. If the session is not proving
helpful for the employee or you, then rearrange again at a more appropriate time in the
near future to discuss the issues when the person is less upset.

Recognizing when professional/clinical help is needed

All who are in a state of psychiatric emergency need
professional help. In all other scenarios need for professional
help should be considered based on the:

Severity of the distress

Nature of the problem at hand

Available resources at the organization

In case an organization is seeking professional help for the

employee, it has to ensure adequate measures are taken to

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obtain necessary consent, discuss with in-house human resource department, EAP service
providers and others specifically concerned. Ensure that at all steps, including adequate
documentation, confidentiality and boundaries are maintained.

To wait, To Provide, To Support or To Force.

A sensitive, supportive and responsive organization can make a large
difference in the final mental health outcome of the distressed
employee. Early identification, providing help and necessary support
remains in the organizations forte.

To err is human. So, it is better to err by providing a helping hand rather than taking the
avoidant or deviant path. Any time you come across an employee suspected to be
distressed, take adequate steps to provide them help.
Ensure, that the current distress of the employee is NOT making them deny the help
provided, if so, do highlight the point to them and make them change their stand. Despite
all efforts if it fails, and there is imminent danger, do the next best action considering the
employees and others safety.
Get the family involved, as and when possible. Family is an important part of the
individuals social system. In situations where it is not planned to inform the family,
document the rationale behind the same.
Any decision taken should ensure:

Rights of the employees are not violated

Best interest of the employees are considered

No harm to the employee is intended

The services provided are in all fairness and equality

4.2 How do we really show that we do genuinely care for the distressed
Any care provided to a distressed employee is to be genuine and
perceived genuine. The subjective perception is most of the times
decided not just by the current crisis or situation being handled, rather
the employees experience of seeing you and other members in the
organization handling similar situations of others. So the genuine care
and interest has to be a systemic organizational behavior backed by

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supportive policies, which gets the distressed employee trust the care offered.
An active absence management, ensuring appropriate contact with the distressed
employee is essential. Creating a healthy workplace by focusing on:

Preventing, eliminating and minimizing stress at the source

Minimizing negative effects of stress via education and management strategies

Assisting individuals who are experiencing the effects of stress

Conducting health promotion activities

Creating employee forums for discussing health related issues

Ensuring similar help and access to professional services to all employees, based on
organizational policies might foster trust in the employee, and reduce the chance of
feeling discriminated.

4.3 We don't want any legal problems.

Document. Document. Document.
Documenting the following details should be extremely useful:

The behaviors noticed in the distressed employee which raised the alarm

Steps taken to understand the behaviors and explanations offered by the


Help offered and services activated from the organization

Challenges and dilemmas faced

The members involved in decision making

Consents taken and organization policies referenced

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Supporting the Distressed Worker

5.1 Proactive health promotion

No matter whatever is the size of the Organization, proactive
health promotion is must and possible by every organization.
Ensure that these health promotion activities are addressing all the
employees, rather than specific teams/groups of the organization.
Keep the program voluntary to understand the employees
interest levels and active participation. It is common to see the
enthusiasm dying in the employees for participating in the promotional activities as work
priorities keep changing, hence having a feedback system and tweaking the health
promotional activities as per the need would help, rather than being throttled from the
top of the organization.
Some employers find that access to talking therapies and company-funded counselling
schemes provide a safe space for staff to explore emerging problems before they become
acute. Counselling using brief, solution-focused approaches has proved particularly

5.2 Keeping in touch during sickness absence

Managers often fear that contact with someone who is off
sick will be seen as harassment. However, the overwhelming
view of people who have experienced mental distress is that
appropriate contact is essential. This view is endorsed by
companies that have pioneered active absence management.
Employees should be informed that they too have a responsibility to keep in contact.
Many organizations have policies around sickness absence that require minimum levels of
If your company does have access to occupational health support, it is important that you
co-ordinate approaches to the individual. This helps to ensure clarity about professional
roles and about what personal support is offered. While the employee might not wish to
be out of sight, out of mind it could be confusing or overwhelming to receive a number
of uncoordinated contacts from different people.

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If an employee rings in sick, you should, as their line manager, take the call personally.
The best outcome of this initial call probably is to agree that the employee will make a
follow-up contact. (It might be useful to agree with the employee how this will be made.
They might prefer to do it by text or e-mail.)
If the employee does not make contact in the agreed way, you are then licensed to
respond. At an early stage, the fact of being in contact may be more important than what
is actually said.

