Workplace Mental Health

and Optimal Disability Management

Ash Bender, MD, FRCPC

Occupational Psychiatrist Asst. Professor, University of Toronto

ash.bender@workplaceinsight.ca

1

Guiding Principles

“ Work is central to a person’s identity and social role. It provides income, but more than that, it is often essential to feeling valued as a person. Loss of work capacity for any reason is a life crisis, but especially so when the loss is due to a mental health disability. A person’s inability to work because of a mental health condition requires focused and significant professional attention and a team response.”

American Psychiatric Association, National Partnership for Workplace Mental Health, 2007 2

Disability-Adjusted Life Years

Whiteford, H. A., et al. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet.

Depression at Work in Canada

• On average, depressed workers reported 32 days in the past year when they were totally unable to work or carry out normal activities

• Presenteeism costs estimated to be 6 times the cost of absenteeism due to injury and illness

• 62% of total costs due to MDD as co-occurring condition

7 out of 10 with depression are in the workforce

Greenberg et al. The Economic Burdern of Adults with MDD in the United States (2005 and 2010). J Clin Psychiatry. 2015;76:155-162 Health Report. Statistics Canada Health Statistics Division. 2006;17(4):1-88.

Stephens & Joubert. The Human Face of Mental Health and Mental Illness in Canada. Gov Can. 2006:57-69. Stewart et al. Cost of lost productive work time among US workers with depression. JAMA. 2003;289(23):3135–3144.

Recommendation #1 Reduce risk for psychological injury.

Sources of Psychological Injury

Non-occupational

stressors

Excessive job strain

Critical Incident Exposure

6

Effort-Reward Imbalance Model

Salary

Supports

Appreciation

Recognition

Respect

Demands

Pressures

Responsibilities

7 Seigrist 1996

Demand-Control-Support Model

8 Health Canada. Best Advice on Stress. 2000

National Standard of Canada for Psychological Health and Safety in the Workplace (2013)

Key Objectives

• Prevention of harm

• Promotion of health

• Resolution of incidents or concerns

Required Tasks

• Leadership and resources

• Education and communication

• Change management

• Critical event preparedness

• Monitoring and evaluation

• http://www.mentalhealthcommission.ca/English/Pages/workplace_guide.aspx

Mental Health Commission of Canada 2013

9

Recommendation #2 Develop an anti-stigma strategy.

Combating Stigma at Work

American Psychiatric Association, 2007 11

1. Anti-stigma programs • Educational sessions for all employees • Shared experience by a person of status

2. Policy and legal enforcement of discriminatory practices under Canadian labour law

3. Enhancing access to confidential mental health services in the workplace

4. Standardizing disability management practices so the physical and mental disorders are treated equally

Recommendation #3 Train your staff.

Mental Health First Aid

• Critical Incident Stress Debriefing (CSID) is not recommended!

• Psychological First Aid (PFA) is accepted standard for 1st responders • Contact and engagement • Safety and comfort • Stabilization • Information gathering • Practical assistance • Connection with social supports • Information on coping • Linkage with collaborative services

13 National Center for PTSD and Mental Health Commission of Canada

The “Good” Manager

• Understands the “business” case for intervening

• Identifies and documents performance issues • Engages in supportive dialogue with individual employees about how their mental health

issue was interfering with their work

• Utilizes constructive ways to confront the “troubled” employees early and encourage help-seeking • Respects and maintains roles and boundaries • Maintains confidentiality

• Knowledge of resources for employees, supervisors, and work teams and gain permission for resources to contact them • EAP/ Health and Wellness • Organizational development • Occupational Health • Family physician

14 National Partnership for Workplace Mental Health, 2011

eTraining for Managers

• High-quality computer-based training

• Customizable to organization

• Essential content for staff and managers • Recognition and communication skills

• Responding to critical incidents

• Managing return to work

• Substance use and work

• Workplace compliance

www.workplaceinsight.ca

Workplace Peer Support

• Coworkers can provide a bridge between an employee with a problem and the people who can help them • Talking to colleagues when you notice a concerning change • Listening without judgment • Sharing experiences with similar challenges • Knowing where professional help is available

• Formal workplace peer-support programs for mental health require resources and training • Effective communication skills • Capacity for Self-awareness • Maintenance of confidentiality and boundaries

AADAC, MHCC

Most workplaces are unprepared to help employees who are struggling with suicidal

thoughts or to assist colleagues following the death of a co-worker by suicide. (CDC, 2010)

Recommendation #4 Improve access to effective care.

Web-based Health Screening

• Highly accessible for most

• Preferred modality for young and computer-literate

• Offered as portal from health education sites

• Brief and easy to read with option for audio

• Low risk

• Facilitates disclosure to health care provider

Canadian anonymous screening at: • http://www.mentalhealthscreening.org

Diamond et al. Development, Validation and Utility of Inter-Based, Behavioural Health Screen for Adolescents. Pediatrics. 2010.

