Promoting Mental Health
and Well-Being in the
Workplace
Dr Samuel Harvey
School of Psychiatry
University of New South Wale...
UNSW Workplace Mental Health
Research Team
• Formed in 2012
• Core funding from NSW
Health
• Additional grants from
Beyond...
Key points
•
•
•
•
•

Need to understand the nature of the problem
The importance of good quality research
What can be don...
Mental Health vs Wellbeing
DSP in Australia by diagnosis
40.00%

35.00%

Proportion of population

30.00%

Psychological/
psychiatric

25.00%

Muscul...
Idea that the modern
workplace is ‘toxic’ to
workers’ (and horses’!)
mental health
Are mental disorders becoming more
common amongst working aged adults?
Percentage of Population receiving DSP for psychiat...
A simple view of workplace stress /
bullying
Prevalence of severe
depression/anxiety symptoms in
Australia
Prevalence of probable caseness of common mental disorders
(...
Mental ill health amongst the working
population is a huge problem, BUT…..
• Rates of underlying mental health symptoms
ar...
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...
What about bullying?
• We know workplace bullying is commonly
reported (prevalence figures around 10% in
most studies)
• T...
Bullying is a risk factor for poor mental health,
but…
• Not a simple cause and effect
• Bullying also strongly associated...
What can be done?
Two recent detailed reviews of the literature ….
Research questions:
• How does work contribute to
the development of depr...
•
•

New National initiative
Founding members:
•
•
•
•
•
•
•
•
•
•
•
•

•
•

National Mental Health Commission
Australian ...
HEALTHY
WORKER

Primary
prevention

SYMPTOMATIC
OR AT RISK
WORKER

Secondary
prevention

MENTAL
ILLNESS

Tertiary
preventi...
HEALTHY
WORKER

Primary
prevention

SYMPTOMATIC
OR AT RISK
WORKER

Secondary
prevention

MENTAL
ILLNESS

SICKNESS
ABSENCE
...
How can an organization know what
risk factors are relevant for it?
• Evaluation of work related psychological injuries da...
What about individual resilience
training?
• There is a lot of it about
• Not that much evidence for workplace based
resil...
Systematic review of RCT of resilience
training
Workplace based resilience training
• Best evidence seems to be for interventions
utilising cognitive behavioural techniqu...
RCT of possible prevention in medical
interns
7
6
5
Intervention

4

Control

3

Mean PHQ-9

Intervention
Completers

2
1
...
RCT of possible prevention in medical
interns
7
6
5
Intervention

4

Control

3

Mean PHQ-9

Intervention
Completers

2
1
...
Workplace health promotion
• Increasing evidence linking lifestyle to risk of
mental illness
• Those who engage in regular...
Risk factor

Resilience
factors

Individual
Workgroup
Organizational

Mental health and occupational
outcomes
Organizational Justice
• Organisational justice refers to the fairness of
rules and social norms within companies
• Distri...
• 4237 non-depressed Danish public employees within 378
different work units
• Mean levels of procedural and relational ju...
Risk factor

Psychosocial
Safety
Climate
Resilience
factors

Individual
Workgroup
Organizational

Mental health and occupa...
HEALTHY
WORKER

Primary
prevention

SYMPTOMATIC
OR AT RISK
WORKER

Secondary
prevention

MENTAL
ILLNESS

SICKNESS
ABSENCE
...
HEALTHY
WORKER

Primary
prevention

SYMPTOMATIC
OR AT RISK
WORKER

Secondary
prevention

MENTAL
ILLNESS

SICKNESS
ABSENCE
...
What helps people get back to work?
• Are effective treatments available for common
mental disorders (depression and anxie...
The role of managers
• Managers have a crucial role
• Wellbeing, handling incidents, early
intervention, team morale, orga...
Fire & Rescue RESPECT Training
• RCT of new training utilising 200 Duty
Commanders of FRNSW Metropolitan
Operations
• Aims...
Workshop Outline
Introductions

Part 1

10
mins
80mins

Black Dog Institute
Key features and impact of common mental healt...
Making a welfare call
RESPECT
 Regular contact is essential
 Earlier the better
 Supportive and empathetic
 Practical ...
“Depression and the
Firefighter who fought it”
Thank you
s.harvey@unsw.edu.au
www.workplacementalhealth.com.au
Dr Sam Harvey, UNSW - Promoting Mental Health & Well-Being In the Workplace
Dr Sam Harvey, UNSW - Promoting Mental Health & Well-Being In the Workplace
Dr Sam Harvey, UNSW - Promoting Mental Health & Well-Being In the Workplace
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Dr Sam Harvey, UNSW - Promoting Mental Health & Well-Being In the Workplace

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Dr. Samuel Harvey, Senior Lecturer in Workplace Mental Health, UNSW delivered this presentation at the Inaugural Workplace Bullying Conference. This event brings together HR, WHS Managers, Workplace Psychologists and Academics to discuss policy and practices for combatting workplace bullying.

