1.

Introduction

This portfolio is based on personal observations of the employees, personal conversations, company
policies and documents. It is estimated that 264 million people suffer from stress globally, many of
which also suffer from symptoms of severe stress (WHO, 2019). Workplace conditions play an important
role in maintaining mental wellbeing. Physical and mental health problems, absenteeism, lost
productivity, harmful use of substances and excessive alcohol abuse can arise due to a negative working
environment. Contrary, workplaces that promote mental health and offer support to employees
suffering from mental disorders are more likely to increase productivity, reduce absenteeism and
benefit economically (WHO, 2019). The World Health Organisation defines health as a state of complete
physical, mental and social wellbeing (Hassard, et al., 2011). Good mental health is usually present when
an individual has a general sense of direction, feeling of purpose and ability to deal with challenges
(Mental Health Foundation, 2018). Most people have experienced stress health problems previously. A
large- scale survey by McManus et al. (2016) showed that, in any given week, one in six people
experience symptoms related to stress. Creating awareness about mental health is important in any
workplace. A good workplace culture which both allows and accepts individuality and personal
differences promote mental wellbeing by making it easier to reach out for help and talk about mental
health problems without feeling judged (Mental Health Foundation, 2018). Mental health promotion will
not only improve people’s wellbeing but also save future expenses. Mental health issues cost 70 million
workdays each year in the UK, incurring extra expenses to employers of around 2.4 £ billion each year
(Mental health foundation, 2020). The Institute for Employment Studies (2016) did a review on studies
about workplace health promotion. The review showed a positive effect of programmes focusing on
supportive workplace stress, which is the central theme in this report (Garrow, 2016).

There are four overall questions (listed above 1-4). Each question contains 5 themes (listed to the left A-
E).

A confidential meeting with line

2.1.Promotion of mental health is currently being approached with

A) A confidential meeting with line manager and supervision. Staff can at any time request a meeting
with the line manager. Furthermore, regular supervision is offered together with the manager if
necessary.

B) Clear job descriptions and expectations or changes to systems and procedures being communicated
to staff (statement from the work-handbook in Accumedic Clinic).

C) Tea and talk(T&T).

A get-together available for all employees. T&T was developed to create a room where employees can
talk about difficult situations. For example, if a member of staff is struggling with a service user. Worries
which are unrelated to work can also be shared here. Unfortunately, this has not been available for the
last 8 months because of construction work. Necessary training and information are provided timely and
effective (statement from the work-handbook in Accumedic Clinic).

2.2. Strength and weaknesses of the current approach

The supervision at Accumedic Clinic is focused on what is going well, what training is available and
whatever else the employee needs to talk about. The head of service mentioned that these supervisions
are important to create a relationship between managers and employees. Support workers from the
outreach and the children’s club had different opinions about the supervision. Some thought it was very
helpful and facilitated skill development while others did not feel that their need for training was being
met.

A good relationship between management and employee is essential for wellbeing at work and
improves mental health among employees (Roncalli & Byrne, 2016). Good supervision is fundamental to
social work (Greer, 2016). Supervision promotes learning, reduce stress, and prevent burn-out of social
workers (Carpenter et al., 2012; Mor Barak et al., 2009). Kardushin and Harkness (2002) focused on
three key factors for creating good supervision. These three factors are Administrative, Educative and
Supportive.

All key factors are covered doing the supervision at Accumedic Clinic. However, some workers expressed
inadequate outcome from the supervision. To achieve a helpful and good personal supervision,
expectations could be matched before the start of supervision. Another important point is the
managers' role. Leadership is a key factor to achieve wellbeing at work. A review conducted by Adams et
al. (2019) highlighted the importance of managers role in supporting the wellbeing of staff in a
healthcare setting. Evident from the review is that establishing a trusting and supporting relationship
between managers and staff improves the health and wellbeing among staff. Such findings emphasise
the strength of regular supervision with the manager.

