Brendan Street of Nuffield Health: 5 Ways That Businesses Can Help Promote The Mental Wellness Of Their Employees

It is important that every team member feels valued, knows their voice matters and is heard and importantly has an understanding of their purpose and how they contribute to the team and the wider organization.

As a part of my series about the “5 Ways That Businesses Can Help Promote The Mental Wellness Of Their Employees” I had the pleasure of interviewing Brendan Street.

Brendan is the Professional Head of Emotional Wellbeing at Nuffield Health. He has over 25 years’ experience in treating mental health problems in the NHS and private sector.

He has delivered mental health treatments in various settings; hospital, community, offenders/prison and homeless hostels, employment/corporate, to adults and children suffering from a wide range of conditions (psychosis, anxiety disorders, depression, PTSD).

Brendan is a BABCP Accredited Cognitive Behavioural Psychotherapist and Supervisor, fully qualified EMDR (Eye Movement Desensitisation and Reprocessing) practitioner, and NMC registered Mental Health Nurse.

Can you share with us the backstory about what brought you to your specific career path?

My mother was a psychiatric nurse when I was growing up. After school I would meet her at work, and wait for her to finish her shift, sat in the dayroom. During this time, I would speak to the patients on the ward. This was during a time before there was a drive to support people with long term mental ill health in the community.

Many of the patients my mother worked with had been in hospital for many years with different symptoms. I recall one day I was talking to a patient called Sylvia (not her real name). Sylvia told me about her “lads”. By this she meant voices that she heard that no one else did. Sylvia told me that one of the reasons she didn’t take her medication was that it made her “lads” leave her…and this made her feel very lonely. I remember being so interested in Sylvia’s experiences and so struck that she hadn’t told anyone else about this.

The following Monday in school when my teacher asked how we had spent our weekend I raised my hand and tried to explain to the class about Sylvia and her voices. I remember vividly the look of concern in the teacher’s eyes as she attempted to close down the conversation. I realised then that not everyone had conversations about mental health the way I did within my family.

Sylvia’s way of explaining her experience also made me appreciate that there was much more to mental health than a diagnosis. This then led to my interest in psychology, I completed a psychology degree, my psychiatric nurse training and then my psychotherapy training. I am still guided by Sylvia’s story — In therapy I always approach an individual with “What has happened to you?”…trying to understand their experiences and what this means to them rather than “What is wrong with you?” merely looking at the diagnosis rather than the meaning.

Can you share the most interesting story that happened to you since you started your career?

I have been a psychiatric nurse and therapist for over 25 years and during that time my work with patients has been incredibly rewarding. Each person is interesting in their own right because of their individual stories, i.e. what has happened to them in their lives to cause the distress they are seeking support for in therapy?

Therapy then involves collaboratively finding out about their personal story and how this has created unhelpful cycles of thinking, behaviours, mood and physical symptoms. My role in therapy is then to ensure the individual has tools/coping techniques in each of these areas to effectively make myself redundant…the individual has the expertise to become their own therapist. I find the personalised ‘road’ to this point so interesting and immensely fulfilling.

In addition to providing therapy a main part of my role within Nuffield Health is related to our mental health strategy. I was recently the subject matter expert for the emotional wellbeing section of Nuffield Health’s new brand campaign How You Feel Tomorrow Starts Today This was a really interesting project.

I was involved from ‘story boarding’ the emotional wellbeing segment, advice on casting (we advised a male patient in order to highlight the import of men seeking support for mental ill health), and as consulting during the day’s filming. I even managed to get a supporting role as a gym member in the background.

From start to finish this was a fascinating project to be involved in. As the UK’s largest healthcare charity, with a remit to improve the health of the nation, it was really important to me that we show how we approach physical and mental health as a connected whole. In addition, I was so proud to see access to health support shown on prime-time UK television. I can’t think of a time that this has previously occurred.

What advice would you suggest to your colleagues in your industry to thrive and avoid burnout?

Now more than ever, the line between work and home life is becoming blurred, with so many employees thrown, unprepared, into the world of remote working. There’s also no indication when this will end. Those having difficulty separating work and home life may stay in a heightened state of stress long-term and it can lead to burnout.

