Birmingham City Council: Reasonable adjustments for mental health

Birmingham City Council is the local government body responsible for the governance of the City of Birmingham. It's the largest county council in Europe, employing around 12,000 people. Birmingham City Council takes a strategic approach to support the health and safety needs of their diverse workforce.

In line with the Labour Force Surveys findings, stress, anxiety and depression features as a cause of sickness absence. Birmingham City Council has a comprehensive range of in-house occupational health services led by a Safe Effective Quality Occupational Health Service (SEQOHS) accredited team. It also has a referral system to support employees with mental health conditions to stay in work.

Employees are referred to occupational health by their managers, though a self-referral pilot is taking place. Referrals are held over the phone unless there are clinical reasons for needing a face-to-face appointment.

The occupational health advisers use the biopsychosocial model. This considers the factors that impact someone's health, for example:

• biological factors, for example physical health 
• psychological factors, for example coping styles
• social factors, for example family and work

They then provide a report with advice on adjustments and adaptations. These might include changes to the work environment or work activity that enable employees to remain in their current role.

Occupational health can also advise on work-related activities an employee might need adaptations to. These can be long or short-term changes.

(Names have been anonymised.)

Katherine is a social worker. She was referred to occupational health during her 4-month absence from work due to anxiety disorder. During her absence, she felt ready to re-engage with work. She was coming to the end of a series of cognitive behavioural therapy sessions and had completed a course of mindfulness to support her in developing relaxation techniques.

She was worried about returning to work. As she was an experienced member of the team, she felt that there might be expectations to get straight back into the role. The thought of going into a full caseload and responsibilities overwhelmed her.

Katherine's manager raised an occupational health referral. She met with an occupational health adviser who encouraged her to be honest and open and they planned for her return to work.

To help Katherine feel supported as she built her confidence back, the occupational health adviser worked with her to draft a structured schedule of activities for the short, medium and long term. The adviser also worked with the manager to agree and finalise recommendations.

As she had been absent from work for 4 months, a phased return was recommended to re-establish a work and home pattern. During this time, she was given a reduced number of tasks and had longer to complete them than she normally would.

Flexibility was key, as was taking formal work breaks away from the work area. Katherine was concerned that her concentration and memory might be reduced. Her adviser recommended that auditory and visual distractions were kept to a minimum and encouraged her to focus on one task at a time. Together they identified several quiet spaces that Katherine could use in her building and outside her building such as the different libraries in the city.

The ability to break up bigger pieces of work into smaller tasks was helpful by having concentration episodes of approximately 20 to 30 minutes followed by a brief break. Memory aids were also introduced, as well as minute and note-taking, access to written instructions and use of diaries to help Katherine stay on top of longer tasks.

The adviser also made Katherine aware of the range of additional organisational support available, including employee networks, Yammer feeds, peer to peer support, the employee assistance programme and continued support from Occupational Health.

Her manager set aside a regular time to review Katherine's work progress and the return to work plan. To prevent any anxiety related to change, it was agreed that her manager would take time to thoroughly discuss any changes to service processes or work activities.

It was suggested that Katherine might benefit from having a trusted mentor. Her manager talked to her about who in the team would be best to take this role. Her trusted mentor helped her re-familiarise with work tasks and get up to speed with any changes that occurred while she was away. They were also aware that regular positive feedback was important to help boost Katherine's confidence and they made efforts to do that as she took on new tasks.

Katherine's role is particularly challenging due to the nature of the activities she undertakes. The team increased the frequency of one to ones, peer to peer support and case reviews as an ongoing support mechanism.

Using the biopsychosocial model to fully understand what is going on for the employee is helpful. This way recommendations can take into account the broad range of factors that impact someone's ability to work well.

Early involvement of an occupational health adviser can help to ease concerns about return to work and provide the employee with a space to talk about concerns and identify ways to manage these.

When the job is known to be challenging it's important to consider carefully how work can be adapted and specifically, how more opportunities for support and checking in can be built into the working day.