Over the last two to three years (maybe my whole adult life), I have battled with mental health challenges. If you want to understand my story and what brings me to writing this;
The aim of this post is to help people to gain a better understanding of what depression and anxiety can look like, especially in the workplace. Hopefully, it will also give employers some clear advice on what is needed once it has been identified.
Depression & Anxiety
My experience tells me that one rarely happens without the other in tow. For me, they were polar opposites and both had very different and scary effects on me. I could not tell you when it really first started, but I would hazard a guess that it was during a heavily alcohol fuelled stag do. The first I really recognised it, was while sat at my desk during the summer.
Traditionally in my company when it is someone’s birthday, the whole office plays a crap Stevie Wonder birthday song and then crowd round the desk with a cake. It just so happened that the chap who sat next to me was the lucky guy on this particular day. I had just received a message from my Mum talking to me about my housing situation, something I was already stressed about and suddenly I am surrounded by happy people singing.
The physical symptoms of the anxiety attack were so severe, that my shirt was wet with sweat, I went white as a sheet and ran as fast as I could out of there. Breathless and shaking, I got to the toilet and vomited. I could not be in that room for a second longer as I felt like I may have a heart attack. I was unable to return to the office and asked someone to bring my keys to me.
Anxiety is very powerful, it can be very sudden and will often have physical symptoms. This ranges from a restless leg, right through to nausea or extreme sweating. The challenge with this, is that it can be very difficult to establish what brought it on in the first place. It can be the smallest thing.
I used to watch my boss walk into the boardroom with someone, and I would panic that they were talking about replacing me. Before I know it, I am looking on Linkedin in sheer panic desperately looking for jobs. Needless to say, the meeting never had anything to do with me.
What many people do not realise about anxiety is that it can cause severe pain. An example of this was while sat in a good friend’s living room watching a boxing match on a Saturday evening. A subject I was not too comfortable with was brought up, and almost immediately I could feel a dull but very painful feeling in my shoulder. The type of pain that makes you feel sick. I got up, made my rather embarrassing excuses and only made it ten paces up the street before physically collapsing against a wall in absolute agony.
It was debilitating. I called my Mum who is an experienced nurse, and recognising the issue, sat me in
her living room with a fan and an ice cube in my mouth. Within five minutes I was pain free and
extremely confused about what had just happened. That is when I knew things were becoming extremely serious.
Depression on the other hand, is much more difficult to identify and diagnose. I suspect I have had an element of depression my entire adult life, however I had labelled myself as a rather negative individual. The best way I can describe the difference between the two is that anxiety for me was worrying about the future, whereas depression made me believe there may not be a future. The biggest lesson I learned was that people with depression cannot drink alcohol to excess, the effects were too severe.
Depressive episodes turned me into a zombie. I would really struggle to do the simplest task, often staring at a slide on a presentation for upwards of 15 minutes before heading off to get a coffee. The very nature of my role and my personality is that I do not really need managing. I just got on with things and delivered what was needed within my role. So it must have been extremely difficult for my boss or those around me to understand how much I was struggling. I became a master at putting on a brave front. My depression brought along with it an extremely low self-worth. I did not believe I was good enough to do my job, I refused to walk anywhere near the mirror because I detested my appearance, the list could go on all day. People with depression are some of the best actors around, they have to be.
Following a night out drinking, I reached my lowest point. This was the day I considered suicide.
Work could not possibly have known. No one knew, not even my closest of friends. I used drinking as a way of escaping my mind. I always had so much fun when drunk, many depressives relate to this level of escapism. Following my Dad’s intervention, I was taken to the doctor who took me through an assessment and suggested I should not be alone. He prescribed a course of medication with immediate effect. I am not going to belittle doctors or the National Health Service, but how he was in a position to suggest such strong medication after five minutes and five questions is beyond me. But I left the surgery with a month’s worth of Sertraline. Sertraline is part of a family of drugs called SSRI’s and is a fairly generic drug for helping people with anxiety and depression. In short, it corrects a chemical imbalance in the brain and gives you the neural nudge needed to start some sort of recovery plan. As with any SSRI, you are always advised that there will almost certainly be a dip in how you feel before they kick in. Normally drugs like this can take up to 6-8 weeks to take full effect, something to bear in mind should an employee or colleague start the process.
It isn’t a quick fix.
