A Guide for Human Resources and Management
This is a guide to aid employers on a common workplace illness; one that can be hard to identify and that can affect employees’ performance at work and is a major cause of absenteeism.
Part One: Anxiety Disorders - The Facts
- What an anxiety disorder is
- How it affects people
- How to identify it
- How to help those affected when at work
- How to help those affected and absent return to work
Anxiety (noun): a painful or apprehensive uneasiness of mind usually over an impending or anticipated ill
-Definition, Medline Medical Dictionary
- Anxiety is a commonly used word to describe an illness by employees, but the word anxiety on its own simply describes a feeling or a symptom. All of us experience anxiety from day to day for a number of reasons. But there are a number of anxiety disorders, which affect individuals much more markedly. Anxiety disorders are not just a tendency to constantly worry. They are medical conditions that are mental health illnesses.
Anxiety disorders are different from work-related stress. Those who suffer from work-related stress may develop a mixture of different symptoms, for example physical symptoms, low mood, drug or alcohol misuse or a feeling of being anxious. Many may have a mixture of these. But whilst the anxiety disorders are a medical illness, stress is not an illness. This is highlighted in an international classification system. However, work-related stress, like any cause of stress, can be a pathway to mental illness.
The majority of employees with an anxiety disorder will have general anxiety disorder (GAD). The other anxiety disorders are less common and are listed below. The rest of this webpage will focus on GAD; however, the principles of management in the workplace apply across the range of anxiety disorders.
Types of anxiety disorder:
Generalised Anxiety Disorder
Obsessive Compulsive Disorder
Post-traumatic stress disorder
Part Two: What to Look Out For – How Anxiety Disorders Affect People
The following are examples of some symptoms seen. Be aware that not all employees will have all of these.
Also employees may hide their symptoms, due to fear of losing their job or concern about the stigma of mental illness.
- Excessive anxiety or worry – that is present on most days
- The worry is difficult for the individual to control
- Restlessness or feeling on edge
- Being easily fatigued
- Difficulty concentrating
- Poor sleep
- Episodes of trembling, sweating or palpitations
The above features are usually present for a significant period of time.
The effect of the above symptoms in the workplace can vary. Fatigue and difficulty concentrating can make an individual take more time to complete a task, or find it difficult to complete. The episodes of trembling, sweating and palpitations can come on suddenly and make it difficult or impossible to carry on with the task at hand for the duration of the attack. The effects vary in both the impact on the individual and the severity of the impact. However, often those with generalised anxiety disorders have marked difficulties at work.
A large international study of those with generalised anxiety disorder found that in 40% of those who had the condition it had a moderate or severe impact on them occupationally. These individuals missed an average of 6.3 days a month.
Part Three - How to Identify it in the Workplace
Unfortunately, the majority of those with anxiety disorders are identified only when they take time off work or their performance comes into question, and those with milder symptoms may not divulge the condition – perhaps due to the stigma of the condition.
Some however, who are both at work and performing satisfactorily, may develop the attacks described above, or appear over time increasingly anxious or worried. They may remain like this the majority of the time.
Specific signs in health professionals, which may manifest in different ways dependent on the requirements of their role, include:
- Taking longer in consultations, due to poor concentration and having to recheck information
- Unwilling to take on extra work
- Disappearing from the ward or clinics
- Not answering bleep/phone in a timely fashion
- Irritability with colleagues or even patients
Generalised anxiety disorder can be treated, but only after it has been recognised and diagnosed.
If HR or managers are concerned about an employee, they should discuss their concerns with the employee and suggest that they make an appointment with their GP. HR or managers should contact their occupational health department for advice, and in most cases a referral should be made in order for the employee to receive an occupational health assessment and advice. This is especially important if the manager or HR have reasons to be concerned that the employee’s illness is compromising patient safety.
Part Four – Will all Employees Need Time off Work?
Not all employees will require time off work. In fact, when an employee is diagnosed with an anxiety disorder, remaining at work can often play a role in the individual’s recovery.
This is for a number of reasons. Work can provide an important social contact, contribute to a sense of self-worth and purpose, provide daily structure and provide financial security. These same reasons also apply in other clinical illnesses; for example in depression.
However, some employees may need time off work, and the employee’s GP or occupational health professional will make a decision based on the severity of their condition, its impact on patient care, patient safety and the impact on co-workers.
Part Five – Returning to Work
Some individuals may have occasional short-term absences of just a few days, but the majority have long-term absences. This is due to two factors. First, the symptoms are chronic – i.e. long term and present each day; thus they don’t resolve after a few days like an infection or toothache. Secondly, the treatment often takes some time to have an impact.
Treatment employees may have had offered. These may be on going when an employee returns to work.
- Physiological therapies – e.g. Cognitive Behavioural Therapy (CBT), the main option studied and used.
- Antidepressants – despite their name, anti-depressants are beneficial and widely used in generalised anxiety disorder. They are beneficial regardless of the presence of co-existing depression.
The most commonly used are the serotonin-based anti-depressants.
Less commonly, other drugs may be used: e.g. Pregabalin, or (for a short period of time) benzodiazepines.
Some employees’ doctors will treat patients with one of the above, or two in combination.
When an individual returns to work, good management of the planned return to work is crucial to helping an individual return successfully.
Firstly, when an individual’s mental health has improved satisfactorily for the physician to deem them fit for work, there can still be some work related barriers to returning.
Obstacles to returning to work:
- Stigma associated with anxiety
- Fear of lack of support from employer
- Fear that reduced self-confidence will make work difficult
- Fear on impact of diagnosis on future training or career options.
Finally, we highlight advice that can be considered to assist an employee’s return to work
- Discuss the issue. This can be at a return to work meeting or soon after returning to work. Simply ask the individual if there is anything that they feel can be done to support their return to work. This may be as simple as telling them who to inform if they have problems or concerns.
- Seek advice from their GP or ideally, an occupational physician or nurse advisor. They will highlight strategies to help them medically return to work and any restrictions or adjustments needed. Discuss and set out how to deal with issues/adjustments raised in the report.
Reasonable adjustments may include:
A phased return to work
Adjusting specific duties
Addressing tasks that the employee feels may be anxious to deal with, and tasks they found difficult before going off work when the condition was initially present. This may be presentations, dealing with difficult staff or public, or dealing with senior management etc.
- Consider a written plan highlighting the issues above and any management issues considered such as plans to monitor the employee’s progress in the workplace.
- Address any work causes. Some of those with anxiety disorders may have specific work related factors which the employee feels has contributed to their illness. These may be highlighted in the Occupational Health report, or by the individual themselves. It is important to listen to these, to allow the employee to air the issues and crucially – were appropriate - take action.