ON Series: Managing mental health issues in the workplace; an introductory overview for employers

ON. Managing mental health issues in the workplace; an introductory overview for employers

On series – by Office of Industrial Relations

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Alicia Bailey: Hello everyone.

Welcome to today's ON Series session titled Managing Mental Health Issues in the Workplace: An Introductory Overview for Employers. The topic and expert speaker is brought to you by the Office of Industrial Relations.

As a Department we are committed to driving initiatives across the whole scheme that improve safety, wellbeing and return to work outcomes for both businesses and workers.

My name is Alicia Bailey. I'm the Manager of Engagement Services for OIR and our Presenter today is Dr Peter Cotton.

Dr Cotton is a clinical and Organisational Psychologist specialising in how work environments influence employee mental health, wellbeing and behaviours.

He works as an advisor to government and the corporate sector.

Dr Cotton has published a number of peer reviewed research papers and book chapters. The information that will be presented in today's session draws upon Dr Cotton's most recent research which was only just released in September.

Dr Cotton was the lead author of the Australian Public Service Commission and Comcare Guidelines titled Working as one: Promoting mental health and wellbeing at work. Dr Cotton holds a range of current professional appointments including Workplace Mental Health Advisor with SuperFriend, the non for profit Mental Health and Wellbeing Foundation funded by Industry Superannuation Fund and member, beyondblue Workplace Mental Health Expert Advisory Group.

We are extremely pleased to have the opportunity to share Dr Cotton's latest work with you, so I will now hand you over to him.

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Peter Cotton: Thank you Alicia.

So today we're going to be talking about a range of sort of issues around this space of managing mental health issues in the workplace. It's a big topic. It's really an introductory overview but we have weaved in a few practical tips along the way. So hopefully you will have some take-aways that will be meaningful and you can follow up on.

So the overview slide there is just indicating the range of issues we'll be covering in this session and I'm going to go straight into things.

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Okay. So the first point I wanted to make is that when I'm talking to individuals who are off work with a mental health issue, whether it's compensable, that is they have a compensation claim or not, these are the sort of comments you still often hear and I won't read them out, but people in this space are extremely sensitive to perceptions of organisational workplace support.

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So when you talk to managers it's not really about any sort of deliberate neglect or callous disregard. It's more fear of the unknown, worries about aggravating problems, it's mental health, so we should just avoid contacting them.

But by and large the principle is that we need to try and keep these people connected to the workplace, maintain regular contact and that's how we achieve much better ultimate outcomes.

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Now just talking generally around this sort of space, we still treat physical injuries differently than mental health issues. GPs tend to allow a lot more latitude with certification. Similarly in the workplace we tend to allow much wider latitude.

But the challenge is that individuals in this space ultimately have better outcomes when we have some clarity, some agreed milestones, parameters. Allowing wide latitude often results in more counterproductive outcomes.

So for example I often get referrals for individuals who've been on a return to work program. It's now several months down the track and the question that is asked is 'This person is now doing these tasks and not these other tasks. Is there a medical basis for this or is it about personal preference?'

So in general having clarity, having clear milestones, a plan is much better in terms of moving forward.

Treatment providers tend to focus on symptoms but in terms of returning to work I'm much more interested in what the person can do. So I'm less concerned about how serious the depressed mood is, but more concerned with how long can they concentrate, what sort of things they're able to do.

The other issue that we know in this space comes up is that because it's mental health often people are diagnosed with total incapacity.

However frequently these individuals have at least partial capacity and it's much better in the long run if they reengage with work earlier. I see a lot of people who are given total incapacity certification go home, they're not talking to anyone, they get more absorbed in their own problems and get worse over time. So engagement with work is generally very positive and helpful for long term health and wellbeing outcomes.

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So this is really just indicating some of the background to what we're talking about and one of the key messages that I want to try and get across is that workplace support has a very significant influence on people's wellbeing and their outcomes quite distinct and separate from any medical, clinical treatment or even rehabilitation support.

