This post is a “conversation” between Barbara Wilson of Working with Cancer and Alex Tambourides, Hammersmith and Fulham MIND.

BW:  I do find it shocking though not surprising that although research shows over 80%  of those  who are working when diagnosed with cancer want to return to work, over 57% have to change their jobs or leave work altogether.

AT: There are some big similarities here with mental health. Even though 1 in 4 people in the UK will experience a mental health problem in their lives, mental health problems in the workplace seem to occupy a hidden space in modern business thinking. Research shows that as a consequence of this many people with mental health problems unnecessarily fall out of employment. Having mental health problems considerably increases the risk of leaving employment compared to other health conditions.  A report conducted by the CBI says that such problems are the most widespread cause of sickness absence (42% manual and 54% non-manual), with cancer also being in the top 5 reasons (29% in manual, and 46% in non-manual).  

BW: I think that fear, misunderstanding and poor communication are often key factors in preventing a successful return to work.   Initially many cancer survivors and their employers believe that once a return- to- work plan has been agreed and a few reasonable adjustments have been made, life will be pretty much back to normal in just a few weeks. It’s alarming that the latest research undertaken by Macmillan Cancer Support shows that 40% of cancer survivors, let alone their employers, are totally unaware of the long-term side effects – physical, emotional and psychological – of cancer treatment.

AT: Again, we’re seeing how the barriers between mental and physical health need to be broken down. There is a strong likelihood that a diagnosis of cancer will impact on a person’s mental health in one way or another. In many circumstances clinicians or OH may forget this and focus purely on diagnosis, not the wider impacts of it on someone’s wellbeing. Research conducted by the Mental Health Foundation found almost half of employees off sick with physical health problems also experienced mild to moderate depression and that they were more worried about informing their employer about their mental health issues than about their cancer or heart disease.   

Another parallel here is that the first time many people experience a mental health problem will be whilst they are working. Our experience shows that both employers and employees sometimes have unrealistic expectations around how best to proceed on the journey back to work. All too often the renewed confidence that can come as people begin to get over the worst can mean that they over-commit upon their initial return. 

BW: Yes, over-committing or just returning too soon or too quickly is a common problem for those returning to work after cancer too. The first few months after treatment has ended can be really difficult. It’s often made worse by the feeling that the support that was available during treatment isn’t there any longer.  Once you are cured or “in remission”, your boss and colleagues assume you must be thrilled and raring to go.  Admitting to depression, or to still feeling insecure and vulnerable at that stage, is often just not for fear of being seen as needy or over-dramatic.

Clinicians tend to focus on physical recovery rather than these ‘softer’ issues, and they give very little advice or guidance about when is the right time to return to work, let alone about dealing with the surrounding feelings or emotions.

AT: There is a big point here around the perception of non-physical issues. So-called ‘soft issues’ have hard impacts. Mental and emotional health can be thought of as ‘soft’ but UK businesses lose over £15bn per year due to mental health related presenteeism. How the person is feeling on their route to recovery can hugely influence outcomes on their return to work.  Line managers and support professionals need to be more adept at dealing with the emotional landscape at work. People who feel listened to and supported will do better. I have begun to wonder whether the reluctance of people to discuss these areas is down to 1) the stiff upper lip; 2) fear of litigation; 3) perceived incongruence with the competitive and macho culture that dominates much of modern industry; or 4) all the above, in varying proportions in varying environments.   

Both mental health and cancer seem to occupy a place within our culture that is fenced off by taboos. The taboo that exists around cancer is about its association with death and loss, things that we find uncomfortable to live with. Taboos around mental health are of a different kind of loss, the loss of self. Our underlying attitudes towards issues of such significance won’t change overnight but by simplifying and demystifying the way we deal we these issues in the workplace we can eventually begin to replace the fear with a more pragmatic and positive way forward.  

BW: In my last blog I outlined a number of practical steps employers might take to help people affected by cancer to return to work – for example taking the initiative to improve awareness and understanding of cancer and its impact within the workplace, and providing better one-to-one support for those coming back to work.  A lot more should also be done to alert those recovering from treatment about the possible physical and psychological side effects of cancer and how they can be self-managed.

AT:  Doing the right thing for a person’s health is also doing the right thing for the business. Dealing with mental health in the workplace requires a simple but aware approach. Neither carrots nor sticks are successful ways to deal with mental health issues. All too often people are overly nurturing or cynical and dismissive.  By following some of the simple steps you outline, and doing what is reasonable to support someone it is possible to be both compassionate and commercial. Taking employee health seriously will ultimately create a more engaged workforce and a healthier and more productive business.  

BW and AT: Clearly, every person’s journey is unique- whether it’s coming to terms with a cancer diagnosis and returning to work, or struggling with a mental health issue in the workplace. Support is vital; employers should be confident and proactive in helping to remove barriers, not increasing the barriers towards returning to work.