Most staff agreed that the job description was clear. However, not everyone agreed that new
procedures were being communicated clearly. Barbouletos (2011) found that a clear job description
positively impacts the wellbeing of employees. The research suggests that a good and clear job
description increases job satisfaction, commitment and wellbeing among staff. Expectations or changes
to systems and procedures are being communicated to staff through email and staff meetings. Some
staff members mentioned that the tone in the emails could be perceived as “cold”, which made them
feel unappreciated and not trusted. Greer (2016) mentions that social work is a skilled and demanding
job, and it is important that the leader creates a climate where staff feel trusted and treated as
professionals. Additionally, acknowledgement is essential for staff to achieve wellbeing (Roncalli &
Byrne, 2016).

Tea and talk were introduced by the head of the service from the workplace. A great initiative to bring
staff together in a room where anything can be discussed. Unfortunately, due to construction work, the
staff have not been able to make use of this.
“Necessary training or information is provided timely and effective” Is listed in Accumedic Clinic’s
handbook under the topic ‘Wellbeing at work’. However, staff members expressed that this was not
always the case. Some staff felt that they were lacking training, despite having asked for it specifically.
To improve and promote mental health at the workplace it is important to provide staff training. A
meta-review published by Public Health England (2016) found that providing staff training can prevent
symptoms of stress.

To promote mental health in the workplace, it is fundamental to have a work and wellbeing strategy.
Focus on workers wellbeing and mental health decrease staff turnover and improve focus at work
(Roncalli & Byrne, 2016).

2.3. Relevant health and workplace legislation and policy

The staff handbook from Accumedic Clinic states that there will be regular supervision with the line
manager to reduce stress and improve wellbeing. Furthermore, the policy encourages staff members to
speak with their manager or HR about health or personal issues, so that the manager can understand
and consider responsible support during employment. However, it does not state what kind of support
is offered.

Upon employment, a clear job description is explained and an employee handbook with information is
handed to the employee. Changes to systems and procedures are communicated to staff either via email
or at team meetings. Team meetings are important support where duties, concerns, opinions and
achievements are shared. As a part of the workplace policy, a new starters questionnaire is available.
The questionnaire helps clarify whether the employee has received adequate training and also covers
topics related to wellbeing and job satisfaction.

There is currently no guideline on the tea and talk approach. Accumedic Clinic has a staff development
policy (last updated April 2018). The policy states that most roles require mandatory training.
Furthermore, career development should be discussed during supervision (staff development policy,
2018).

2.4. Improvement of current approaches

Support from supervisors can decrease the effects of professional stress (Day, et al., 2017). At
Accumedic Clinic, the staff had conflicting opinions regarding the importance and necessity of the
supervision. Some staff mentioned that the surrounding environment was nice and quiet, but they did
not feel that they were listened to doing the supervision sessions, as their concerns were not addressed.
Greer (2016) recommends an exercise to make staff prepared for supervision with topics they find
important. To improve supervision, this table could be completed by each staff member before
attending supervision. This would promote person-centred supervision. Using the table as a supervision
tool could improve the supervision for staff and at the same time make it possible for the manager to
match expectations.
As mentioned earlier, not all staff agreed that their job expectations were being met. A solution might
be to make use of the new starters questionnaire which is currently not being used. When asked, none
of the staff had heard or completed the new starters questionnaire.

Tea and talk (T&T) aim to promote mental health by creating an environment where it is possible to
share worries without being judged. To maintain good mental health, talking about one’s feelings can
help (Mental health foundation, 2020). To improve mental health, the T&T approach should be available
again and promoted via Accumedic Clinic. Due to reconstruction and now the current pandemic, T&T
has not been available for several months. It is therefore essential to look at other ways to reintroduce
T&T. T&T could, for example, be done online. This is also a good opportunity for colleagues to discuss
and share how they experience work and how they cope in general. Furthermore, it is a good
opportunity for the management to check in on the staff. The department for health and social care
(2020) recommend managers to check in on staff regularly and use video when possible to maintain
face-to-face contact.