5.3 When they come back?

You should consider with the employee any factors that
contributed to their absence that could realistically be






adjustments need to be made to ease their return. You can

then agree how their progress will be monitored.
You must make sure the employee doesnt return to an
impossible in-tray and thousands of emails.
When they return, brief them on whats been happening social life as well as work
developments. Be realistic about workloads be aware that some people will wish to
prove themselves and may offer to take on too much. Instead, set achievable goals that
make them feel they are making progress.
Take the time to have frequent informal chats so there is an opportunity to discuss
progress/ problems without a formal (and possibly intimidating) session.
Give positive and constructive feedback. You will also need to discuss honestly the things
you can change and those you cant. Some organizational factors are out of your control.
Can they be mitigated?
You might also consider a mentoring scheme with another employee so that the person
returning can also talk to someone who isnt their manager.
Above all, make sure you and the team make the person feel welcomed back.

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Making the person feel they are a special case this can cause resentment both with the
individual and with peers, and failing to deal with their work whilst they have been off
work. Check whether a backlog of unfinished work has built up and deal with this also.

Be aware:
If the employee is on medication they may experience distressing side effects. They may
or may not feel able to discuss this with you.
However, it may be helpful to consider that it can be easy to confuse side effects with the
illness. Any effects on work may be temporary and/or the person may only take
medication for a short time.
For people with a longer term problem, it may take some time and patience to establish
the right medication and dosage. Hence the employee may not immediately know if
medication will affect their ability to do the job.
It is important they continue with their medication until they have discussed this with their
mental health physician. You also need to ensure that any side effects are considered
against their job requirements. This is particularly crucial in jobs where there are health
and safety risks.

Some adjustments to consider

Almost no-one is ever fully fit when they return to work after an illness (physical or
mental) and it takes some time to recover speed, strength and agility of both mind and
Waiting for people to be become 100% fit for their work before allowing them back is
therefore unrealistic it lengthens absences unnecessarily and may ultimately even
compromise their future employability.
It is common sense to adjust work in the early days after an extended spell of absence to
promote full recovery and to ease the individual back into productive employment. Most
adjustments are simple, inexpensive and need only be temporary.
Some examples of adjustments are a phased return to work starting with part-time,
working and building up. Perhaps you could look at aspects of the job that the person
finds particularly stressful and rearrange responsibilities. You might think about adjusting
the content of the job.

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You might think about whether you have identified the training needs of the individual.
After their return to work, it may be helpful to have a review of training, development or
support needs. These may be around the specific job requirements and/or around skills
enhancement such as: communication skills, time management, etc.
You could offer the option of working at home for some of the time; time off for
attending therapeutic sessions. (This should be allowed for all medical problems);
changing shift patterns or exploring different work option

5.4 Returning to work

Most people improve significantly to join back work
successfully. An effective, supportive and reality based
planning of their return should work out cost effective and
help all the stakeholders in the long run.
Effective planning should be weaved considering the
organizations policy, inputs from related departments, the
Frontline manager and the employee.
Factors to consider in planning an effective return:
Consider the employees reason for absence and see is there any organization related
contribution which can be changed or accommodated.
Discuss with the employee about the plan for monitoring progress, ensure the employee
is taken into confidence, rather than feeling it as a boundary violation.
Create a workable plan about the employees return about the pending and overflowing
work and mails, during their absence. This is one of the biggest fears of the returning
Set achievable and practical goals, returning time is not a time to prove or disprove the
beliefs of self or others.

Take the time to have frequent informal chats so there is an opportunity to discuss
progress/ problems without a formal (and possibly intimidating) session.

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Give positive and constructive feedback.

You will also need to discuss honestly the things you can change and those you
cant. Some organizational factors are out of your control. Can they be mitigated?

Above all, make sure you and the team make the person feel welcomed back.

Consider these:
Almost no one is fully fit!
Recovering employee, however experienced and capable, might have lost some sheen
out of their work abilities. This might not necessarily be due to illness, but many other
factors, like, changed priorities, adjustment issues on returning, lack of energy, drug
induced, etc.
Waiting for complete cure and 100% fitness might be unrealistic. In fact, it might
compromise the employees self-esteem, return to work and as well future employability.
Most adjustments are simple, inexpensive and need only be temporary.
Phased return and reworking the roles and responsibilities might be beneficial.
Any suitable training can be reconsidered if necessary.
Consider working from home option, flexible timings, phased return to work, sharing of
responsibility as a means of supporting the returning employee.
Note: Returning to Work meeting can be made mandatory to all employees after any
long leave, thereby reducing the chance of discrimination, stigma, and also creating a
platform for returning employees to discuss.

