Webinar 3: Psychological barriers to rehabilitation and return to work

25 November 2015

Get serious about a healthy workplace

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Matthew Bannan Industry Manager WorkCover Queensland

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Meet your presenter

Dr Robert McCartney Occupational Physician

Today’s format

• Case study • Key concepts • Practical suggestions to

manage the case study • Questions

Case study

• 55 year old Registered Nurse at a major tertiary hospital

• Work history • Medical history • Family and social history • Recent events • Work related injury

Benefits for Health and Safety

Dr Rob McCartney Occupational Physician

PSYCHOSOCIAL WELLBEING

Psychosocial health –

a state of mental, emotional, social, and spiritual well-being

closely linked with general physical health

Not the elimination of life stressors but the way we view ourselves and how we deal with stressful situations

Psychosocial Health Like ourselves Accept mistakes Take care of ourselves Empathy for others

How we view ourselves and how we deal with stressful situations

Control anger, hate, tension and anxiety Optimistism Can work alone and with others well

Social Health

Spiritual Health

Mental Health Emotional

Health

Psychosocial Wellbeing

Physical inactivity

Tobacco smoking

Sedentary lifestyle

Alcohol and other drugs

Poor diet and nutrition

Lifestyle risk factors

Min

ing

Alcohol Obese Overweight Inactivity Inadequate diet Smoker

Psychological

experience a mental health

condition in their lifetime

45% experience a mental health condition this year

20%

Stress

Depression

Anxiety

Mental Health

45%

One in five Australians experiencing a mental illness within a 12-month period. Almost half (45%) of Australians aged 16-85 years will experience a mental illness at some stage in their lives. Prevalence (including substance use disorder) is greatest among 18-24 year olds (26%) Third leading cause of disability burden in Australia, accounting for an estimated 27% of the total years lost due to disability. Major depression accounts for more days lost to illness than almost any other physical or mental disorder.

Psychosocial Wellness

So what?

Psychosocial Wellness

per year impacted of

mental health conditions

11B $5B in absenteeism

$6B in presenteeism

$146M compensation claims

Mental health

Sleep disorders Fatigue

Alcohol and Other Drugs

Interrelated Health Issues

Physical health

Mental Health

and MSD

Functional limitations and chronic pain predisposes to mental health problems (anxiety, depression, substance abuse)

Mental disorders affect physical illness, pain and disability

Pathways

Immune/endocrine/nervous; and

Behavioural factors (e.g. poor diet, lack of physical activity and substance use)

Mental Health

and OHS

Accidents and Incidents Increased accident rates

Poor decision-making

AOD

Yellow Flags

Barriers to rehabilitation and return to work

Yellow Flags Psychosocial, workplace and other factors that increase the risk of developing or perpetuating long-term disability and work loss associated with musculoskeletal conditions. • Personal, family and social issues

• Workplace and injured workers interaction

• Workers compensation, financial and legal issues

Alcohol and other

drugs (AOD)

of all accidental workplace deaths

4% of workers reported absences

3.5% work under the influence of drugs

2.5%

Sleep loss effects work performance via:

Sleep disorders

Involuntary micro-sleeps

Unstable attention to intensive performance

Cognitive slowing with increased errors

Response time slows

Performance declines in short-term recall of working memory

Sleep disorders

70% more likely to be involved in an accident

Highly disturbed sleep plays a role in occupational fatalities

More likely to report industrial accidents or injuries

Twice as likely to be involved in workplace accidents

Sleep-related fatigue is an independent risk factor in work-related injuries and fatalities

Mental Health

and Sleep

Complex Relationship Sleep and depressive illness Depression causes sleep problems Share risk factors and biological features and the two conditions may respond to some of the same treatment strategies. Evidence suggests that people with insomnia have a ten-fold risk of developing depression compared with those who sleep well. Depressed individuals - sleep onset insomnia, sleep maintenance insomnia, unrefreshing sleep and daytime sleepiness. OSA linked with depression.

