How can workplace health promotion assist with mental health? Professor Niki Ellis Workplace Health Promotion network, Sydney 21 November 2012

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1 How can workplace health promotion assist with mental health? Professor Niki Ellis Workplace Health Promotion network, Sydney 21 November 2012

2 Model for Mental Health Promotion Occupational Health and Safety Voluntary Health Practices Workplace Organisational Culture The Canadian Mental Health Association, 2010

3 Levels of OHS interventions Individual

4 Traditional OHS: injury prevention HEALTH GAINS ORGANISATIONAL GAINS HEALTH PROMOTION Promote health and well-being Improvements to productivity OHS Health promotion in the workplace HEALTH PROTECTION Prevent harm physical environment individual - Reduce losses Psycho-social environment Work-related conditions Non work-related conditions

5 Current best practice - Talking Health, Thinking Safety: Parmalat Motivated by poor Worker Health Check results By offering people advice on healthier lifestyle options, we could not only potentially lower our work related injuries, but also give people the opportunity to embrace a healthier lifestyle and take responsibility for their own wellbeing

6 Current best practice - Talking Health, Thinking Safety: Parmalat Program includes: making healthier food choices quitting smoking dealing with depression the importance of exercise and stretching prior to work

7 Current best practice - Talking Health, Thinking Safety: Parmalat Impact: 54.5% decrease in MTI and LTI during 2011 Health behaviour changes

8 The Job Stress Process: modifying variables and interventions points Primary Intervention To eliminate or reduce job stressors Secondary Intervention To alter the way individuals perceive or respond to job stress Tertiary Intervention To treat, compensate, and rehabilitate workers with job stress-related illness Working conditions Distress Short term response Enduring health outcomes Modifying variables: Individual or Situational Characteristics Social Non work related stressors Socioeconomic status Biophysical Age Sex Health status Psychological Personality Coping abilities Behavioural Exercise Recreational activities Nutrition Genetic Inherited predisposition to mental illness, heart disease Figure 1: The Job Stress Process: Modifying Variables and Interventions Points (LaMontagne, Keegel et al., 2007)

9 1 2 3 Identify Hazards Obtain management approval and engage employees Assess nature and extent of risk Analyse HR data Conduct a survey Undertake a workplace inspection 4 5 Confirm risk assessment and get ideas for action Focus Groups Develop an action plan Workshop 6 Monitor and review

10 WA Police Operations Centre: Stress audit Final report By Dr Niki Ellis 31 October 2007

11 What are the factors which are risks and opportunities for organisational health? Organisational health - way work is indicator organised Job security Workload Job control Scheduling Job content Social environment Physical environment Relevance to WA POC ++ Sworn police likely to be here for short period of time +/- Periods of calm then all hell breaks loose, Busy channels -- No control over who rings and no control over cars, Electronic monitoring, No input to decision making +++ Shift design, Flexibility in rostering and breaks ++ Meaningful and interesting, Job rotation, but also Exposure to trauma + Interact on the floor with your pod, With 20 guys out there + Good work environment, Lack of amenities, especially food and exercise Based on focus groups and interviews with middle management

12 What are the factors which are risks and opportunities for organisational health? Organisational health indicator - way work is managed Role and feedback Relationships Change management Training and development/career pathway Relevance to WA POC -- Lack of recognition, performance management system not seen as relevant +++ Management on the floor here are reasonable, they re flexible, good they re alright + Accepting of change, change to date has been smooth, but they don t know what the agenda is so there is guessing, rumour and negativity +/- Police staff would like more development Based on focus groups and interviews with middle management

13 Traditionally, OHS and WHP separate OHS WHP Prevention of work-related conditions Prevention of non work-related conditions Health protection model (prevent injuries through risk management) Emphasis on workplace environmental change Employer responsibility Mandated Has focussed on physical risk factors, resistance to psychosocial factors Health protection model (prevent disease) Emphasis on individual behavioural change Worker responsibility, employer support Voluntary Historically focussed on disease prevention, but responding to mental wellbeing agenda more rapidly than OHS

14 Integrated Approach to Workplace Health and Safety HEALTH GAINS ORGANISATIONAL GAINS SOCIAL CAPITAL GAINS + HEALTH PROMOTION: and HEALTH PROTECTION: Organisational Health and Safety Management individuals - + physical REDUCED environment LOSSES Organisation social environment IMPROVEMENTS TO PRODUCTIVITY REDUCED SOCIAL ISOLATION family and community

15 Evidence based model for integrated approach Source: NIH and CDC workshop, 2010, Am J PH

16 Integrated approach to workplace health and safety (health and productivity management) Driver is optimisation of productivity through health and wellbeing (beyond compliance, ie assumes foundation of good OHS) Health promotion model optimisation of wellbeing and performance, goes beyond reducing injury and illness Recognises social capital as well as business enhancement Prioritises health problems by impact on workplace (noting a key factor in effectiveness is basis on worker needs) Balance of organisational level and individual level interventions, reinforced by family and community interventions, most effective

17 Guiding principles for beyondblue Workplace and Workforce initiative Workplaces provide a relevant and appropriate setting to address depression and anxiety Workplaces often don't know how - we aim to address knowledge and skills Workplace factors can contribute to poor mental health

18 UK Government Response to Black Report 2008 Vision We want to create a society where the positive links between work and health are recognised by all, where everyone aspires to a healthy and fulfilling working life, and where health conditions and disabilities are not a bar to enjoying the benefits of work

