Mental Health in the Workplace

This post is about Mental Health in the workplace, examining the range of conditions which can affect employees and offering advice on how and where Herbal Medicine can play a part in supporting mental well-being.

It has become (almost) taboo to even mention the term mental health due to its negative connotations as well as the fear and panic that it can evoke. Every so often it surfaces in the public domain when high profile cases hit the media headlines. The recent and tragic death of Robin Williams is an example of how opportunities and a forum for discussion appears to only arise under such circumstances and how aware we are of mental illness but how society does not embrace this nor tackle it properly.

In reality though, mental health is an issue that line managers are dealing with more and more regularly. It is encouraging to see events like this today being organised.

The Government’s report entitled ‘No health without mental health’ states that mental health problems affect 1:4 of us at some point in our lives with 1 in 4 people experiencing a mental health problem every year. It accounts for 30% of absences in the workplace, the highest being in the NHS.

In 2012, it was estimated that poor mental health in the workplace cost the UK £26billion every year, that’s equivalent to £1,035 for every employee in the UK workforce. The average employee takes 7 days off sick every year with 40% of this being due to mental health problems.

Figure: Adult psychiatric morbidity in England,
The Health & Social Care Information Centre, 2009

Mental health can fluctuate along a spectrum in the same way that physical health does and there may be times when it is better than others. Mental health problems cover a range of conditions such as (the list is not exhaustive):

• depression
• anxiety
• panic attacks
• obsessive compulsive disorder (OCD)
• phobias
• bipolar disorder (manic depression)
• schizophrenia
• personality disorders
• psychosis

For many people stress and mental health are closely associated. According to a report by CIPD / MIND, while stress itself is not a medical condition  ‘...prolonged exposure to unmanageable stress is linked to psychological conditions such as anxiety and depression...’Managing stress is therefore a key part of creating a mentally healthy workplace.

Herbalism is the use of herbs for healing. People have been using herbs to cure diseases for centuries.  Many herbal remedies worked and many did not, it is obvious that knowledge and technology would have played a big part (and still do) in finding nature’s hidden treasures and using them to achieving health benefits.

So how would a medical herbalist tackle a mental health problem? Well, first of all, a definitive diagnosis is key. This in itself is a problem eg. differentiating between MCI and true dementia…

Herbalists do not deal with serious mental health disorders such as paranoid schizophrenia or severe psychosis because they warrant conventional medical management. However, conditions such as depression (mild to moderate), anxiety, panic attacks, sleep disorders / insomnia, stress-related symptoms, and OCD amongst others…..

Although a little more straightforward, these conditions still have negative connotations and many people don’t readily want to admit a problem given the social stigmas and difficulties in accepting mental illness.

Equally, given that many employers, private companies, insurers and government agencies have access to so much of our personal information, including aspects of our medical records, it is unsurprising many are worried about declaring they have mental health problems.

Mild to Moderate Depression	Antidepressants	St John’s Wort Rhodiola Turnera
Anxiety	Anxiolytics	Lemon Balm Passion Flower Lime Flowers
Panic Attacks	Nervine Tonics	Skullcap Wood Betony Verbena Vervain Rose
Insomnia/ Sleep Disorders	Sedatives	Chamomile Wild Lettuce Indian Ginseng
	Hypnotics	Valerian Hops Californian Poppy
Restlessness/ Agitation	Nutrients	Oats Alfalfa
	Nervines	Skullcap Wood Betony
Stress	Adaptogens	Korean Ginseng (Panax ginseng) Siberian Ginseng (Eleutherococcus senticosus) Indian Ginseng  aka Ashwaghandha (Withania somnifera)

More often than not, herbalists treat the more common symptoms such as mild to moderate depression, anxiety, insomnia, panic attacks, restlessness and the gamut of symptoms associated with stress. Let’s look at some examples:

Stress-related symptoms
This requires a special mention as modern living makes it almost impossible to avoid stress. Prolonged stress can lead to all sorts of symptoms and part of our job as a herbalist would be to examine the bigger picture and to treat the patient in a holistic context.