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5.5 Managing reactions from colleagues and clients

Fear, ignorance and hostility from colleagues and others
related at workplace can be a source of great distress. Real
patients acknowledge experiencing the wrath of stigma,






Many times, rather than ill will, sheer ignorance and fear fuels stigma. The fact that many
do not know how to respond, makes them avoid the distressed individual, which further
worsens the existing relationship with them.
Talk to the employee and decide on what shall be shared, when and by whom.

Be guided by the employees wishes. Some people are prepared to be more

open than others. Encourage the person to talk if they wish but dont
pressurize them to do so

Treat people returning from absence due to mental ill health in the same way
as those with physical ill health

Treat mental health issues in a matter-of-fact way they are common and
should not be a source of office gossip or conjecture.

After a time, ask the employee how they are getting on with peers/clients.
Review if there is any support that you can give, and consider mental health
awareness raising for all.

Anticipate intrusive people and hostile reactions, plan ahead in discussion with the
employee about the stand to be taken to handle such events, this shall reduce ambiguity
and double standards.


Shrouding the issue in secrecy

Making assumptions about workloads and capacity to cope.

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5.6 Managing an on-going illness while at work

On-going illness shall not mean




between the distressed employee and






abilities and responsibilities, most of

the time the person with on-going illness shall have almost the same parameters of
judgement, like any other employee in the organization. In fact, any discrimination or
excessive consideration could turn out counterproductive.
Ensure the person with on-going illness is:

Under adequate professional care as the situation warrants

Knows the organizations expectations out of him

Having some coping strategies in case of relapse of the primary problems

Able to give advance statements about whom and where to talk to, in case of the
relapse of illness.

5.7 Supporting an employee who is off sick

It is essential to keep in touch. Supporting the distressed employee during absence shall
be an extremely useful step in the quick recovery of the individual. Support should be
adequate, non-intrusive and create a healthy as well a transparent environment of
adequate trust and mutual interest. This shall ensure effective communication between
the recovering employee and the organization, thereby helping both to take realistic
steps while handling the crisis.
Sincere attempts to address the below mentioned issues, would be required:

Reassure, respect and maintain the medical, personal and organization


Review their needs/wishes for support

Consider working from home option if feasible

Phased return could be considered, if feasible

Support is always offered, it cannot be forced upon someone

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Contact the distressed employees treating professional.

It is an absolute right of the Distressed Worker, asking you to keep away
from the treating professional. Even, in the context where you want to
share valuable information about the distressed person with the
professional, it has to be done after obtaining consent of the employee.
Any interaction should be transparent, kept to the minimum and necessary
only. Do not pressurize the professionals asking them to divulge or give
100% reassurance about his recovery (As it is unethical to claim 100%
recovery, even in cases of possible reality.)


What to do if the person requests no contact

A request for no contact is not uncommon, adequate steps have to be taken to explore
the possible reason(s) for this request, following which it has to be requested. Some
possible reasons are:

It is their Private Space

Social Embarrassment

Do not want sympathy of others

Do not want to mix up personal and work life

Worried their return to work might be difficult; as

their colleagues might behave differently (We are
humans, we change!)

Current decision making and thinking might be colored by the ongoing emotional or
psychological distress, leading to errors in thinking. Example: A depressed patient might
feel worthless, hopeless and helpless. Making them refuse help offered or not wanting to
discuss their issues with others.
Keeping in touch Policy
Creating a Keeping in touch policy for all absentees, wherein an appropriate and
empathetic communication is made to all absenting employees in an organization, asking
them about their well-being (rather than a specific mention about the illness, even if
known) and respecting their contribution to the organization. Moreover, if there are any
positive team developments, it can be communicated to the absenting employee.

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6 Four big challenges which shall always remain!

Despite all the knowledge, training and understanding one can have, there shall be four
equally important domains, challenging you at every move taken in relation to a
distressed employee, namely:

Helping the individual

Organizations Interest

Personal Interest

Dealing with ones own emotions

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"Let's leave behind world a better place"

Training Division

Clinical Division

Public Health Division


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