I had my first breakdown in 1997 (when I was 37), and my second two years later in 1999. Up until then my life had been relatively uneventful. The first time, it built up slowly, over a few months, even years. As well as relationship issues at home, causes included the constant pressure to meet deadlines and lunch only being a hurried sandwich at the desk. On one occasion, I took what most would regard as a ‘minor conflict’ with a senior manager at work (over a stress research project no less!) as a major, personal insult and this blew the lid off everything for me.
In 1997 my behaviour began to change. Gradually, more people realised that there was something wrong. I was experiencing mania and later, delusions. This all took place over the space of six to eight weeks. During the last few days I really wasn’t making sense. I met with my manager and his boss in a relaxed environment outside of work, and they diplomatically recommended that I rest and see a doctor. By this time they had realised something was seriously wrong. I was recommended for psychiatric care and, on being admitted I broke down completely: I had experienced ‘an acute psychotic episode’.
There were various further diagnoses: stress-related illness, schizo-affective disorder, and finally bipolar affective disorder (manic depression). I was in hospital for a month, and off work for three months altogether. During that time even the first, brief visit by a very caring personnel officer, on neutral ground had me in tears for no reason. Everybody was very supportive, my employer, my manager and my work colleagues. I was the one worrying about how people would take it, what I would say. How could I explain something that I didn’t understand?
Importantly, the rehabilitation involved a gradual return to work and was a well-managed process. For instance, after meeting with the personnel manager the first time, I met with both her and my line manager, again on neutral territory for coffee in a hotel. It helped just to talk about work and how to best phase me back in. With my consent, as well as obtaining general occupational health advice, my personnel manager discussed my welfare with my consultant psychiatrist. At every stage, we discussed and agreed my options. We talked about the job, likes, dislikes, strengths and weaknesses, but there was no pressure to change.
After I had been off work for three months the rehabilitation involved being phased back in gently over a further three months: a few hours, a few days at a time to three and fours days a week. Initially, I would arrive at work later and leave earlier. First, the return to work was just for me to visit, to be there to meet colleagues, to talk, to feel accepted. This helped me to overcome the initial fear of simply stepping over the threshold.
I was more closely supervised at the start; meeting informally with my manager and personnel manager. Gradually, still on medication and under the supervision of my consultant psychiatrist, the work increased until after two or three months I could cope with a more normal workload.
A redesign of my current job role has provided a broader workload that addresses some of my concerns and interests. The whole process of a phased return to work helped to rebuild my confidence and to confirm my capability.
The second breakdown, in May 1999, took everyone by surprise but this time I was only out of work for a month.
The same consultative step-by-step approach was taken to phase me back in. I am aware everyday of the potential for a relapse. Occasional days working at home on specific tasks are helpful, and I’ve negotiated a day off a fortnight (self financing) to pursue my hobbies: writing and performance.
I now focus on outcomes rather than minutes at the desk. Where possible, I also try to take a proper lunch break each day, and often combine lunch with a walk through the local park. I still have to monitor my feelings and experiences for any irregularities and my manager works with me to ensure a manageable workload.
It is important that managers are:
It is also important that:
For more information on how to conduct a stress risk assessment visit The Management Standards
Steve had a serious psychiatric condition, which is not the case for the majority of employees who feel stressed. However we used the approach set out in our managing sickness absence toolkit to help Steve back to work gradually. In this particular case, it meant encouraging him to meet colleagues and become familiar with the work environment again.
More generally, EEF has produced guidance on managing stress which was cascaded throughout the organisation. This focused on a risk assessment approach; identifying stressors, and looking for the signs and symptoms of stress. To help prevent employees developing work related stress, EEF developed the Work Organisation Assessment Questionnaire (WOAQ) in conjunction with the University of Nottingham. It is an alternative tool to the Management Standards tool, with the added benefit of identifying what is good about the work environment as well as identifying what needs to improve. EEF has used the WOAQ tool for its own staff and this helped to ‘celebrate success’ as well as target action that would impact on the most number of people. The WOAQ is available free to all employers at http://www.workorganisation.org.uk
For further insight into the nature and experience of my illness, look up my book:
‘Fast Train Approaching’
If you have any comments on this article please email firstname.lastname@example.org