1 Mental Illness versus Performance How is an Employer to Know? October 2016 Schedule 2 Group The Statistics $51 Billion/ year spent on employee Mental Health by Canadian Businesses 1 in 3 Canadians will have diagnosed mental health problem – CMHA 2015 Less than half of those diagnosed will receive adequate treatment Two thirds of those that need assistance do not come forward due to the stigma or self stigma 46% of Canadians think “mental illness” is used as an excuse for poor behavior and personal failings 1 in 4 are afraid to be around someone with a mental illness Depression is the number one cause of disability in the world – WHO 2015 A Perfect Storm . . . Increased incidence of mental health issues Stigma Fear Lack of support High costs Lack of resources for treatment
Transcript
1
Mental Illness versus Performance
How is an Employer to Know?
October 2016
Schedule 2 Group
The Statistics$51 Billion/ year spent on employee Mental Health by Canadian Businesses1 in 3 Canadians will have diagnosed mental health problem – CMHA 2015Less than half of those diagnosed will receive adequate treatmentTwo thirds of those that need assistance do not come forward due to the stigma or self stigma46% of Canadians think “mental illness” is used as an excuse for poor behavior and personal failings1 in 4 are afraid to be around someone with a mental illnessDepression is the number one cause of disability in the world – WHO 2015
A Perfect Storm . . .Increased
incidence of mental
health issues
Stigma
Fear
Lack of support
High costs
Lack of resources for
treatment
2
Most Common Mental Health Disorders
Anxiety Disorder
Depressive Disorders/Mood Disorders
Learning Disabilities
Mental IllnessesMood disordersAnxiety disorders SchizophreniaEating disorders Personality disordersSubstance use disorders (commonly called addictions) Dementia Attention deficit (hyperactivity) disorder (ADD or ADHD)
3
Results of Mental Health Issues in the Workplace
Presenteeism – productivity at work
Lost time
Quality issues at work
Isolation
Relationship concerns
Financial concerns
Turnover
Manage the Illness
Strategies for managing:• Proactive
• Policies and Procedures • Be proactive - Inform/educate staff to recognize signs and symptoms• Promote work – life balance• Promote a culture that is supportive• Offer supports – Management training, EAP programs, flexible work
schedules
• Reactive• Stay involved with employee, once they go off work• Ensure receipt of proper objective evidence • Communicate with health care providers• Consider 2nd functional opinions• Provide work adjustments – hours worked, work location, tasks
assigned
4
Occupational Health Guidelines and Mental health• Reviewed 4 high quality guidelines
• Most guidelines recommend employing an inventory of symptoms, diagnostic classification, performance problems and workplace factors. All guidelines recommend specific return-to-work interventions, and most agreed on psychological treatment and communication between involved stakeholders.
• Joosen MC, Brouwers EP, van Beurden KM, Terluin B, Ruotsalainen JH, Woo JM, et al. An international comparison of occupational health guidelines for the management of mental disorders and stress-related psychological symptoms. Occupational & Environmental Medicine. 2015;72(5):313-22.
BODY BEHAVIOUR MIND FEELINGS
No energy Agitated, restless Easily distracted Depressed, down
Sleep changes Cry at least thing Poor memory Anxious, scared
Appetite changes Can’t start things Can’t think clearly Hopeless
Weight changes Social withdrawal Body image worry Numb
Stomach problems Can’t finish things Can’t make decisions Discouraged
No sexual interest Clumsy Slowed thinking Worthless
Lump in throat Slowed down Racing thoughts Ashamed, guilty
Tense muscles Snap at people Spaced out Can’t feel
• structured telephone outreach and care management program was more effective in reducing sickness absence than usual care
• Nieuwenhuijsen K, Faber B, Verbeek JH, Neumeyer-Gromen A, Hees HL, Verhoeven AC, et al. Interventions to improve return to work in depressed people. Cochrane Database of Systematic Reviews. 2014;12:CD006237.
Depression Treatment & RTW
• Moderate quality evidence
• work-directed intervention added to a clinical intervention reduced sickness absence vs clinical care alone
• enhancing the clinical care in addition to regular work-directed care was not more effective than work-directed care alone
• telephone or online cognitive behavioural therapy was more effective in reducing sick leave than usual primary or occupational care
Depression Treatment & RTW
• Low quality evidence
• regular care by occupational physicians that was enhanced with an exposure-based return to work program did not reduce sickness absence compared to regular care by occupational physicians
• psychological combined with antidepressant medication – no effect on sickness absence
• Medication – inconsistent results
6
BODY BEHAVIOUR MIND FEELINGS
Tense musclesNumbness, tinglingFeeling hot or chilledFlushed faceLump in throatTrembling, shakingWeakness, unsteadyDizzy, lightheadedSweatingHeart poundingChest painInsomniaWeight lossNauseaDiarrheaShortness of breathDry mouth
AvoidingAgitated, restlessMulti-taskingCan’t start thingsCan’t finish thingsSnap at peopleFrantically busySocial withdrawalCry at least thingHypervigilanceOversleepingUnable to be aloneSeeking reassuranceCompulsive behaviorsSelf-medicating
Anxiety Symptoms
Canadian Anxiety Guidelines (2014)Katzman et al ; Canadian Clinical Practice Guidelines for the Management of Anxiety, Post Traumatic Stress Disorder and Obsessive Compulsive Disorders; BMC Psychiatry 2014, 14 (Suppl 1)
Guidelines include principles of diagnosis and management,
six sections on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder)
Manage the SAW/RTW
7
Can Someone Stay at Work OR Return to Work?