The dip for me was extreme, it pretty much enhanced all of my significant symptoms two fold. For a week I was unable to leave the house and slept for large periods of time. Around week four, I was sat with my parents running through the symptoms with a highlighter and we stopped when we got to twenty seven. The drugs were having an extremely adverse effect on me and we were immediately seen by the doctor who advised I stop taking the medication. It is really important to point out here that I would never have been able to work during this time. It would have been quite literally impossible, walking down the street at times was extremely challenging. The doctor advised to change the medication for another one but I declined, at this point I was scared and extremely vulnerable. I did not want to be at the mercy of medication or anything else.
Alongside the drugs, my initial appointment with the doctor resulted in a promise that I would be referred to, and contacted by a local counselling service to arrange a time for me to speak with someone. I was keen on this. I have always been quite an open person and one of the positives through all of this was the ability to talk to my closest mates and my parents, it really helped.
The call was promised to me within the next two days. I waited a week and nothing. I got hold of their number and I called them, only to be told that they had my referral and would call me back within a few days as soon as it had ‘processed’. A week later I called again, was promised the same and gave up.
The call eventually arrived after nearly four weeks and was quite an experience! A man with an extremely strong, possibly foreign accent began the call by asking if he could present me with some questions, which I agreed to. His first question; “Are you going to commit suicide”? This guy had the tact of an elephant and he proceeded to aggressively probe the seriousness of my condition with questions that just did not feel appropriate. He finished the call by saying I was not serious enough for immediate counselling. He gave me the number of a local group I could try attending and told me to go back to the GP who had referred me in the first place. Had I been truly suicidal, I would have done it long before he called me! It was just not good enough.
I made the decision to pay for my own private counselling because I had no other choice. After researching online, I made the decision to go with someone locally. She had a friendly face and specialised in both counselling but also life coaching. I wanted someone to help me get my life back on track, so it seemed to make sense to me. With hindsight, I needed a lot more support in this decision making process to ensure I chose the right path for my needs, a friendly face does not really cut it! I built a bond with my counsellor over the twelve months that I saw her, and I would be lying if I said that she did not help. She provided me with the impartial perspective I needed and the empathy I was unable to give myself. Sometimes I would leave sad, sometimes motivated, but that is all part of the process. Unfortunately, she became routine and my close friends and family began to question her influence following my second breakdown. Twelve months down the line, I had limited coping mechanisms in place, no resilience, and I certainly was not given any strategy for improving the situation. She was just a sounding board and that was only going to get me so far.
I upped the stakes and paid to see a psychiatrist for £300 an hour, to assess and analyse me and hopefully help me establish what to do next. I did not have the money but I had no choice and knew I had to do something. It turned out that it was the best value for money I had ever spent. In one hour he was able to establish what was wrong, what needed doing and advised me on the type of person to speak with. I needed a CAT Psychologist, who specialised in both looking back at my early life ,but also helping me plan forward, with structure and goal focused tasks to carry out to get better. And so I found a CAT Psychologist, requested her input and was told that it would take 16 weeks treatment with her before seeing any improvement.
16 weeks down that line, and I was a different human being. I was able to cope with the issues I
had been struggling with, improved my self-worth, now training harder than ever in the gym and
back to being motivated and full of ideas and enthusiasm at work.
Back To Work
During the 16 weeks I had returned to work. Unfortunately for many people suffering from mental health, they are faced with a crippling dilemma; Money vs Health. Statutory sick pay differs between employers, but ultimately, you are normally given 2 weeks before your pay is reduced drastically. I can say now that I was not ready to return to work. I took an additional two weeks holiday to give myself more time but once over, I had no choice but to return. Financially, things were very tight for me and I weighed up the pressure of returning versus the pressure of financial constraints. There was only one winner.
Work were empathetic, understanding and helped me to devise a back to work strategy over a number of weeks. Much as my pride wanted to fight it, I needed it. I was removed from high pressure situations such as pitches or face to face client meetings. I was able to focus on strategically moving my department forward until I was ready to jump back into the firing line.
We had regular weekly catch ups, I was set simple milestones and tasks to accomplish to retain my self-worth within the organisation. This was a big thing for me, I needed to feel like I was adding value.
How Can You Support?
The best way to view this is over a timeline from the identification of a mental health issue through to your employee’s return to work.
Give them time - As soon as a problem has been identified, remove them from the workplace. Before anyone, including themselves, understands the extremity of the situation it is important to give them some time off. It is likely they are yet to be fully diagnosed or have a treatment plan in place and may need a week or so to get the proper help and support they need.