Employees are no longer commuting to and from work, it doesn’t mean they should be working those extra hours instead. It’s important to maintain the boundaries between work and free time. It makes the difference between having a ‘head-full’ and having ‘head-space’.

While remote working can offer greater flexibility in working hours, this can actually be detrimental for many workers, whose days can end up lacking structure and see them working additional hours. There is a limit to how many hours we can sustainably work in a day, every day, before exhaustion takes over and we find ourselves unable to cope, an occupational phenomenon now defined by the WHO as ‘burnout’.

Nuffield Health published a white paper in 2019 outlining the benefits and risks of remote working. From available evidence remote working can have positive effects on wellbeing and stress…but these benefits are very dependent on making sure the correct management support is in place. In addition, we found that the benefits of remote working start to reduce, and risks like: stress, poor work/life boundaries and loneliness, start to creep in if you work over 2.5 days remotely.

It seems that a split office and remote balances risk and benefit. Our research was published in the context of a pre Covid-19 world. Home working is now, for many, enforced. We aren’t simple remote workers; we are individuals trying to work from home during a global pandemic. The past benefits, the ‘banked social capital’ of working with others in an office is starting to wear off and individuals are reporting working from home is impacting on mental health

So, what can we do to limit anxiety and the desire to overwork from taking over? Firstly, we need to recognise some of the signs we may be burning out:

People on the road to burnout often feel a mounting sense of helplessness. Your mind can feel like it is in ‘overload’ as you struggle to process the endless thoughts running through your head. Once you reach exhaustion it can be hard to find solutions to even minor problems.

Those heading towards burnout might experience noticeable mood swings such as outbursts of anger or irritation. You may put this down to being stressed, but left unchecked, stress in the long term can lead to mental ill health such as anxiety, panic attacks and depression.

Problem solving becomes difficult as we start experience stress and anxiety. Individuals start to worry more and have ‘What if…’ type thoughts. As such employees might find it difficult to delegate tasks. It doesn’t matter if you’re passing work onto a highly competent team member or even to someone senior, the thought of not having complete control at this moment in time fills you with dread.

Working from home means you must be organised when it comes to communicating with your teams. This communication will require different modalities and frequency for different employees. One size does not fit all. If, however, you are permanently logged into your inbox and checking emails compulsively, until late at night you are not giving yourself the downtime that you need and not necessarily giving employees the best contact, they need.

The first step to dealing with burnout is to evaluate your work environment and what you’re having difficulty with most with when it comes to working from home.

One main area, vital for wellbeing, is likely to be sleep.

The blurring of boundaries between work and home, created by remote working due to Covid-19, in my opinion is likely to lead to widespread sleep difficulties amongst employees. Many are using their bedrooms for work related activities. ‘Bedmin’…doing work admin in bed…is on the rise. Employees may be working right up until bedtime. Blurring the boundaries of what we use our bedrooms for will also lead to poor quality sleep. This is turn may lead to reduced ability to concentrate, increased proneness to anxiety and depression and an increased propensity to burn out.

Within many executive working environments, there’s been a long-established culture where organizations overvalue the employees who undervalue sleep. While many companies extol the merits of stopping smoking, eating well and exercising more, colleagues who are able to function on little sleep (or ‘burning the candle at both ends’) often wear their lack of sleep as a badge of honour or see it as a form of competition with their peers.

Attitudes such as ‘I’ll sleep when I am dead’ and the habit of ‘pulling an all-nighter’ assume that sleep is a luxury which can be readily sacrificed for other ‘priorities’. Figures in history who were able to manage on limited hours of sleep (such as Winston Churchill and Margaret Thatcher) are often seen to possess positive characteristics upheld as examples we could all aspire to.

The truth is that sleep is vital to our health — with new research revealing it is more important than previously thought. In Emotional Wellbeing we refer to sleep as the ‘Swiss Army knife of health’ — as it serves so many important functions.

Inadequate or poor-quality sleep is linked with increased risk of accidents, injuries in the workplace and poorer physical health, with greater risk of obesity, heart disease and diabetes.