Safety
Ability to Function
Strategies needed
Implementing supports
Understanding Function
Diagnosis and
Impairment
Medical Restrictions /
Contraindications
Capacity
Employee
FunctionJob
What is the difference between restrictions and limitations?
Medical Restrictions = Risk to Employee or recovery (no weight bearing on broken leg)
Capacity = What Employee can do today (hours, lifting, skills)
Tolerance = What Employee can tolerate (pain, fatigue, stress, anxiety)
8
Barriers and solutions
Possible Barriers Possible Solutions
What if discussion.What do you think might happen if RTW? If it does what will you do to manage the situation?
Key phrases to elicit solutions
What do you need for support at work?
What information would assist you in getting ready for work?
What can your manager do to support your return to work?
What can your coworkers do to support your return to work?
Factors impacting work related absence
• Modifiable worker factors found to have consistent evidence across two or more health conditions included emotional distress, negative enduring psychology/personality factors, negative health and disability perception, decreased physical activity, lack of family support, poor general health, increased functional disability, increased pain, increased fatigue and lack of motivation to return to work.
• Wagner S, White M, Schultz I, Murray E, Bradley SM, Hsu V, et al. Modifiable worker risk factors contributing to workplace absence: a stakeholder-centred best-evidence synthesis of systematic reviews. Work. 2014;49(4):541-58.
9
Functional Cognitive/Behavioural Assessments
Occupational Therapist Assess cognitive capabilities of employee
Assess job demands
Provide functional accommodations to match employee capabilities
Similar to FCE for physical issues
Cognitive Screening
Client self-rating scales:
The Memory Functioning Questionnaire (Gilewski, 1990; Lane, 2003)
Objective Testing:
• BrainFX testing of all cognitive areas
Depression and Cognition
Attention
Memory
Problem solving
Organization of thoughts
10
Anxiety and Cognition
Attention
Ability to problem solve
Safety sensitive judgements
Compensatory Strategies for Cognition
Specific to deficitsChecklists
To do lists or applications
Small chunks of information
Memory techniques – mnemonics etc
Binders or other standards to refer to
Use of outlook, calendar, follow up cues
Time blocking strategies
Have you provided the
accommodations?
11
Duty to AccommodateEmployers duties
Duty to accommodate to undue hardshipReason of disability
Union dutiesCollective agreement wordingParticipation in accommodation
Employee’s dutiesSharing information regarding accommodation needsActively cooperate in investigating optionsOffer reasonable explanations for refusal to accept offersaccept reasonable accommodation
Duty to Inquire
If an employer “ought reasonably to have known” that the employee may be dealing with an invisible illness the onus is on the employer to inquire
Manage Code of Conduct
12
The importance of regular conversations with employees for supportManagers must know the employees and what helps employees achieve success
Everyone has their own personality
Everyone interacts differently in the environment
But they function and perform on the job
Treasury Board of Canada -Secretariat
If you recognize an issue meet with the employee:
Approach your concern - workplace performance issue
Raise the possibility of providing adjustments
Provide access to an Employee Assistance Program or referral to community services
Assure the employee that meetings with an EAP provider are confidential
Set actions – who is responsible for the actions
Set a time to meet again to review
Document this meeting fully
13
Treasury Board of Canada -Secretariat
Code of Conduct
What is your code of conduct in the workplace
Do you educate and manage all behaviours?
What are the consequences for behaviours in the workplace?
Managing Negative Thinking
• Employees may have different types of negative thinking that impacts the way that they see the world
• These filters need to be challenged to present realistic and fair statements
• My friend cancels lunch
• I think that she is mad at me
• Change to: She is very busy and has a lot on her plate--- It isn’t about me but about her
14
Rethinking behaviours and feelings
When my boss comes into the office and says good morning to another colleague but does not say good morning to me
I get anxious = I must have done something wrong and I am going to lose my job
CHALLENGE – I will say hello to my boss. If I am concerned, I will ask my boss if there is anything that I need to improve in my job
Emotion and thought – I am in control of my performance and I will not mind read but I will ask for clarification
Triggers
What is the thought that triggers the emotion?
Why am I thinking that?
What is a more fair and realistic thought?
What is my emotion when I apply the fair and realistic thought?
