Signs of poor mental health

An artist doing some work at her desk

We’ve all heard of mental health diagnoses like depression, anxiety and bipolar disorder.

But having a diagnosis does not necessarily mean that someone's mental health is poor right now. You could have a diagnosis of a mental health condition but, right now, be able to manage it and function well at work and at home.

Equally, they might not have a particular diagnosis, but be finding things very difficult.

  • Get to know your team

  • Treatment and support

Everyone’s experience is different and can change at different times. As a manager it’s important to get to know your team and understand what they need and when.

Understanding some of the signs of poor mental health does not mean you should make assumptions about what mental health problems your employees may have. Instead, use them as a way of noticing when you should check in and start a conversation about how your employee is coping right now.

“A particular condition can manifest itself in such a variety of ways … the onus is really on the person to explain how their condition is likely to impact on the way in which they work or interact with their colleagues.” – Fiona S

Have a team-building session focused on mental health. Remind your team that we all have times when our mental health is less good. You might call this stress or burnout. Or you might think about it in terms of a particular diagnosis.

Ask people to share ideas about the early signs that they’re finding things more difficult. It might help to share your own experiences first. Think about how these might affect your work too.

Some ideas of early signs might be:

  • poor concentration
  • being easily distracted
  • worrying more
  • finding it hard to make decisions
  • feeling less interested in day-to-day activities
  • low mood
  • feeling overwhelmed by things
  • tearfulness
  • tiredness and lack of energy
  • sleeping more or less
  • talking less and avoiding social activities
  • talking more or talking very fast, jumping between topics and ideas
  • finding it difficult to control your emotions
  • drinking more
  • irritability and short temper
  • aggression

Talk about the support you find helpful too. If you start to notice these signs, in yourself or in others, what can you do? It might help to ask your team to make two lists: early signs and helpful support. They can share these with the team or just with you.

This kind of activity can be a good starting point for developing Wellness Action Plans. It can help you understand your employees better. It can also help you become more aware of your own mental health and notice earlier when things are feeling more difficult.

You might find that your employees are reluctant to share their experiences at first, especially if your organisation does not traditionally have a culture of openness around mental health and wellbeing. But you can help.

  • Explain why you’re running this session and how you hope it will help employees and the team. It may help to use our information on mental health and why it’s important to look after it.
  • Share your own experience.
  • Make the discussion more general rather than focusing on individuals. It might help to change the focus by asking people what they think early signs in others might be, and what advice they would give them.
  • Continue to promote mental health and wellbeing initiatives across the wider organisation.
  • Start slowly by introducing ‘opening rounds’ in team meetings – for example, ask each team member to say something that makes them happy. This kind of light touch activity starts to help employees feel more comfortable talking about their wellbeing in meetings.
  • Be approachable and continue to provide opportunities for employees to speak to you when they’re ready.

We’re all different and not everyone will be comfortable sharing their experiences straight away. But the better you know each other, the easier it will be to offer the right support at the right time.

This page explains some of the treatment and support options you or your colleagues might be offered.

Different treatment options are right for different people. What someone is offered will also depend on their experiences, a diagnosis (if they have one) and what is available in their area.

It may take someone some time to find the right treatment for them. Often, a combination of treatments is found to be most effective.

For managers, this section includes some advice on how you can understand the needs of employees who are undergoing certain treatments.

What kinds of treatment and support are available?

  • Talking therapies aim to help you understand your feelings and behaviour. There are a number of different types of talking therapies available – some are more effective at treating certain mental health problems. Unfortunately waiting lists are often long and it can be difficult to access treatment when you need it.

    Your employee may not be able to access talking therapies outside office hours. You may need to support them to attend treatment by giving time off or offering flexible working so they can make up their hours at another time.

    Sometimes talking therapies can be difficult. They may bring up painful thoughts and feelings or make the problem feel worse for a while. Your employee may need additional support while they’re having this treatment.

    See our topic page for more information about the different types of talking therapies.

  • There are four main types of medication prescribed for mental health problems. They are antidepressants, antipsychotics, mood stabilisers and tranquilisers. They’re usually prescribed to help reduce the symptoms of a mental health problem.

    Most medication will take some time to work and may have side-effects. It may help to talk to your employee about how their medication is affecting them and what adjustments might help them to work more effectively.

    “I have a lot of side effects from my pills (shaky hands, forgetfulness and sleeping problems) but these aren't really accepted as reasons for lateness, or errors. I am made to feel like I am making excuses.” – MaggieMay

    Antidepressants

    Antidepressants may be prescribed for depressionanxiety and some eating disorders. They increase the amounts of certain chemicals in your brain.

    You’ll usually need to take an anti depressant for at least six months – but some people have to take them for much longer.

    It can sometimes be a couple of weeks until you feel a difference. Some antidepressants make you feel worse initially.

    All antidepressants have side-effects but people will experience them differently. Many side-effects are short term or can be reduced by changing medication or adjusting the dose.

    Common side-effects are:

    • feeling sick or vomiting
    • diarrhoea or constipation
    • feeling anxious or agitated
    • trouble sleeping or sleeping more
    • feeling dizzy
    • feeling tired

    See our page on antidepressants for more information.

    Antipsychotics

    Antipsychotics can be prescribed for psychosis, schizophrenia and schizoaffective disorder, bipolar disorder, hypomania and severe anxiety. You may have to take them in combination with other drugs to help treat side-effects or other symptoms.

    Antipsychotics do not cure psychosis but they help make the symptoms more manageable. It’s not known exactly how they work but they are thought to affect the dopamine receptors in the brain.

