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How to Manage Mental Health Problems in the Workplace
Infonex: Managing YourDuty to Accommodate
9:10 – 10:10 Aug 30, 2011 Calgary 985
Chris Hylton, MACG Hylton & Associates Inc.
800 449-5866 [email protected]
Agenda
What is mental health? Types of mental health concerns:
addictions and other mental health issues Solutions for a mentally healthy workplace Managerial and supervisory support Identifying problems with addiction: know
the early warning signs Key indicators of substance abuse
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Do you have any workplace issues we can try and solve for you in this session?
What is Mental Health? World Health Organization defines mental
health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”
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What is Mental Health? People learning and be able to cope with:
Stress Changes in life and the workplace Demands in the workplace Home life Work life
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What is this?6
Freud7
Love and work are the
cornerstones of our
humanness
http://www.freud.org.uk/
and you wonder why we work?
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“No other technique for the conduct of life attaches the individual so firmly to reality as
the emphasis on work; for his
work at least gives him a secure placein a portion of reality,
in the human community”
“Therein we have one of the fundamental paradoxes we face today:
Work is good for your mental health and work can make you crazy”
Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada (2006), Standing Senate Committee on Social Affairs, Science and Technology, Honourable Michael J. L. Kirby, Chair
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Mental Health – Overlapped by Addictions
25% of adults in a year have anxiety, phobias, panic attacks,
depression, bipolar/manic depression, OCD, ADHD,
schizophrenia, or suicide, with half having multiple MH
conditions at same time
45% of mental health cases have medical conditions – pain,
heart disease, COPD, diabetes, asthma, hypertension,
cancer, sleep problems 1 in 3 mental health cases also have substance or other
addiction problems at the same time
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Abusers in Past Year as Percentage of Adults (Canada)
20 19 15 14 2
Alcohol Tobacco Medications Marijuana Illicit Drugs
Source: Attridge & Wallace (2009), MacMillan et al. (2009)
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Behavioural Addictions Increasing
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Addiction Rate in Adult Population
Historical Trend
Gambling 5% problem; 2% pathological
Increasing
Sex 3% to 6% Increasing
Food / Eating 5% women, <1% men Increasing
Internet Use 1% unknown Increasing
Workaholism 1% unknown Increasing
Addictions are in the Workplace
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Most people with addictions have jobs and are actively in the workforce
Alcohol and drug use tends to be higher among smaller size employers and in certain industries: ◦ construction and oil/gas mining◦ transportation ◦ installation, maintenance and repair◦ arts, entertainment and recreation◦ accommodations and food services◦ retail service occupations
Workplace Demographics15
It Starts Young. Younger age workers are most at risk for developing mental health and substance abuse problems, as these often start in the teens and early adulthood. This age group is most relevant for prevention activities, early screening and brief interventions.
It Gets Complicated. Older age workers may experience declining health status due to the cumulative effects from undertreated mental health and addiction problems. This age group is most relevant to integrated care approaches.
Alcohol and Drug Addictions Costs to Society: Canada
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Combined costs of: health carelaw enforcementwork productivity disabilitypremature death
Average $1,267 per every citizen
Source: Single et al (1996); Rehm et al (2006)
Other Workplace Consequences
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Majority of all addiction related costs (61%) are in area of diminished on-the job work productivity and unscheduled work absence.
Addictions also are also associated with higher health care costs, worker injuries, disability claims, workgroup morale problems, job turnover, and company risks for safe work environments, equipment loss and lawsuits.
Source: Attridge (2008), Attridge (2009)
Case Study - Jack18
Safety-sensitive, oilfield construction
Knee surgery due to work accidentseveral years before
Military Veteran, previous treatment for PTSD
Missing work — leaving early, coming in late, called in sick, spoke to Manager
Expressed Suicide wish, disclosed drug use, asked for help
Response to Jack19
Immediate appointment toassess safety and stabilize
Immediate EAP or substance abuse specialist
Employer input to counsellor
• Observations of behaviour• Performance• Previous assessments/testing• Any other pertinent work history
In cooperation with EAP Program
Set schedule of counselling appointments over 24 months
Review and monitoring of compliance with substance abuse recommendations, e.g. inpatient treatment, abstinence, & 12-step programming
Regular reporting of attendance
Option to coordinate on-going substance testing
Two-Year Relapse Prevention Program20
Why is the problem to difficult and complicated?
