First published as an article in Coaching at Work, May 8 2017
By Liz Pick and Liz Hall
Part 1 of a series of articles published to mark UK Mental Health Awareness Week on 8-14 May 2018, that looked to support individuals and organisations in challenging times.
Is a blanket refusal to work with coaching clients with mental health issues tenable?
By Liz Pick and Liz Hall
Many people with mental health issues fail to get support from coaching because coaches and organisations believe it falls outside their remit. Yet with mental health issues on the rise and mental ill health costing UK employers an estimated £26bn a year (London’s City Mental Health Alliance), a blanket approach of refusing to work with anyone who has experienced mental illness is arguably impractical, untenable and needlessly exclusive.
Take ‘Helen’ (not her real name), who has previously suffered from mental illness. She’s just been promoted to a high-profile and potentially highly stressful role and has been assigned a coach to help her transition. Helen can manage her condition so it doesn’t impact on her work, so she hasn’t told her employer about it. She has told her coach because coaching sessions are confidential and she thinks she may need to adapt her style of working to prevent future relapses.
However, Helen’s coach tells her that he/she doesn’t work with clients with mental health conditions, that she’d really be better off seeing a counsellor and that the coaching programme should end prematurely. When Helen’s manager asks her why the coaching stopped and guesses correctly, it goes on her HR records.
Was Helen asking for help with her condition? No, she wanted coaching on her work. Did she need counselling? Not to the coach’s or our knowledge. Was she able to engage with coaching? Neither we, nor the coach, have reason to think otherwise.
This is not an unusual scenario. Many people are seemingly being unnecessarily and undiscerningly excluded from development that their colleagues enjoy, purely on the grounds of mental ill health.
The reality is that it’s by no means just the occasional client who is affected with mental health or other health issues. One in six working people has a diagnosed mental health condition, and other statistics highlight how widespread mental health issues are (see Fact file and Further information section below).
Are we saying that all these people are uncoachable? Are we stigmatising people who are able to work effectively because they self-manage well – and are perfectly able to engage in coaching? Are we denying people the opportunity to get support to ‘nip things in the bud’?
Are employers unnecessarily excluding certain groups of people from gaining access to support offered to others, even laying themselves open to protracted periods of sickness absence, even litigation?
Although coaching practice has in some cases become stuck when it comes to working with mental health and other illness, more and more coaches are realising they’re ideally placed to help promote health and well-being. The establishment of the Association of Integrative Coach-Therapist Professionals, which held its first conference in January (News, page 12) is helping open up dialogue about increased fluidity around approaches.
One problem is that coaching codes of ethics don’t really offer clarity, leaving it to coaches to decide. For example, the Global Code of Ethics, to which both the Association for Coaching and European Mentoring & Coaching Council are signatories, says (4.1): “Members will have the qualifications, skills and experience appropriate to meet the needs of the client and operate within the limits of their competence. Members should refer the client to more experienced or suitably qualified coaches, mentors or professionals, if appropriate.”
As Eve Turner, who has researched ethics in various contexts, says: “This seems sensible as it is not proscriptive and relies on our professional and ethical practice to guide us.”
However, as she points out: “This will work as long as it is something that we actively engage in, for example, through our CPD, supervision and active reflective practice.”
We would add coach training here too. Many programmes fail to equip coaches to navigate mental health or even explore emotions – Duffell and Lawton Smith (in their article Once more with feeling) highlight a lack of training for coaches to work with emotions arising in coaching, even though these offer valuable information.
Yet coaching has much to offer those managing mental health issues. One advantage is that employees can discuss poor mental health or other conditions confidentially. Given the still prevalent stigma surrounding mental illness, some employees may be resistant to therapy or to using an Employee Assistance Programme (EAP). Although 23% of employees said they had access to an EAP, just 2% had used it during their most recent instances of mental ill health, according to UK charity Business in the Community (BITC)’s 2016 National Employee Mental Wellbeing poll of more than 20,000 people.
As Carrie Birmingham highlights in her article as part of this series (That sinking feeling), coaching can be a just-in-time intervention, helping employees avoid becoming depressed and taking time off work. It can offer a safe space where individuals can explore difficult feelings, thoughts and symptoms. It can help them develop personalised strategies to work with these, while ‘normalising’ what’s going on for them so they don’t feel alone. Where necessary, it can offer a portal to further specialist help, including therapy.
