Identifying mental health issues

Mental health apps – silver bullet or nice-to-have?
December 10, 2017

Identifying mental health issues

Accountants have an ethical as well as a professional duty of care towards their clients. David Adams outlines how to identify and support those suffering from mental health issues

Mental health problems are extremely widespread: one in four adults living in the UK are likely to experience them in any given year, according to the UK government’s Health & Social Care Information Centre (HSCIC). Depression and anxiety affect around one in 10 people, while conditions such as schizophrenia and bipolar disorder may affect between 1% and 3% of the population, says Stephen Buckley, head of information at mental health charity Mind.

Any of these conditions may impair individuals’ ability to take financial decisions, or lead to a decline in their performance at work. So what should accountants do if they suspect that a client, whether an individual who uses their services or someone working for a client organisation, seems to be affected?

Kelly Feehan, services director at the Chartered Accountants Benevolent Association (CABA), says the prevalence of mental health issues means it is likely that an accountant will come into contact with a client whose mental wellbeing is at risk. “It’s important to be aware of the signs of mental ill health and know how to help someone who may be suffering,” she says.

What is an accountant’s duty of care to the individual or organisation in question? Unlike other service provider/client relationships, such as that between a lawyer and client, there is no formal structure in place defining best practice. An accountant may be subject to a fiduciary duty, but this is not clearly defined in law.

If an accountant is concerned about the wellbeing of the individual, rather than any specific threat to their finances or an employer, their response will be determined in large part by the nature of the relationship they have with that individual. It is easier to imagine an accountant who has helped an individual manage their personal finances for some years asking them if everything is alright than it is to imagine this in a pure service-organisation-to-client-organisation context.

Either way, how can you identify whether a client is affected by mental health issues? Feehan lists some likely symptoms: fatigue; restlessness and agitation; poor appetite or weight loss; low spirits; difficulties in concentrating; or personality or mood changes.

Chris O’Sullivan, a policy and development manager at the Mental Health Foundation, also sees behavioural changes as an important indicator. “This person might be withdrawing, or not communicating as they did previously, doing things like sending emails at strange hours of the day,” he suggests. “Maybe this is someone who used to be on the phone talking to you all the time, but suddenly contact with them has become much more haphazard. Or, if they’ve previously been very driven and focused, they might now appear to be losing direction.” It may also be possible to identify the symptoms of specific conditions, such as the alternating high and low mood states associated with bipolar disorder.

You might suppose that one indicator would be that an individual starts to make poor decisions, but the symptoms of conditions such as stress and depression may not manifest themselves like this, says Dr Rajeev Dhar, a consultant psychiatrist at Nightingale Hospital in London. Instead, he says, in his experience it is more often a lack of decision making that reveals these issues. “You see people struggling to make a decision, and then decisions start to pile up,” he explains.

What could an accountant do to help? Empathy is important, says O’Sullivan. “Everyone has ups and downs,” he says. “One of the best ways to think about mental health is to think about times when we have had to take steps to cope.”

“People should seek help from their GP,” advises Dr Dhar. “If they’re in crisis they can access emergency support lines for various agencies: there are groups they can get in touch with if they have problems with substances or difficulties with relationships. It may be necessary to get a psychiatric assessment. If they have got a diagnosable condition they should try to get a care and treatment plan in place.”

So how should accountancy firms and other employers be arming staff with more knowledge about this subject and guidance on how to help affected individuals to find support?

“Noticing mental health problems and talking about them with a client may seem awkward,” Feehan admits. “However, as the illness becomes more commonplace, it’s important for firms to guide accountants to have a technique in managing clients’ mental wellbeing or stress levels.” If done well, she believes this can even strengthen the client relationship – although there is a risk it will produce the opposite effect if handled badly.

One significant obstacle to overcome is a reluctance to reveal they are experiencing these sorts of problems. “It’s often hard for people to be honest and open about the way that they’re feeling,” says Dr Dhar. “There’s a lot of pressure to hide the fact that you’re struggling to cope. People may feel that if they ask to take time off their job may be at risk. Those worries can create additional stress.” For that reason, he says, it can be useful for individuals to be able to turn to someone else within the organisation to whom they can speak in confidence.

EY’s Thinking Differently programme has incorporated new initiatives and training across the company, including a mental health buddy scheme to provide an informal support network. EY has trained more than 400 employees in Mental Health First Aid, enabling them to act as one of the first points of contact for employees trying to cope with mental health issues.

The training provided can also be applied in other aspects of staff’s professional and personal lives, says Amy McKeown, health, mental health and wellbeing senior manager at EY. “This is about increasing awareness of what is often viewed as the last workplace taboo,” she says. “We actively encourage our people to use the pathways and resources we have in place. At the same time we encourage clients to do the same within their organisations.”

Workplace mental health promotion programmes save almost £10 per £1 spent on them, according to research conducted in 2010 by the London School of Economics.

“It is important for society to recognise how common mental illness is,” says Feehan, “and how vital it is to support and offer advice on these issues. In some cases, talking about how we are feeling is not part of the culture, so it’s even more important for advice services to be available at work.”

Buckley hopes that awareness-raising campaigns run by employers and in public by Mind, the Mental Health Foundation and other organisations, will help to break the taboo, but he fears “there is still a long way to go before people feel as comfortable discussing their mental health as they do discussing physical health problems”.

What to do if you think a colleague is suffering from mental health issues

Mental ill health is thought to cost the UK around 70 million working days per year (UK Department of Health figures); while UK employers also spend approximately £2.4bn per year replacing staff who leave as a result of mental ill-health, according to the Chartered Institute of Personnel and Development (CIPD).

It is usually easier to identify a colleague who is being affected by mental health issues than it would be with a client simply because you spend more time with your colleagues. As the Mental Health Foundation’s Chris O’Sullivan suggests, you may notice that someone is not interacting with colleagues as they once did, is withdrawing from socialising, or appears particularly tired, unwell, or suffering from the effects of “self-medication” such as increased alcohol consumption.

Mind lists some important principles to apply when trying to offer support to colleagues: listen; reassure; stay calm (helpful if someone has to explain something distressing, because it will help them to remain calm); be patient; try not to make assumptions; and maintain social contact.

O’Sullivan believes the effectiveness with which employers handle these issues varies a great deal, but what is most important is the creation of an environment where it is seen as acceptable to ask for help.

“Responsible employers should make good mental wellbeing a priority and take steps to create mentally healthy workplaces,” says Mind’s Stephen Buckley. “Looking after employees’ wellbeing can improve productivity, staff retention, morale and levels of sickness absence – and can improve how staff support clients who may be experiencing mental health problems.”

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