Rather than making employees more productive, factors such as creativity, intelligence, motivation, efficiency, effectiveness and even perceptions of attractiveness are all negatively impacted by lack of sleep.

As a tired employee you are likely to be less productive, more prone to accidents, poorer at memory tasks and problem solving, and less creative than your well-rested colleague. You’re further likely to be less able to accurately read the emotions of those around you, making navigating already-complex work and social relationships even harder.

Sleep deprivation can lead to a negative feedback loop. You feel less productive and then try to catch up by working longer and then get less sleep.

Sleep should therefore be a key focus for employers. Educating employees about good sleep habits should be seen as important as supporting employees to exercise more, eat healthily or stop smoking.

What advice would you give to other leaders about how to create a fantastic work culture?

The key to establishing a positive work culture is understanding that there is no one policy or approach to wellbeing support that suits everyone. Managers should always listen and try to understand their team’s needs and, where reasonable, make adjustments to suit the individuals within the teams.

It is important that every team member feels valued, knows their voice matters and is heard and importantly has an understanding of their purpose and how they contribute to the team and the wider organization.

From my perspective a major part of having a fantastic work culture is a culture where employees feel that a dialogue about mental health is both welcomed and expected. Developing such a culture is dependent on two factors:

1. Ensuring that within the work culture, mental health is seen as much more than the absence of mental illness. This involves communicating clearly to staff the concept that mental health exists on a continuum from healthy to stressed to ill. As such employees should perceive what they can do to support mental health in terms of Enhancement (for those who are mentally fit but want to be fitter), Prevention (for those who are experiencing stress and don’t want it to worsen) to Treatment (for those experiencing mental ill health).
2. Connected to 1 employers provide, and let staff know about, the range of options available within the workplace that can support then in terms of enhancement (e.g. Mental Health Awareness training), prevention (e.g. Resilience Training) to treatment (e.g. fast access to effective psychological treatment).

Can you please give us your favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life?

“People are not disturbed by things, but by the views they take of them.”

This is a quote from Epictetus. Epictetus was a Greek Stoic philosopher. I am not a general follower of the Greek Stoic philosophers…but know this quote because it is the basic premise of Cognitive Behaviour Therapy (CBT), the type of therapy I am trained in.

In essence this quote means — It isn’t things (stuff that happens to us) that leads to our mood…i.e. make us unhappy, irritable, sad, angry, worried etc. It is the way in which we think about these things that leads to our mood. It is such a simple premise but also very powerful in a number of ways. Firstly, if it isn’t the thing (the weather, the argument, the fact that that person didn’t say hello today) that led to my mood then I have the opportunity to change my thinking and hence my mood (and the way I then act, i.e. my behaviours).

Secondly, it isn’t all about positive thinking. Once I am aware that is my thinking…not events, that leads to my mood, I can then start to consider if my thinking is unhelpful or helpful. Note, not positive or negative. Individuals often make the mistake that CBT is about positive thinking…and as a result have difficulty engaging with it. Looking at the world today it would be very difficult to think positively about many things. However, there are more helpful and less helpful ways to think about what’s happening.

For example “The world’s ruined, everything is falling apart…there’s no point in trying anything” is likely to lead to low mood and anxiety and withdrawal in terms of behaviour, whereas “Things are very difficult at the moment…there are lots of things I can’t change…what areas of my life can I have an influence on?” is more likely to lead to more hopeful mood and problem solving behaviours.

We would love to hear about five steps or initiatives that companies have taken to help improve or optimize their employees’ mental wellness. Can you please share a story or example for each?

We have supported a range of employers to support employee wellness. Most importantly we started with ourselves. Nuffield Health employs 16000 employees across a range of business areas; hospitals, fitness and wellbeing centers, corporate sites, and contact centers. During the pandemic our ‘Healthy Work — Supporting our People’ initiative put mental health at the core of our agenda. We took the continuum approach I described earlier and provided all employees access to modes of support to enhance, prevent and treat.

If we are to effectively support other employers to optimise employee mental wellness we need to get it right internally first. I am really proud of the work we have done internally in this area.