Of course, just because a client shares personal information about their health with their coach, doesn’t mean they’re asking for help. They’re possibly telling the coach because it forms part of their thinking about the interplay between their work and well-being, and believe it would be useful if the coach knew.
Making the call
So how can coaches decide whether they should embark on or continue with coaching someone with a mental health or other condition?
Turner’s Master’s coaching dissertation research among 376 participants, showed that coaches felt there was a continuum, rather than a line coaches shouldn’t cross in terms of the subjects they tackled. Where people put themselves on this continuum varied according to their training, background and experience, she found.
In practice, many coaches are happy to work with clients, whatever their condition.
However, this is often happening under the radar, in confidential coaching conversations that are often not recognised or measured in terms of impact by the sponsoring organisation.
Other coaches, who may embrace building resilience, play safe by simply refusing to work with anyone who isn’t ‘healthy’. But is this realistic?
As Eve Turner says, “There is an assumption that coaches/mentors work with people who are mentally well, but given the statistics many people we work with are likely to have had some mental health problems.”
We only need to look at the statistics (see Fact file) to realise that every coach is likely to have clients living with challenges to their physical and mental state or personal lives, whether the coach knows it or not. Clients are likely to have people in their teams with their own well-being challenges. And of course, coaches and other helping professionals may also have their own mental health issues.
For Eve Turner, it’s about “considering whether the condition means the person we are working with is capable of functioning in the world.
“That is not something I would do lightly, but with experience, support in my practice, for example through CPD, supervision, ongoing reflection and referring to Andrew and Carole Buckley’s book, A Guide to Coaching and Mental Health (2006). My own view is to stay alert to possibilities – not to rule out someone because they have a mental health condition, but to understand context and make a judgement, including on my competence.”
She says that where the client is working with other professionals, such as a therapist or psychiatrist, she will always ask them to “explicitly check with that person that nothing we do would jeopardise other work they are doing”. And of course, discussing what she feels competent to work with is also part of the initial contracting, she says. Having access to CPD and supervision is crucial, as is paying attention to initial contracting.
If the client is able to continue working effectively, and we feel sufficiently equipped to support them, why deny them the benefits of coaching? Even if we help them find additional support, this doesn’t mean we have to stop the coaching.
Instead of an exclusive approach of “I won’t work with clients’ mental or physical health conditions,” why not try a more inclusive one? (see An inclusive approach below).
Liz Pick has been a coach for 23 years and set up Performance & Wellbeing Ltd in 2009, because so many of her clients needed to manage issues that impacted on their work, such as stress, physical and mental illness and burnout. Over the years, she developed an integrative approach to coaching, meeting with any client well enough to work, as long as they are able to engage productively with coaching.
Liz Hall, the editor of Coaching at Work, draws on mindfulness, compassion and somatics to inform her coaching approach, allowing her to help clients facing challenges, including around mental health.
Case study: The turning point
Stephen Larke, a former vice president at IT consultancy Capgemini, was performing well at work and had no previous history of mental illness. So when he was diagnosed with clinical depression in 2015, it came as a shock to himself and work colleagues.
He’d been able to function at work, he says, “very effectively when it came to visible and urgent activities, even very demanding or high-profile ones. This made my plight invisible to those I worked with”.
He feels business leaders need to do more to encourage discussion about mental health issues, to help dispel people’s fears about the impact on their career prospects if they seek help.
“Since going through my experience, I‘ve become far more aware of the inconsistent way the topic is dealt with in the workplace. I’ve been prepared to speak openly about my experience to people I know well and have found several others that have become unwell and not all have had the level of support that I received. There is a need to train managers in how to support staff, not just at the time of becoming unwell, but through the process of re-integration into work. And there is a need for senior leaders who have been through this experience to share their story. I know that one year on I am a stronger, more resilient and hopefully wiser and more supportive leader than I was before.”
He believes coaches, too, need to make sure they don’t see mental illness as failing. “For coaches, it’s important that they don’t see someone getting help for a mental illness as a failure. A coach is likely to want their client to excel and few will have a success criteria that involves being diagnosed with depression or anxiety. But in fact, and in my case, this was the turning point that allowed recovery to take place and the real benefits of coaching to then be more easily accessed.”
