PI Brief Update

How should People with Mental Disability be Protected from Stress? - Dr Mark Burgin

03/02/23. Dr Mark Burgin discusses whether the lessons learned from the adjustments for physical disability can be applied to those with mental disabilities.

There has been a recognition that the physical environment can ‘disable’ people. A common example is how a step can prevent a wheelchair user from entering a building. What is less recognised is how psychological environments can disadvantage those with mental disabilities.

Research confirms that response to severe stress varies with some finding the experience helpful and others developing a post traumatic response. Case law is increasingly active in cases where protected characteristics are infringed at work. Less progress is being made where those with mental disability suffer discrimination.

Defences include - other people do not have problems with the work practice or that it is an intrinsic part of the job. These are fallacies as they assume that the workplace does not have a responsibility to make reasonable adjustments. If workers who do not reach the threshold for disability have similar problems this may not be good business either.

The chronic unpredictable mild stress (CMS) protocol

Scientists have discovered an animal model for depression called the CMS protocol. The animals are exposed to several weeks of unpredictable minor-intensity stressors. Although severe stressors are well known to cause harm to normal people the effects of mild stresses are less well known.

When the types of stresses are mild and in insensitive subjects it can take 8 weeks for effect to occur. This research is on animals but there is no reason to suppose that humans would not appear depressed if exposed to CMS. Although many workers currently complain that they are suffering adverse psychological effects from their workplace data is lacking.

The protocol suggests that there may be a safe threshold for stress above which the stress reaction is harmful. Comparing toxic stress with toxic fumes from an industrial process may be useful when putting in place protection for workers. In organisations such as the NHS where burn out rates of 50% are reported it is not likely that any claim could be defended.

Targets

Most organisations run at high but not intolerable levels of stress and whilst the turnover is high many workers are able to cope. There is a tension between having a work situation that drives out those who cannot perform and the duty to protect those who have mental disabilities. Most businesses positively try to create happy workplaces but some do not.

One method that is commonly used to create a hostile environment is the use of targets. These vary from the bizarre Bradford Factor on sickness to payment by results and penalties for poor performance. In some industries the workers have hundreds of contradictory targets that their performance is measured by.

To manage stress the number of targets should be; no more than three, measure something real about the worker’s performance and consistent with the aims of the job. If further targets are necessary then previous targets should be removed. Feedback from the workers can indicate whether the target is mildly stressful or is causing greater problems.

Change

Many workers who have been able to manage and even thrive in an organisation may collapse at times of change. New targets are certainly part of the problem as is having large rapid changes to catch up with innovations. The managers are often tied up with implementing the changes and are not aware of the damage to the workforce.

The workers are likely to resist change however higher levels of stress occur when it is the in the wrong direction. Even where the managers later correct course to a better direction, significant psychological injuries can already have occurred. Psychologists call this type of harm as moral injury and there is increasing interest in protecting such ‘whistle-blowers’.

Some organisations suffer from continual and arbitrary change and often have worsening performance. Working such an organisation is invariably unpleasant and often previously normal workers develop mental health disabilities. The environment becomes increasingly dysfunctional and the only effective solution is a ‘disaster response’.

Conclusions

In this article I have discussed mainly the effects of stress on normal people rather than those with a mental disability. When writing a disability report it is important to start with whether the workplace is safe for normal people. Only then should the expert discuss whether the claimant’s mental disability puts them at a relative disadvantage. This is because the defendants will have put in place some reasonable adjustments.

There are two areas that are particular interest to the disability analyst in these cases the first is targets as these are management decisions. The second is change as it can explain why a previously stable employee was not able to cope. In contrast with case law which focuses on severe stress most discrimination arises from CMS.

It is the employer’s responsibility to ensure a safe working environment and the HSE should be involved if there are general risks to mental health. Those with mental health disability should be identified so that steps are taken so that they are not unfairly disadvantaged with respect to other workers. Reasonable adjustments are likely to involve the monitoring of chronic mild stress. Far from being a burden on the employer reducing CMS is likely to make everyone’s workplace safer.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

Paul Willner Reliability of the chronic mild stress model of depression: A user survey Neurobiol Stress. 2017 Feb; 6: 68–77. Wet bedding, cage tilt, light-dark reversal, food deprivation, water deprivation, immobilization, crowding, loud noise, stroboscopic lighting, forced swim and cold swim

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

Image ©iStockphoto.com/JodiJacobson