This commitment to workplace mental wellbeing has (deservedly) been recognised, with the Nuffield Health initiative being shortlisted by both the Nursing Times Workforce Awards and the ‘Not a Red Card’ Awards — celebrating Mental Health Excellence in the Workplace.

Five key steps that were taken by Nuffield Health were:

We have given ALL staff free access to a proven effective online self-help cognitive behaviour therapy platform. This aids staff to develop skills and coping techniques to improve mental wellbeing in many areas (sleep, money worries, body image, stress, resilience etc.) Uptake of this platform has been high with positive feedback.

We also developed and delivered Emotional Literacy Training (via an online platform) to all staff. This was designed to equip all employees with the skills to hold conversations confidently around mental health (as managers and employees) and give them a common language to discuss their feelings. This training builds a positive culture around mental health, helping employees notice signs of distress in others and giving them the confidence to approach them appropriately. In fact, at Nuffield Health, over three-quarters of employees have successfully completed Emotional Literacy Training.

It is notable that this training was not made mandatory, with high uptake mainly due to good initial internal communications and then word of mouth. Following completion of the training 94 percent of participants stated that they felt confident supporting a colleague showing signs of emotional distress.

In addition, we have trained 230 Emotional Wellbeing Champions (via our internally developed Mental Health First Care Training course) across all areas of the business. These individuals act as ambassadors of the open culture of mental health and normalize conversations around mental health. They give employees the knowledge that there’s someone to talk to who is empowered with the knowledge and empathy to listen to them and point them towards the right support. This network of Emotional Wellbeing Champions, in combination with emotionally literate line managers, have the confidence to encourage conversations around mental wellbeing and to ensure employees gain access to the right support at the right time.

Within Nuffield Health we have also offered a range of webinars as well as ½ day, 1 day and 2 day courses on subjects such as sleep, stress, resilience, the menopause. This maintains a conversation about mental wellbeing and builds a culture where discussions about mental health are both welcome and expected. We have also developed a Wellbeing Hub, which is a fantastic repository, on our intranet that stores a range of articles, guide, and tools to support mental, physical, financial and social wellbeing.

Finally, we offer access to psychological therapy free of charge to ALL staff. Staff are able to access a booking portal on the Nuffield Health intranet. If an employee is concerned about their mental health, they book an appointment with a mental health professional who will then offer advice and if necessary, get the individual booked in for treatment with the appropriate mental health professional.

Data we have collected internally suggests that our progressive approach, has been very effective during the most difficult of circumstances. Having tested what works and how, we have the expertise and confidence to guide our clients to develop their own wellbeing strategies using some or all of the elements above.

What strategies would you suggest raising awareness about the importance of supporting the mental wellness of employees?

The cost of mental ill-health to businesses up to £42 billion a year as a result of absenteeism and presenteeism stemming from employee mental ill health. Raising awareness of this often-unspoken issue can help leaders understand the issues facing those on the front line and the very real impact for the business. But you need more than just quoting the cost ‘at’ people.

As noted previously the key to raising awareness is ensuring that there is a range of support within the workplace that act as a signpost that a dialogue about mental health is both welcomed and expected. In addition, these types of support then need to be communicated to all staff effectively. It is vital that this is communicated with the right message and via the correct medium.

The right message = Mental health is much more than the absence of mental illness. We all have mental health and it exists on a continuum. ‘It’s okay not be okay and its okay to want to be better than okay’. As such as an employer we offer the following support to enable you to enhance, prevent and treat mental health.

The correct medium = Typically employers email messages. Working with large corporates in various sectors and with our staff in the hospitals we have found that this doesn’t always work. For example, supermarket staff and nurses have one thing in common…they don’t look at emails. We had to design bespoke posters (with easy access QR codes) to go in staffrooms, back of toilet doors…in order to reach these staff in ways which would work. In addition the correct medium may be via people — enthusiastic Mental Health Champions (who understand their local teams) or key leaders with lived experience of mental ill health are very effective in raising awareness about the import of mental wellness of employees.