Productivity Absenteeism/ Presenteeism

Staff turnover/ early retirement

Risk reduction

Workers’ compensation costs

Income protection claims

Rationale for psychosocial wellbeing strategy

Business case

EMPLOYERS have much to gain from engaging with their workers’ psychosocial wellbeing

EMPLOYEES who are healthy, fit and resilient are less likely to suffer physical and mental illness

Psychosocial Health and productivity

Virtuous circle

Healthier, productive workplace

Improved working conditions

Healthier workforce

Improved productivity

Organisational culture

Absenteeism Turnover, recruitment and training

Insurance premiums

Workers compensation

Business case

Short and long-term disability

Employee disengagement

Reduced motivation

Business reputation

Effective Interventions

Limited

Those that showed promise were largely multi-modal and included

Alcohol screening, social support, peer interventions, workload adjustment, improved work environments, and policy implementation.

Manage Risk

Prevention Primary

Avoid disease / injury either through eliminating disease agents or increasing resistance

Secondary

Methods to detect and address existing disease prior to the appearance of symptoms

Tertiary

Methods to reduce negative impact of disease / injury such through case management (treatment and rehabilitation)

Primary Prevention

Assess Workplace

Suitability FFW

Training Education

Policies Procedures

Assess Workplace

Integrate messages in meetings

Integrate into communications

Provide health behaviours/ industry issues information

Assess Workplace

Suitability FFW

Training Education

Policies Procedures

Psychological Hazards

Psychosocial hazards in the workplace can create a physical or psychological risk to workers. The Work Health and Safety Act 2011 imposes a legal duty on business operators to do what is reasonably practicable to eliminate or minimise these risks. This legislation defines 'health' to include physical and psychological health The How to Manage Work Health and Safety Risks Code of Practice 2011 sets the standard for systematically managing psychosocial risks in the workplace. The Code should be followed in conjunction with hazard specific guidance material on work-related stress, bullying, violence, and fatigue . See also, Safe Work Australia’s Preventing Psychological Injury under work health and safety laws fact sheet.

Psychological Hazards

Identify Psychosocial Hazards Assess Risk Control Risks Review control Measures l

Identify the Psychological Hazards

Step 1: Identify the hazards The first step in the risk management process is to identify workplace hazards. This means looking for those things in the workplace that have the potential to cause harm. The source of work-related stress can be determined by evaluating: productivity levels, rates of absenteeism, separation rates/turnover, exit interviews, staff engagement/ morale, customer feedback, peak/seasonal demands, analysing incident reports and data trends.

Working conditions job demands job overload work-life insecurity

lack of supervisor support

work setting factors conducive to risky alcohol or drug use

Occupational

Hazards

Assess the Risk

Step 2: Assess and prioritise the risk This step involves assessing the likelihood and consequences of injury or illness that may result from exposure to work-related stressors. Stressors or risk factors for work-related stress include:

• Work demands (emotional, mental, physical) • Low control • Poor support • Lack of role clarity • Poorly managed change • Poorly managed relationships • Low levels of recognition and reward • Organisational injustice.

Assess the Risk

How to conduct a risk assessment Risk factors for work-related stress can be assessed by understanding worker complaints, observing interactions between workers, gaining feedback from workers, having one-on-one discussions with workers and through the use of focus groups or a worker survey. Findings from focus groups or worker surveys would then inform a decision about the likelihood and consequences of injury or illness from exposure to work-related stress and make it clear which risk factors are contributing to that risk.

Psychosocial illness and injury risks to workers can be identified and assessed:

• through anonymous surveys • effective consultative practices • effective communication processes • review of injury reports • review of absence data.

Control the Psychosocial Risks

Step 3: Control risks After assessing the risk and determining which factor(s) have the greatest contribution to that risk, the most appropriate control measure(s) that are reasonably practical in the circumstances need to be selected and implemented. When selecting a particular control, it is important to be able to justify why it was chosen over a different measure. For work-related stress, deciding on control measures usually means altering a problem risk factor. For instance, reducing work demands, increasing the level of control a worker has over his or her job, and increasing the amount of peer and/or supervisor support a person is receiving.

Review Control Measures

Step 4: Review control measures The last step of the risk management process is to review the effectiveness of the control measures that have been implemented to ensure they are working as planned. When reviewing the effectiveness of control measures, it is important to weigh up whether the chosen controls are effective or whether they need some modification. Risk management for work-related stress is not a one-off exercise, but something that must go on continually in the organisation. The dynamics and complexity of organisations can mean that changes such as a new supervisor, new workers or new processes or procedures can have marked, unexpected and unplanned effects on the stress levels of workers.

