How to Manage Mental Health Problems in the Workplace

Infonex: Managing YourDuty to Accommodate

9:10 – 10:10 Aug 30, 2011 Calgary 985

Chris Hylton, MACG Hylton & Associates Inc.

800 449-5866 chris@hylton.ca1

Agenda

What is mental health? Types of mental health concerns:

addictions and other mental health issues Solutions for a mentally healthy workplace Managerial and supervisory support Identifying problems with addiction: know

the early warning signs Key indicators of substance abuse

2

3

Do you have any workplace issues we can try and solve for you in this session?

What is Mental Health? 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”

4

What is Mental Health? People learning and be able to cope with:

Stress Changes in life and the workplace Demands in the workplace Home life Work life

5

What is this?6

Freud7

Love and work are the

cornerstones of our

humanness

http://www.freud.org.uk/

and you wonder why we work?

8

“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 placein a portion of reality,

in the human community”

“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

9

10

Mental Health – Overlapped by 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

11

Abusers in Past Year as Percentage of Adults (Canada)

20 19 15 14 2

Alcohol Tobacco Medications Marijuana Illicit Drugs

Source: Attridge & Wallace (2009), MacMillan et al. (2009)

12

Behavioural Addictions Increasing

13

Addiction Rate in Adult Population

Historical Trend

Gambling 5% problem; 2% pathological

Increasing

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 Workplace

14

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 Demographics15

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 Costs to Society: Canada

16

Combined costs of: health carelaw enforcementwork productivity disabilitypremature death

Average $1,267 per every citizen

Source: Single et al (1996); Rehm et al (2006)

Other Workplace Consequences

17

Majority of all addiction related costs (61%) are in 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 company risks for safe work environments, equipment loss and lawsuits.

Source: Attridge (2008), Attridge (2009)

Case Study - Jack18

Safety-sensitive, oilfield construction

Knee surgery due to work accidentseveral 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 Jack19

Immediate appointment toassess 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

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

Two-Year Relapse Prevention Program20

Why is the problem to difficult and complicated?

21

ANY IDEA WHAT CAUSES ADDICTIONS?

Various Theories22

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 addicted23

Traditional Continuum Model of Progression Toward Substance Abuse (Alcohol/Drug):

Source: Attridge & Wallace (2010)

Epigenetic Neuroscience Research24

“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 - Epigenetics25

Links Addictions to a Combination of Genetic Links Addictions to a Combination of Genetic and Biological Factors that Interact with Early and Biological Factors that Interact with Early Child Development ExperiencesChild 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.

26

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

27

Care and Prevention28

Can the problem be treated or prevented?

Range of Treatments29

self-help (often multiple failed attempts) = self-help (often multiple failed attempts) = weak evidenceweak evidence group-based peer-support programs (AA) = group-based peer-support programs (AA) = modest evidencemodest evidence talk therapy - cognitive behavioral therapy (CBT) = talk therapy - cognitive behavioral therapy (CBT) = best evidencebest evidence brief residential detox with counseling = brief residential detox with counseling = good evidence for severe casesgood evidence for severe cases Rx medications and general medical care = Rx medications and general medical care = mixed evidencemixed evidence harm avoidance programs = harm avoidance programs = emerging good evidenceemerging good evidence

TRENDS = Gender differences & Holistic treatment model bestTRENDS = Gender differences & Holistic treatment model best

Addiction is a Life-long Condition

Source: Cleck & Blendy (2008)

The Addiction Cycle Often Repeats Over Time, Even with Treatment and Can Worsen

30

Solution31

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_prevention_of_workplace_stress.pdf

Workplace Solutions - Morale

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

32

33

Performance Appraisal Make it employee focused Career path Training Tools they need Job description updated

Workplace Solutions – HR Forms

NO BULLYING!

Bullying any co-worker on or off the workplace is still an offense

Creates low self-esteem and toxic work environment

34

Workplace Solutions – HR Policies

Absenteeism Management

Establish average absentee rate

Place those x% above, in an Absenteeism Management Program

35

Workplace Solutions – HR Policies

Policies are only as good as their communicationManagers need support on how to act and react

Workplace Solutions: Manager Training Agenda

What do substances look like? What do they do?

Enabling, Privacy, Rights

ER and EE Obligations

Treatment, Support, Accommodation

Performance Management

Prevention, Recognition, Response Skills

36

37

What is an “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

What is an EAP?

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

38

39

Typical Reasons for Calls to EAP

Substance Abuse

Family

StressDepression

Alcohol

Workplace

25%

22%

25%

18% 8%

40

Reasonable Cost 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?

41

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

EAP Cost We offer an EAP No cost to set up $125 per hour

cost

For more info contact me

42

43

Drug & Alcohol Testing

Discrimination rules No pre-employment

testing No random drug

testing No alcohol testing

for non-safety sensitive positions

Safety sensitive position is one where impairment due to drug or alcohol use could result in injury to self or others

44

When can you test? Random alcohol testing for

safety sensitive positions ok Drug or alcohol testing for

“reasonable cause” or “post-accident” is ok

How nice should you be?

45

Consider:is it better to fight discrimination suit than

injury or death claim caused by a drunk or impaired employee?

Face to face Therapy

Research conclusively shows that traditional face-to-face (FTF) psychotherapy is generally effective for mental health issues

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

Source: Lipsey & Wilson (1993), NICE (2008), Seeling & Katon (2008)

46

Access not always possible

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

47

48

•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 Research Internet Counselling

49

• Internet-based forms of psychotherapy (e-mail andweb 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 Research Internet Counselling

50

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 aseries of ten hour-long sessions of online text-based (e-mail) interactionwith 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)

51

Selecting and Strengthening

Employee Assistance Programs:

A Purchaser’s Guide

EASNA’s 2009 Purchaser’s Guide to EAPs

W52

Resources America’s Health Insurance Plans - www.ahiphiwire.org/wellbeing

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

53

Our offer to you54

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 Job Descriptions Salary Grids Wellness at Work Staff Morale Training and

Workshops

Benefits, Pensions,

EAP Strategic Planning Drug and Alcohol

programs Dept re-orgs Leadership

compensation

55

Tel 403 264 5288chris@hylton.ca

Thank you for the opportunity to meet today!

Tel 403 264 5288 or 800 449 5866 (800 4hylton)

chris@hylton.ca

56