Stress Update
2 Summaries of presentations
Maureen Dollard, Director, Centre for Applied Psychological Research
Defining “Psychological Injury”
“Psychological Injury”, a term that is suspect in many minds, relates here to standard diagnoses in the DSM 4 manual such as anxiety disorder, depression and adjustment disorder. Maureen, one of the best known researchers in this area in Australia, summarised the international discourse about the work-relatedness of these conditions and the consequent public health benefits of healthy work. This discourse is similar to the one in the Department’s Stress Guideline. Stress claims in Australia are compensable. Compensation data and other studies show that:
- Stress claims are increasing,
- they are costly - @$200 million p.a. in Australia
- they result in much more lost time than physical injuries
- some disorders are independent risk factors for CVD and MI
- mental health is responsible for the greatest proportion of the burden of population disability in Australia
- depressed workers have a productivity decrement of $12 700 annually, by one estimate
- working conditions affect mental health
- conditions that result in psychological injury also predispose to MSD.
Maureen summarised three work-stress theories:
- The Demand-Control-Support model of Karasek and Theorell
- The Effort-Reward Imbalance model of Siegrist and
- The Job Demands-Resources model of Demerouti et. al.
She briefly reviewed the Victorian WorkSafe publication “Stresswise” and its successful application to a project in 90 companies. She observed that, with lots of education, these interventions can be beneficial, but they must address the working environment and upstream conditions as well as bodily reactions.
Rob Guthrie, Head of School, School of Business Law, Curtin University.
Psychological Injury – Overview of Legislation and Legal Issues in Australia
- All States/Territories legislated to recognise work-related disease in the 1980s.
- For all States/Territories – except Tasmania – the formula is ‘personal injury arising out of or in the course of employment’. In Tasmania, it is ‘personal injury arising out of and in the course of employment’.
- All jurisdictions recognise and compensate stress injuries if work-related. An increase in the number of work-related diseases e.g. RSI & stress was noticed, and restrictions on acceptance of work-related diseases was imposed:
- Additional requirement introduced “significant or substantial contribution” work-related element
- Tasmania also requires the work contribution to be the major or most significant factor in the onset of disease
- This is very much subject to debate and litigation cases – balance of probabilities burden of proof required
Stress claims in Particular
- Exclusions are generally imposed, varied slightly amongst States/Territories but generally include:
- Reasonable disciplinary action
- May not include effects of counselling prior to disciplinary action, but subject to litigation (Quarry v Comcare and Choo v Comcare state the opposite)
- Failure to get a promotion/benefit/transfer
- Performance appraisals and actions stemming from them
- Redundancy
- Reasonable administrative action by employer to employee
- Decided on case by case basis
- Procedural fairness important but company’s particular culture or situation will influence decisions
- About 90% stress claims are contested by Insurer, usually on these issues and others, e.g.
- Simionato v Red Rooster Foods Pty Ltd (worrying about a stress claims is not covered)
- Wigeand v Comcare Australia (if claimant claim stress arose from their perceptions of incident/situation, claimant must prove incident/situation occurred)
ComCare is a significant litigator (largest insurer across Australia), most stress-related court decisions stem from them.
Prevalence of stress claims
- Validity of data on prevalence of stress claims not reliable due to difficulties extracting information from various Insurer databases
- Introduction of these exclusions does not appear to have influence a decrease on stress claims
- For work-related disease claims, other diseases have decreased, stress claims have increased
- South Australia and Victoria appear to have the highest numbers of acceptance of stress related claims
- Costs associated with stress claims have increased
- Average cost of 1 stress claim = A$115,000
- Generally twice the cost of other claims
- Lost time associated with stress claims has increased
- Dr Guthrie theorises that legislative restrictions on stress claims has not impeded the number of stress claims submitted and accepted
- Compensation for stress claims, of course, is the ambulance at the bottom of the cliff and does not pro-actively address the causes of stress or prevent it occurring in the workplace.
In the Future
- Commonwealth has opted for stronger/more robust exclusion provisions in workers’ comp. Legislation
- Employers can migrate to the Comcare system from previous private insurer arrangements if they exist in their jurisdiction
- Continued debate and litigation on stress claims expected
Kim Hobbs, Well-being Services and Health Benefits Director, IBM
Employee Mental Health Management
Kim Hobbs reviewed IBM’s experience of stress claims. They are responsible for about 40% of cases, 80% of lost time and costs. Stress is involved in 40% of turnover and is a major driver of Workcover premiums.
