overview of occupational disease case studies dr. clint ramasir
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Occupational Mental Ill Health With a Focus on Work Related Stress
Clint RamasirMBBS: MSc. Occ. Med.
Occupational Health Physician
Hazard – the potential of the chemical, biological, physical agent to cause harm.
Risk – the likelihood of harm occurring in actual circumstances of use.
Important Terminology – Hazard and Risk
Physical – Noise, vibration, ergonomic, radiation or lighting, heat
cold, manual handling, accidents (cuts, falls, burns)
Chemical – Dusts, fumes, gases, aerosols, fibres, liquids, vapors
Biological – Bacteria, viruses, fungi and moulds, yeasts, insects
Psychosocial – Job stress, job autonomy, job organisation, unsocial hours
Simple Hazard Checklist
The Range of Problems
Occupational Mental Health
Stress & Adjustment reaction
Brain Injury & Learning Difficulties
Psychosis
Including
Schizophrenia
Organic Disorders & Neurotoxicity
Anxiety & Depression
Phobias
Personality Disorders
Post Traumatic
Stress Disorder
Dementia
Alcohol & Drugs
Estimated incidence rates of self-reported work-related illness, for people working in the last 12 months
all illnesses musculoskeletal disorder
stress, de-pression or
anxiety
Other Illnesses0
500
1000
1500
2000
2500
2001/02 2003/04 2004/05 2005/06 2006/07
Rate per 100 000
I 95% confidence interval
HSE statistics 2006/07
Incapacity Benefits claimants by primary medical condition
1996 1998 2000 2002 2004 2006 20070%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
nervous system
injury and poisoning
circulatory and res-piratory
musculoskeletal
other
mental and behavioural
year
Source:DWP Administrative data
Hearing Problems
Breathing or lung problems
Stress, depression or anxiety
Lower limbs mainly affected
Upper limbs or neck mainly affected
Back mainly affected
Any musculoskeletal disorder
0 200 400 600 800 1000 1200
Estimated prevalence of self-reported work-related illness, by type of complaint, 2006/07
Estimated prevalence (thousands) I 95% confidence interval
HSE statistics 2006/07
6. Alzheimer's/Dementia
5. Trachea/Bronchus/Lung Cancer
4. Chronic Obs. Pulmonary Disease
3.Alcohol Use Disorder
2. Ischaemic Heart Disorder
1. Unipolar Depression
0 2 4 6 8 10 12
3.01
3.07
3.65
4.08
6.76
10.3
US and CanadaBurden of Disease: Leading Individual
Disease/Disorder Contributors
Percent of Total DALYs: US & Canada
Data courtesy of WHO
2004Disease or Injury
As % of total DALYs Rank
Lower Respiratory infections 6.2 1
Diarrheol diseases 4.8 2
Unipolar depressive disorders 4.3 3
Ischaemic heart disease 4.1 4
HIV/AIDS 3.8 5
Cerebrovascular disease 3.1 6
Prematurity and low birth weight 2.9 7
Birth asphyxia and birth trauma 2.7 8
Road traffic accidents 2.7 9
Neonatal infections and other 2.7 10
COPD 2.0 13
Refractive errors 1.8 14
Hearing loss, adult onset 1.8 15
Diabetes mellitus 1.3 19
Ten Leading Causes of Burden of Disease,World, 2004 and 2030
RankAs % of total DALYs
2030Disease or injury
1 6.2 Unipolar Depressive disorders
2 5.5 Ischaemic heart disease
3 4.9 Road traffic accidents
4 4.3 Cerebrovascular disease
5 3.8 COPD
6 3.2 Lower Respiratory infections
7 2.9 Hearing loss, adult onset
8 2.7 Refractive errors
9 2.5 HIV/AIDS
10 2.3 Diabetes mellitus
11 1.9 Neonatal infections and other
12 1.9 Prematurity and low birth weight
15 1.9 Birth asphyxia and birth trauma
18 1.6 Diarrheol diseases
WHO GBD 2004
Number of Diagnoses With Disorders of the Brain in Europe
Headache
Anxiety disorders
Sleep disorders
Mood disorders
Somatoform disorder
Addiction
Stroke
Dementia
Child/Adolescent disorders
Psychotic disorders
Personality disorders
Mental Retardation
Traumatic Brain Injury
Epilepsy
Eating disorders
Parkinson's disease
Multiple Sclerosis
Neuromuscular disorders
Brain tumor
152.8
69.1
44.9
33.3
20.4
15.5
8.2
6.3
5.9
5
4.3
4.2
3.7
2.6
1.5
1.2
0.5
0.3
0.2
(million)
Eur. Neuropsych. (2011) 21, 718-779
8.4
15.1
2.4
sickness absencereduced productivity at workstaff turnover
£billion
The Economic Burden of Mental Illness
© The Sainsbury Centre for Mental Health, December 2007
Business costs of mental ill health at work
Costs Per Average
Employee
Total Costs to UK Economy
% of Total
Absenteeism £335 £8.4 billion 32%
Presenteeism £605 £15.1 billion 58%
Employee Turnover
£95 £2.4 billion 9%
Total £1,035 £25.9 billion 100%
Costs to employers of mental ill health
© The Sainsbury Centre for Mental, December 2007
Common areas of impairment
-Impaired concentration and attention
-Impaired motor skills
-Impaired communication and social skills
-Risk to self and others
-Effects of abnormal illness behaviour
How Mental Problems Might Interfere With Work
Multiple and complex
Suggested by other behaviors……-Sickness absence
-Work disputes
-Avoidance behavior
Work is associated with better mental health Reduced risk of common mental health disorders compared with
unemployment or economic inactivity(1)
……. Reasons for association are complex and debatable
Presentations may be :-
Reference: (1) “Is work good for your health and well being”, HMSO; Waddel & Burton; 2006
Definitions of StressWork Related Stress is…
“The adverse reaction people have to excessive pressures or other types of demand placed on them at work”(1)
Stress occurs when(2) … An individual perceives … …They are unable to cope .. …With the demands placed upon them, … … Causing a negative outcome for them.
