Freud said some funny things but he did make some astute observations: “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 place in a portion of reality, in the human community”Marie Jahoda, positive mental health movement, pointed out that work Provides structure, Provides social meaning, Provides opportunity for social interaction , Provides an identity…. Not to mention- provides an incomeHowever, multiple studies have demonstrated increasing rates of workplace distress, demoralization and disabilitye.g. 2002: Health Canada study suggest that there is a work/life imbalance- that the lack of balance is getting worse, especially for middle managers and public sector.
Does this mean work or the workplace causes mental illness?Not really, as we do not know the exact cause of any disorders, likely a combination of biogenetic and psychosocial factors which will vary from person to person.But, a psychologically unhealthy work environment can contribute to the onset and severity of a disorderWhile at the same time, a psychologically healthy environment can prevent the likelihood and minimize the severity of a disorder
The cycle of addiction. Following the initial exposure to an addictive sub- stance, acquisition of drug taking occurs, in which infrequent drug taking escalates into chronic drug use. Periods of chronic drug use are followed by intervals of withdrawal. These periods of abstinence from the addictive drug can last days, weeks, months, or years. However, most addicts do not remain drug free and relapse back into drug use, creating a vicious cycle. Stress can exacerbate drug taking throughout this process facilitating initial drug exposure, increasing acquisition of drug taking, and causing a relapse to drug-taking behavior during withdrawal. Source: Attridge PNWER presentation
Institute for Health Economics and Alberta Health, Jan 2009
Accomodation and prevention substance abuse
Accommodation I: Substance Abuse and Prevention 1:45 pm Oct 25, 2010 Infonex 940 Vancouver By Chris Hylton, MA. CG Hylton & Associates Inc. 1
3 Do you have any workplace issues we can try and solve for you in this session?
What is Mental Health?4 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‖
What is Mental Health?5 People learning and be able to cope with: Stress Changes in life and the workplace Demands in the workplace Home life Work life
Freud6 Love and work are the cornerstones of our humanness http://www.freud.org.uk/
and you wonder why we work?7 ―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 place in a portion of reality, in the human community‖
9 “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
10 Why does this matter to Canadian employers? Making the case
11 Presenteeism Absenteeism Extended Health Claims Disability Claims Lost Productivity
Stress in the Workplace - 3 in 10 at risk12 Sector Serious Significa Total % Reporting Risk Concerns nt Concerns Manufacturing 5% 33% 38% Public 3% 29% 32% Administration Health Care 4% 28% 32% and Social Assistance Retail Trade 4% 24% 28% Finance and 2% 22% 24% Insurance
Mental Health – Overlapped by13 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
Abusers in Past Year as Percentage14 of Adults (Canada) 20 19 15 14 2 Alcohol Tobacco Medications Marijuana Illicit Drugs Source: Attridge & Wallace (2009), MacMillan et al. (2009)
Behavioural Addictions15 Increasing Addiction Rate in Adult Historical Trend Population Gambling 5% problem; 2% Increasing pathological 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 Workplace16 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 Demographics17 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 Costs18 to Society: Canada $ Billions Combined costs of: 39.8 health care law enforcement work productivity disability premature death 8.9 Average $1,267 per every citizen 1992 2002 Source: Single et al (1996); Rehm et al (2006)
Other Workplace19 Consequences Majority of all addiction Costs of related costs (61%) are in Addictions 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 Work Productivity company risks for safe work All Other Areas environments, equipment loss and lawsuits. Source: Attridge (2008), Attridge (2009)
Case Study - Jack20 Safety-sensitive, oilfield construction Knee surgery due to work accident several 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 Jack21 Immediate appointment to assess 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
Two-Year Relapse Prevention Program22 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
Why is the problem to difficult and23 complicated? ANY IDEA WHAT CAUSES ADDICTIONS?
What ―Causes‖ Addictions24 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 addicted25 Traditional Continuum Model of Progression Toward Substance Abuse (Alcohol/Drug): Source: Attridge & Wallace (2010)
Epigenetic Neuroscience Research26 ―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 - Epigenetics27 Links Addictions to a Combination of Genetic and Biological Factors that Interact with Early Child 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.
28 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
So what have we learned so far?30 Source: Suomi (2010)
Care and Prevention31 Can the problem be treated or prevented?