Fact file and further information
- At least one in every three working age people (aged 16-64) have a long-term health condition which might in the future, or may already, affect their ability to work (The Work Foundation). Of those with a physical long-term health condition, one in three also has mental illness, most often depression or anxiety.
- The total number of working days lost due to mental health in 2015/16 was 11.7 million days. This equated to an average of 23.9 days lost per case (Health & Safety Executive).
- Some 77% of employees have experienced symptoms of poor mental health at some point, with 62% saying work was a contributing factor, according to UK charity Business in the Community (BITC)’s 2016 National Employee Mental Wellbeing poll of more than 20,000 people, released in October 2016.
The curse of the strong
Standard Chartered Bank is at the forefront of organisations taking a holistic approach to employees’ well-being, offering a suite of interventions and tools including: coaching, counselling, neuroscience-education and gadgets to monitor heart rates, for example.
One of its leaders, Samantha King, global head of executive development and an executive coach, knows from experience the value of an employer looking after their people well – she herself had a breakdown nine years ago.
She’s happy to share her story to help break through the stigma attached to mental illness and to improve the level of support offered to those experiencing difficulties. It’s also a cause dear to her heart because when she was 23, her 25-year-old brother took his own life. Nobody had realised he was ill.
This was the case with Sam too. “I was so good at saying, ‘I’m fine’. I cut off my emotions. I had absolutely no idea how ill I was…I suspect people who are seriously ill don’t show it.”
Sam says she’s “like many – a working mum, with four kids, and I’ve always worked very hard.
“As Tim Cantopher says (2012), ‘depressive illness is the curse of the strong’. There are two psychological profiles that make it more likely: 1) If people are externally referenced, caring a lot about what other people think, and 2) If they’re strivers, driven to achieve. I’m both of those. I don’t know when to stop and if I hit a hard time, I think, ‘I’ll just work harder’.”
Sam’s husband has always played a significant family role and yet also travels with work internationally. Sam herself found she was travelling nearly every other week to Russia over two years – all in a highly pressured work situation. Not seeing any alternative, she fell into a pattern of working through the night once at least every fortnight, regularly coping with three hours’ sleep. “Because I’d run a marathon in the past, I treated myself like an ox. I had no idea what damage a lack of sleep does. I’d think, I’ve got to finish all the work so I’d stay up. I became insomniac – when I wanted to sleep, I couldn’t.”
She then discovered she had breast cancer. Six months after an operation and radiotherapy, she still hadn’t fully recovered and when her employer sent her for counselling at the Priory Hospital, she “completely unravelled” and took two months to recover.
“There were some funny stories – humour can play a great role in getting better. I knew when I was getting better because people were saying they felt safer when I was there, being a coach to others.”
Sam says “the main thing is to identify the early signs of being at risk, and give people the proper help they need or avoid it altogether.”
For Sam, physical signs included getting a stiff neck, chest pains and unusual headaches. “I prefer to describe it as a chemical breakdown, with what feels like electric shocks when the serotonin is low.”
Nowadays, it’s “recognising lack of sleep and brain fogginess, starting to forget and lose things and losing the ability to read and concentrate. These are all symptoms of your body telling you to back into a cave and be solitary, to stop all roles to get better.”
After a tough 18 months’ recovery, she joined Standard Chartered. Advertising itself as “a bank with a heart”, Sam has found it a critical step on her recovery, with its very friendly, diverse culture. Setting out to work differently from the start, Sam took advantage of the Bank’s flexible working and gradually dared to share more of her own experience for others’ benefit.
Sam wishes she’d met neuroscientist Tara Swart earlier. Sam introduced Swart as part of a team of performance and well-being specialists. “She makes it real for leaders, making it clear how harmful it is not to get enough sleep, even that a lack of sleep causes dementia,” says Sam.
From the sports field, the Bank has added Simon Shepard’s Optima-life’s digital heart-rate monitoring as part of executive development interventions. “It offers a fantastic structure for starting to change behaviour. Being bankers, they value the personal data,” she says.
Leaders are offered feedback coaching, and all interventions include peer group coaching to share insights.
When things get really bad, coaching isn’t the right approach. But can coaching nip things in the bud? “Absolutely. Coaching has a big role in prevention and avoidance.”
Does Sam wish she hadn’t gone through her breakdown? “Actually I’m ironically grateful for it, although I wouldn’t wish it on anyone…it somehow makes you stronger, like the phoenix rising from the flames. Everything unravels, all the roles you take on in society, you see what’s left, and how you can rebuild yourself, working at the heart of your identity.