As we'll see in due course, we're not talking about managers becoming clinicians or diagnosticians or counsellors. It's about what you do in your role as a people leader.

The return to work literature is starting to recognise this. So there now is an emergent literature that's telling us that people's perception of support in the workplace can significantly improve, hinder or derail their return to work.

Perceived organisational support – that's an organisational psychology research physician, more than 30 years of research in that space and essentially it tells us that perceptions of organisational support and what they mean by that practically is that it's the local leader, the local manager, the local supervisor or team leader that is regarded by employees as embodying that perception of organisational support. But that does impact on reporting of stress issues, absenteeism, coping with pain and the effort that people put into their work, the engagement.

We do know that positive and supportive team climates are protective of mental health.

If we look at occupations such as Police, we know that there are limits around the extent to which you can mitigate risk. In other words you can't eliminate risk because that's what the job entails. Going to callouts, arriving at a domestic situation etc and not knowing what's going to happen next - so exposure to risk is part of the job. But what we do know is that if those officers have supportive leaders, a positive, engaging team environment, that's a protective factor and helps mitigate the impact of some of that exposure.

The point about grief leadership is it's just an analogy to reinforce this point. In the grief area this is talking about disasters at a community sort of level – floods and fires and so on, but what's well recognised in that literature is that when local leaders are able to step up and articulate what the community is experiencing, provide a sense of support and direction, that's regarded as having a significant impact on healing with community members above and beyond all the counsellors, all the support from clinicians and doctors and so on.

So it's human support distinct from medical support.

The Health Benefits of Work agenda which many of you may well be aware of is developed by the Australian College of Occupational and Environmental medicine. It's on their website. The original statement came out in about 2011. There's been a recent update in late 2015 and what this document tells us is that in general work is good for people's mental health and wellbeing.

The mental health of unemployed Australians is up to four times worse than people in employment. The evidence update includes OECD research and findings that tell us that work is actually therapeutic, that it helps people get over their problems earlier and reduces the need for treatment. So work is generally good for people's mental health and wellbeing.

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So when we're talking about workplace support as I've indicated, we're talking about being a people leader, not becoming a counsellor or diagnostician. Now a very important practical tip is this.

In my workgroup or my team presumably we have team meetings now and then,  I don't want all my team meetings to be an endless list of administrative matters or operational matters that we tick off on. What I'm going to do is quarantine a little bit of time in each second or third meeting to have some sort of general reflection on how the team is travelling, open discussion on issues and how the team is travelling.

What I also want to insert into the meetings as a leader is that wellbeing is on my radar. So for example, 'Team, we just had a peak period. The pressure's been on but wellbeing's important and anyone who's struggling or have any hassles, please come and talk to me.' So that role modelling of the leader validates help seeking behaviour and we do know that where leaders role model that sort of behaviour it does increase the likelihood that staff will go and use the employee assistance program if organisations have that type of service, or maybe more likely to go and see their family doctor earlier.

So there is an important role for leaders to role model and validate help seeking and wellbeing. I've seen numerous examples in many organisations where that validation does increase early help seeking because the earlier that people seek relevant help and care, the quicker they tend to bounce back. In mental health we use the analogy of the hotplate. The longer you put your hand on the hotplate the more damage is done. The quicker you get your hand off, the quicker you recover and bounce back. So the earlier that people seek help, correspondingly the quicker they tend to bounce back.

So no doubt you'll be familiar with some of the sort of interpersonal phrases around active listening. So that's genuinely listening to what the person has to say and demonstrating you understand what they're saying, not jumping in and telling them what they're thinking but listening to them and then reflecting back that you've understood.

As a manager, as a team leader, as a supervisor building clarity, so regular discussion around priorities, expectations in terms of the work to be done, what task priorities there are, greater clarity is better for individuals in this space.