Range of Treatments32 self-help (often multiple failed attempts) = weak evidence group-based peer-support programs (AA) = modest evidence talk therapy - cognitive behavioral therapy (CBT) = best evidence brief residential detox with counseling = good evidence for severe cases Rx medications and general medical care = mixed evidence harm avoidance programs = emerging good evidence TRENDS = Gender differences & Holistic treatment model best
Addiction is a33 Life-long Condition The Addiction Cycle Often Repeats Over Time, Even with Treatment and Can Worsen Source: Cleck & Blendy (2008)
Rx Treatments for Addictions - Limited & Often Ineffective34 Effective treatments for drug abuse involve both behavioral therapy and medication. However - the list of medications approved for treatment of addiction is quite limited. Many of the medication treatments available are only given when the addict is actively using the addictive substance. Thus, very few treatments are prescribed during the critical withdrawal period when needed to prevent relapse. No medications for addictions are available for prevention. Source: Cleck & Blendy 2008
Solution35 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_pr evention_of_workplace_stress.pdf
Solution: Changing the Workplace to Prevent Problems and Support Workers36 Research has consistently revealed that interventions delivered at the organizational level are needed and also tend to be often more effective than traditional interventions delivered at the individual level because they address the prevention of problems. Employee ―Engagement‖ in Work Family Leave Benefits & Flex Scheduling Positive Corporate Culture Psychological Safety Legal Context Source: Attridge et al. (2009), Barling (2007), Bergerman et al. (2009), Harvey et al. (2006), Richardson & Rothstein (2008)
Workplace Solutions - Morale37 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
Workplace Solutions – HR Forms38 Performance Appraisal Make it employee focused Career path Training Tools they need Job description updated
Workplace Solutions – HR Policies39 NO BULLYING! Bullying any co-worker on or off the workplace is still an offense Creates low self-esteem and toxic work environment
Workplace Solutions – HR Policies40 Absenteeism Management Establish average absentee rate Place those x% above, in an Absenteeism Management Program
Workplace Solutions: Manager Training Agenda41 What do substances look like? What do they do? Policies are only as good as their Enabling, Privacy, Rights communication ER and EE Obligations Managers need Treatment, Support, Accommod support on how to ation act and react Performance Management Prevention, Recognition, Respo nse Skills
Workplace Solutions – Employer of Choice42 What is an ―Employer of Choice‖?
What is an43 ―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
Which results in44 Employees choosing to work or continue to work for your organization… even when presented with other and more enticing employment opportunities
Corporate programs - EAP46 A program that offers: short-term, professional counselling and referral services support in dealing with a wide range of stressful situations (personal/work related) assistance and advise Services are free and confidential
What is an EAP?47 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
Typical EAP Usage48 8-12% (2007) (avg range from 2 of 3 major Canadian EAP providers) 11% in 1997 (Can Federal Public Service) 25% in a mine, where the counsellor was a former miner who just hung out for coffee with the miners
Typical Reasons for Calls to EAP49 Work place Family 18% 8% 25% Alcohol Substance Abuse 25% Depression 22% Stress
Reasonable Cost50 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?
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 51
Drug & Alcohol Testing Discrimination rules Safety sensitive No pre-employment position is one testing where impairment No random drug due to drug or testing alcohol use could result in injury to self No alcohol testing or others for non-safety sensitive positions 52
When can you test? Random alcohol testing for safety sensitive positions ok Drug or alcohol testing for ―reasonable cause‖ or ―post- accident‖ is ok 53
How nice should you be?Consider:is it better to fight discrimination suit than injury or death claim caused by a drunk or impaired employee? 54
Face to face Therapy55 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 Research conclusively shows that traditional face-to-face (FTF) psychotherapy is generally effective for mental health issues Source: Lipsey & Wilson (1993), NICE (2008), Seeling & Katon (2008)
Access not always possible56 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
57 •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 Research58 Internet Counselling • Internet-based forms of psychotherapy (e-mail and web 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 Research59 Internet Counselling 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 a series of ten hour-long sessions of online text-based (e-mail) interaction with 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)
EASNA’s 2009 Purchaser’s Guide to EAPsSelecting and Strengthening Employee Assistance Programs: A Purchaser’s Guide 60
Resources America’s Health Insurance Plans - www.ahiphiwire.org/wellbeing63 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
Our offer to you64 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 Benefits, Pensions, Job Descriptions EAP Strategic Planning Salary Grids Drug and Alcohol Wellness at Work programs Staff Morale Dept re-orgs Training and Leadership Workshops compensation Tel 403 264 5288 email@example.com 65
Thank you for the opportunity to66 meet today! Tel 403 264 5288 or 800 449 5866 (800 4hylton) firstname.lastname@example.org