Nothing characterises the inherent failure to treat mental health and physical health equitably more than the way people respond when you are off.

I had lunch today with a chap who has just gone back to work after 8 weeks off with depression. He does a difficult job, in really challenging conditions, while single parenting two teenagers. A tricky new boss had been the icing on his already quite indigestible cake. The stress had a corrosive effect, ultimately leading him through persistent low mood, fatigue, poor appetite and, counterintuitively, weight gain and dreadful concentration to a point where he began to have suicidal thoughts. He didn’t have means or a plan – but he found himself so overwhelmed he hoped his train would crash. Dying, or at least serious injury, seemed an attractive way to stop the darkness he was living with.

He went off, quite open about why he was signed off. The team dynamics have always been good, lots of socialising and positive reinforcement and he had spoken often to everyone about the importance of looking after their mental health, determined to bust the stigma and make sure people felt OK to say if they felt overwhelmed, stressed or struggling.

He was off for 8 weeks in total, receiving excellent care and support from the NHS and his family. While off he received no calls, no cards, no flowers from work – nothing.

Also while he was off another member of the team – we will call him Jim, suffered a heart attack (note to self, avoid a job in this place…!). Like his colleague, Jim too had experienced a pain so bad he thought death would be a release. In all likelihood it, too, is stress driven. He too had excellent NHS care and returned after 8 weeks. However, while he was off, he also received hospital visits, cards and funny messages from the team to keep his spirits up.

When asked why they had been strangers to the depressed colleague, the team replied, variously:

“I didn’t want to disturb”

“I didn’t know what to say”

“I didn’t want to make it worse”

“I was worried I would say the wrong thing”

His new boss, when asked if he had made the required ‘keep in touch calls’, openly declared to HR “I don’t think it helps to call people in ‘these situations’ “. His peers in other teams similarly heard of his absence but ‘didn’t think it was their place to say anything’, though several knew and had genuinely sympathised with his increasingly difficult position before he went off.

At his lowest ebb, at a time when he added the guilt of being absent to all the other dark thoughts he was having, when he felt most isolated, no one he worked with on a daily basis thought he would welcome contact.  These are the people he saw more often than anyone in his family, more often than any of his friends. People he socialised with and enjoyed raucous nights out with, commiserated with over their family and work drama’s and celebrated their triumphs and life events were too uncertain about how to help and therefore defaulted to avoidance.

No one thought he would value being reassured that everyone was rooting for him, that everyone sent their best wishes and that everyone was looking forward to seeing him back as soon as he was well.

They did all root for him and they were looking forward to his return. But the ‘mental health thing’ made them wary, reluctant and shy.   A heart attack? Oh that’s a known thing – an actual illness, we can rise to that – we can wish him well in his recovery – that doesn’t involve emotions, possible tears and inexplicable outbursts. We know where we are with a heart attack.

How marvellous would a workplace be where:

a)      His deterioration was noticed early by compassionate managers who observed the change in his behaviour, approached him to gently ask if al was OK and he got the support he needed sooner so he didn’t need time off.

b)     If time off was needed, he received the same overt expressions of support that physical illness sufferers received, and his struggles were not compounded by clumsy assumptions and increased isolation and guilt as a result.

c)      Mental health was openly discussed and staff had training to explore ways to respond, ideas for starting conversations and experience of talking about mental health so they didn’t feel unsure but instead felt confident and could be actively supportive.

We have a long way to go before that’s completely commonplace but change starts with the individual.