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Also of course individuals need to feel that you are approachable and accessible as a leader, that if they have issues or concerns they can come and talk with you. It's not that your door's always closed or that when someone talks to you, you start looking at your watch, but that you are genuinely approachable and accessible.

So open communication is critical and leaders vary in their ability and their capacity to do that. Regular check-ins with the individual who may be on a return to work program or coming back to work and also getting on the front foot and initiating straightforward care and concern conversations with people who may be at risk. When we say 'at risk' we're not talking about diagnosing. We're talking about people behaving differently than they usually do.

As a leader I will try and have my finger on the pulse of the team and I should notice when people are behaving differently than they usually do. Because I've also validated the message around wellbeing - it's important, it's part of the way we do business - I'm also going to encourage colleagues, co-workers to also encourage that individual to seek help or make contact with myself.

We need to recognise that the default way of coping for many people who are moving into the space of having a mental health challenge or difficulty is that they will try and ignore it and just forge on regardless. So often it is a supportive colleague or manager that is the first to notice that something's not right and the first to engage with that person.

So there's all sorts of training available in conversations. There's respectful conversations, courageous conversations, training etc and multiple providers out there. So sometimes an injection of that sort of training does help managers to be more confident in being more on the front foot and engaging with staff. But the key point is about coming across as being genuine in terms of engaging with a staff member.

You don't want to convey the message that 'I'm talking to you because I'm worried about my KPIs.' That's going to be completely counterproductive. Straightforward care and concern. This is early intervention. It's not linked with another process or discipline etc and often the outcome will be that the person agrees to go and consult your employee assistance program or go and see their family doctor. So that prompting through being a supportive leader or a colleague can be very, very important in this space.

So when someone's off work the general principle is about trying to keep them connected to the workplace because that achieves better wellbeing outcomes in the long run.

Sometimes there are some nuances there in terms of negotiating the regime of contact. So asking the person, 'If I can call you next Monday afternoon?' or fortnightly or whatever. Now this is where sometimes I'll get push back from a manager who will say "Well in good faith I rang my staff member to indicate concern about their wellbeing. The next day I got the solicitor's letter saying 'stop harassing my client'."

If that's the situation you're in that's probably indicating that the person is really wanting to disengage and probably will be unlikely to return. That's where you need to be talking to your human resources department and looking at where it's going from there.

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This slide is just talking about people who are anxious in the workplace. Some people are more worriers than others, they anticipate, they think ahead. So particularly in a context of organisational change they can really arc up. But what this latest research tells us is that perceived support in the workplace as we've already talked about significantly offsets those effects and it's both at a co-worker level and a supervisor/team leader/manager level. So open communication, clarity around expectations really helps these people to cope more effectively.

So again we're not moving into the clinical realm. We're talking about human support as a people leader or as a co-worker.

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This slide is really just to indicate that what we know is that the longer someone stays off work the less likely they will be to successfully reengage in employment. As this graph shows and this is just based on workers' compensation data, that when you're off work for say, up to 12 months, the chances of ever then successfully getting back to work are down around five per cent.

So this is part of the rationale why different workers' compensation authorities and regulators emphasise early return to work. It's not about cutting insurer costs. It's about people's wellbeing outcomes. The quicker people reengage with employment the better the long term outcome tends to be.

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I've already talked about the Health Benefits of Work: Evidence Update so I won't go into this here. You can go and follow that up and find that document on the College of Occupational Physicians' website.

Sickness certification is a key issue. In Victoria we've been running what's called an Early GP Contact program. That's through the Workers' Compensation Authority in Victoria and what that program has found, that's where the claims are reviewed and then when people are put off work with total incapacity one of our doctors or one of our physiotherapists because physiotherapists can certify in Victoria as well, rings the doctor or physio.

What we've found is that the treaters tend to have a mindset of either total incapacity or total capacity and they don't see the shades in between. So we found that we're getting a lot of change in certification after those contacts for partial clearance so that the person can start to reengage with employment. That reengagement with employment early improves their longer term prospects.

