Supporting the mental health and wellbeing of Anaesthetists

Supporting the mental health and wellbeing of Anaesthetists. What can the workplace do?

Jaelea Skehan, Director

• Setting the scene

• Impact of work on our mental health

• A workplace approach to mental health and wellbeing

• Modern theories of suicide prevention

• Considerations for the workplace in suicide prevention

Presentation overview

• Suicide rates in female doctors higher than in general population;

• Female, Indigenous and young doctors (transition from study to work) appear to be most vulnerable to mental health problems;

• Specialities such as psychiatry, ENT and anaesthesiology amongst the highest suicide rates.

• Rates of suicide for anaesthetists estimated at 44.0 per 100,000 (Elliot et al, 2010).

Why is this an issue for anaesthetists?

Barriers to seeking support (Hawton et al, 2001):

- lack of confidentiality or privacy (52.5%),

- embarrassment (37.4%),

- impact on registration and right to practice (34.3%),

- preference to rely on self or not seek help (30.5%),

- lack of time (28.5%),

- concerns about career development or progress (27.5%).

Barriers to help-seeking:

Let’s explore resilience…

Which of these is most likely to ‘bounce’ back?

What if this was the surface they were bouncing off?

Approaches need to focus on

The individual The environment

Mental health and wellbeing?

• State of wellbeing, where we can realise our potential, cope with normal stressors, live and work fruitfully, and make a contribution to society.

• More than the absence of illness.

Influences on mental health?

• Structural: e.g. safe and healthy working conditions,

employment security, inclusive workplaces etc.

• Community: e.g. sense of belonging, access to social support, freedom from bullying etc.

• Individual: ability to deal with thoughts, manage life and cope, good physical wellbeing

Can work contribute to mental ill-health?

• Generally working is good for our mental health.

• But, many work factors can contribute to mental health problems or make existing problems worse.

• When work related stress is high and ongoing it can be a risk factor for mental illness.

• It is important to PREVENT issues where possible and mitigate risk where it is not possible.

An introduction to the promotion of mental health and wellbeing and the prevention of mental ill-health in the

workplace.

Prevention First: workplaces

Actions to prevent the onset of mental ill-health in the whole workplace population (including families & community)

Action Area 1

Actions to prevent the onset of mental ill-health in groups at higher risk within the workplace and community

Action Area 2

Actions to identify and intervene early with individuals showing early signs of mental ill-health in the workplace

Action Area 3

Actions to support referrals to appropriate treatment & return to work plans for those experiencing acute periods of mental ill-health

Action Area 4

Actions to reduce the ongoing impact of mental ill-health on individuals entering or returning to work

Action Area 5

Actions to promote mental health and wellbeing in individuals experiencing or recovering from a diagnosed mental illness in the workplace

Action Area 6

Actions to promote mental health and wellbeing in the whole workplace population (including families & community)

Action Area 7

Mental Health Promotion

• Mental health promotion is about enhancing social and emotional wellbeing and quality of life.

• Initiatives can occur:

– with whole populations (e.g. the whole workplace), selected groups (e.g managers, female staff, young staff) or individuals

– in any setting (e.g. workplaces, the home, schools, communities, health settings)

• Mental health promotion is relevant to all people, whether they have a diagnosed illness or not.

Platforms for Action

1. Healthy workplace policy – e.g. stigma reduction, social inclusion, OH&S policies, HR policies.

2. Creating supportive environments – e.g. anti-bullying programs, strengthening families, healthy work initiatives.

3. Strengthening workplace & communities to take action – peer support, worker-led initiatives.

4. Developing personal skills– e.g. life skills training, mental illness literacy, parenting skills, financial management.

5. Reorienting OH&S services to a promotion and prevention approach – e.g inclusion of mental health and wellbeing

Prevention of mental ill-health

Prevention interventions work by focussing on reducing risk factors and enhancing protective factors. Activities may work at three main levels and seek to:

• primary prevention - prevent the onset or development of a problem or illness: types = the whole workplace & groups at higher risk.

• secondary prevention - lower the severity and duration of an illness through early detection and referral to appropriate treatment;

• tertiary prevention - reduce the impact of an illness through rehabilitation back into the workplace.

Mental health problems,

mental illness

Support recovery

from illness

Support for mental health

problems

Identify and respond

early

Reduce individual risk factors

Support good health

Managing mental health at work

Reducing risk Promoting Recovery

Reduce environ-

mental risk factors

*Note – colours align sections to the relevant parts of the Prevention First Framework

• Ensuring a good fit between the job and the person doing the job;

• Preparing people well for the work they need to do (consider pre-service as well as in-service training);

• Creating a culture of high expectations along with support;

• Having a culture of fairness and equity;

• Promoting mental health literacy (how to stay mentally healthy – particularly adapted for the profession);

• Good communication between managers and staff;

• Increasing social connection and opportunities for peer-support across the profession.