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ANY IDEA WHAT CAUSES ADDICTIONS?
Various Theories22
Moral Model – only a “bad person” gets addicted and can’t quit
Disease Model – what are the genetic and neurobiological factors involved?
Behavioural Model – what is rewarding to the person about their addiction?
Early Environment Stress – what kinds of toxic stress (abuse, trauma, low SES) was experienced as a youth or in past?
How does someone get addicted23
Traditional Continuum Model of Progression Toward Substance Abuse (Alcohol/Drug):
Source: Attridge & Wallace (2010)
Epigenetic Neuroscience Research24
“This is an extraordinary moment in the science of mental disorders. The intellectual basis of psychiatry is shifting, from reliance on psychological principles and theory to research findings and understanding the brain through neuroscience.”
Dr. Thomas Insel, Director of the National Institutes of Health (NIH – US) (Journal of Clinical Investigations, 2009)
New Research - Epigenetics25
Links Addictions to a Combination of Genetic Links Addictions to a Combination of Genetic and Biological Factors that Interact with Early and Biological Factors that Interact with Early Child Development ExperiencesChild Development Experiences
The Greek prefix epi- in epigenetics implies features that are "on top of" or "in addition to" genetics; thus epigenetic traits exist on top of or in addition to the traditional molecular basis for inheritance.
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development in utero and in childhood, environmental chemicals, drugs and pharmaceuticals, aging, and diet
Results in cancer, autoimmune disease, mental disorders, or diabetes among other illnesses. National Institute of Health
Source Wikipedia: National Institute of Health
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Care and Prevention28
Can the problem be treated or prevented?
Range of Treatments29
self-help (often multiple failed attempts) = self-help (often multiple failed attempts) = weak evidenceweak evidence group-based peer-support programs (AA) = group-based peer-support programs (AA) = modest evidencemodest evidence talk therapy - cognitive behavioral therapy (CBT) = talk therapy - cognitive behavioral therapy (CBT) = best evidencebest evidence brief residential detox with counseling = brief residential detox with counseling = good evidence for severe casesgood evidence for severe cases Rx medications and general medical care = Rx medications and general medical care = mixed evidencemixed evidence harm avoidance programs = harm avoidance programs = emerging good evidenceemerging good evidence
TRENDS = Gender differences & Holistic treatment model bestTRENDS = Gender differences & Holistic treatment model best
Addiction is a Life-long Condition
Source: Cleck & Blendy (2008)
The Addiction Cycle Often Repeats Over Time, Even with Treatment and Can Worsen
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Solution31
Screening Brief intervention Referral for treatment Study by Institute for Health Economics and
Alberta Health last year Organizational Interventions for the prevention
of Workplace Stress Jan 2009
http://www.ihe.ca/documents/Interventions_for_prevention_of_workplace_stress.pdf
Workplace Solutions - Morale
Make the work place a positive place! Celebrate birthdays Celebrate holidays Team building exercises: staff day at the movies,
staff day in the park, etc Sit fighting co-workers down and help solve the
issues between them Teambuilding workshops Have a zero tolerance policy
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Performance Appraisal Make it employee focused Career path Training Tools they need Job description updated
Workplace Solutions – HR Forms
NO BULLYING!
Bullying any co-worker on or off the workplace is still an offense
Creates low self-esteem and toxic work environment
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Workplace Solutions – HR Policies
Absenteeism Management
Establish average absentee rate
Place those x% above, in an Absenteeism Management Program
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Workplace Solutions – HR Policies
Policies are only as good as their communicationManagers need support on how to act and react
Workplace Solutions: Manager Training Agenda
What do substances look like? What do they do?
Enabling, Privacy, Rights
ER and EE Obligations
Treatment, Support, Accommodation
Performance Management
Prevention, Recognition, Response Skills
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What is an “Employer of Choice”?
Any employer of any size in the public, private or not-for-profit sector that attracts, optimizes and retains top talent… because the employees choose to be there
What is an EAP?
Mental health assistance for EEs and their families
So EEs may concentrate on work Short service model Coordinates response to critical incidents in
the workplace Deals tangentially with addictions
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Typical Reasons for Calls to EAP
Substance Abuse
Family
StressDepression
Alcohol
Workplace
25%
22%
25%
18% 8%
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Reasonable Cost EAP costs fraction of average
medical or dental plan $200 per ee per mo for Dental
insurance $5 per ee per mo for EAP
What Price?
