Confronting the issue
PAUL STEPHEN investigates how the rail industry is already stepping up its efforts to tackle mental health problems and improve wellbeing.
With an estimated one in four of the population experiencing an acute mental health problem each year, PAUL STEPHEN asks some of the organisations supporting the Million Hour Challenge how the rail industry in particular is stepping up its efforts to address the issue
When it comes to the prevalence of mental health issues, the statistics speak for themselves. Despite the often hidden nature of the various conditions, it is believed that up to a quarter of our friends, family and colleagues are affected each year.
The Thriving at Work independent review conducted in 2017 confirmed the scale of the economic and human cost of the problem, with poor mental health costing employers between £ 33 billion and £42bn a year. Meanwhile, some 300,000 people with long-term problems were thought to have left their jobs each year as a consequence of their illnesses - that’s the equivalent to the whole population of Newcastle or Belfast.
The impact of poor mental health doesn’t end there, touching not only the lives of individuals but also those around them. Then there is the greatest human cost - loss of life through suicide. Thriving at Work sets out what employers can do to better support all employees, recommending in particular that all employers, regardless of size, should adopt six ‘mental health core standards’ including developing greater awareness in the workplace, and routinely monitoring employee mental health and wellbeing.
Crucially, the review also acknowledged that rates of poor mental health and suicide are higher for employees in certain industries.
Unfortunately this includes rail, in which 60% of workers have experienced mental ill
health and the rate of suicide in the workforce is 1.6 times higher than the UK average.
The Million Hour Challenge aims to make huge inroads into both raising awareness of the issue and tackling it, but it should also be seen in the wider context of the huge efforts already being made by industry to provide greater support to colleagues and to identify and prevent mental health problems before they occur.
Playing a leading role is the Office of Rail and Road, which urged the rail industry to go much further than simple legal compliance in managing occupational health as part of its health programme for 2014-19.
As a public sector organisation, the ORR has also responded positively to Thriving at Work’s call on the entire civil service to help lead the way with its own staff, in its position as one of the UK’s largest employers.
ORR Director of Strategy and Mental Health Wellbeing Champion Dan Brown says: “We have accepted all of the ‘mental health core and enhanced standards’ that lay the basic foundations for better mental health in the workplace.
“These areas include mental health at work plans, mental health awareness for employees,
We are changing how we think and act about mental health and encouraging a culture of openness. Dan Brown, Director of Strategy, ORR
line management responsibilities and routine monitoring of staff mental health and wellbeing, but we still have work to do before we can say we are where we want to be.”
The ORR is currently developing a mental health strategy backed by internal communications campaigns, support guides for managers and the training of mental health first aiders across the organisation.
According to Brown, this will give managers a greater understanding of the crucial role they can play and help them to identify additional opportunities to support employees, while also enabling them to provide more advice and support.
He adds: “We have been working with Mind, Time to Change and St John Ambulance as we learn what more we need to do to support good mental wellbeing. We are changing how we think and act about mental health and encouraging a culture of openness.
“It will be a long and challenging journey as we address sensitive issues, but there is no hiding for responsible employers as we all step up to meet this challenge.”
The Rail Accident Investigation Branch
It takes courage for some people to come forward, but they are now coming. Nisa Carey, Head of Safety and Wellbeing, BTP
(RAIB) takes its responsibilities just as seriously, with much of its work as the UK’s independent investigator for incidents and accidents on the railways placing its staff at the sites of accidents.
As well as enduring the harrowing visual impact of these visits, investigators will also routinely interview those involved and meet with bereaved families as they try and come to terms with what has happened.
Chief Inspector of RAIB Simon French says that his organisation is painfully aware of how deeply affected its staff and those from other agencies can be when they become involved in a tragedy or traumatic near miss.
This is why RAIB has introduced a comprehensive trauma risk management system designed to secure the welfare of people exposed to such events.
He explains: “Train drivers, mobile operations staff, guards and station assistants are just some of those who sometimes witness terrible events, or are required to manage the aftermath. We also recognise that exposure to the scene and the resultant human misery is not without risk to RAIB’s teams of inspectors and support staff.
“Our system involves training some of our people to help detect early signs of traumatic stress problems, provide early informal support and facilitate formal help for those who need it. While most people who experience a potentially traumatic event will not go on to develop post-traumatic stress disorder, the aim of the process is to provide an early indication of individuals who may be vulnerable to developing it.”
On the specific issue of suicide, he adds: “Although each suicide is a personal tragedy, the ripples of harm spread beyond the individuals concerned and affect the mental wellbeing of families and also those who deal with the aftermath. It is for this reason that we are so strongly supportive of the rail industry’s Million Hour Challenge in support of Samaritans.”
RSSB (formerly the Rail Safety and Standards Board) also shares many of these sentiments, and has identified the Million Hour Challenge as an opportunity to further tune into the national movement to promote better mental wellbeing within the UK.
According to RSSB it already encourages employee volunteering, and will be carefully tracking its contribution to the MHC.