Work Related Stress
(1) Definition (UK Health and Safety Executive,1999
(2) Centre for Organisational Health and Development, University of Nothingham.
1999 2000 2001 2002 20030
200
400
600
800
1000
1200
1400
1600
1800
2000
stressmusculoskeletal
OPRA 1999 - 2003
Work Related Stress
Risk Assessment
Work Related Stress- Outcomes
STRESSORSINTERACTION
OR TRANSACTION
OUTCOMES
WITHIN DIRECT MANAGEMENT CONTROL
•Demands (hours, shifts, job content)•Control (degree of autonomy)•Support (advice, training)•Role (well defined?)•Relationships (colleagues, supervisor)•Change (anticipated, agreed, oppose)
OTHER•Home/work Interface•Career
ORGANISATION
•Sickness absence•Labour relations•High staff turnover
INDIVIDUAL
•Mental illness•Other illness•Sickness absence
INDIVIDUAL
Work Related Stress- InterventionsSTRESSORS INTERACTION
OR TRANSACTION
OUTCOMES
WITHIN DIRECT MANAGEMENT
CONTROL
• Demands• Control• Support• Role
• Relationships• Change
OTHER• Home/work Interface
• Career
ORGANISATION• Sickness absence• Labour relations• High staff turnover
INDIVIDUAL• Mental illness• Other illness
• Sickness absence
INDIVIDUAL
SECONDARY• Education• Awareness• Support
INTERVENTIONS
PRIMARYChanging the Environment
TERTIARYDealing with the
consequences• Counseling
• Occupational Health• Case Management PROACTIVE - REACTIVE
Risk Assessment- The HSE Management Standards 2004
Management Standard Employees indicate that they (are)….
DEMANDS Workload , work patterns and the work environment
Able to cope with the demands of their job
CONTROL The way employees do their work Able to have a say about the way they do their work
SUPPORT Encouragement, sponsorship and resources
Receive adequate information and support from their colleagues and superiors
RELATIONSHIPS Avoidance of conflict and the management of unacceptable behaviour
Not subjected to unacceptable behaviors , eg: bullying at work
ROLE Ensuring people understand their roles and the avoidance of conflicting role
Understand their roles and responsibilities
CHANGE Management of change and how it is communicated
The organization engages them frequently when undergoing organisational change
Gail’s Story Gail is 44 and works as a social worker for a local authority,
managing a case load of clients. She has suffered from anxiety and depression in the past. She recently told her manager that she is feeling very anxious and has been suffering from panic attacks. She has been finding it hard to concentrate on writing client reports when she is back in the busy, open-plan office and has difficulty prioritizing her workload. Gail has been to see her GP and is now receiving therapy from the practice’s counselor.
Case Studies
There is no capacity within the team for Gail’s caseload to be reduced but her manager suggests that they increase her monthly supervision to weekly to discuss client cases and help Gail to prioritize her workload. Gail’s manager also reminds her that she can book a quiet room for a couple of days a week so that she can concentrate on report writing – an option available to all employees. As Gail already has flexitime agreement, her manager agrees for her to come into work later on the day of her therapy. Gail and her manager agree to review these adjustments in a couple of week’s time to see if they are working.
What can you do?
Mahinder is 35 and as an IT Support Technician for a large company. He has bipolar disorder and has been hospitalized in the past. He has been off work with depression for eight weeks and has kept in contact with his manager over this time. Knowing that Mahinder was considering a return to work his manager referred him to occupational health for advice on what support he may need to return to the workplace. Mahinder attends a back to work meeting with his manager to agree adjustments.
Mahinder’s Story
The Occupational Health physician suggests that Mahinder returns to work on a phased return, graduallybuilding up his hours to full time over 4 weeks. She also suggests that Mahinder introduces his work tasks slowly, concentrating on desk work in the first few weeks and gradually reintroducing customer query facing work which is more demanding.
Although Mahinder is feeling a lot better his medication makes him drowsy in the mornings which means that he is unsafe to drive. They agree the adjustments in a live document and agree a provisional date for Mahinder to return to work.
What can you do?
HAVE A GREAT DAY
THE END