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Stitch in time
If mentally, employees believe “I am disabled” is their natural state = difficult to cure
“I am temporarily having some difficulties that I with help of the EAP I will be able to overcome!” = easy to cure
Prevention key
EAP Cost We offer an EAP No cost to set up $125 per hour
cost
For more info contact me
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Drug & Alcohol Testing
Discrimination rules No pre-employment
testing No random drug
testing No alcohol testing
for non-safety sensitive positions
Safety sensitive position is one where impairment due to drug or alcohol use could result in injury to self or others
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When can you test? Random alcohol testing for
safety sensitive positions ok Drug or alcohol testing for
“reasonable cause” or “post-accident” is ok
How nice should you be?
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Consider:is it better to fight discrimination suit than
injury or death claim caused by a drunk or impaired employee?
Face to face Therapy
Research conclusively shows that traditional face-to-face (FTF) psychotherapy is generally effective for mental health issues
Mental health and addiction problems are common to the workforce, overlap with many medical conditions and have negative consequences for the person and the company
Source: Lipsey & Wilson (1993), NICE (2008), Seeling & Katon (2008)
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Access not always possible
But, access to and use of FTF treatment is problematic. Less than 1 in 3 people affected get quality care
FTF care also is not uniformly effective for all patients even when received
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•Telephonic therapy for mental health has been tested in more than 30 research studies.The general conclusion is that telephonic therapy is effective or at least promising in most of the empirical tests conducted. Cognitive Behavioral Therapy (CBT) has been the most commonly used form of intervention.Telephonic therapy services are effective for many conditions: Anxiety, depression, panic disorders, substance abuse, trauma, PTSD, and others.
Summary of Research Internet Counselling
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• Internet-based forms of psychotherapy (e-mail andweb tools) also shows initial support in over 20 research studies; many with RCT study designs.
Online therapy services and tools appear to work best for certain kinds of patients, when used to support other ongoing therapy, and for use as self-care and relapse prevention.
Positive clinical outcomes have also been obtained with therapist use of the Internet to interact via e-mail for patients with depression, anxiety, social phobias, PTSD, eating disorders, and panic disorder.
Source: Griffiths & Christensen (2006), Reger & Gahm (2009)
Summary of Research Internet Counselling
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Conducted in UK by Kessler et al. (Lancet, 2009)
It used an online, real-time CBT intervention for 113 patients, compared to 97 cases with care as usual by a general medical practitioner.
In-person assessment of diagnosis and symptom severity, followed by aseries of ten hour-long sessions of online text-based (e-mail) interactionwith a mental health therapist.
After treatment, more patients recovered from depression in the online treatment group (38%) than in the control group (23%). This effect also was found at 8-month follow-up (42% and 26%).
Source: Kessler et al. (2009)
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Selecting and Strengthening
Employee Assistance Programs:
A Purchaser’s Guide
EASNA’s 2009 Purchaser’s Guide to EAPs
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Resources America’s Health Insurance Plans - www.ahiphiwire.org/wellbeing
Centers for Disease Control - www.cdc.gov/nchs/fastats/hinsure.htm
Canadian Institute for Health Information - www.cihi.ca
EASNA www.easna.org/purchasers.php
Gallup-Healthways Well-Being Index™ - www.well-beingindex.com
Health Canada – Healthy Living - www.hc-sc.gc.ca/hl-vs/index-eng.php
Health Promotion Advocates http://healthpromotionadvocates.org/sources_detail_documents.htm
IHPM - Institute for Health and Productivity Management - www.ihpm.org
Mental Health Commission of Canada - www.mentalhealthcommission.ca
National Wellness Institute - www.nationalwellness.org
WorldatWork: global human resources association focused on compensation, benefits, work-life and integrated total rewards - www.worldatwork.org
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Our offer to you54
Please call if you have any HR, or workplace issue that you are overwhelmed with
We can help you
We also are pleased to do Free Workshops for your organization (some limits apply) Let us know what your needs are and we will make it happen!
CG Hylton - Services
HR Consulting Job Descriptions Salary Grids Wellness at Work Staff Morale Training and
Workshops
Benefits, Pensions,
EAP Strategic Planning Drug and Alcohol
programs Dept re-orgs Leadership
compensation
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Tel 403 264 [email protected]
Thank you for the opportunity to meet today!
Tel 403 264 5288 or 800 449 5866 (800 4hylton)
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