Where do you go for help?

Access Points

•Employee Assistance Program (EAP)

•Occupational Health Staff

•Family Doctor

•Union Steward

Publicly Funded

•General Practitioner psychotherapists

•Psychiatrist

•Hospital-based programs

•Community Programs

Privately Funded

•Medication Benefits

•Psychology/Psychotherapy Benefits

•Independent Medical Examinations

•Other

Most need education and encouragement to seek treatment due to stigma, fears of treatment with “addictive medication” or expected breaches of confidentiality.

Do your benefits address the needs of your organization and employees?

EAP that provides effectiveness data beyond utilization rates

Enhanced psychological benefits to cover a full course of treatment

Comprehensive medication formulary to improve likelihood of treatment initiation, adherence, response and relapse prevention

Rehab-focussed STD and LTD insurance carriers

Insurers which work collaboratively with your organization to improve likelihood of sustained RTW

Work-focused Psychological Care • 12 month follow-up of 168 employees on full sick leave due to psychological

problems including depression, anxiety and adjustment disorders • 79 workers received 12 sessions of cognitive-behavioural therapy (CBT) over 6

months

• 89 workers received work-focused CBT (W-CBT) with sessions focused on work examples and RTW as a goal

• Both experienced substantial reductions in mental health problems in both groups at similar costs ($5275)

• W-CBT group achieved full RTW 65 days earlier and partial RTW 12 days earlier

22

Lagerveld et al. Work-focused treatment of common mental disorders and return to work: a comparative outcome study. J Occup Health Psychol. 2012 Apr;17(2):220-34.

Use of Prescription Medication to Treat Depression

After Returning to Work from a Leave of Absence

Employee Experiences

Yes (80%)

No (8%)

Has not yet returned to work

(12%)

Yes No Has not yet returned to work

The Conference Board of Canada 2013

Recommendation #5 Supportive and flexible RTW approaches.

Getting Better Documentation

Physician Barriers

• Lack of time in family practice setting

• Limited knowledge impairment and required job roles

• Doctor acting as a “advocate” by limiting detail of the mental health or making broad restrictions.

Strategies to Improve

• Provide the clinician with a job description highlighting mental demands

• Use a brief standardized functional evaluation form specific to mental health to clarify any impairments • ex. Cognitive Demands Evaluation

• Physician to physician communication via telephone

Task/Duty Accommodation Considerations

Communication Written requirements (Documentation) Verbal requirements (face-to-face/phone) Coworkers, Team and External meetings

Social/Interpersonal Management of conflict Ability to work effectively in a team or with public Supervision requirements/accountabilities

Cognitive demands Duration and complexity of tasks Safety sensitivity of duties/equipment operation Meeting deadlines/quotas

Scheduling /Location Shift duration/start-time/schedule Time allocated for treatment Work location and commute

Supports/Barriers HR and Union policies Supervisor and coworkers relationships Home situation

Support and Monitor Progress

27

1. Regular meetings to check-in on progress and performance while health-related issues remain active • Agreed upon schedule • Trusted contacts at work • Offer to collaborate with health-care providers

2. Planning up front for how the employee can let the supervisor know when they are having trouble coping, and what is needed

3. Prepare for potential high-risk situations • Inappropriate or aggressive behaviour • Talk of suicide • Intoxication at work

Recommendation #6 Evaluate and improve.

Where’s the Data?

Direct • Job descriptions/job demands analysis

• Rates of absenteeism/turnover

• Return to work and accommodation data

• STD/LTD rates/costs and relapse

• EFAP utilization/effectiveness

• Benefits utilization rates

• Health risk assessment data

• Workers compensation data

• Organizational Audits

Indirect

• Employee Engagement

• Job satisfaction

• Team effectiveness

• Morale

• Complaints/incident reports/investigations

• Retention rates

• Competitive hiring

• Industry standards/best practices

Mental Health Commission of Canada

The Disability Care Pathway

Recovery-Focused Treatment

Timely access to care.

Comprehensive psychological and psychiatric assessment and treatment.

Proper medical documentation.

Interdisciplinary collaboration between family physician, insurer and workplace.

Financial Stability

Assistance with completing required paperwork and obtaining medical documentation.

Maintenance of benefits and job security during course of disability including RTW transition.

Comprehensive benefits coverage.

Work and Family Support

Regular communication with trusted workplace contacts.

Family is supporting healthy coping.

Return to work coordination.

Peer-support engagement.

Bender A. 2015

Thank you! ash.bender@workplaceinsight.ca

Mental Health Commission of Canada www.mentalhealthcommission.ca/English/Pages/Workplace.aspx

Mental Health Works (CMHA) www.mentalhealthworks.ca

National Partnership for Workplace Mental Health (APA) www.workplacementalhealth.org

Great West Live Centre for Mental Health www.gwlcentreformentalhealth.com/wti

31