Stressing the bottom line


The IoD attempts to grasp the nettle of mental health at work

The recent IoD policy report into mental health in the workplace is another welcome indicator that the conversation around mental health is starting to gather momentum.  They are to be applauded for grasping the nettle.  As they rightly state there is both a moral and a business case for workplace mental health provision with the socio-economic costs of mental ill health in London alone estimated at £26 billion annually.

Mind The Gap

Around 1 in 6 UK adults feel the effects of a common mental health disorder each week – 10 times greater than the number of people who attend a professional football match.  72% of employers state that they would refer a colleague with a mental health problem to their GP.  Yet the view from the charity MIND that GPs are not as effective as they should be in managing mental health problems gives cause for concern.  As an experienced GP, having worked in hospital psychiatry and at the coal-face of primary care for many years, these assertions need some qualification.  The majority of GPs are keen and highly trained to accurately diagnose and manage mental health problems and mental illness represents a huge proportion of general practice consultations. GPs find themselves caring for a number of patients with mental health problems, but a lack of funding leads to excessive waiting times for psychological therapies which are approved by the National Institute of Clinical Excellence for their treatment.   This leaves a gap in provision, and one that employers should play more of an active role in providing.

Beware Compartment Syndrome

The IoD report also rightly highlights the need for a “whole-life” approach towards good workplace mental health. In my experience, it is imperative to recognise the importance of non-work stressors and give people effective tools to manage these too. We must be careful not to compartmentalise work and non-work stress. It’s the same person – the two are inter-related and each has the potential for spill-over.

Mind AND Body

The report also argues that physical health is easier to plan for than mental health and this is indeed often the case. However, physical and mental health are intricately linked.  We know that mental health problems often present with physical symptoms and that long-term physical conditions carry an increased risk of mental illness. Too many organisations are failing to ensure that their people practically and effectively address the physical aspects of good health which underpin performance and robust mental health. All too often interventions only focus on avoiding negative outcomessuch as sickness absence and attrition or are guilty of “free fruit” tokenism.  They fall short of providing people with an evidence-based toolkit which enables them to be ready to perform both physically and mentally. With increasing pressures on the NHS and reduced capacity to deliver the kind of support and care that is needed in a timely way, enlightened organisations need to find ways to provide additional effective support.  This is not altruism, it’s in their own interests.

Stressing… the evidence

The IoD makes some sensible recommendations that business leaders institute formal mental health and wellbeing policies and that mental health advocates in top teams ensure that mental health openness is culturally installed across organisations.

Much of the advice that is currently incorporated into workplace wellbeing programmes can be simplistic and generic or faddish and piecemeal.  I am passionate to see more organisations adopt an evidence-based approach, which is under-pinned by the latest scientific research and which equips those in the workplace, at whatever level, to manage themselves, and their physical and mental health effectively to ensure that they remain in the best possible state to perform and manage others.

Dr Sarah Hattam is a GP in West Yorkshire with an interest in applying evidence-based health research to improve work-place performance. She also runs ConcilioHealth, an organisational health consultancy.


Watch Out For The Millennial Boomerang

Peter Pan to PLC?

Much has been written recently about millennials in the workplace. With a reputation for being tech-savvy, purpose-driven and energetic, this segment of the workforce represents potential gold dust  for many organisations as they scramble to secure and retain top talent.  None more so than at this time of year when the frenzied jostling amongst ambitious undergrads to attract the attention of recruiters and to secure their place on one of the UK’s prestigious graduate schemes is in full swing.   Students carefully craft CVs which demonstrate desirable skills and attributes with stand-out features which will set them apart from peers, whilst organisations seek to prove they are the “coolest” with their funky offices, free food and coloured bean bags.  These millennials are poised for action as the starting gun fires on their careers.


(photo istock)

However, in spite of all the generational upsides, just how well prepared are these new graduates for the rigours of working life?   And how effective are organisations in preparing these bright sparks to make a smooth transition from academic life to the workplace.  Whilst it is undoubtedly the case that this cohort represents considerable potential to organisations, if we are going to facilitate their performance over a sustained period of time, we too need to adapt our focus on their development from the outset.  Why So?

Sleep waking?

