The Manager's Guide to Mental Health

How to lead and line manage people who experience mental illness.

This article gives information and further links from the seminar of this title at our 2018 LeadWELL conference.

The audio is available to download here.

Download PDF of slides handout [5.4MB].
Download slides PDF


People who experience mental illness are dealing with complex issues every day. Despite this they are strong and skilful – usually more strong and skilful than you or they may think. However, their symptoms can affect their performance at work and adaptations may be needed. Managers can be fearful of raising the topic – worrying that people will be sensitive or that it will expose their own ignorance or even stigma in this area.

Faith-based organisations often have small teams that mean it is hard when one person is not fulfilling their role. Also, they use volunteers, which can complicate things as they are not technically employed, but are still working for you. The principles and responsibilities are the same – be approachable, offer suitable support and maintain your standards.

This article introduces a simple three-step model that will guide you in promoting mental health, managing the more straightforward issues and knowing when and where to get more help. At the end of the video are links to further resources – there are lots of good guides out there.

A simple model

Think of this area as having three distinct stages. The first is what you can do in your team to promote good mental health – helping people before the problems start. The second is some easy things you can do to try and turn things around before they become stuck. The third stage is realising that you need more help!

  • 1: Promoting good mental health is important in every team. It also means the issue is out in the open and people are more able to come forward of they need help
    • Good mental health is associated with a supportive and encouraging work environment.
      • Sort out ‘hygiene’ factors – things that negatively affect everyone like noise, desk space, car parking, IT problems
      •  Encourage ‘enjoyment factors’ – things that make you feel good. Praise people specifically, allow time off for training and leave, discuss career progression.
    • Each employee should also have a Personal Development Plan. People are happier at work when the strengths are developed. This doesn’t mean everyone has to be ‘progressing’ or ‘developing’ – this can be quite frightening for some people. But it is about showing you know them and what will help them be the best them they can be.
      • Try and cover things specific to them as well as ‘mandatory training’ and team issues. Develop leadership if this is relevant. Encourage physical health and time off.
      • If there have been specific issues that year, it is best to raise them, even if the outcome is just to monitor things
  • 2: Nipping things in the bud is easiest if people feel open to share and you are clear that this is not a sign of weakness or low commitment.
    • Just as with physical health, a ‘stitch in time can save nine’. It is good if you have a specific policy that lists things in detail so people know how much is OK.
      • Taking a mental health day. Essentially this is ‘self-certifying’ yourself for a day like you would do if you had flu or a vomiting bug. However, it is also preventative – take one now instead of five later. And do something enjoyable – no need to ‘rest up’ if that is not what you need. However, for some people these are literally ‘duvet days’. How many could your organisation allow each year?
      • Larger organisations may have an Employee Assistance Programme which can provide a small number of counselling sessions. Its usual to access this yourself, not through your line manager.
      • Create a WAP – a wellness action plan. This will help you understand what causes you stress and what helps you stay well. You can download examples from the internet – see the links at the bottom of this article.
    • Some people will have more chronic problems, perhaps disclosed when they started work. If they filled in an ‘occupational health’ form this is not usually seen by the line manager unless Occ Health think they need to see it. But people can also tell you directly.
      • The aim is not necessarily to ‘fix’ people – these are often long lasting difficulties. Instead, your responsibility as line manager is to help them to do their best at work
      • Simple things still work, and many people will know what works for them.
      • If they have an unusual request – try to go along with it if possible.  For example, allow ten mins break each hour instead of an hour for lunch can help if you struggle with concentration or an eating disorder.
      • Allow time off for hospital appointments – and be aware that if a person is having some therapy then this may be an hour each week plus travel.
  • 3: Getting more help if things are complex / severe / problematic.
    • Managers will vary in their skills in this area. All should be able to do stages 1 and 2, but the remainder of this article will consider more complex situations such as when someone doesn’t want help, when more severe mental illness is present, and how to have difficult conversations.
    • Some larger organisations will have an occupational health department or facilitate a referral to an external company.
    • There is also the NHS working alongside, though this is usually confidential. Employees can ask the NHS for a mental health report but the person has to consent and there will usually be a cost.

A good manager will be reviewing things in an ongoing way.  For everyone, there should be a regular review of their PDP and this should include some gentle questions about mental health – such as ‘how have your stress levels been this past year?’ or ‘have you come close to having to take any time off’. You can also ask about any particular stressors you know of, for example if they have a partner who does shift work – but don’t pry if they seem sensitive.

For people who have made use of ‘Stage 2’ or are at 'Stage 3', this needs to be discussed too. It may be that all is fine and they are dipping in and out of support. Or it may be that they are not managing to do their job. Do not shy away from addressing the elephant in the room, but ‘do so with gentleness and respect’.

Reflection: What ‘rewards and benefits’ does your organisation offer? Is this enough? Find out more about anything that you don’t know about – its best to this now rather than when trying to support someone who is struggling!

What does the law say?

Managers get very worried when ‘the law’ is mentioned, but actually this is a simple area. Mental health problems are a ‘disability’ and so a protected characteristic under the Equality Act. You will already be aware of the Health and Safety at Work Act – this still applies, which links into occupational health services and larger organisation’s responsibility to provide or facilitate them.

The key principles are:

  1. Focus on what the person CAN do. These are usually skilled and capable employees or volunteers – with a bit of help they will be a great service to your organisation.
  2. Make ‘reasonable adjustments’ – this is just what is says – usually small adjustments like those we discussed in the last section that enable that person to remain at work. There is no requirement to make unreasonable adjustments – such as they having no timetable at all, or avoiding all team meetings.
  3. This goes both ways – the employer has responsibilities to assess and reduce workplace stress, but so too does the employee – to seek help, and to follow any guidance issued.