Common symptoms of stress include:
• headaches
• skin breakouts & exacerbation of existing conditions eg. eczema, psoriasis
• IBS & exacerbation of other gut disorders eg. ulcers
• tiredness, fatigue, lethargy
• muscle aches & pains
• recurring and frequent infections eg. colds
• sleep problems & insomnia
• menstrual irregularities
• infertility

The treatment rationale invariably involves:

• adrenal support one of the first glands to be compromised

1. adrenaline/noradrenaline
2. cortisol (endogenous corticosteroid)
3. testosterone
4. aldosterone

• nerve support adaptogens & their functions
Key herbs:

1. Korean
2. Siberian
3. Indian

• immune support boosting immune function
preventing recurring infections due to reduced immune defence
powerful immune boosters: echinacea

1. astragalus
2. turnera
3. wild indigo
4. St. John’s Wort (antiviral)

• addressing debility usually with a range of stimulants, nervine tonics & nutrients all increase energy levels and are excellent for debilitated states:

1. rosemary
2. turnera
3. astragalus
4. ginsengs
5. oats
6. alfalfa

• antidepressant St. John’s Wort (alternative rhodiola if compatibility issues)

1. rosemary (stimulant)
2. turnera
3. Siberian ginseng
4. Korean ginseng

For young people however, mental illness can be devastating. here is an article from a UK patient information website written and posted by Dr Hayley Willacy.

Mental health in young people: The time of their lives?

Just take a moment to think about your teenaged children, particularly girls, should you have them. Do they seem happy?

I'd love my boy to be less anxious, but Asperger's creates extra issues there, so I am definitely not expecting huge belly laughs on an hourly basis.

A recently published study into the state of mental health in England found quite alarming evidence that more young people are experiencing mental health problems than ever before, and particularly young women aged 16 to 24. This was a screening document and many of the respondents were undiagnosed and untreated. Sexual violence, childhood traumas and pressures from social media are being blamed for dramatic increases in the number of young women self-harming, having post-traumatic stress disorder (PTSD) or a chronic mental illness.

Psychological distress is now so common that one in four in that age group have harmed themselves at some point, according to the government-funded Adult Psychiatric Morbidity survey (1).

The number of women of that age who screened positive for PTSD had risen from 4.2% to 12.6% between 2007 and 2014, although the use of a more accurate screening tool in the new survey may explain some of that rise. When I first read the headline I was hugely sceptical. How can so many young women have PTSD?

I thought about the importance of resilience, how anxiety can make people more prone to see a blip as a disaster and how the authors were defining PTSD - obviously too loosely, open for interpretation. Unfortunately, I was wrong.

Reading through the document itself, they had been very precise in their definition and had stated specifically the criteria. Traumatic events were defined as experiences that either put a person, or someone close to them, at risk of serious harm or death, like a major natural disaster, a serious car accident, being raped, or a loved one dying by murder or suicide. About one in three adults in England report having experienced at least one such traumatic event.

How can so many young people have experienced this type of event? There we have a very unpleasant reflection of the society our children are growing up in; one that our political leaders should be examining closely. The dean of the Royal College of Psychiatrists said more research was needed to fully understand the rise in PTSD, but said rape or other sexual abuse were possible triggers. She said the rise in chronic mental illness among 16- to 24-year-old young women was clearly worrying, with social media a likely key contributor; 26% of women, and 9% of men aged 16 to 24 reported symptoms of common mental disorders in the week prior to the survey.

"This is the first age group that we have had coming of age with social media," Lovett said. "There are some studies that have found those who spend time on the internet or using social media are more likely to [experience] depression, but correlation doesn't imply causality."

The chief executive of the mental health charity Mind said untreated mental illness was still a huge problem. "It's still clear that nowhere near enough people are getting the support they need - in fact, more people than not are having no treatment at all," he said. About half of those who screened positive for PTSD were already receiving mental health treatment: 38.9% were taking medication and 24.0% were having psychological therapy. Child and adolescent mental health services (CAMHS) are usually resource poor and hugely over-burdened. A colleague describes a referral to the CAMHS locally as 'dropping a letter into a black hole.' There are some great 3rd party organisations who are trying to pick up the slack, but there still seems to be a growing gap.

The RCGP journal this week was devoted to mental health and describes children and young people's mental health services as the 'Cinderella of the Cinderella services', chronically underfunded and undervalued (2). We know that mental health problems in this group can have an effect on physical, social and educational development with effects lasting into adulthood. This group needs access to timely help, or we are truly storing up problems on a massive scale for generations to come.

We also know that young people find accessing healthcare difficult. How many of you have young people in your PPGs, or have practice news and information on social media? Something to consider maybe, and if you're feeling truly inspired, have a look at this beacon of good practice.

It is time to recognise that the kids are definitely not alright.

1) National Study of Health and Wellbeing: Adult Psychiatric Morbidity Survey (APMS); September 2016. https://www.statisticsauthority.gov.uk/monitoring-and-assessment/assessment/current-assessments/national-study-of-health-and-wellbeing-adult-psychiatric-morbidity-survey-apms/

2) Mughal F, England E. The mental health of young people; British Journal of General Practice. October 2016.

ref: http://patient.info/blogs/pro/2016/10/mental-health-in-young-people-the-time-of-their-lives