Disability awareness at work has increased phenomenally in recent years and with the development of disability discrimination protection laws (from the old DDA to the newer Equality Act 2010) more and more disabled people are finding it easier to access employment.

But not all disabilities are visible or immediately obvious – so how do we help support and manage people with hidden disabilities?

Types of hidden disability might include:

• “Neurodivergent” conditions – such as autism, Asperger’s, ADHD, dyslexia, dyspraxia and Tourette’s)
• Mental Health conditions – such as anxiety, depression, Bi-Polar disorder and agoraphobia
• Physical conditions that are not immediately obvious – such as Crohn’s Disease, IBS, endometriosis and epilepsy

I’ve covered reasonable adjustments for disabled staff in other blogs, but wanted this one to focus more on potential real-life scenarios that you might come across in your teams.

Example 1 – Jenny and IBS

Jenny frequently goes to the toilet while at work and sometimes spends 20 minutes away from her desk. Her colleagues know that she has IBS but think that she is using it as an excuse to avoid work. She is not pulling her weight and the colleagues start to keep a tally of when she goes to the toilet and how long she spends there. Jenny hears about the list and feels that her colleagues are making fun of her, but is too embarrassed to confront them.

What can you do as a manager?

• Meet regularly with Jenny to discuss her health issue and what the Practice can do to support her. Ensure the discussions are friendly and supportive, reminding her that she can talk to you if she has any problems or concerns
• If you spot any of the behaviours from her colleagues, or Jenny discloses them to you, tackle it head-on. Explain to the staff that what they’re doing could amount to bullying and harassment and that we should be supporting colleagues who suffer from health problems. Consider raising awareness of IBS amongst the staff to educate them on the impact of the condition

Example 2 – Steve and Depression

Steve suffers from depression and anxiety. He works as a prescription clerk in a busy surgery with 15,000 patients. He has been off sick for 6 weeks due to his depression and came back to work two weeks ago. He explained to his line manager last week that he is struggling with the volume of work and that he felt under pressure to hit his KPI’s. His manager suggests that he arrange some counselling sessions and asked if there was anything she could do to help. Steve feels awkward about asking her to reduce his workload so replied that he wasn’t sure of anything that could help. If things don’t improve he is considering resigning as he doesn’t feel he can carry on in the job and is worried about making mistakes.

What can you do as a manager?

• Revisit the conversation – employees are often shy in coming forward with information that they feel may not paint them in the best light, so don’t just take a first refusal and move on. Make suggestions yourself if they say they can’t think of anything. Some people are more likely to accept help if they don’t have to get over the hurdle of asking for it in the first place.
• Increase your own awareness of how depression and anxiety might be impacting the employee in their role, and what suggestions you can make to help. If concentration is affected, do you adjust their targets so they have more time to check their work? If medication makes them tired, can they adjust their hours or working pattern or take more breaks to keep up?
• What assistance can the Practice provide? If there is a long wait for NHS counselling can the Practice pay for some private sessions? Do you have access to an Employee Assistance Programme?

Example 3 – Jeremy and Dyslexia

Jeremy is dyslexic and applies for and is offered a job as a secretary. He completes a ‘new starter form’ and disclosed on the form that he is dyslexic. The Senior Partner says that she doesn’t think they should take on someone with dyslexia as the GP’s don’t have the time to proofread every letter and correct mistakes, so the job is withdrawn and Jeremy is told there is no need for the vacancy anymore.

What can you do as a manager?

• First of all you can’t let this happen as it could see you end up in a tribunal!
• Explore with Jeremy how the dyslexia affects him and how that might manifest in this role
• Consider what adjustments you could make that would minimise the impact of his dyslexia or negate it completely – for example dictation software, coloured paper etc.
• Consider educating your Senior Partner on the potential implications of disability discrimination!

Example 4 – Steph and Asperger’s Syndrome

Steph has Asperger’s and as a result has difficulties with social communication and social interaction. She takes a very literal understanding of what others say and do. She finds it difficult to understand jokes and gets particularly upset when others interrupt her train of thought or bombard her with too many questions and comments. She works for you as an administrator and is responsible for taking notes in meetings and presenting information. Colleagues have noticed that when she is interrupted when speaking she becomes upset, stops what she is saying and starts from the beginning again, which some colleagues can find frustrating and don’t know how to react to.

What can you do as a manager?

• Educate your staff on Asperger’s Syndrome and how it might manifest itself. If Steph feels comfortable to do so, have her explain her preferences for communication
• You can also seek to educate Steph about social interactions, explaining that meetings are often a good place for people to discuss ideas with each other and that people can be passionate about certain subjects, so if they interrupt her it’s not to be rude, it is because they want to contribute to the discussion

The last two examples reference staff with neurodivergent conditions. Some big businesses have recently started to emphasise recruitment of individuals with these conditions – including Microsoft, Ford, Vodafone and Hewlett Packard – as they appreciate the value people with these conditions to their industry. However still only around 15% of those diagnosed with these conditions are in employment, which many think is a waste of talent.

Neurodivergent conditions are often seen as very difficult to manage – but I feel this is somewhat of a misconception borne out of anxiety around how to manage people who are just “different” than most other people. As a sector the NHS seeks to value diversity as well as recognising that stable employment contributes to good health.

So how can we better manage and support staff with hidden disabilities?

• Have a clear job description so the employee knows what they are expected to do
• Ask the employee is they wish to disclose any disabilities or if they require any reasonable adjustments. Ensure your culture is one of openness, staff should find you approachable and feel comfortable to discuss these issues with you
• Ensure you have the necessary and appropriate policies in place – for example around sickness absence, performance management, recruitment and for reasonable adjustments
• Ensure your staff have the necessary training, and periodically carry out refresher training. Raise awareness of particular conditions if it impacts on the workplace –don’t allow ignorance to cause problems
• Refer staff with conditions to Occupational Health for guidance on how best to support them in the workplace, and make reasonable adjustments
• Handle internal procedures with care – ensure understanding of what is going on and consider formats that will help the employee to do so (e.g. following things up in writing, allowing a companion or representative to attend meetings etc.)
• Make use of available resources from the experts e.g. the British Dyslexic Association have an employer section of their website, as do the National Autistic Society and the ADHD Foundation
• Remember not to assume that all individuals with a condition will experience it in the same way or have the same symptoms or presentations. Take time to find out from the individual how their condition impacts them and how this might manifest itself in the workplace.

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