Training is an important part of the job. According to Accumedic Clinic’s policy regarding training, it is
the managers' role to identify required training for the staff. Training and development needs are
supposed to be discussed doing supervision. Training programs for care staff working with clients who
have challenging behaviour has shown to be effective in changing staff behaviour. The changed staff
behaviour experienced after training includes improvement of skills, knowledge and a positive attitude
towards the clients (Knotter, et al., 2018). Furthermore, training care staff has been shown to lower staff
turnover, lower absenteeism, increase the quality of work and increase employee engagement.
Providing training makes staff feel valued and appreciated (Cedar & Walker, 2020). Additionally,
appraisals and career development can also be very challenging for people who experience mental
health problems (Mental health foundation, 2020). This makes it essential to have a person-centred
approach during supervision about training and career development. Training is necessary for staff to
feel comfortable and confident in their role and helps develop new skills which improve empowerment.
Additionally, training about warning signs and symptoms associated with professional stress could be
taught to improve mental health awareness among staff (Newell & MacNeil, 2010).

To promote mental health in the workplace, it is fundamental to have a work and wellbeing strategy.
When developing the strategy it is important to include staff in the process. This brings existing staff
issues to the forefront (Department of Health, 2011). A part of the wellbeing strategy should be centred
around mental health promotion. Health promotion could include support services along with diet and
exercise advice. An intervention to promote mental health with little cost could be schemes that
encourage active travel to work and guidance on healthy working (Department for Work and Pensions,
2008). Physical exercise is a key characteristic in promoting mental health and could be included in the
wellbeing strategy. Another approach could be that the workplace offered free psychological counselling
and specific psychological support (European Agency for Safety and Health at Work, 2011).

Improvement 1
A) As mentioned, a bit of conversation can be used by staff before attending supervision. Another
improvement could be as Rankine (2019) suggested: A thinking aloud process. The thinking aloud
process is a cognitive interview technique. Participants say their thoughts out loud for deeper reflection
and understanding of the information they draw upon. The thinking aloud process maintain three
different stages.

1a) Researcher facilitates the process

2a) Staff and manager reflect through active participation

3a) Feedback and review

The thinking aloud process provided space for critical thinking and enhanced positiveness to
supervisions (Rankine, 2019). Furthermore, the Social Care Institute for Excellence (2017) recommend
supervisors to continually update their clinical intervention skills for the people with whom their staff
are working with. Also, the organisation could consider implementing training in specific supervision
skills and techniques such as critical thinking, feedback and reflection. Policies should support the
practice of supervision to maintain quality. Additionally, it could be useful to monitor the supervision
practice (SCIE, 2017).

Improvement 2

The National Institute for Health and Care Excellence (NICE) (2015) recommends management to create
a supportive environment that protects and enhances the individual’s health and wellbeing. Moreover,
NICE (2015) recommends organisations to develop mental health policies. Regarding stress, they
recommend the principles of the Health and Safety Executive's Management Standards for work-related
stress. This covers 6 aspects of work and the process for assessing and managing these are:

•Demands (workload and work environment)

•Control

•Support (from organisation, colleagues and line manager)

• Relationships (promote positive working)

• Role (understanding of role)

• Change (how change is managed and communicated)

Employees tend to have worse mental health if there are few supportive networks (Department for
Work and Pensions, 2008). This emphasises the need for a supportive network within the workplace.
Positive interpersonal relationships with colleagues can enhance job satisfaction, work performance and
prevent stress (Roncalli & Byrne, 2016). To promote positive relationships, it is recommended that
colleagues should be sharing difficulties and challenges with respect to teamwork and their work with
service users. T&T can be used to create an open and harmonious environment where difficulties are
shared between colleagues. It is recommended that team Coordinator value team members’ specific
competencies, promote shared accountability and promote reciprocal consideration and support. It is
furthermore recommended that an individual attending T&T will be open and respectful towards other
professionals, share challenges and accept and offer support (Roncalli & Byrne, 2016).

Improvement 3

As previously mentioned, staff development is essential in promoting mental health in the workplace.
Therefore, the staff development policy should be explained to staff members at the first supervision.