Occupational stress describes the physical, mental, and emotional reactions of workers who perceive that their work demands exceed their abilities and/or their resources (e.g. Time, access to help/support) to do the work. Unmanaged occupational stress can result in: • job dissatisfaction, low morale and workplace conflict • low productivity • increase in escalated calls • absenteeism • workers' compensation claims (both psychological and musculoskeletal) • increased turnover.

How does occupational stress affect you?

What is not work-related stress? Work-related stress is not a disease. Worker's responses to stressors may be positive or negative depending on the type of demands placed on them, the amount of control they have over the situation, the amount of support they receive and the individual response of the person. In the vast majority of instances people adjust to stressors and are able to continue to perform their normal work duties. Health effects When stressful situations go unresolved, the body is kept in a constant state of stimulation, which can result in physiological and/or psychological illness. Common health outcomes linked to stress include cardiovascular disease, immune deficiency disorders, gastrointestinal disorders, musculoskeletal disorders and psychiatric/psychological illness.

1. High mental, emotional and/or physical work demands

2. Low control over work and the way it is organised

3. Low levels of support from supervisors and peers

4. Lack of role clarity or increased role confusion

5. Poorly managed workplace conflict

6. Poorly managed organisational change

7. A poor workplace justice climate

8. Low levels of worker recognition and reward.

Occupational stress risk factors include:

• ensure workers have adequate training to perform their tasks • ensure supervisors are adequately trained to provide timely and appropriate performance

management in a reasonable manner • ensure work demands are realistic and within workers' abilities, particularly during peak

periods • regularly review workloads to ensure workers have sufficient time and support to meet their

work demands • review workloads during team meetings, through an informal check-in, or by undertaking a

worksite assessment • encourage workers to speak up at an early stage if they feel their task demands are excessive • encourage workers to seek guidance from management about priorities • ensure worker's concerns are recorded in a hazard register and actioned • ensure procedures are in place to allow worker input on decisions about work design, rosters

and safety issues • implement processes which allow workers or their representatives more control over

rotation/task variation opportunities

Ways to minimise occupational stress include:

• consult with workers on decisions regarding control over the flow of calls or customer queues • provide concise and clear scripting which allows workers some flexibility to adapt the information to

their personal communication style • provide flexibility around scheduled and personal breaks • provide new workers with full induction training programs, including customer handling, conflict

management, de-escalation techniques, and stress management • provide workers ongoing training on effective communication and conflict resolution strategies • provide software programs that are easy to view and understand and allow for efficient provision of

services • provide positive, supportive supervision • ensure workers can access breakout areas to take a short break from emotionally demanding

interactions with clients • ensure staff appraisals/performance reviews: • identify gaps in skills related to their role • are based on workers' performance against the requirements of their roles. • provide clear procedures about monitoring systems and how they are to be used • ensure reward and recognition systems are based on agreed performance outcomes • promote and encourage workers to engage in internal and external health and wellbeing programs and

initiatives • provide workers with access to support services including employee assistance programs or other

counselling services.

Ways to minimise occupational stress include:

Occupational Psychosocial Factors

The environment Relationships Individual factors

Contributing

The nature of work

Secondary Prevention

FLAGS

• Unplanned Absence

• Behaviour

• Life events

• Recurrent injuries / near misses

Safety Critical Work

Strategies to predict

EAP

Quality, accessible and responsive service behind the glossy brochure?

• What is average referral rate?

• How do they manage the Critical Incident Response Service?

• What are the Qualifications of the people providing counselling services?

• How will services be delivered?

• What statistics or feedback will I receive about the service utilisation?

• Do you have a Supervisor Support Service?

Limitations

Strategies to predict

Tertiary Prevention

Acute Illness Management

Prompt Specialist Involvement

Rehabilitation

Follow up

MANAGEMENT COMMITMENT

PLANNING

ASSESSMENT

ACTION PLAN

EVALUATION

Executive buy-in/cultural implementation

Pre-employment assessments

Health management plans

Periodic health/ Workforce cross-sectional assessments

Interventions

The holistic integrated approach

Benefits for Health and Safety in Qld Mining

Dr Rob McCartney Occupational Physician

PSYCHOSOCIAL WELLBEING

0402 261 524 admin@resile.com.au

Case study – what can you do?

• 55 year old Registered Nurse at a major tertiary hospital

• Work history • Medical history • Family and social history • Recent events • Work related injury

Questions

Get serious about a healthy workplace

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