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  • Writer's pictureKathy Cox | Health & wellbeing consultant | PAM OH Solutions

Encourage ‘courageous conversations’ to reduce absence

Managers who are brave enough help employees open up about their underlying health issues can significantly reduce sickness absence.

Hidden health conditions, ranging from anxiety and depression to menopause and heart conditions affect one in five people, with one in three choosing not to tell their employer. This means 16% of employees are not getting the support they need to stay in work.

Managers are usually the first to notice when someone is struggling. But, if they don’t feel brave or skilled enough to ask someone how they are, they tend to say nothing.

Our latest research shows that one in three managers are waiting until the employee goes absent before offering support. Yet by that stage just half (53%) of those off sick will be in work a month later, compared to 91% of those offered support while still in work.

Fortunately, upskilling managers to have the ‘courageous conversations’ needed to make someone feel safe discussing an underling health can be easily achieved. Here one of our manager trainers, health and wellbeing consultant, Kathy Cox, shares her top five tips.


Kathy will be running a free 45-minute training session at 9.30am on Weds 13 September. This is for employers interested in learning how to hold courageous conversations linked to hidden mental health issues driving absence.


Five ways to help managers manage hidden health conditions

Kathy Cox shares her top five tips for encouraging managers to hold the courageous conversations needed to help employees with hidden health conditions stay in work.

1. Make it part of the induction process

Instead of waiting for underlying health conditions to manifest as performance or absence issues, encourage managers to talk to employees about any support they might need as soon as they join the organisation. Whether someone is on heart medication that makes them feel fatigued or has back problems that can flare up, having the opportunity to discuss this and get the upfront support they need will not only reduce absence but make them feel supported.

To make people feel safe opening up about any hidden health conditions, share case studies about how other people, with both physical and mental health issues, have been supported. Explain what support services the organisation offers, be this access to an EAP, occupational health or a physio service, and give examples of reasonable adjustments that could be offered to help them continue to work around health conditions or if they’re having a bad day.

2. Provide education on symptoms

Not everyone will feel safe opening up about a hidden mental health condition, so it is important managers are trained to recognise these. Different health conditions will present in different ways, but general warning signs that someone is starting to struggle include:

- Constant tiredness

- Increased forgetfulness

- Feeling overwhelmed

- Emotional outbursts

- Changes to physical appearance

- Reduction in performance

- Unexplained absences

With more people working from home, managers need to take the time to get to know their team so if they become more withdrawn, start taking less care of themselves or avoid turning their camera on, they will notice this change.

3. Help managers see beyond ‘I’m fine masks’

Sometimes employees with an undiagnosed health condition might not even realise they’re starting to struggle. Someone under intense strain at home or work might not realise they’re starting to develop an anxiety disorder and need help to bolster their mental health. While a woman in her late 30s, who is starting to struggle with brain fog and fatigue, might not realise this is linked to the perimenopause and that there is help to manage these symptoms. Others might just not want to admit they’re struggling or think their manager won’t really care.

As a result, many people will put on their ‘I’m fine’ mask if asked how they are, even if they’re not. Managers need to ask: ‘But how are you really?” on a one-to-one basis and take the time to talk to employees about how they’re feeling, instead of just talking about how their work is progressing.

4. Provide guidance on what to say and what to do

Even when managers can see that someone is struggling, it can still be very daunting for a manager to ask someone if they’re okay, for fear of seeming intrusive or becoming personally involved. To help managers overcome this fear, make sure they know it isn’t their role to try and counsel or solve the employee’s problems for them. Instead, their role is to listen and signpost them towards support. The ALEC framework can help managers remember to:

Ask appropriate questions – about how they’re feeling and what’s going on

Listen and pay attention – by echoing back what the employee is saying without advice

Encourage action – by helping the employee identify for themselves what they need to do

Check-in – follow up with the employee to see if things are better or signpost to support

Remember most managers will have been promoted according to their technical or organisational abilities and will not yet have the soft skills needed to manage health and wellbeing. Identify any skills gaps in this area and offer workshops and training to make sure managers have the capability and confidence to manage wellbeing. (See below for details about a free online training session we’re offering this September).

5. Make it a manager responsibility

Make sure managers know what their responsibilities are when it comes to managing health and absence and ensure any company policies are aligned to this. For example, if you have a policy saying that people should be offered support after six weeks of absence, but you want managers to support people to stay in work, make sure your sickness prevention policy stresses the importance of referring people at the first sign of a problem.

Many hidden health conditions are recognised disabilities, requiring reasonable adjustments. If there is an occupational health service in place to support with this, make sure managers know how to raise a referral. Instead of just writing ‘diabetic’ or ‘got depression’ on the referral form, the more detail they can provide about what the employee is expected to do, what they’re struggling with and what adjustments have already been tried the better.

Note: PAM OH provides a free pre-call to enable managers to provide more context on what the employee is struggling with, as well as a free post-referral call, to help put in place the recommendations. 1:1 coaching on how to fill in the referral can also be provided.


Free training session: How to hold a courageous mental health conversation

9.30am Wednesday 13 September 2023

Join Kathy Cox, health and wellbeing consultant, PAM OH Solutions, for a free 45-minute training session on how to use courageous conversations to reduce mental health absence.

During this 45-minute session (with 15 mins of Q&A afterwards), you will learn:

- How to spot the signs of poor mental health before someone goes absent

- How to hold a courageous conversation with someone who is struggling

- How to recognise a ‘red flag’ case and what to do if someone isn’t ready to talk

- How to upskill managers to manage mental health and other conditions

- Tips for maintaining your own mental health and wellbeing


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