As a result IBM attempts to make employee wellbeing a fundamental part of line management, part of its business strategy, planning, reviews, reports and product offerings.
- IBM Managers can make an error in any business decision without fear of reprisal, but if they mess up employee relations, that’s serious.)
Managers must actively promote a culture of well being, train staff re workplace well-being and foster their involvement in those programs. ‘
These programs address personal health risk factors and total wellbeing and are delivered through company channels – and are regarded as all the more important in an industry that is basically sedentary.
Mid-low upper level management is the most affected – they can be the meat in the sandwich and are at high risk owing to ambition and workload.
She reviewed the results of a Medibank private study of the Health Profile of Australian Employees in relation to sickness absence, productivity and productive hours and observed that IBM regards their programs as affecting productivity favourably.
Peter Cotton, Director, Psychology Services, Health Services Australia Group.
The Influence of Leadership and Climate on Employee Wellbeing and Injury Management Outcomes
Organisational stressors such as experiences of aggression, conflict etc don’t appear to correlate to individual stress responses.
These stressors can be mediated by workplace morale, the work climate, and the employee’s individual susceptibility.
If a workplace has a high morale amongst staff, a better buffer exists to combat stressors. The opposite is also true – people in a workplace with low morale will be more susceptible to stressors.
If there is a decline in morale, employees become more aware of “organisational justice” – particularly if they believe that they have been an unfair target of organisational justice.
Leadership is the cornerstone in the workplace climate.
| Popular leadership | Supportive leadership | Overly directive leadership |
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Suggestions to improve organisational climate:
- Supportive leadership training
- Identify managers who are good leaders vs. those needing assistance
- Mentor programmes
- Management accountability mechanisms
- 360° performance appraisals
- Leadership KPIs
- Climate surveys, feedback
Tony Cotton, Manager, Wellbeing Network, Australian Federal Police.
Overview of proactive intervention strategies: Getting in early to manage workplace mental health – implementation, effectiveness and continuous improvement.
Opening message was that there needs to be acceptance that mental health is a factor in the workplace and that work can cause and/or affect that.
Reiterated the 1:5 statistic (1 in 5 Australians experiences symptoms of mental illness each year) and emphasised the impact including costs to the workplace.
In relation to preventative strategies he commented that in providing information to employees, they will probably remember only a couple of facts out of a presentation e.g. some of the statistics and possibly where to go for help but often forgotten as “it doesn’t apply to them!” This is one of the main issues around acceptance of mental health problems in the workplace.
Early interventions (before employees become “broken biscuits” improves outcomes because the effects of psychological injury are not entrenched (just like intervening early for OOS - May only take a small adjustment to resolve).
Elements of a good intervention program;
- Peer support programs – good boundaries and supervision.
- Management endorsement is critical – acceptance/understanding.
- Workplace chaplains – integrated into other interventions
- Screening to identify those at risk, using well validated tools and backed up by services. Not diagnosing debriefing or treating.
- Early treatment for problems identified.
(Tony Cotton and Peter Cotton are not related.)
Jacky Jones, Project Manager, Health and People Management, Australian Tax Office
Mind the mind: the psychological wellbeing initiative of the ATO
The Australian tax office workforce was identified as one of sedentary work with a high mental load.
A psychological well being program – Mind the Mind was introduced 2 years ago within the health and safety program which included other well being programs such as the 10,000 steps and quit (smoking) programs.
The program included monthly themes for the tax office that complemented and related to current work programs of the tax office and national health promotion such as October – Mind the Mind theme for mental health awareness week.
The initiative had three broad categories;
- Direct intervention including a risk management and tax safe map which ensured risks of psychological harm were included in the health and safety plan, Keeping in touch (KiT) promoting communication and rapport between managers and staff and early psychological intervention process to mirror the physical injury process.
- Education including a national training program for managers, an internet resource directory of providers for psychological injury and well being activities related to psychological health.
- Awareness including a communication campaign, information booklet and other resources including books and videos.
Susan Goldie, Director, Healthy Mind Works, Pty. Ltd.
Mental Health First Aid (MHFA) Training & Research Programme
The aim of this entirely new programme is to raise the level of mental health “literacy” in the community. It is commonly accepted that trained people administering first aid for physical injuries is critical for stabilising the injury until professional medical assistance is received. Why not have trained people skilled in first aid for mental health emergencies?
This serves both to educate a wide sector of the community (not just workplaces) of the basic signs and symptoms of certain mental health issues or illnesses, but also helps to reduce the social stigma associated with people experiencing mental health issues or mental health illness – “stigma-busting”. This should lead to an increased uptake of people seeking assistance for mental health problems.