Managing Conflict
Many individuals will AVOID conflict
Conflict Management Circle
Conflict management questionnaires
Practice ways to manage conflict that will allow employee to understand new ways to deal with conflict
15
Managing Performance
Employee responsibilities
Attendance
Performance of essential duties
Participate in accommodation process
Behaviour following code of conduct
“Fit for work”
Employer Responsibilities
Manage employee code of conduct
Provide expectations - policies
Manage performance – crucial conversations early to provide support for performance and training
Provide appropriate resources to meet expectations
Accommodate for disability
Manage team behaviours and expectations
16
Employee Function vs Diagnosis
Does diagnosis and functional issues match?
Does treatment match diagnosis?
Behaviours – Controllable or not?
Stage of illness
Safety concerns – is being Eccentric an illness or safety risk – not overreacting
Workplace Performance
What are the performance requirements?
How is performance measured?
What was the performance prior to the illness?
Is the performance related to illness or job fit?
17
Case study
Employee successful until 6 months ago and now not meeting targets
Case study
High performing employee
Exceeds targets
Outbursts with manager and coworkers
Urgent “needy” – inappropriate response
Denies illness
Eventually comes with note from MD but denies that any accommodation or treatment needed
Case study
Employee with history of complaints by customers, co-workers and managers
First responder - off work with diagnosis of PTSD
On RTW – managers and coworkers are reluctant to work with employee
Employee does not take responsibility for behavioural responses
Does PTSD excuse complaints and behaviours?
18
Case Study
Employee with kleptomania
Performs work well
Caught stealing from tool crib
Is this employee able to be warned or terminated?
Case study
Employee that has always struggled with meeting targets
Switched to many different managers – new manager asks to have employee performance managed
Throughout the performance management process until level 3 – close to end termination
Note from MD - mental illness
Case study
New employeeStruggling with learning new role
Taking longer in training
Below targets
Started into performance planning levels
Employee indicates that has health condition
Requests accommodation from employer
19
Managing Workplace and
coworkers
Mental Health or Performance Issue?
• Fairness• Competence
• Security• Resources
Physical Mental
SocialEmotional
Equipment, people, funding,time
Skills, knowledge, training, refreshers
Role clarity, safety,
job security
Perceived and actual justice
Everyone strives to meet their needs
Coworker Support
20
Depression at Work • Informants struggled with the negative experiences of
work that led to emotional, cognitive and somatic symptoms. Relationships with supervisors and colleagues, work load and work pressure and their self-image as a good worker conditioned the struggle.
• Self Management strategies: tending to symptoms and altering prospects for their future.
• The consequence of the on-going struggle was that the informants distanced themselves from their work
• Hjarsbech PU, Nielsen MB, Andersen MF, Rugulies R, Christensen U. Struggling at work - a qualitative study of working Danes with depressive symptoms. Disability and Rehabilitation. 2015;37(18):1674-82.
Depression at Work contd• Practitioners and other health and rehabilitation
practitioners working with people with depressive symptoms could inquire about supervisor behaviour and relationship between supervisors and employees.
• Interventions that targets both the individual employee as well as work environment focused interventions at the organisational level could be beneficial for employees with mental health problems as well as the workplaces
• Hjarsbech PU, Nielsen MB, Andersen MF, Rugulies R, Christensen U. Struggling at work - a qualitative study of working Danes with depressive symptoms. Disability and Rehabilitation. 2015;37(18):1674-82.
Job Control and Mental Health
• As people’s level of job control increased, so did their mental health, supporting the value of targeting improvements in job control through policy and practice interventions
• Bentley RJ, Kavanagh A, Krnjacki L, LaMontagne AD. A longitudinal analysis of changes in job control and mental health. American Journal of Epidemiology. 2015;182(4):328-34.
21
Emergency Emotional Action Plan
What will we do:When the manager believes the employee is unwell
When the return-to-work plan is not being implemented in the way it was agreed
When there are performance management issues
What will the employee do to ensure this workplace plan is successful for you?
Stop“walking on egg shells”
Talk about it
Trying to look for PROOF that the employee has an illness
Do not ask the Doctor for something they cannot give you
Micromanaging Past performance does not dictate future performance
Start Managing expectations
Hold the employee accountable for performance and managing health
Before you say no, ask why?Finding solutions together ..”and what else could we do differently…”
Accept that the solution has to come from the employee
Managing performance and giving feedback
22
Regaining trust in the employee
Solutions may be temporary or permanent
Give responsibility to the employee to solve the issues
Gradually increase expectations as the employee progresses
Gradually adjust the monitoring
Objectively assess performance once accommodations are in place
![Research Article The Injury/Illness Performance Project (IIPP ...downloads.hindawi.com/journals/jsm/2013/523974.pdfloss of function through injury or illness [ , , ], he also highlighted](https://static.documents.pub/doc/80x56/604db96dd31c6255f6082459/research-article-the-injuryillness-performance-project-iipp-loss-of-function.jpg)