19 Robert Wood Johnson Foundation model Work based health protection and promotion strategies Preventing workrelated illness & injury Reducing work-related stress Supporting healthier behaviours through workplace environments & services offered at work Expanding workrelated resources & opportunities Workplace safety measures Control of workplace hazards Improved ergonomics Health and safety training Decreasing job strain Fostering social support among workers Stress management Supporting work family balance (e.g. through flexible schedules) Health screening and services Promoting healthy behaviours Creating a health promoting environment Medical care benefits Paid sick & personal leave Child & elder care services Job training & education Adequate wages & salaries Figure 1: Work Based Strategies to Improve Health (Robert Wood Johnson Foundation, 2008)

20 Glaxo SmithKline Resilience Strategy for occupational stress Figure 1: GSK Resilience Strategy for Occupational Stress (Robertson Cooper Ltd. & UMIST, 2003)

21 EDF Energy the strategy The Strategy embraced prevention and early intervention, and included: A comprehensive programme of management training: over 1900 trained Integrated internal communication and dialogue through Health and Safety campaigns, including the usual posters and intranet messages. Innovative policy of putting wellbeing on agenda in formal meetings. A suite of initiatives to tackle all major aspects of staff wellbeing : - the Employee Support Programme - Review of physiotherapy services and ergonomic assessment - Stress and Resilience Training and Enhancement Programme - The Transition Toolkit - Healthy Lifestyle programmes. Courtesy of Dame Carol Black

22 What does well-being mean at EDF Energy? Being mentally fit and resilient, especially during times of change Being physically fit and healthy, and safe in our working environments Feeling connected, cared for and supported by others and fitting in Courtesy Dr Margaret Samuel, CMO EDF Energy, 2012

23 A positive workplace Visible senior leadership regarding well-being Accountable, competent managers throughout the organisation demonstrating the right attitudes and behaviours Job design that recognises good work principles such as strong relationships, fairness, flexible working, meaningful work, etc. (standards set by HSE the UK s Health and Safety Executive). Empowers employees to care for their own health both mental and physical Courtesy of Dame Carol Black

24 OH input to Being Mentally Fit PRIMARY Prevention Recognising stressors Building resilience for all employees SECONDARY Targeted intervention Resources for impacted groups TERTIARY Rehabilitation Clinical support for affected individuals Stress Risk Assessment Stress & Resilience Awareness Resilience Programme Health campaigns Transition Toolkit Building resilience through change Referrals to OH Employee Support Programme Case management Roundtable meetings Rehabilitation plans Courtesy of Dame Carol Black

25 Stress & Resilience Awareness Training EDF s three-hour Stress & Resilience Awareness Training for Managers sessions were piloted in February 2009 with c.1,900 attendees to date Sessions include information on: - What stress is - How to recognise the signs of stress - Where to look for further support - How to increase personal resilience and coping mechanisms They also explore the six Health & Safety Executive (HSE) Stress Management Standards which can help teams work together more effectively. Courtesy of Dame Carol Black

26 HSE Stress Management Standards Demands* The demands of people's jobs (relating to workload, work patterns, working environment) Support The support provided by the organisation, line management and colleagues Role Extent to which people understand their role in the organisation and do not have conflicting roles Control How much control (or how much say) people have in the way they do their work Relationships Relationships at work Change* How organisational change is managed and communicated *Key referral areas Courtesy of Dame Carol Black

27 Transition Toolkit for Leaders EDF Energy s Transition Toolkit for Leaders focuses on improving leaders skills in supporting people through change The toolkit includes theories of change and transition and provides exercises, tips and further resources to equip managers through all types of change Workshops have been developed to bring the Toolkit tools and techniques to life and encourage people to apply them in live business scenarios Courtesy of Dame Carol Black

28 Building resilience through change EDF Energy s newest 3-hour workshops, extra to the on-line Resilience Porgramme, are being delivered by The Mitchell Practice, London The sessions explore the psychology of change at an individual level (e.g. change and stress, reinforcing resilience through change) They provide practical ideas on how managers can work to build their team s resilience (e.g. assessing the likely effects of change) A pre-event questionnaire enables participants to identify where they sit on the stress curve and the areas they need to focus upon. Courtesy of Dame Carol Black

29 OH input to Being Mentally Fit PRIMARY Prevention Recognising stressors Building resilience for all employees SECONDARY Targeted intervention Resources for impacted groups TERTIARY Rehabilitation Clinical support for affected individuals Stress Risk Assessment Stress & Resilience Awareness Resilience Programme Health campaigns Transition Toolkit Building resilience through change Referrals to OH Employee Support Programme Case management Roundtable meetings Rehabilitation plans Courtesy of Dame Carol Black

30 Conclusion Employers are increasingly interested in mental health interventions in workplaces Currently prevailing practice aims to increase availability of support services, with some limited effort to enhance management capability Relationship between work and mental health poorly recognised Workplace interventions currently operate at the individual level, and neglect the potential for work to be both a risk and an opportunity for mental health Research evidence shows that the most effective health programs are aimed at a combination of individual and organisational level change, reinforced by family and community; and address physical, psycho-social and organisational factors A UK case study has been presented Australia has a long way to go, your network can help

31 How mental health can help Recognise the relationship between work and mental health: both risk factors and opportunities Recognise OHS infrastructure can be useful in workplace mental health programs (but they need your expertise) Ensure workplace mental health programs balance organisational-level and individual-level interventions Advocate for inclusion of mental health in all workplace health and safety programs