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Posttraumatic Stress Disorder just briefly gets a lot of attention in the media. It's obviously a big issue in our Police and Emergency Services sector where they have higher levels of exposure to potentially traumatic incidents compared with other industry sectors. It's quite complex because PTSD is sometimes over diagnosed. If you are an Emergency Services worker and go to see a GP or Psychologist, they're highly likely to then go 'Bingo, must be PTSD.'

But on the other hand a lot of individuals avoid dealing with their PTSD. Avoidance behaviour is part of one of the elements of PTSD. So it's also under diagnosed and in some of the Emergency Services there's a lot of self stigma, meaning you just ignore the symptoms because 'I should be strong', 'It shouldn't be a problem', 'I help other people so I shouldn't need help.' So self stigma is a big issue across that sector.

Further, there's an assumption by a lot of treaters and clinicians that the diagnosis of Posttraumatic Stress Disorder automatically equals total work incapacity, but this is completely false.

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I won't read this out but this is a quote from our official guidelines on the management and treatment of Posttraumatic Stress Disorder – Phoenix. It used to be called the Australian Centre for Posttraumatic Mental Health. They renamed themselves as Phoenix. So keeping the person engaged with work as far as that as practical is very, very important.

I've been involved in a review of Victoria Police Mental Health and Wellbeing Services earlier this year and one of our recommendations was around ensuring that we have alternative positions, what we called the 'interchange bench'.

State Government departments and Treasury are often hovering over and culling, looking for costs, positions to cut etc, but we need to quarantine some of these positions because we'll get much better outcomes and return to full operational duties when people have these intermediary work roles to engage in that as this quote indicates, it helps people maintain a routine, access to collegial support and so forth.

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So that really leads onto talking about what does it mean to be psychologically fit for work?

Again it's about functioning more than symptoms as such.

So when I'm looking at whether the person is psychologically fit to attend work or reengage with work, the first sort of area we'll look at is 'Can they attend in a regular and reliable way?'

By the way when someone is cleared to return to work with a mental health issue, the medical clearance might be they're fit to start every morning at 10:00am because they're on medication that makes them a big cognitively slower first thing in the morning, but then they should be accountable for starting at 10:00. That free range approach we talked about earlier becomes counter-productive. People fare much better and have much better longer term health and return to work outcomes where there is some structure, accountabilities, milestones and that accountability.

So are they able to perform the role, actually do the tasks that are part of their role?

Further, we all these days or most of us work in team environments. So you have to be able to operate in terms of the parameters of expected behaviours, values, code of conduct. I'll often see people that are cleared to return to work but they're actually not fit to function in a team environment. So from an occupational health and safety point of view team wellbeing is exactly as important as individual wellbeing.

So if someone is creating a risk to the team then we need to address that issue. 'Are they actually fit to be in the workplace?' because their behaviour may be having the effect of other people are distancing themselves, feeling alienated. That can lead to a risk to psychological health and safety. So we need to balance team wellbeing with individual wellbeing.

Of course we need to make sure the work doesn't make the employee worse.

I see many people in areas like Child Protection workers, Police, other roles where people get to a point of a genuine sort of burn out and you might be able to gee them up to get back in the saddle but you know that's going to be associated with high risk of falling over again. So there comes a point when it's better to move on and look for alternative types of work roles.

As I've said, functioning is more important than symptoms. So rather that knowing how severe the depressed mood is I want to know can the person drive a vehicle and how long for? What are they doing at home every day? Do they watch TV? Are they able to follow a program from beginning to end? Do they use social media or internet or emails? How long do they do that for? That's telling me about their actual psychological capacity. So in that sense symptoms are less important. It's all about functioning.

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This is really just providing a bit more detail which I won't go into but when we're assessing people in terms of returning to work, looking at a lot of detail around their actual activities of daily living, what they're actually doing day-to-day, the extent to which they're not doing things they usually do, their capacity, their vitality. As I've already mentioned in terms of cognitive capacity I'll ask them about watching television, the extent to which they can read a newspaper, engage with social media etc. That all tells me something about their actual cognitive capacity.

