Towards better line management training on mental health
The project, 'Understanding the conditions for successful mental health training for managers' (reference T1124) has been commissioned on behalf of the cross-industry Health and Wellbeing Economics Group – which includes representation from right across the rail industry. So what’s the goal?
Stress and mental health are the leading cause of long term absences in the rail industry (ORR, 2018). The Centre for Mental Health estimates that a total of 72 million working days are lost each year on absence due to mental health issues, costing employers an estimated £35 billion per year (The Sainsbury Centre for Mental Health, 2017). Effective strategies could reduce this by as much as 30 per cent, including awareness training and effective rehabilitation – saving employers up to £8 billion per year (Centre for Mental Health, 2007).
RSSB’s report on the impact of suicides on railway staff (RSSB 2005), highlights how the unique working environment of rail workers can engender specific mental health issues. Furthermore, the report ‘Costs of impaired health across the network’ (RSSB 2014) provides a strong business case for greater mental health and wellbeing support in the industry, which found 1.06m days are lost to sickness in the industry due to ill health in general. There is increasing acceptance that there is no ‘one-size fits all’ MH training and that different sectors and roles require different approaches. Line managers and supervisors are key targets for training as they arguably represent the ‘frontline’ of wellbeing management and act a gatekeeper to pathways to support. Managers are also in position to address (or report) work stressors that can compromise mental wellbeing. Line managers can lead by example, raise awareness, promote dialogue, tailor job design, and create an open environment around mental health once they themselves have a good understanding the subject. MH awareness training can empower managers to approach mental health more effectively, with the potential to impact positively on their direct reports.
RSSB has commissioned IES to conduct a research project with the aim of finding the best way to support the rail industry in providing training in this area, specifically targeting mental health training for managers. IES have completed a review of the literature to understand the conditions for successful mental health training for managers in the rail industry. It has been noted in the academic literature that there is a general lack of evaluations of training programmes that address mental health issues, and that ‘randomised controlled trials of manager mental health training on objective occupational and public health outcomes are scarce’.
What are the best mental health and wellbeing topics to teach to line managers?
Some themes common to effective courses can be drawn out.
The main themes and topics that the evidence suggests mental health training for line managers should contain are:
(1) Awareness of mental health (in relation to self as well as others)
(2) Communication skills (eg having conversations about mental health)
Line manager role
(3) Supporting mental wellbeing through managing workplace risks
(4) Managing absence, return to work and making workplace adjustments
First response skills
(5) Responding appropriately to signs and symptoms (in direct reports)
What are the best methods available to train line managers in mental health and wellbeing?
Of the studies reviewed, most evaluations were of face-to-face training (classroom style training or workshops) while a few looked at e-learning/online learning. None have compared the two.
Reflecting on the best quality academic literature, successful results for face-to-face training, and marginal effects for e-learning have been identified. Furthermore, high quality sources indicated the potential effectiveness of half day courses delivered either face-to-face or online.
Some generic features of training courses have been highlighted as successful including:
- Providing opportunities for interaction with other learners
- Using real-life experiences to illustrate points, for example
- personal accounts of real employees who have struggled with their mental health (eg on video)
- ‘case studies’ showing how particular situations were managed at work
- Tailoring content as far as possible to participants’ sector/job roles
Demonstrating Value: Outcomes and Returns on Investment
The studies described in the literature review typically did not monetise the costs and benefits of training. Although training duration was usually reported, the costs of developing and delivering that training were not. Only one study, published in the Lancet, has produced compelling results on return on investment. Milligan-Saville et al (2017) conducted a cluster randomised controlled trial of manager mental health training within a large fire and rescue service, with a six-month follow-up. Managers were randomly assigned to either a four hour face-to-face mental health training programme or a deferred training control group. Firefighters and station officers who were supervised by each manager were included in the study via their anonymised sickness absence records.
At the six-month follow-up, those who received the training demonstrated improvement in confidence when communicating with employees regarding mental illness and reported sickness absence. The improvement in work-related sick leave attributed to the intervention was equated to a reduction of 6·45 hours of sickness absence per employee per six months, with an associated return on investment of £9.98 for each pound spent on the training. This Australian study that has shown positive effects stands alone in terms of its rigour and findings. The authors commented that ‘this cluster randomised controlled trial shows, for the first time to our knowledge, that simple mental health training for managers in the workplace can generate meaningful public health and individual benefits’.
Along with return on investment, the literature review highlighted the value of using outcomes concerned with acceptability of the training to trainees, knowledge, confidence and (self-reported) behaviours. No research has examined the impact of training in such depth in the rail industry.
Building an Evidence Base in the Rail Industry
RSSB are working with IES to conduct a robust research project on the effectiveness of line manager training on mental health. The project is heavily influenced by IES’ literature review, with the aim of addressing key gaps in the evidence base, using outcomes identified as valuable in the literature review, and providing a depth of evaluation not yet achieved in rail. We will compare e-learning with face-to-face administration, as well as with a group of managers who receive no intervention. It will be the first study of its kind to compare these modalities for line manager mental health training. RSSB are working with Mind as the training provider, who’s “Managing Mental Health at Work” half day training course for line managers, will be evaluated alongside their new e-learning package for line managers, “Positive about mental health in the workplace”.
The research will explore the nature of evidence and arguments that stakeholders require to build a business case to invest in this area. RSSB will provide information about the costs of training procured for the evaluation. Costs arising from lost productivity during training attendance will also be estimated as accurately as available data allows. The project is evolving with heavy participation from industry, including a Roundtable event which will be held with industry stakeholders. RSSB would like to extend thanks to participating members, who are fundamental in the execution of the project.
It is expected that the analysed data will be available in an industry report by September 2019.