Australian statistics state that about 1 in 5 Australian adults will experience some form of common mental health problem in any one year.
MHFA follows the conventional first aid model, where help is provided to a person who may be developing a mental health problem before professional help is obtained, but can also be used to prevent mental health problems from developing by increasing awareness and social acceptance. However, it is not a therapeutic programme and is not a substitute for getting professional help.
The course lasts for 12 hours over two days. Participants receive a course manual and certificate of achievement. Cost is about A$100-300 per participant.
The course had its beginnings in June 1999 when Prof Tony Jorm and Betty Kitchener of ORYGEN Research Centre, University of Melbourne, formed an advisory ground to direct the curriculum of the MHFA course, including:
- 3 mental health consumers
- 2 mental health carers
- 2 teachers
- 1 psychiatrist
- 1 psychiatric nurse
- 2 Red Cross first aid instructors
- 2 mental health researchers
The course includes:
- A knowledge and skills component for common mental illnesses, including:
- Depression, Anxiety, Psychosis, Substance use disorders
- Handling crisis situations:
- Suicidal people, Panic attacks, Traumatic event experiences, Threatening violence, Overdoses
- 5 basic steps:
- Assess the risk of suicide or harm
- Listen non-judgementally
- Give reassurance and information
- Encourage the person to get professional help
- Encourage self-help strategies
The programme has solid evidence for its effectiveness from four randomised controlled trials and qualitative studies:
- Uncontrolled trial Kitchener & Jorm, 2002)
- Randomised controlled trial with wait-list control group, Kitchener as instructor (Kitchener & Jorm, 2004)
- Randomised controlled trial, local health service instructors (Jorm et al., 2004)
These trials showed that the trained group: showed improved confidence in giving help; were more likely to advise people to seek help; better concordance with health professionals in beliefs about treatments; participants own mental health improved (unexpected bonus).
Development of standards is progressing – for completion 2008 – for 6 crisis situations and 5 developing disorders in addition to the above: eating disorders and self harming behaviour.
The programme is being adopted/adapted and rolled out by a number of countries:
- Scotland, Hong Kong, Canada, Finland, Singapore, England, Sri Lanka
- Pilot in place for Northern Ireland and the Republic of Ireland.
- A Chinese romance novel has been written.
Instructor Joy Peters from NSW spoke at one of the regional New Zealand Dairy Farmers Conferences in March 2007, but a MHFA programme has not yet been developed or released in New Zealand yet – MHFA Friends Newsletter January 2007. Betty Kitchener emailed to say that she has had a number of enquiries and much interest shown from NGOs in New Zealand but no requests yet to take the MHFA program over.
The MHFA Training and Research Programme received the Public Health Programmes Award for Innovation from VIC Health in September 2006. They have won various awards throughout Australia since September 2003.
The New Zealand Ministry of Health has asked the New Zealand Mental Health Foundation for a commentary on the suitability of the course and manual for New Zealand.
Len Lambeth, Directorate of Mental Health, Australian Defence Force.
Implementing a “resilience programme” for management of “everyday” stress.
Mental health is the foundation upon which resilience is based and is unique to the individual. If you have good resilience you have the ability to adapt, play and choose.
Resilience is a set of behaviours and actions that can be learnt.
Emphasis on recognising that people suffer physical and psychological harm e.g. if you own a sports team expect physical injuries if you have stress work expect some mental injuries.
Psychological harm results in intellectual (memory/concentration), emotional (irritability/isolation) and physical (headaches/sleep disturbance) symptoms.
Our experience of stress depends on how we think about and then interpret a problem. We then develop a feeling about that interpretation and act on that feeling either appropriately or not.
Resilience training involves cognitive strategies/behavioural coping strategies to match cognitive appraisal of the original stressor.
- Take control
- Plan – step by step
- Action – effort concentration
- Avoid distractions
- Avoid procrastination
Look at the problem in a positive way BUT also accept the reality of the problem and focus on the solution NOT the problem.
Paul Morgan, Deputy Director, SANE
Good Mental Health = Good Business
Opening statement was that good mental health = good business!
Companies need to retain good people and avoid the risk and cost of replacing.
The purpose of SANE is to ensure a better life for all Australians with mental illness though education, early diagnosis and treatment, and improving attitudes towards mental illness with a particular focus on the workplace over the past two years.
This recent focus came about because the changes in welfare (Australian) has resulted in a drive to get all Australians into work, resulting in higher incidence of people with mental health issues in the work force, a high percent of time is spent at work where mental illness is a “real world” issue and because work is the locus of our social being.