In terms of their interpersonal functioning are they sitting in a bedroom most days with the blinds drawn or are they actually engaging with people? To what extent are they able to maintain or continue their levels of social interactions and engagement?

Coping – some people resort to things like nicotine, caffeine and alcohol to sort of self medicate which can become counterproductive over time. So that needs to be taken into account as of course the effects of various medications that people are on. With chronic pain for example some of the narcotic analgesics significantly reduce people's capacity for driving and decision making. So that needs to be taken into account.

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So I think we're getting towards the end of the slides and what I wanted to note here is that we call it 'psychological injury' or 'stress related compensation claims' but what we've found is that a significant number of those claims are actually more about low morale rather than about a substantive increase in medical symptoms. But what we do is we tend to medicalise these claims. We give it the, I'm sure some of you heard this 'adjustment disorder' label and as a consequence people become worse over time.

In Victoria we've had a pilot called the Workplace Support Service which is about triaging claims and where it's identified that there is an interpersonal barrier more than a medical barrier, those claims are then referred to a skilled rehabilitation provider whose role is to liaise with the employer and the employee and try and resolve those issues. So conflict resolution, vocational guidance, HR interventions are what this group of people really need.

Further beyond that we also get issues around perceptions of unfair treatment in justice. They can exert a very significant influence over outcomes. I often see situations where the person may actually have a compensation claim accepted but the organisation has undertaken an investigation into allegations of bullying and not made any adverse finding.

So that perception of injustice tends to dominate and also makes people less responsive to standard sort of medical and psychological type treatments.

So I guess one of the overall messages from this session is about from the workplace point of view that basic human support is very important in this space. It's what you do in your role as a people leader, not becoming a clinician or a counsellor and it does have a significant impact on overall outcomes and is very, very important.

Further as I indicated earlier, I think probably if I review everything we've talked about, a key practical tip is as a leader I want to convey the message to my team that wellbeing is on the radar, it's important and people can come and talk to me. So I want to role model that openness and that validation of wellbeing as being very important.

As we indicated earlier, when we do that it also makes it easier. From time to time I will initiate a conversation with a staff member because I might be concerned about them and there'll be less pushback because we've validated that wellbeing message.

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So I think that we don't have live questions. So I think we're about at the end of what we're covering today in terms of an introduction and let me perhaps just summarise again that it's about people's functioning is what's most important more so than symptoms. Engagement with employment or reengagement with employment as early as possible is better in the long run.

We don't want managers to become quasi-counsellors. It is in your role as a people leader.

Now there's lots of nuances in this space, so perhaps the final point I'll make is that when you're supporting someone if that's taking a lot of time, if they can't return to their usual duties, technically we do have a legal obligation around making what's called 'reasonable adjustments' but there is a limit to that.

So the limit to that means that sometimes there may be a situation where someone needs to move into a process of medical ill health retirement because they're not able to fulfil the inherent requirements of their job any longer.

That's going into perhaps a bit much detail but just to indicate that we promote the message of being supportive. Supportive workplaces are better for people's mental health. Supportive workplaces do reduce psychological health and safety risks and when people experience difficulties they're more likely to seek help earlier. So that's the key message, validating that earlier help seeking.

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So I think that's the end of this sort of initial overview. There's a few references there you can follow up but thank you for attending.

Alicia Bailey: Thank you Dr Cotton. We're really pleased that you were able to share your insights for Queensland businesses following the release of that latest research which is noted on that last dot point on the references slide. So if anyone's interested in accessing Dr Cotton's latest research feel free to access it from those details there.

We hope this helps empower you in dealing with psychological injuries and as Queensland businesses in taking some of the strategies that Dr Cotton has actually highlighted today and implementing them in your workplaces.

We hope you can participate in future on the ON Series sessions and we look forward to talking to you soon.

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