There are some behaviours and levels of functioning that are not compatible with fulfilling the role in hand and it will hurt both the organisation and the person if this is not addressed. However, these situations are rare – especially if things area picked up early.

There is some really good help available online in this area – such as what constitutes a reasonable adjustment and how to do a WAP. We give some links at the end and in the accompanying notes.

Reflection: Are you up to date on your mandatory training, including about the Equality Act? Consider how the Health and Safety At Work Act applies to mental health and workplace stress.

How to spot mental health problems

The key message is to be proactive.

  • Consider running an organisation-wide mental health awareness day. Perhaps use World Mental Health Day [10th October] as a focus, or Mental Health Awareness Week [mid-May].
  • Encourage ALL your team to do a Wellness Action Plan – not just those who are struggling.

However, there are also specific things you can watch out for. Some of these will be symptoms of mental illness, others will come from HR such as sickness rates.

  • Poor time keeping
  • Increased use of alcohol/drugs
  • Frequent headaches/backaches
  • Poor judgement / making mistakes
  • Withdrawal from social contact / team meetings
  • Increased sick leave
  • Tiredness or low energy
  • Unusual displays of emotion such as tearfulness

Of course, these things may not be due to a mental health problem – the may be another cause like relationship difficulties or debt.

Also, it may not be impacting their work – in which case it isn’t officially part of your business as their line manager – though you can still help as a caring employer or friend. To work this out, consider:

  • Are there work-based issues?
  • Is there a performance issue?
  • Have other staff or volunteers said anything?

Difficult conversations

If you are concerned about someone, it can be really hard to start a conversation. Sometimes there is a timely excuse such as an annual review, but usually you are worried about prying, making things worse or causing floods of tears.

Be especially careful if you got the report of the issue second-hand or from gossip. Ask this informant for evidence. Be clear that you cant do anything unless there is a work-related performance issue.

The best place to start is a creating a culture where wellbeing and mental health are discussed regularly. However, sometimes you need to grab the bull by the horns and say something.

Here are some things to bear in mind:

  • Be clear from the start that this is a specific conversation about a possible performance issue / area of concern.
  • It might not be a mental health problem – so start with open questions. Make sure you have set aside time [eg 30mins] and won’t be disturbed. Tissues may be useful.
  • It may be helpful to have a colleague from HR with you, or another person [such as a staff member from the local church]. They can bring a support person too.
  • Be clear about confidentiality – ordinarily you will be able to keep things confidential, but if it is affecting their work or they [or another person/child] is at risk you may not be able to do this. Please refer to your organisation’s safeguarding policy.
  • Don’t come up with trite solutions or offer one-line comments – ask them what they think would help. Be clear that there is an issue, but this is just the start of a conversation and not everything needs to be fixed today.
  • Understand their uncertainties about discussing this. This webpage explains the pros and cons of telling your employee about a mental health problem. Remember it’s inappropriate [for most jobs] to consider health-related information before offering someone a job – you interview and offer on their merits, then aim to make ‘reasonable adjustments’.

For a more general set of links about this topic see The link to The Shaw Trust has some good do’s and don’ts in this area.

What if someone doesn’t want to engage?

Even with a mental-health-aware culture and being willing to tackle mental health issues, there are sometimes people who refuse to believe there is a problem. This can be tricky as things may not be so bad as to be able to sack them outright, but things will grumble on and they are not getting the help they need.

  • You can take time – this issue has most likely been going on for some months and another week or so won’t hurt so there is no need to go in all fired up.
  • If they can’t/won’t talk to you, they may feel able to talk to someone independent – their GP is a good place to start, and there is also ‘Day One’ occupational health input available through the EAP.
  • As a last resort, you can make a formal occupational health referral without their consent. They are legally obliged [as part of their employment contract if it is written right!] to attend and to work with the recommendations that come out of this process.

It may also be that the mental health issue is more pressing than any work-related issue. If such, you can behave as a member of the public [take your managers hat off]. For example, if they are suicidal, you may need to accompany them immediately to the hospital/GP and not take no for an answer as we discussed in the mental health training video. Staff can have similar mental health problems to CAP clients.

It might also be helpful at some stage to ask if they are worried about seeing a ‘secular’ mental health professional. Some Christians think all emotions should be handled spiritually.

Where to find more info

You are not alone. You can ask for support from your organisations head office, mental health professionals or GPs locally or in your church or find further information online. Independent churches may find this a good time to be a member of the Fellowship of Independent Evangelical Churches [or similar non-denominational body]. Some trusted websites are:

General Mental Health Resources:

  • The Mind and Soul Foundation [this website] – – Christian mental health information – over 500 articles, over 100 podcast episodes, social media
  • Mind – – an excellent general resource and support and local groups. Mind are the main UK mental health charity.
  • An Online Course – ‘Living Life To The Full With God’ is a free online CBT-based course for helping with anxiety and depression from a Christian perspective.

Occupational Health Resources

COVID-19: this helpful article covers some of the additional mental health worries in people working remotely:

Reflection and Self-test

Complete this simple quiz to test your learning:

1.     As a manager, I can raise concerns about:

a.     A performance-related issue

b.     A general mental health issue

c.     A general physical health issue

d.     A health issue that affects how someone works


2.     Examples of ‘reasonable adjustments’ include:

a.     Allowing someone a light-box if they have seasonal affective disorder
b.     Working for some of the week from home

c.     Allowing multiple short breaks rather than fewer long breaks

d.     Allowing time off each week for therapy.


3.     Which of the following statements are true?

a.     People with mental health problems are unreliable employees

b.     Getting help early is usually effective

c.     I can make a formal occupational health referral if I am concerned

d.     Christian staff members should seek faith-based help first



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