EVERYONE has mental health issues at some time to some degree (bullying, harassment, “stress”), mental illness is at the other end of the spectrum.
Discussed the signs and symptoms of major psychotic disorders, depression and anxiety and noted the specific characteristics of each.
Described the managerial response of FUD – Fear, Uncertainty and Doubt.
Because symptoms are behavioural the assumption is made that it is a behaviour problem when it is a physical problem. There is no obvious response, which leads to frustration. Management response then, is likely to be behavioural and emotional (buck-pass and dismissal). Focus again on early intervention of USA;
- Understanding – preparation, demystifying, empathy.
- Support – inclusion, attitude, safety net, flexibility.
- Action – recognise early warning signs, make adjustments, discuss, agree a plan.
David Dixon, Director, Workforce Planning, Hunter New England Area Health Services
Integrated Enterprise Risk Management and its relevance to Worker’s Compensation and Occupational Health and Safety at Hunter New England Area Health Service (HNEAHS)
David Dixon, from the largest health employer in NSW (and 58th overall in Australia) described the AHS efforts to address employee well being and decrease mental health claims simultaneously.
These have increased markedly in recent years. The emphasis has been on creating a supportive workplace culture – good management support, sound peer relations and individuals feeling valued.
“Wellness, job satisfaction and employee commitment are all within the control of the organisation. The organisational culture, particularly its systems and management style, is the key tool to impact these factors and this to impact bottom-line performance.”
The ROI in wellness programmes is between $1.64 and $6.85 per dollar invested.
HNEAHS places a very strong emphasis on values as key to organisational success: Teamwork, Honesty, Respect, Ethics, Excellence, Caring, Courage, Commitment.
Richard Kaspercyzk, Executive Director, Resolutions RTK
People risk management: Identifying relevant mental health hazards in the workplace
The reality of workplace stress is that it hurts (unproductive, costly) and it is increasing.
If we have a “stress” problem in the workplace why isn’t it managed with the same RIGOR and Commitment as physical illness?
Many reasons why in particular a fear of identifying the problem (then you have to deal with it) and that interventions are frequently at odds with principles of business.
The problem can be addressed (most managers don’t want to damage people) but the issue can be emotive for managers as most of them experience stress themselves. Also it is seen as an individual issue not an organisational issue that is complex and not linked to economic measures which often drive interventions.
Need to de-mystify and challenge people into a new way of thinking. Example of water on floor in a workplace everyday. Would you ignore it? – Unlikely even though not everyone is likely to slip or hurt themselves.
Need attitude change to think the same way for the psych realm as we do in the physical realm.
Need to build resilience in people. Need to change the word stress to psychological harm. And need to use the same language in relation to risk management for psychological risk as we do for physical risk.
Martha Knox-Haly, Principal, MKA Mitigation
Ensuring the psychological health of your organisation – and mitigating hazards that could result in claims
Website: www.mkarisk.com.au
Stress and bullying are issues that impact both on employment relations, occupational health & safety, discrimination and harassment.
Performance management appears to be a key area for the majority of stress claims.
Approximately 80% of people with chronic physical injuries like RSI are thought to be co-morbid with depression.
Key Court Cases
Koehler v Cerebos (Aust) Ltd 2005
- Employee informed employer that they could not cope with workload, left work due to health problems, later diagnosed with depression, Court found that employer did not investigate or attempt to remedy situation
NSW v Gary Donald Jeffrey & Ors (2000)
- Defendants complained to employer about prevalence of a workplace bully; employer did not dismiss bully from employment
Graham v Brisbane City Council (2001)
- Applicant allegedly bullied/threatened to harm others, employer tried to offer counselling, terminated his employment after investigation, employer’s decision upheld
Midwest Radio v Arnold (1999)
- Employee with previous history of sexual abuse was sexually harassed/bullied by co-worker, resigned, still could not find work approximately 8 years later, Court ordered compensation of lost wages for 12 months out of 8 years, determining that rest of her psychiatric issues resulted from previous history
Implications from court cases: dealing with bullying
- Develop a workplace culture that rejects bullying behaviour
- Provide training/counselling and support to both victims and perpetrators of bullying
- Procedural fairness in dealing with bullying issues is critical
- Investigations must be conducted into bullying allegations
- Management need to understand all of the implications of bullying, e.g. morale, turnover, financial, corporate reputation, litigation costs, etc
Management of employees with psychiatric disabilities
- There is a need for workplaces (employees and management) to be educated about the prevalence, symptoms and myth-busting of psychiatric/psychological disorders
- Psychiatric disabilities can complicate performance management issues – again, procedural fairness is necessary
- Create a workplace culture where employees with psychiatric disabilities are accepted, especially if/when workplace adaptation is needed for those employees
Dorothy Frost, Branch Manager, Stress Projects, Victorian WorkCover Authority. Melbourne.