Find out more at http://www.informa.com.au/workplacebullying_13


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Dr Sam Harvey, UNSW - Promoting Mental Health & Well-Being In the Workplace

  1. 1. Promoting Mental Health and Well-Being in the Workplace Dr Samuel Harvey School of Psychiatry University of New South Wales
  2. 2. 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
  3. 3. 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
  4. 4. Mental Health vs Wellbeing
  5. 5. DSP in Australia by diagnosis 40.00% 35.00% Proportion of population 30.00% Psychological/ psychiatric 25.00% Musculoskeletal & connective tissue 20.00% Intelletctual/learning 15.00% Nervous system Circulatory system 10.00% Other 5.00% 0.00% 2000 2002 2004 2006 Year 2008 2010 2012
  6. 6. Idea that the modern workplace is ‘toxic’ to workers’ (and horses’!) mental health
  7. 7. Are mental disorders becoming more common amongst working aged adults? Percentage of Population receiving DSP for psychiatric/ psychological problems 2.0% 1.8% 1.6% 1.4% Total 1.2% 1.0% Males 0.8% Females 0.6% 0.4% 0.2% 0.0% 2000 2002 2004 2006 Year 2008 2010 2012
  8. 8. A simple view of workplace stress / bullying
  9. 9. Prevalence of severe depression/anxiety symptoms in Australia Prevalence of probable caseness of common mental disorders (%) 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 2000 2002 2004 2006 Year 2008 2010 2012
  10. 10. 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
  11. 11. Where we are at in terms of understanding ‘work stress’
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. What can be done?
  16. 16. 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
  17. 17. • • 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
  18. 18. HEALTHY WORKER Primary prevention SYMPTOMATIC OR AT RISK WORKER Secondary prevention MENTAL ILLNESS Tertiary prevention Illness and sickness absence rarely appear suddenly. They are often the endpoint of a journey with many stages SICKNESS ABSENCE
  19. 19. HEALTHY WORKER Primary prevention SYMPTOMATIC OR AT RISK WORKER Secondary prevention MENTAL ILLNESS SICKNESS ABSENCE Tertiary prevention What is the evidence that mental disorders can be prevented by workplace interventions? 1. 2. 3. Designing work to minimize known risk factors Enhancing individual resilience Enhancing organizational factors which can increase resilience
  20. 20. 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
  21. 21. 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
  22. 22. Systematic review of RCT of resilience training
  23. 23. 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
  24. 24. RCT of possible prevention in medical interns 7 6 5 Intervention 4 Control 3 Mean PHQ-9 Intervention Completers 2 1 0 Pre- 3 Months 6 Months 9 Months 12 Months Internship 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
  25. 25. RCT of possible prevention in medical interns 7 6 5 Intervention 4 Control 3 Mean PHQ-9 Intervention Completers 2 1 0 Pre- 3 Months 6 Months 9 Months 12 Months Internship 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
  26. 26. 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
  27. 27. Risk factor Resilience factors Individual Workgroup Organizational Mental health and occupational outcomes
  28. 28. 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
  29. 29. • 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
  30. 30. Risk factor Psychosocial Safety Climate Resilience factors Individual Workgroup Organizational Mental health and occupational outcomes
  31. 31. HEALTHY WORKER Primary prevention SYMPTOMATIC OR AT RISK WORKER Secondary prevention MENTAL ILLNESS SICKNESS ABSENCE Tertiary prevention What about once symptoms develop? How can early treatment be facilitated? 1. 2. 3. 4. 5. Manager training Screening (but not without risks) Mental health literacy training Appropriate response to trauma or when bullying occurs ? EAPs (limited evidence)
  32. 32. HEALTHY WORKER Primary prevention SYMPTOMATIC OR AT RISK WORKER Secondary prevention MENTAL ILLNESS SICKNESS ABSENCE Tertiary prevention Once someone is off work due to a mental illness What doesn’t seem to work – standard symptom based treatments
  33. 33. 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
  34. 34. 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
  35. 35. 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
  36. 36. Workshop Outline Introductions Part 1 10 mins 80mins Black Dog Institute 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 Developing effective communication and management skills Part 3 Summary 39 45mins 10mins Feedback
  37. 37. Making a welfare call 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 40
  38. 38. “Depression and the Firefighter who fought it”
  39. 39. Thank you s.harvey@unsw.edu.au www.workplacementalhealth.com.au
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