dr sam harvey, unsw - promoting mental health & well-being in the workplace

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• Need to address some outdated ideas around the workplace being a simple “toxin” which automatically leads to poor health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

s.harvey@unsw.edu.au

www.workplacementalhealth.com.au