The VWA’s approach to work related stress.
Dorothy summarized the VWA experience:
- Stress claims are growing, whilst overall claim numbers are dropping - -10% of total scheme claims
- Most prevalent in the public sector (20% of Public sector claims)
- ‘Expectations’ re stress and workers compensation have evolved
- Great variance regarding degree of disability / contribution to work
- Lack of understanding re most effective treatment, and what will assist with recovery and return to work
- Many claims are related to inter-personal conflict between colleagues
She described an intervention piloted by VWA in (under the supervision of Maureen Dollard) that she said clearly showed that psychological risk factors can be reduced.
She cited the VWA publication “Stresswise” (it adopts a risk management approach) released in March 2007 as the basis for the intervention.
Other efforts are under way to improve the claims management experience.
Sandra Sutalo, Website Manager. SANE Speaker.
Personal Experience of Mental Illness and Working
Sandra is a part-time public speaker with SANE.
She has experienced a schizo-affective disorder for approximately 15 years, a psychotic illness combining schizophrenia and bipolar disorder. As listed below, the symptoms she experiences can impede one’s employment effectiveness in the workplace.
Her symptoms:
- Aural hallucinations, including hearing voices that consistently told her that she wasn’t “doing a good job”. She could hear the voices for hours on end, and were loud enough for her to have trouble distinguishing their voices from the voices of colleagues
- Visual hallucinations, such as seeing faces of people she associated with fright or fear
- Feelings of paranoia, where she believes that someone is trying to harm her, and/or everyone is trying to harm her
- Delusions, where she might take on the identify of a witch, which further led to her feeling isolated in the workplace
- Continually fidgeting, feeling jumpy, poor short term memory, social withdrawal
- Having an altered perception of how others act around or in relation to her
- Occasionally having manic episodes, where she would feel unusually, extremely happy or “high”
Medical Management and Rehabilitation:
The causes of mental illness are often not known, and medications may not or cannot cure the person completely of symptoms. Medications can in the best case stabilise symptoms, or in the worst case, have no effect.
There are side-effects associated with taking medications, which can in turn create issues when a person is trying to seek or maintain employment. These include but are not limited to:
- Weight gain
- Personality changes
- Fatigue, disorientation
- Short-term memory problems
Mental health illness rehabilitation is a long-term procedure, as it takes time to establish if symptoms are improving, if medications are affective, or to determine what actions/beliefs are experienced normally as part of one’s personality.
She still occasionally suffers relapses, and needs to constantly monitor her medications so that she can function socially, i.e. timing the taking of sedating medication so that she will not be tired at work the next day.
Sandra’s employment experiences:
Sandra has a varied work history, such as working in the socially-demanding role of customer service for a multi-national organisation, engaging in tertiary studies while working, and temping work after a redundancy, before working as a Website Manager for a mental health organisation. She jokingly referred to herself as a “qualifications junkie”.
For approximately 6 years, she coped with her illness without seeking treatment by predominantly internalising her symptoms, but did not speak publicly of her experiences, some of which would have been very frightening for her.
She would not realise that she had constantly had very high workloads, instead, she though that she was working inadequately and not coping, where it was expected of her that she should be. She was also abusive to others at times (she spoke of these issues as if someone had told her about them; she does not appear to have any personal recollection of these matters).
In one employment situation, she was also bullied by a colleague. She decided that she was being bullied because God was punishing her. She confided in a colleague, who laughed at her experiences, and did not advise her to seek psychiatric help.
Informing the employer:
There are advantages and disadvantages to notifying an employer about one’s mental illness. In her experience, due to the psychotic nature of her illness and the social stigma associated with psychosis, she does not recommend informing anyone, although she concedes in some situations, depending on the nature of the illness and symptoms, it may be more advantageous for the employer to be aware of and be able to work positively with the person(s), to incorporate modifications if necessary (see below). It may also help colleagues’ understanding of symptoms and help create a more co-operative atmosphere.
Other advantages:
- Workstation, work time or work method modifications
- Having time off work for medical appointments
- Finding quiet spaces for reflection, letting others know if this is required
Her current employer is involved with mental health in the community and she has informed them of her circumstances.