Support good health

• Reducing drug and alcohol misuse;

• Support healthy diet and physical fitness;

• Develop individual skills – stress management, communication skills, conflict resolution;

• Management of physical injury and/or pain;

• Options to support workers managing ill-health in family;

• Provide support and flexibility for staff exposed to traumatic events at work or experiencing difficult life events.

Reduce individual risk factors

• Reduce or manage occupational risks

– Fatigue

– Excessive stress

– Bullying and harassment

– Disharmony

Reduce environ-

mental risk factors

Mental health problems,

mental illness

Support recovery

from illness

Support for mental health

problems

Identify and respond

early

Reduce individual risk factors

Support good health

Managing mental health at work

Reducing risk Promoting Recovery

Reduce environ-

mental risk factors

*Note – colours align sections to the relevant parts of the Prevention First Framework

• Promote awareness of mental illness, signs, symptoms etc;

• Support early identification (self or others):

– Self-identification, peer-identification and support; Identification by supervisors or mentors;

• Promote culture of acceptance of mental health problems;

• Promote culture that help-seeking is a positive thing;

• Promote a culture of offering support, expressing concern for work colleagues;

• Supervisor/mentor training to increase skills in raising difficult, personal issues with staff in a helpful, non-threatening way.

Identify and respond

early

• Promote use of EAP for early support;

• Provide immediate first aid for staff experiencing a mental health crisis at work;

• Reassurance of support for staff receiving treatment for mental illness;

• Partnerships and referral pathways to mental health providers that staff will accept and trust;

• Provide or facilitate access to peer-support models and/or online treatment modalities.

Support for mental health

problems

• Take a positive optimistic approach;

• Manage absences well;

• Identify and address any workplace contributing factors;

• Manage return to work well;

• Make reasonable adjustments to the work environment;

• Facilitate access to support options for family and friends;

• Address stigma in the workplace.

Support recovery

from illness

What do we know about why people die by suicide?

Traditional approach of risk and protective factors

Modern theory by Thomas Joiner

Summary – risk factors

Serious Attempt or Death by Suicide

Those Who Desire Suicide

Those Who Are Capable of Suicide

Perceived Burdensomeness

Thwarted Belongingness

Sketch of the Theory by Thomas Joiner

Prevention Implications (Joiner)

• The model’s logic is that prevention of “acquired ability” OR of “burdensomeness” OR of “thwarted belongingness” will prevent serious suicidality.

• Belongingness may be the most malleable and most powerful.

Suicide prevention for the medical profession

Primary Prevention Building stronger more resilient doctors

Secondary prevention

Recognise and seek additional support when risk factors and warning signs emerge and reduce access to means

Early Intervention Seek support and help when critical events occur

Intervention (suicidal)

Seek specialist help; increase social connection; remove means of suicide

Postvention Support those affected by the suicide of a peer (or other).

Evidence for public health approaches

Activity Evidence rating

Means restriction (incl barriers) good

Media reporting guidelines good

Multi-faceted programs good

Community based programs promising

School based programs good (immediate)

Workplace programs limited

Emergency Dept brief interventions promising

Child welfare/detention programs limited

Prison-based programs limited

Evidence for public health approaches (cont)

Activity Evidence rating

Programs for veterans/defence forces good

Programs for substance use problems limited

e-therapies good

Gatekeeper training and peer education promising

Education and support for GPs good

Telephone services promising

Support to family friends of those at risk good

Postvention support limited*

Screening promising (youth/ older)

Evidence for mental health approaches

Activity Evidence rating

Intensive care plus outreach good

Hospital admission poor

CBT good

Inpatient-based therapies poor

Outpatient-based therapies poor

Psychosocial interventions good

Ongoing contact good

Crisis cards poor

Summary - What can workplaces (and/or

professional bodies) do?

Workplace responses

Things to address

1. Promote mental health and wellbeing and build resilience;

2. Address individual and environmental risk factors for mental ill-health and suicide;

3. Create a culture that accepts that mental health challenges will occur and promote early pathways to support.

4. Take a comprehensive approach thinking about undergraduates, early career and experiences practitioners.

Factors for success

1. Commitment from senior leaders;

2. Employee participation;

3. Develop and implement policies;

4. Allocated resources for success;

5. Ongoing effort for a sustainable approach

6. Plan and evaluate outcomes

From PwC report

Contact Us:

Email: Jaelea.Skehan@hnehealth.nsw.gov.au

Twitter:

@jaeleaskehan @HInstMH

Websites:

www.himh.org.au