Date post: | 23-Jan-2015 |
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Promoting Mental Health and Well-Being in the Workplace Dr Samuel Harvey School of Psychiatry University of New South Wales
UNSW Workplace Mental Health Research Team
• Formed in 2012
• Core funding from NSW Health
• Additional grants from BeyondBlue, National Mental Health Commission and Employers Mutual
Key points
• Need to understand the nature of the problem
• The importance of good quality research
• What can be done?
• Multilevel approach likely to be most effective
• Need to address some outdated ideas around the workplace being a simple “toxin” which automatically leads to poor health
Mental Health vs Wellbeing
DSP in Australia by diagnosis
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
2000 2002 2004 2006 2008 2010 2012
Pro
po
rtio
n o
f p
op
ula
tio
n
Year
Psychological/psychiatric
Musculoskeletal &connective tissue
Intelletctual/learning
Nervous system
Circulatory system
Other
Idea that the modern workplace is ‘toxic’ to
workers’ (and horses’!) mental health
Are mental disorders becoming more common amongst working aged adults?
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1.4%
1.6%
1.8%
2.0%
2000 2002 2004 2006 2008 2010 2012
Per
cen
tage
of
Pop
ula
tion
rec
eivin
g D
SP
for
psy
chia
tric
/
psy
cholo
gic
al
pro
ble
ms
Year
Total
Males
Females
A simple view of workplace stress / bullying
Prevalence of severe depression/anxiety symptoms in
Australia
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
2000 2002 2004 2006 2008 2010 2012
Pre
vale
nce
of
pro
bab
le c
ase
nes
s o
f co
mm
on
men
tal
dis
ord
ers
(%)
Year
Mental ill health amongst the working population is a huge problem, BUT…..
• Rates of underlying mental health symptoms are not rising
• Simple cause and effect models unlikely to reflect complexity of situation
• Understanding this complexity can provide great opportunities for interventions
• Good quality research should be the ‘key’ that helps ‘unlock’ this problem
Where we are at in terms of understanding ‘work stress’
Cautionary tail of debriefing
• Popular intervention after trauma
• Seemed like a sensible idea
• When the research caught up, and proper trials conducted, found to be not effective and possibly harmful
• Example of unexpected consequences and the need for good quality research
What about bullying?
• We know workplace bullying is commonly reported (prevalence figures around 10% in most studies)
• Those who report bullying have increased rates of depression and anxiety
• Bystanders also have increased rates of mental health problems
Bullying is a risk factor for poor mental health, but…
• Not a simple cause and effect
• Bullying also strongly associated with lots of other workplace factors (e.g. leadership, work control, organisational climate, etc)
• Simple measures, eg anti-bullying policies are necessary, but unlikely to be very effective unless other areas are addressed
What can be done?
Two recent detailed reviews of the literature ….
Research questions: • How does work contribute to
the development of depression and anxiety disorders?
• What interventions have been effective in addressing depression and anxiety disorders in the workplace?
• What does all this mean for businesses
• New National initiative • Founding members:
• National Mental Health Commission • Australian Chamber of Commerce and Industry • Australian Psychological Society Ltd • beyondblue • Black Dog Institute • Business Council of Australia • Comcare • Council of Small Business Organisations of Australia • Mental Health Council of Australia • Safe Work Australia • SANE Australia • University of New South Wales
• Literature review focused at a business audience (written together with the Australian School of Business)
• Due to be released in early 2014
HEALTHY
WORKER
SYMPTOMATIC
OR AT RISK
WORKER
MENTAL
ILLNESS
SICKNESS
ABSENCE
Primary
prevention
Secondary
prevention
Tertiary
prevention
Illness and sickness absence rarely appear
suddenly. They are often the endpoint of a journey
with many stages
HEALTHY
WORKER
SYMPTOMATIC
OR AT RISK
WORKER
MENTAL
ILLNESS
SICKNESS
ABSENCE
Primary
prevention
Secondary
prevention
Tertiary
prevention
What is the evidence that mental disorders can be prevented by
workplace interventions?
1. Designing work to minimize known risk factors
2. Enhancing individual resilience 3. Enhancing organizational
factors which can increase resilience
How can an organization know what risk factors are relevant for it?
• Evaluation of work related psychological injuries data • Exit interviews • An assessment of how involved different levels of staff are
in decision making • Focus groups of employees • A survey of employee engagement • People at Work Project surveys
(http://www.peopleatworkproject.com.au) • HSE Management Standards for Work Related Stress • (http://www.hse.gov.uk/stress/standards/) • External expert advice (eg Black Dog Institute) • Recognition of upcoming organisational change
What about individual resilience training?