The American Psychological Association states that millennials experience more stress which they are less equipped to manage than previous generations. 50% report that stress affects their sleep and 2/3rds report recent anxiety symptoms.  There are several theories as to why this may be the case.  Much has been written about erratic sleep habits amongst students and it is a fact that poor sleep generates a physiological stress response which contributes to anxiety and emotional fragility. In addition, new graduates struggle to negotiate the subtle shift away from discrete, well-defined measurement of success (essay and exam grades) to the broader work-based outcome measures with a longer feedback loop.  This can lead new graduates, looking to make short-term impact, to experience self-doubt and heightened stress.

Helicopters and Gadgets Don’t Come to The Rescue

Added to this there is evidence of an increase in the so-called “helicopter parenting”, creating a dearth of opportunity to experiment and “fail” in the younger years, which may have effectively stunted the mental and emotional resilience of many of the current generation about to enter the workplace.


Simon Sinek’s analysis of millennials recently went viral highlighting the physical and psychological aspects which play a part as well as the rise in social media and immediacy.   The tech-focus of millennials leads to an omni-connectivity with many of them reporting being constantly on-line.  This persistent digital multi-tasking, flitting between multiple activities in search of a quick dopamine fix, has been demonstrated to have a direct negative impact on productivity.  The consequent effects on sleep quantity and quality as well as a lack of real down-time in which to switch off and recharge impinge on day-to-day performance.

Lastly, there is much to suggest that, whilst this generation in the workforce is more health-conscious than its predecessors, the flip side of this may be a tendency to embrace pseudo-scientific initiatives, rather than understanding and implementing strategies to maximise physical health and energy levels which are based on sound evidence-based research.

Getting Fit for the Long Haul?

A successful and fulfilling career demands investment, not merely in the acquisition of knowledge and skill, but also in habits and practices that underpin career longevity and sustainable productivity.  With the steady increase in retirement age, our grads need to be prepared for sustainable performance. It’s a marathon not a sprint.  In order to accomplish this, alongside traditional leadership training, we need to make the right investments into their physical and mental wellbeing. We need to develop practices which enable our graduates to make meaningful and sustainable contributions to the businesses in which they land.   We may need to adapt our practices too.


In a recent interview, Dame Ellen MacArthur, the record-breaking yachtswoman who sailed solo around the world, spoke about her experiences of being in the race for the long haul. Of how she spent day after day navigating and planning ahead to ensure that every aspect of the voyage was negotiated with precision to maximise the conditions for success.  Not merely keeping her vessel well-maintained, but also taking pains to negotiate weather conditions and meticulously optimising every detail to ensure she reaped the performance edge in order to be the fastest to cross the finish.

Organisations can invest in ensuring that all aspects of the graduate transition are negotiated with such precision.  By providing training which incorporates an understanding of how to maintain the best physical condition and teaching mental resilience to our graduates we can give them a framework for navigating the choppy waters of the workplace. We can support them to manage themselves effectively as the necessary prerequisite to effectively management of others.

Graduate and early management training programmes would do well to incorporate educational modules which include the physical building blocks of consistent high performance – diet, sleep, exercise as well as the key principles that underpin robust mental health and resilience.  Only then we will have graduates who are not just fit for purpose but can truly thrive in the workplace and be successful in leading others.



Dr Sarah Hattam is a GP in West Yorkshire and is Director of Concilio Health, an organisational health consultancy specialising in applying health research to improve performance in the workplace


Does Your Organisation Need De-Worming?

In 1990 I spent my medical elective, whilst training to be a doctor, working in a rural hospital in northern Kenya.  My learning curve was so steep as to be almost vertical.  During this time I treated many children, the vast proportion of whom were emaciated and lethargic, suffering from effects of malnutrition or dehydration, compounded by the effects of the intestinal parasites that had taken up residence in their small bodies.

A few years later, health economists, perturbed by the poor educational attainment in Kenyan school children, undertook some research to determine which interventions were having the greatest impact on learning outcomes.

Contrary to expectations, their data showed that the introduction of free text books and visual aids had little or no impact on learning outcomes.  Such interventions missed the mark.  The researchers determined to trial a different approach, simply that of de-worming school children.  This proved to be immensely successful, not only increasing school attendance and educational outcomes, but also demonstrating that treated children went on to perform better in adult working life.

It strikes me that there is a direct parallel here with many companies who invest in a whole range of initiatives in their endeavours to improve individual, team and organisational performance and increase engagement.  Many of these have positive aspects but lack real evidence of efficacy and return on investment perhaps because their organisations need a form of “de-worming”; to address some basic pre-requisites which are holding back performance in a hidden way.