From your experience or research, what are different steps that each of us as individuals, as a community and as a society, can take to effectively offer support to those around us who are feeling stressed, depressed, anxious and having other mental health issues?

We often hear that it’s ‘time to talk’ about mental health — which is absolutely true and talking is crucial in normalizing conversations around mental health, which can encourage more people to seek support when they need to, instead of struggling in silence.

However, I believe it’s also ‘time to listen’. The onus should not be on those experiencing distress or mental ill health to talk. The onus should be on us all to be able and willing to listen, For many individuals, opening up about their experience with mental ill-health is stressful and they need to know that the person they’re speaking to is truly listening, understanding and onboarding what they’re telling them.

Active listening is a skill all leaders should focus on improving. It’s about more than just being there for an employee who wants to talk, it requires a genuine understanding and retention of what’s being said and providing a considered response. This means providing feedback, showing you’re not simply a passenger in the conversation. The key to this is having a non-judgmental and empathic attitude, where rather than thinking ‘What is wrong with you’ you are able to understand that emotional distress has a cause which you may not always be aware of or fully understand due to everyone’s experience being different. This will help maintain ‘meaningful’ active listening.

Sensitively repeat key phrases back to employees to show you’ve taken them on board and, where possible, rephrase key messages to show you’ve grasped the meaning.

Don’t speak over individuals or second-guess what they’re saying, as this implies, you’re not absorbing their disclosure but waiting to speak yourself. Speaking about your own experiences may seem comforting but be aware it may also look like you’ve not considered issues from their perspective or are trying to ‘top’ what they are saying. So best used really carefully.

Also, consider the language being used when discussing mental health. A culture of unhelpful words or phrases can prevent people from speaking openly for fear of being stigmatized. The Journal of Positive Psychology suggests conversations about mental health should focus on wider feelings rather than clinical diagnosis, replacing terms like depression or anxiety with dialogue around more general distress.

Habits can play a huge role in mental wellness. What are the best strategies you would suggest developing good healthy habits for optimal mental wellness that can replace any poor habits?

As with any behaviour change or strategy to develop healthier strategies the key should be “Think small but act big”. That is…start by making small changes but REALLY commit to them. The key areas that help to maintain mental wellbeing are:

1. Social Connections — having frequent, positive connection with important the people your life
2. Maintaining ourselves physically — attending to diet, sleep, exercise, etc.
3. Living a life that has purpose — Identify your values, passions and what matters most to you in life
4. Helpful vs Unhelpful Thinking — The ability to think about your thinking, notice unhelpful thinking and replace with more helpful thoughts.
5. Self-awareness and self-compassion — Appreciate strengths and learn to practice self-compassion rather than being self-critical.

I would suggest taking each of these 5 areas and then committing to making small changes in each area.

For example, 1. I will commit to ringing my daughter once per week, 2. I will go for a 15 minute walk each night after work, 3. I will restart photography — I will take one photo each week, 4. I will keep a thought diary to help me notice unhelpful thinking, 5. I will make a note of one thing I am grateful for at the end of each day.

Then set an alarm on your phone for a week’s time and review how you did.

Do you use any meditation, breathing or mind-calming practices that promote your mental wellbeing?

I user a number of strategies to manage stress and keep my mind healthy depending on the situation. My preferred technique is probably a version of mindfulness. Mindfulness, as a concept is often misunderstood. People often associate it with sitting still in awkward poses for long periods or alternatively it has often been hailed as a ‘cure all’ for any psychological difficulty.

In my experience mindfulness works best when used simply as tool which encourages me to ‘pause’ and ‘notice’. This gives me the opportunity to reflect calmly in a situation and gives me the opportunity to ‘’choose how I respond rather than simply ‘reacting’ as if on auto-pilot.

For me it works best in bite size doses and has helped me become much more self-aware. For example, if I notice I am experiencing a strong emotional reaction, I will pause, notice what is happening (by asking myself ‘what is happening with my thoughts’ or what is happening with my body’) and then consider different alternatives for how best to respond. It helps me to slow down in stressful situations and think about different possibilities which often stops me over reacting.