However, I always remain vulnerable for it to return, which is scary, but I try to keep aware.”
T Cantopher, Depressive illness: The Curse of The Strong, London: Sheldon Press, 2012
An inclusive approach
My definitions are as follows:
Inclusive organisations: those which create a physical and cultural work environment that anticipates and caters for the needs of the widest possible number of employees, so that everyone can work to the best of their ability.
Inclusive coaching: where the focus is on enabling each person to work to the best of their ability, whether or not they are seen as belonging to any groups defined by the Equality Act 2010:
- disability or illness
- pregnancy and maternity/paternity
- religion or belief
- sexual orientation
- gender reassignment
For the coach, this means:
- Adopt an inclusive starting position: This means you will work with anyone unless they are unable to engage positively with coaching and/or unless there is a case for them causing harm to self and others or if they are engaged in illegal activity. This way you meet the person and assess their ability to engage. Test this over two or three sessions and, if the client is still not engaging, then stop, as with any other client.
- Ask upfront: Rather than waiting to be told, asking about mental health says it’s important and relevant. Remember, if the client chooses to inform the coach about mental illness, this doesn’t necessarily mean they want help with the condition. They may want help with how to achieve the organisational agenda within any challenges.
Questions to ask the client:
- Is there anything in your past that influences how you work?
- What determines your quality of work and of life?
- What energises you and what drains you?
- What makes you happy and what stresses you?
- Is there anything it would be useful for me to be aware of?
- Could you summarise our conversation and the areas you want to work on with me, and those you can work on in other ways?
- Do what you’re comfortable with: Of course, health issues are not always easy to talk about and you may decide not to work with particular clients for reasons of your own. In which case, make it clear this is due to your own issues, not theirs.
For the coaching sponsor, this means:
- Change the culture: Avoid passive exclusion from coaching of certain categories of people, such as those with a mental health issue. Instead of looking at what coaches won’t work with, take the approach that every coach will work with clients with wellbeing challenges, unless they specifically say otherwise.
- Take a systemic approach: Make sure you know not only how well-being is addressed generally, but how/whether coaching is being offered to those managing health conditions.
Questions for purchasers to consider:
- Do you have a strategy for addressing both positive and negative client well-being in coaching?
- Do you know which of your coaches address the impact of both positive and negative well-being?
- If one of your coaches stops working with a client for health/well-being reasons, how do you manage it?
- Do you provide self-referred access to coaches? If so, do you know what goes on in the coaching?
Case study: Returning to work after acute illness
The first time I was asked to work on both the performance and well-being of a client was with ‘George’, a global account director for a financial institution, with responsibility for a multi-billion pound budget.
George was returning to work after six months’ sickness and although he was assessed as fit to work, his employers were anxious he didn’t have a relapse due to the stress involved in his role.
My initial reaction was anxiety – wasn’t this outside my level of competence? What if he got worse? I talked to my supervisor who understood my concerns, but asked me to question why I would refuse to work with George before finding out what he wanted.
As the referral was from occupational health and George had been assessed as fit to return to work, it was possible he was looking for exactly what I could offer. So I arranged a meeting to find out more, thinking he perhaps wanted to become more efficient through improved delegation, time management and communication while ensuring that he didn’t increase his stress levels.
In fact, George wanted help with working nine to five for health reasons in a department with a long hours culture; adapting to new systems introduced while he was away; managing some predictably stressful situations and to stop working at home.
During our first meeting, George informed me that his illness wasn’t stress-related, but purely physical. “I don’t do feelings”, was a phrase he used. He then described his responsibilities and modes of working and it became clear that he had a strong drive to feel in control, had a somewhat confrontational communication style and displayed a typical ‘type A’ personality.
I explored with him other potential sources of stress and found that he had a very happy home life and was relatively financially secure. I therefore decided that although he was in my view prone to very high levels of stress and suppressed emotion at work, this work was suitable for a coach with my experience and we agreed to work together.
Over time he became adept at recognising when he was experiencing anxiety and developed ways of managing his stress levels. Towards the end of our work he acknowledged openly that his illness was almost certainly stress related.
Two years after our coaching programme he remains healthy and achieves the demanding targets set by the organisation.