As a doctor, I have seen at first hand the effects of organisational culture and practices on the performance of individuals. Many businesses choose to ignore a simple but obvious truth,  that  human performance is directly affected by our physiological and mental state. Too many organisations are investing heavily in a range of performance initiatives whilst their organisational culture and practices leave their people in physical and /or mental deficit.

The result?  …… continued poor performance.

The good news is that organisations can “de-worm” their practices and culture through the application of simple educational and behavioural change interventions.

Taking action here may be just as important to unlocking performance and resilience across our organisations, as de-worming was to educational improvement in Kenya.

Dr Sarah Hattam is a GP in West Yorkshire and is Director of Concilio Health, an organisational health consultancy specialising in applying health research to improve performance in the workplace.

Sugar Tax – Too much fizz?

Jumping for joy with Jamie?

The chancellor’s decision to levy a special tax on sugary drinks is a welcome move, and one which will please many. Healthcare professionals will be jumping for joy along with Jamie Oliver who “just happened” to be passing Westminster on the day of the budget.  With approximately 30% of all children in the UK now overweight or obese, the Academy of Royal Medical Colleges has been calling for fiscal action for several years.  And the government’s intended re-investment of this proposed £520 million sum back into increasing exercise and activity levels among school children…..well, what’s not to like.?


Celebrity chef Jamie Oliver on College Green in Westminster, London, after he welcomed the announcement of a tax on sugary drinks, telling fellow campaigners: “We did it!”

Superficial solution

The problem is that this seeming  political no-brainer,  with its over-selective execution doesn’t go far enough.  Why just soft drinks?   As a nation, we have a sugar addiction which is driving a burgeoning increase in chronic illnesses related to obesity , such as type 2 diabetes.  The British Dental Association now lists tooth decay as the number one reason for hospital admission among young children, with a 10% increase in hospital-based extractions in the past 4 years. The new sugar tax could well demonstrate its adherence to the law of unintended consequences over time.  Instead of addressing the nation’s sweet tooth, the drive may well be towards unlimited consumption of soft drinks containing artificial sweeteners and a switch to alternative, sugary foods currently unaffected by the tax. According to the Institute for Fiscal Studies, a mere 1/5th of sugar consumption derives from soft drinks.

Conflicting evidence

The European Food Safety Authority has undertaken a rigorous review of artificial sweeteners such as aspartame and saccharin and concluded that they are safe for human consumption at usual levels of exposure (apart from individuals with metabolic disorders such as PKU),  a position which is  endorsed by the NHS  on their website. Nonetheless, there is evidence to suggest that consumption of diet and artificially sweetened soft drinks may actually be linked with increased obesity and data suggests that individuals who consume these regularly end up weighing more and being in worse health.  The reasons are not entirely clear, but may include metabolic disturbances and tricking the body to expect a calorific hit, thereby driving appetite.  A recent meta-analysis published in he BMJ produced summary evidence that habitual consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice was prospectively associated with type 2 diabetes,  independently of being overweight.

“Big Mac and Diet Coke please”

The fact that artificial sweeteners are 200 times sweeter than sugar, and may fuel an ongoing craving for sweet satisfaction should concern us.  Add to this the “Big Mac and Diet Coke” phenomenon where consumers display cognitive dissonance in their food choices, often compensating for foods that are seen as calorie-free by over-indulging on high calorie treats with little or no nutritional value.  And we’re completely missing the point if we only tax the sugar containing drinks.  Sugar is not the only culprit in tooth decay, enamel is also destroyed by the acid in carbonated drinks, even sugar-free varieties. If we want to “Keep Britain’s Children Smiling Sweetly”, as proposed by the British Dental Association, we need to limit the enamel erosion from all acidic fizzy drinks.

Likely to go flat

Whilst this is a step in the right direction,  Mr Osborne, I’m not jumping quite as high as Jamie as this is too tentative and too slow to make any serious impact.  Economists generally agree that government intervention, including taxation, is justified when the market fails to provide the right outcome for society’s well-being.  With healthcare costs rising exponentially, we need more comprehensive and robust population-based measures which fuel healthy choices, and ensure that appropriate switches are made towards food and drinks with real nutritional value, avoiding the mixed messages communicated by the cane of the sugar tax, and empowering the UK to make positive and informed choices, and kick its habit! How about a fruit and vegetable subsidy? Or would that be a carrot too far….?


Dr Sarah Hattam is a GP in West Yorkshire with a special interest in simplifying health messages to improve performance in the workplace.