I find that a thought diary is also helpful and helps me to appraise whether my thinking style during any situation is helpful or unhelpful.

I would really encourage anyone who hasn’t tried these techniques to give them a go. Like any new skill they take practice, and you don’t always see the results straight away. It really is worth persevering as they can have a really positive impact — they have certainly changed my life in many ways.

Is there a particular book that made a significant impact on you? Can you share a story?

Man’s Search For Meaning — Viktor E Frankl. “Everything can be taken from a man but one thing: the last of the human freedoms — to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

This book an autobiographical account of Viktor E. Frankl’s development of a type therapy called “Logotherapy.” (‘meaning therapy’). Frankl was a renowned 19th century psychologist initially working in Vienna. In essence Logotherapy argues that finding meaning and purpose in life is the key to personal happiness and well-being. The book isn’t a psychological theory book though — it shows how to practically use psychological techniques in very extreme life circumstances. From 1942 Frankl, his pregnant wife, his parents and his brother where imprisoned for three years, first in a Nazi ghetto and then in Nazi concentration camps. All of them apart from Frankl died. Frankl applied his theory to his own immediate situation, to console himself and his fellow prisoners. It sounds like a really hard read…but it isn’t, his approach is so powerful and uplifting.

I first read this book early in my career in psychology when I was trying to understand how I could help people when their situation — on the face of it — seemed truly really really hard and hopeless. At the time I was working as a psychiatric nurse in the community. I’d visit people who had long term mental ill health and were living in really difficult living conditions with very little money and I’d wonder “How can I help…make any difference?” This book was so helpful in giving me the focus to help people find their own meaning to life.

The narrative and many of the quotes within this book are eerily pertinent in a Covid-19 world. “For the world is in a bad state, but everything will become still worse unless each of us does his best.”

If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

In the current context of a contagious virus that impacts so much on the quality of all our lives my movement would be #SpreadKindness

At Nuffield Health we are in the business of kindness — being kind to our patients and members is part of the job. There are many different motivations for kindness. Kindness may occur due to empathy, compassion, gratitude and due to seeing someone else being kind. Whatever the motivation, one thing is clear, kindness has never been so important. Kindness can:

• Reduce stress
• Increase happiness
• Boost our immune system
• Lower blood pressure.

Doing an act of kindness produces the single most reliable increase in well-being of any exercise that has been tested. Kindness strengthens interpersonal relationships and establishes virtuous cycles of positive behaviour within organizations.

Kindness should be built into business decisions, government policy and official systems in a way that supports everyone’s mental health and also reduces discrimination and inequality.

It can have a positive impact on the culture and performance of organizations — kindness within organizations builds trust, collaboration, productivity and loyalty. And people who work in a kind environment are more inclined to be kind to customers.

And…

Inspires More Kindness.

The current stress caused by Covid-19 could lead to some of us becoming more self-focused — the very thought of being kind can seem exhausting. But this overlooks the ‘ripple effect’ of kindness. Kindness spreads.

Researchers have shown that kindness spreads from person to person to person. One small act of kindness can echo much more widely than the original act of kindness. When people benefit from kindness, they are more likely “pay it forward” by helping others, and this creates a butterfly effect that transmits kindness to dozens more within a social network. ​

However, it is easy to forget where kindness should begin. Kindness toward the self. Kindness begins with the individual. We usually think of kindness as kindness toward others but being kind to yourself is equally important. So, my movement would focus on spreading kindness by starting with Self-Kindness.

Self-kindness involves a gentle and understanding relationship with ourselves rather than being harsh, critical and judgmental. It means treating ourselves as we would treat a close friend. How often do we call ourselves the names (I’m such an idiot…) that we would not dream of calling someone we care about.

Real kindness starts with being kind to yourself. Once you are truly kind to yourself your capacity to be kind to others will increase.

“Be kind to yourself.”

By making this commitment we embrace kindness, we set the right conditions for the ripple, and create a wave of kindness that unites us and improves the experience of being humankind for all of us.

What is the best way our readers can further follow your work online?

The easiest way to follow all my latest articles and emotional wellbeing advice is on the Nuffield Health website, which you can find here.