Remove all pressure - At this point, regardless of what they say, they are unable to function at the level required to do their job (Industry not important here). There is a fine line between removing them from the company and removing them from pressure. Remove deadlines, pass control of meetings and the more human element of a role. Give them smaller tasks if they are still in the office. If removed from the office, reassure them that everything is being taken care of
and they no longer need to dial in, open email, look at slack or a messenger service.
Reassure them - Almost certainly, one of their biggest causes of stress and angst will be that they think their job is in jeopardy and that they will be seen as surplus to requirements. I can vouch for this! I received the most amazing text message from my MD, he treated me as a friend, not an employee. To this day it is one of the nicest things that has ever happened to me and so, so needed. Send them a card or some flowers, show them their colleagues are behind
them and always will be.
Invest in them financially - It’s surprising how few companies have a medical contingency for situations like this. I really struggled to finance regular counselling, especially with the dip in salary through time off. The extra £200 a month needed would have gone further than anyone knew at the time. This £200 often means very little to a company, but can be life changing to someone going through hell.
Have an open door policy – Segregation from the workplace and your colleagues can often have a detrimental impact if necessary for a long duration. Understand that if your employee reaches out to find out about a certain deal or how business is going, the worst way to react would be to tell them to stay away. They want to know they are still valued and involved. Answer their questions, send them a weekly update, whatever it takes to keep them in the loop.
Give them more time - There is no finite timescale to be put on this, different people cope and mend at a different pace. What I will say here though, is to review your statutory guidelines and extend them. A two week period is not enough, four weeks probably is not enough! I understand you have a business to run, but giving people time, easing the pressure
financially, with your undivided support is merely investing wisely. I guarantee you that they will return to work fitter stronger and most importantly, more loyal.
Be guided by them regarding disclosure - People will have questions and communication internally is important, but allow them to decide on who is informed of the situation and how it is done. They may want to handle it, they may wish for you to do so.
Back to Work
Bring them up to speed - It can be overwhelming not knowing what has been going on, especially with so many other concerns on your first day back. A call to run through things, an email overview or even better, emails from several colleagues touching base with an update will go a long way.
Meet them off site - Walking in on a Monday morning can be daunting anyway, but I can speak from experience about the sheer levels of paranoia faced in the first instance of walking through those doors. Relieve the pressure by going for a coffee later than the usual start time. Chat through things casually. I did this with my MD and we had a good laugh which broke the ice before walking into the office.
Medication sucks – It is impossible to understand medication and its effects. What you do need to understand is that medication can and probably will take someone to the depths of hell at some point. The beginning and end of the treatment are always the worst. I cannot emphasise enough that it would be crazy for anyone to turn up to work within two weeks of taking medication. The ups and downs are too extreme, work is not the place. Unfortunately it is not plain sailing once they have kicked in either. Some people will struggle in the mornings (I did) some will have days where they need to be alone (I worked from home or found a corner with ear phones) but once they kick in, calm will normally find itself.
Flexible working where possible - I was offered shorter working hours which I did not take because it was better for me to be busy, others may struggle with the longer days and need to ease back in slowly. We agreed for me to work from home on a Tuesday to break the week up and to allow me to make a counselling session during the day, plus the opportunity to work from home at will, should I need to or feel like things were piling up.
Good pressure or bad pressure? - A really serious question needs to be asked and an answer often teased out of your employee. “How much pressure is too much?” I’m both stubborn and proud, which means that I was never going to admit to not being able to pitch/meet clients. A few questions later and the decision was very tactfully taken out of my hands and sold to me that the strategic side of the business was more important than me on the front line. Funnily enough, half way through my back to work plan I decided that I needed the pressure and began the transition back to what I was best at!
Task orientated objectives - To avoid the feeling of worthlessness while not working on my day to day, I was given objectives and tasks to complete. It gave me a sense of worth and achievement. I smashed them and enjoyed doing so.
Regular catch ups - I met every week without fail with both my MD and HR Director. These catch ups were great because it gave them clarity on how things were going. They monitored my workload to identify any areas I may be struggling and it was a chance to review my objectives to ensure things were getting completed on time. The longer this went on, the more casual and humorous they became! There was certainly a correlation between me getting better and how much laughter was had in that room!
As you can probably tell, I was one of the lucky people who benefited from working for a great, supportive and human employer. Yes there were some areas that could have made it easier for me, but this was their first real experience of dealing with a mental health issue in the workplace. In my opinion, they played an absolutely huge part in getting me back on track and feeling fantastic again.
I have so much more to say on this subject, especially how to help people integrate back into the company following a challenging time. This is an open invite to anyone reading this; if you want advice, or have any questions that you think would help you deal with a similar situation, just shout. I would love to help!
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