    Antipsychotics can have a range of side-effects. Reducing the dose or changing to a different drug can sometimes help manage them.

    Side effects can include:

    • abnormal movements of the face or body
    • weight gain
    • sedation and feeling sleepy
    • difficult concentrating
    • dry mouth and blurred vision
    • constipation
    • lower tolerance to glucose (and increased risk of diabetes)

    If you take antipsychotics you may need to attend regular medical assessments, especially at first.

    Mood stabilisers

    Mood stabilisers may be prescribed for bipolar disorder and hypomania and mania. They can help stabilise your mood if you have extreme mood swings. The most common mood stabilisers are lithium, valporate and lamotrigine. The drug you’re prescribed will depend on the way you experience mood swings – for example whether you experience more mania, more depression or both.

    Mood stabilisers can have a range of side-effects. These vary considerably depending on the type of mood stabiliser you take. Some are short-term and will go as you get used to the drug.

    Tranquilisers

    Tranquilisers may be prescribed for anxiety and insomnia. They’re sedatives and work by helping you feel more relaxed. You’ll usually only be prescribed them if your anxiety or insomnia are very severe and other treatments have not helped.

    You’ll usually only be prescribed tranquilisers for a short period of time as they can be addictive. You may experience side-effects such as sleepiness and confusion.

  • Art therapy involves working with a trained therapist and using the arts (music, drama, dance or visual art) to help you express your feelings. It can help if emotions are too difficult, complicated or distressing to put into words. It is available on the NHS in some areas of the country.

    You may be offered art therapy alongside other treatments. It’s particularly recommended for people with a diagnosis of schizophrenia, schizoaffective disorder or psychosis.

  • Treatment programmes based on mindfulness – mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) – are recommended to help treat mild depression. MBCT can help prevent further episodes of depression. It may also help treat anxiety and low mood.

    Mindfulness and related programmes can help you to create space between yourself and your thoughts and emotions and choose how you want to react. It can also help you identify negative emotions earlier and be kinder to yourself.

    MBCT and MBSR are structured courses that usually take place over 6–8 weeks.

    Mindfulness can also help if you have negative thoughts and feelings, find it hard to relax, feel stressed or worry a lot. Watch more about how mindfulness can help you in your everyday life.

  • You may be admitted to hospital if you’re very unwell, if other treatment hasn’t worked or if you’re in crisis. Admission may be voluntary (this means you consent to be treated in hospital) or you may be detained under the Mental Health Act (sectioned).

    In many areas of the country there is a shortage of beds. This means you may have to travel away from home to be treated.

    If your employee is admitted to hospital, you may find it helpful to look at our information on managing time off and return to work.

  • You’re unlikely to recover from a mental health problem using self-care alone – but there are things you can do to help make things easier. These suggestions can benefit everyone in the team.

    • Eating well can give you more energy, help you feel calmer and improve your mood.
    • Exercise can boost your wellbeing and mood. It can help prevent and treat some common mental health problems.
    • Getting enough sleep helps improve concentration and energy levels. Lack of sleep can increase your risk of developing a mental health problem.
    • Practising relaxation techniques – such as progressive muscle relaxation – can help when you’re feeling stressed.
    • Talking to friends, family or other people with similar experiences can help you feel less isolated.

    As a manager, it’s worth bearing in mind that someone who is off sick with a mental health problem may find it helpful to exercise or socialise to help them recover. Seeing them out and about does not mean they’re any less unwell or do not need time off work.

    It may also help to think about how you can encourage your employees to look after their mental health during work hours. The section on promoting good mental health at work has some more ideas.

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    • Psychosis and schizophrenia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, February 2015
    • Bipolar disorder. NICE Clinical Knowledge Summary. cks.nice.org.uk, October 2015.
    • Generalised anxiety and panic disorder in adults: management. NICE Clinical guideline CG113, January 2011. www.nice.org.uk
    • Professions. Health and Care Professions Council. www.hcpc-uk.org [accessed April 2017]
    • Psychosis and schizophrenia in adults: prevention and management. NICE Clinical guideline CG178, February 2014
    • Depression in adults: recognition and management. NICE Clinical guideline CG90, last updated April 2016
    • Hofmann, Stefan G et al. The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review. Journal of Consulting and Clinical Psychology 78.2 (2010): 169–183
    • Segal, Williams & Teasdale. Mindfulness Based Cognitive Therapy for Depression. Second Edition. The Guildford Press, 2012
    • Kabat-Zinn. Full Catastrophe Living, Revised Edition: How to cope with stress, pain and illness using mindfulness meditation. Piatkus; Revised edition, 2013
    • Mental Health Act 1983. legislation.gov.uk [accessed April 2017]
    • Eating well and mental health. Royal College of Psychiatrists. www.rcpsych.ac.uk [accessed April 2017]
    • Lawrence D, Bolitho S. The Complete Guide to Physical Activity and Mental Health. A&C Black Publishers: London, 2011
    • Paunio et al. Sleep, work and mental health. Psychiatria Fennica 2015;46:5,566
    • Smith, JC. Relaxation, Meditation, & Mindfulness: A Mental Health Practitioner's Guide. New York: Springer Publishing Company Ltd, 2005
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  • Produced by Clare Foster, freelance health editor, and Nick Ridgman, Head of Health Content, Bupa UK, September 2017
    Next review due September 2020

    Bupa UK expert reviewers:

    • Naomi Humber, Psychology Services Manager, EAP
    • Stuart Haydock, Resilience Lead, Health Clinics
    • Sarah Deedat, Head of Behaviour Change
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