To increase workers awareness on mental health, an intervention such as Coping With Strain (CWS)
could be implemented. Research conducted by Sælid et al. (2016) found that cognitive behaviour theory
based CWS courses are an effective tool to promote positive mental health in employees. CWS is an
adapted version of the coping with stress (DPW) course. CWS is a group-based cognitive behavioural
intervention aimed at teaching participants how to cope better with strains and minimize stress at work.
The coping skills are believed to strengthen positive mental health, well-being and reduce mental
distress. CWS has eight weekly sessions, lasting two and a half hours with eight to twelve participants.
CWS has been shown to increase the individual’s self-efficacy, self-esteem and vitality. Furthermore,
CWS has both long and short-term effects on the participants mental wellbeing. By offering CWS in the
workplace, employees may address their mental health challenges early (Sælid, et al., 2016).

Improvement 4

Hazard et al. (2011) found that the integration of health promotion in a company’s practices and policies
was an important success factor for wellbeing among workers. Workplace data could help to develop a
health and wellbeing strategy. Such data could be: the number of staff sick for more than 28 days with
mental health problems, staff turnover, suffering from work-related stress, work pressure felt by staff,
support from immediate managers, staff job satisfaction and impact of health and wellbeing impact on
the ability to perform work (Nottingham University Hospitals, 2012). Physical exercise could be an
activity in the health and wellbeing strategy. Key findings from a systematic review conducted by Abdin
et al. (2018) showed that exercise, yoga and walking interventions can improve wellbeing among
workers. Another study conducted by Calogiuri et al. (2016) showed that outdoor exercise has a positive
effect on managing stress among employees.

Both could be achieved by implementing a cycle to work scheme. The health benefits of cycling are
many. In the cycle to work scheme, the employer pays for the bike while the employee “hires” it. The
Department for transport and health have developed a guide for employers on how to implement the
cycle to work scheme (Department for transport, 2019).

Furthermore, an employment assistance programme (EAP) could be introduced. Nottingham university

hospital (2012) fund an EAP which offers telephone-based counselling, legal advice and face-to-face
counselling service. To promote mental wellbeing this approach could be used in the health and
wellbeing strategy.
Evaluation plan for improvement 1

The evaluation of supervision with the line manager should focus on the workers' outcome. This could
be done by giving staff a survey to complete after the first couple of sessions (2 months). To keep the
ongoing improvement of supervision, surveys should be conducted annually.

Evaluation plan for improvement 2

Pre- and post-measures should be considered to evaluate the effect of T&T on workers health and
wellbeing. Any changes associated with the T&T can be identified from the pre-and-post employee
wellbeing data (Mental Health Foundation, 2014). Additionally, a brief resilience scale can be answered
by workers (Smith, et al., 2008).

Evaluation plan for improvement 3

The CWS course should be evaluated by participants after attending the course. Questions related to
staff development training can be found in the new starter’s questionnaire.

Evaluation plan for improvement 4

When developing a Health and wellbeing strategy data should be gathered. This includes sickness
absence data, staff turnover rates, exit interviews and information from existing staff forums. Surveys
such as the one developed by the NHS Survey Coordination Centre (2019) could be completed by staff
within the next 6 months. This should be repeated annually to keep improving the health and wellbeing
strategy. Feedback on the cycle to work scheme could be collected at staff meetings.

Limitations

Due to the current pandemic, it has not been possible to access additional information such as exit
interviews, data on sickness absence and turnover rate. To understand where the main needs in the
Accumedic Clinicre, these data would have been relevant to analyse. To improve health and wellbeing in
the workplace these data should be collected to understand what future intervention should be aiming
at.

Conclusion

Accumedic Clinic has some good initiatives related to mental health promotion, though there is always
room for improvements. Based on up to date research it is recommended that the thinking out loud
process is used to improve supervision sessions as well as supervision training aimed for supervisors.
Additionally, training should be evaluated annually to keep improving. To create an environment which
improves mental health, it is recommended to maintain T&T where staff share difficulties. Furthermore,
training and staff development are essential for staff acknowledgement. At last, the workplace needs to
finish the health and wellbeing strategy as it shows that staff’s mental health and wellbeing is
prioritised.