RSSB has been at the vanguard of research and analysis into improving mental health in UK rail, and in 2018 managed a research project - ‘Understanding the conditions for successful mental health training’ for managers - on behalf of the cross-industry Health and Wellbeing Economics Group.
Forming part of RSSB’s R&D programme which is funded by the Department for Transport and supported by RSSB’s members, it found that better line manager training could reduce lost working time by up to 30% by making better support available to staff and giving them the right treatment to return to work.
Rail companies are now working with RSSB to develop practical options for line manager training. Meanwhile, through its System Safety and Health Directorate, it is also supporting a successful rail industry health and wellbeing programme that features mental health as a key theme. As part of this initiative RSSB is helping members to enhance capability in areas including line manager training in mental health, trauma guidance, research into abuse to railway staff and reducing mental health stigma.
RSSB recognises that as well as conducting research, it should play a leading role in the implementation of a broader health and wellbeing programme.
Therefore, as well as being one of the first organisations to sign up for MHC, RSSB is also a member of the Time to Change mental health campaign that was launched in 2007 to reduce stigma and discrimination.
RSSB has also won grant funding from the Department for Work and Pensions to set up an employment support service to provide even greater help to keep people with mental health conditions in work.
Darryl Hopper, RSSB’s principal health and wellbeing specialist, adds: “As a railway company we want to play our role in this positive societal change and the Million Hour Challenge is a significant part of our internal drive to support mental wellbeing.
“There is a particular challenge to the railway from suicide, and to play a part in reducing its occurrence and ethically manage
its tragic aftermath really resonates with us. Behind the statistics are individual lives, families and friends as well as those railway workers who become directly involved and are deeply affected.”
Last but not least, mental wellbeing is also a key agenda for the British Transport Police as almost all its officers and staff work in stressful, traumatic situations, and are exposed directly and indirectly in their daily work on the railways dealing with suicides, fatalities and other critical incidents.
These can range from assaults and injuries sustained during arrests to major incidents where BTP officers have often been first responders, including the fatal tram crash at Sandilands in November 2016, the Grenfell Tower fire in June 2017, and the terrorist attacks at London Bridge ( June 2017), Westminster (March 2017) and Manchester Arena (May 2017).
BTP launched its Wellbeing Strategy and Framework in April 2016, of which a key part is its Trauma Support Programme to try and minimise the potentially negative impact of traumatic stress and to proactively prevent the progression of Post-Traumatic Stress Disorder in BTP employees.
The TSP is centrally governed and led by the BTP Safety and Occupational Health Department.
One of the key areas is a peer support system called Trauma Risk Management (TRiM), which is an early intervention system initially developed for military personnel who have been exposed to suicide, deaths and other situations involving high levels of emotional stress in the course of their deployments.
BTP has invested more than £ 50,000 in training 72 TRiM practitioners who are able to provide peer support to colleagues, monitor trauma-exposed staff and, if needed, help them to access professional support.
TRiM practitioners are based nationally and around the clock so that one can be on-site immediately, if needed.
After an incident, employees can opt to enter what is known as the TRiM pathway, which begins with a Trauma Incident Briefing within 72 hours to help defuse post-incident issues. After 72 hours employees can voluntarily attend an initial TRiM session when and if further support is required.
If signs and symptoms of PTSD are detected, an individual will then be fast-tracked through Occupational Health to access appropriate clinical treatment, and will have regular reviews with TRiM practitioners.
BTP’s head of safety and wellbeing Nisa Carey says: “The first time this was used was at Sandilands. It’s often difficult to document all the individuals involved but within 72 hours of that we’d conducted 279 Trauma Incident Briefings, after which staff can ask to go on the TRiM pathway.
“We had a total of 35 cases of PTSD (in approximately 5,500 staff) in 2018. I would say that’s quite low because we have so many people exposed to trauma, but it does show evidence that using TRiM as an early intervention is an effective system.
“When I started here in 2015 there was quite a macho culture, but that is changing and members of staff will now approach us [in Occupational Health] because they recognise its value. You can’t force an individual to do anything and it takes courage for some people to come forward, but they are now coming.”
Apart from the TRiM process, BTP has developed other initiatives such as a mental health support guide for employees and their families, which includes information on the range of services on offer.
Additional support services including a confidential telephone counselling service. Online resources are also available through an employee assistance programme called BTP Assist. This is aimed at dealing not just with traumatic events in the line of duty, but also stress and anxiety from other life events including pregnancy, and divorce or separation.
Carey adds: “We will soon be launching our first 16 mental first aiders. They are intentionally not called counsellors because the job title helps to destigmatise mental health. We’re creating more and more add-ons and creating a more accepting culture, which I think BTP does really well.
“Some organisations will rely on the NHS, but doctors are not always best qualified to diagnose PTSD and will sign people off work when they need to be on a clinical pathway. My principle is to try and bring people back to work. I think the TRiM system and early intervention is great, and I encourage other organisations to do the same.”