Workplace Wellbeing 4: What kind of treatment is available for employees?
In the first instance, if a person is concerned about their mental health they should speak to their GP.
The GP will be able to offer advice and guidance and if necessary prescribe medication or make a referral for appropriate treatment, such as counselling. There can often be long waits associated with accessing talking therapies and therefore, going through your employee assistance programme may enable them to get help quicker.
You can support the member of staff to access the treatment that they would prefer and feel most comfortable doing. It may be that they access talking therapies via the workplace employee assistance scheme, however, the GP will have a clinical responsibility for your employee. Hence, it is important they are involved and kept informed of any treatments.
Talking Therapies Explained
A person experiencing a crisis will be seen more immediately, but often this support is short-term and will only provide support through the crisis period. Ongoing support will need to be accessed to build resilience and for long term recovery.
We always recommend people who are experiencing mental health difficulties to;
- Get help as soon as possible, which could be a combination of the different options.
- A course of anti-depressants whilst waiting for talking therapies may be helpful. We do not advocate for antidepressants but we do recognise medication can be helpful to improve emotional wellbeing.
- Online treatment whilst waiting for a face to face option should always be considered, as with antidepressants it should not be the only option, but considered alongside other options
We do not recommend having more than one therapy at the same time. For example, if regular sessions of CBT are being received we would not recommend accessing psychotherapy at the same time.
Many services are under increasing pressure as mental health needs continue to rise and the number of trained therapists and services available are unable to support demand. There may be longer waits to access some of the more specialist services. For example, for psychotherapy in secondary care, waiting times can be up to 18 months.
Cognitive Behavioural Therapy (CBT)
A person referred for therapy through the NHS is likely to be offered a type of talking therapy called cognitive behavioural therapy (CBT). CBT is a relatively short-term treatment which aims to identify connections between thoughts, feelings and behaviours, and to help develop practical skills to manage any negative patterns that may be causing difficulties. This treatment is deemed most appropriate for mild or moderate anxiety and depression.
IAPT (Improving Access to Psychological Therapies)
IAPT is the NHS programme of recommended talking therapies for people experiencing depression and anxiety disorders. IAPT services usually provide two types of CBT therapy:
- High-intensity therapy for people with moderate to severe depression. 12-14 face to face sessions are recommended.
- Low-intensity therapy for people with mild to moderate depression and anxiety. 6-8 sessions on the telephone or face to face are recommended.
- Some IAPT services offer computerised CBT which is more self-guided with remote online or telephone support.
- In some areas, self-referral to IAPT services is possible, in others, referrals need to be made via a person’s GP.
- IAPT services often also have employment services or links with other services such as housing, drugs and alcohol or benefits/debt advice.
Psychodynamic therapy is a long-term therapy and although offered on the NHS, it has a much longer waiting list and is often accessed privately. This type of therapy works by exploring how personality and early life experiences influence current thoughts, feelings, relationships and behaviour to enable a person to understand themselves more deeply. These insights may help to manage anxieties more effectively and create opportunities to respond differently in difficult situations.
Other Talking Therapies
There are many talking therapies which can support a person on their journey to getting better. Group therapy, family therapy, couples therapy, mindfulness-based therapy, interpersonal therapy, gestalt therapy and humanistic therapy. Most people are not interested in the type of therapy, the modality is more relevant to the professional. What is important is that someone feels supported and it is helping to improve emotional wellbeing.
Online self-management programmes can provide computerised CBT which can help to teach about stress, anxiety and depression to raise awareness of feelings and offer different approaches to help change behaviour. This is not for everyone as it requires working remotely with no input from a trained counsellor. Some organisations will provide additional support alongside online therapy.
Emergency or Crisis Support
If a person’s mental health problems are severe or long lasting, or the treatment a doctor has offered isn't working, then specialist mental health services can be accessed. These include:
If you or someone you know is in a mental health crisis and needs help fast:
- Go to the Accident and Emergency (A&E) department at a local hospital if there is immediate risk such as suicide
- Get an emergency appointment with a doctor
- Call the Samaritans (116 123)
- In extreme cases, call 999 if someone is endangering themselves or other people
A GP may make a referral directly to a psychiatrist who can assess a person's needs and determine if they need to see a psychiatrist or a different mental health professional. Most psychiatrists work as part of community mental health teams (CMHTs), in outpatient clinics or hospital wards. During the first appointment, the psychiatrist will carry out an initial assessment. They will look at both a patients mental and physical health. After making an assessment, the psychiatrist may prescribe medication or recommend other treatments, such as psychotherapy or cognitive behavioural therapy. They may also section people and recommend a stay in a hospital if they are at risk of harming themselves or others.
Community Mental Health Teams (CMHTs)
CMHTs support people living with mental health problems and their carers. The team may include a community psychiatric nurse (CPN), a psychologist, an occupational therapist, a counsellor and a community support worker, as well as social workers. There is usually a high threshold to access this service as they are specialists who provide support to people with mental health needs who are usually at high risk. Hence, people with long-term, enduring mental health needs such as bipolar disorder or schizophrenia are supported by CMHTs. They do support people with depression, anxiety or personality disorders, but more severe cases where people may have tried to commit suicide or have had a stay within a hospital for their mental health. Every area will have a crisis team that can assess and signpost you to local services.
Social workers work closely with CMHTs to provide care or support to enable people to carry out day-to-day tasks or live independently. A carer of someone with mental health problems may be entitled to receive some support from social services and can ask for a care act assessment to assess what support they may need. Social care services include;
- Residential Care: If a person is unable to cope on their own at home, there is short-term accommodation, with supervision, to help until they can live more independently. This is usually for people with mental health needs alongside other illness like frailty or a learning disability;
- Residential care homes; offer a much higher level of support for people with severe mental health problems, learning difficulties or frailty
- Therapeutic communities; are for short stays, with groups or individual therapy as part of their rehabilitation programmes
- Supported housing schemes; enable independent living, in furnished accommodation, with support from a mental health support worker in case extra help is needed.