• There is a lot of it about
• Not that much evidence for workplace based resilience training
• Is good evidence from other sectors (eg high school) that individual training can help prevent mental disorders
• Best evidence approaches based around cognitive behavioural interventions
Systematic review of RCT of resilience training
Workplace based resilience training
• Best evidence seems to be for interventions utilising cognitive behavioural techniques (CBT) and Acceptance and Commitment Therapy (ACT)
• May allow individuals to intervene with controlling techniques early
• Currently no good evidence for single session interventions
• Possible role for e-health in the future
RCT of possible prevention in medical interns
Constance Guille, M.D. 1, Helen Christensen, Ph.D. 2 Kenneth Ruggiero, Ph.D. 1,3, John Krystal, M.D. 4,
Breck Nichols, M.D. 5, Srijan Sen, M.D, Ph.D6 1Department of Psychiatry and Behavioral Science, Medical
University of South Carolina, Charleston, SC, 29425 Department of Psychiatry, Yale University School of
Medicine, New Haven, CT 06511, 29425
Mean PHQ-9
0
1
2
3
4
5
6
7
Pre-
Internship
3 Months 6 Months 9 Months 12 Months
Intervention
Control
Intervention Completers
RCT of possible prevention in medical interns
Constance Guille, M.D. 1, Helen Christensen, Ph.D. 2 Kenneth Ruggiero, Ph.D. 1,3, John Krystal, M.D. 4,
Breck Nichols, M.D. 5, Srijan Sen, M.D, Ph.D6 1Department of Psychiatry and Behavioral Science, Medical
University of South Carolina, Charleston, SC, 29425 Department of Psychiatry, Yale University School of
Medicine, New Haven, CT 06511, 29425
Mean PHQ-9
0
1
2
3
4
5
6
7
Pre-
Internship
3 Months 6 Months 9 Months 12 Months
Intervention
Control
Intervention Completers
Workplace health promotion
• Increasing evidence linking lifestyle to risk of mental illness
• Those who engage in regular physical activity less likely to develop depression
• ? Biological cause
• ? Altered reaction to stress
• ? Improved self esteem, etc
Risk factor
Individual
Workgroup
Organizational
Mental health and occupational outcomes
Resilience factors
Organizational Justice
• Organisational justice refers to the fairness of rules and social norms within companies
• Distributive justice – fairness of resources and benefits distribution
• Procedural justice - the methods and processes governing that distribution
• Relational justice - the level of respect and dignity received from management
• 4237 non-depressed Danish public employees within 378 different work units
• Mean levels of procedural and relational justice were computed for each work unit
• Two years later, working in a work unit with low procedural justice (adjusted ORs of 2.50) and low relational justice (adjusted OR's of 3.14) predicted onset of depression.
• Not much research on how an organization can increase its levels of organization justice
Risk factor
Individual
Workgroup
Organizational
Mental health and occupational outcomes
Resilience factors
Psychosocial Safety Climate
HEALTHY
WORKER
SYMPTOMATIC
OR AT RISK
WORKER
MENTAL
ILLNESS
SICKNESS
ABSENCE
Primary
prevention
Secondary
prevention
Tertiary
prevention
What about once symptoms develop? How can early treatment
be facilitated?
1. Manager training 2. Screening (but not without
risks) 3. Mental health literacy training 4. Appropriate response to
trauma or when bullying occurs
5. ? EAPs (limited evidence)
HEALTHY
WORKER
SYMPTOMATIC
OR AT RISK
WORKER
MENTAL
ILLNESS
SICKNESS
ABSENCE
Primary
prevention
Secondary
prevention
Tertiary
prevention
Once someone is off work due to a mental illness
What doesn’t seem to work –
standard symptom based treatments
What helps people get back to work?
• Are effective treatments available for common mental disorders (depression and anxiety)
• Can usually reduce symptoms • BUT….is now increasing evidence of a disconnect
between symptom reduction and improvement in occupational outcomes
• May be a delay in more subtle cognitive symptoms
• Likely that there needs to be a greater rehabilitation focus from early in treatment
The role of managers
• Managers have a crucial role
• Wellbeing, handling incidents, early intervention, team morale, organizational justice, sickness absence management
• Studies show that early and regular contact reduces the time of a sickness absence episode
• Mental health literacy not enough, have to also be trained in the skills they need
Fire & Rescue RESPECT Training • RCT of new training utilising 200 Duty
Commanders of FRNSW Metropolitan Operations
• Aims to:
– Increase mental health literacy
– Build managers’ skills and confidence in communicating with employees suffering from mental illness
– Provide guidance on manager’s role during employee sickness absence
• Training expected to commence in November 2013
Workshop Outline
39
Introductions 10
mins Black Dog Institute
Part 1 80mins Key features and impact of common mental health issues in the workplace
20mins Break
Part 2 60
mins Role and responsibilities of senior officers in the recognition and management of mental health issues
15mins Break
Part 3 45mins Developing effective communication and management skills
Summary 10mins Feedback
Making a welfare call
40
RESPECT
Regular contact is essential
Earlier the better
Supportive and empathetic
Practical help, not psychotherapy
Encourage help-seeking
Consider suitable duties
Tell them the door is always open, arrange next contact
“Depression and the
Firefighter who fought it”
Thank you
www.workplacementalhealth.com.au