PREVENTION, INTERVENTION AND COMPENSATION IN REGARDS TO MENTAL INJURIES AND MENTAL HEALTH

Occupational Health Clinics for Ontario Workers Inc.

Definitions:

Mental Injury: Mental Disorder: Mental Illness: Mental Disease: Mental Condition: Mental Health:

Mental injuries/disorders/illnesses Anxiety Disorders Attention Deficit Disorders (ADD) Bipolar Disorder Depression Eating Disorders Mood Disorders Psychosis Schizophrenia Self-Injury Suicide ViolenceDiagnostic and Statistical Manual of Mental Disorders (DSM-5)

http://www.mooddisorders.ca/sites/mooddisorders.ca/quiz2/checkup.php

Check-Up from the Neck Up:

What is normal?

exactlyaverage

does “abnormal” start here?or here?

what about out here?

The effects of labelling:

If you given a diagnosis of “soft bones” (osteoporosis) what effect does that have on your quality of life?

If you are given a diagnosis of “manic depressive” (bipolar disorder), what effect does that have on your quality of life?

What are the attitudes to mental illness in your workplace (stigma)?

Economic burden: “10 to 25% of Canadian workplaces

effectively mentally injurious – not good for the mental health of their employees” … “leading cause of short-term disability and long tern disability – it’s the biggest single reason people are off work for periods of time”

“estimated at $51‐billion” … “ up substantially over the past decade”

Speech of the Honourable Michael Kirby on Workplace Mental Health

A workplace issue

http://www.youtube.com/watch?v=5qfTFxOc6Xo&feature=player_embedded

http://www.statcan.gc.ca/pub/11-008-x/2011002/article/11562-eng.pdf

“What’s stressing the stressed?Main sources of stress amongworkers”by Susan Crompton (Stats Can) 2011 “In Canada, in 2010, 27% of

working adults reported that, on most days, their lives were ‘quite’ or ‘extremely stressful.”

the new CSA Standard Z1003-13

http://shop.csa.ca/en/canada/occupational-health-and-safety-management/cancsa-z1003-13bnq-9700-8032013/invt/z10032013/?utm_source=redirect&utm_medium=vanity&utm_content=folder&utm_campaign=z1003

Psychological& social support

Growth and developme

nt

Engagement

Psychological demands

Protection of physical safety

Workload manageme

nt

Civility and respect

Psychological

protection

Involvement and

influence

Clear leadership & expectations

Balance

Recognition and reward

Organizational culture

Vision A workplace that promotes workers’ psychological well-being and allows no harm to

workers mental health...

Key Drivers

Risk Management

Excellence & sustainability

Recruitment & Retention

Cost Effectiveness

Strategic pillars

Prevention (1°) Promotion (2°) Resolution (3°)

Tracking the Perfect Legal Storm (Shain, 2010)

Labour relations law Employment standards Human rights legislation Law of torts (negligence) OH&S law (violence & harassment) Workers’ compensation changes (BC) Awards up 700% over that last 5 years

… recent opinion (22/10/2013) that CSA standard sets the legal criteria for a psychologically safe system of work… no specific legislation …http://www.mentalhealthcommission.ca/English/node/506?terminitial=30

WSIAT/Charter Decision:

WSIAT/Charter Decision:

WSIAT Decision No. 1945/10

“The distinction is, therefore, substantively discriminatory against injured workers who develop a mental disability.

Mental disability is an enumerated ground in subsection 15(1) of the Charter.

Subsections 13(4) and (5) of the WSIA therefore infringe subsection 15(1) of the Charter.

The provisions of subsections 13(4) and (5) of the WSIA are not saved by section 1 of the Charter as a reasonable limit demonstrably justified in a free and democratic society.”

Focus on what’s going on between the ears

Biomedical Model: …disease the result of disruption of psychological processes wherein subjective perceptions, behaviors and personality factors ( e.g., neuroticism) are of primary importance (i.e., disease proceeds from the individual to the environment).”

Occupational Psychology

P. Schnall, Session # 1 – Part 1: Introduction to “Work and Health”, UCLA SPH EHS 270/CHS 278 Spring 2009 (March 31, 2009)

Social Epidemiological Model: “negative health outcomes (illnesses) are due to the impact of social epidemiologic factors (in general class, work, race and gender)”

– Occupational Sociology

Focus on the interaction between the social environment and the person

P. Schnall, Session # 1 – Part 1: Introduction to “Work and Health”, UCLA SPH EHS 270/CHS 278 Spring 2009 (March 31, 2009)

Prevention

individual organization

prevention

level

primary - coping and appraisal skills

primary – changing the workplace

secondary - wellness, relaxation techniques

(mindfulness)

secondary - awareness, screening

(MH 1st aid)tertiary - therapy,

counselling, medication, support

tertiary - Employee Assistance Programs (EAP), Return to Work

soooooo….How would you go about measuring stress?

If you can’t measure it …

Misquote from Deming

Some of the most important things at work (in life) can’t be measured (e.g. Valentine’s)

Objective and Subjective measures: objective bias (more scientific)

Stress Check App (Azumio)(measures heart rate variability)

https://itunes.apple.com/us/app/stress-check-pro-by-azumio/id439500612?mt=8 https://play.google.com/store/apps/details?id=com.azumio.android.stresscheck&hl=en

Measurements over a 40 hr period

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Psychological “Subjective” Measures:

Remember, perceptions/symptoms are the “gold standard” (DSM-V)

Diagnoses made on the basis of answers to a series of questions (some of which are observable by others; some not)

Some questions don’t work directly (… are you depressed?) and thus need to be questioned indirectly

http://www.dsm5.org/Pages/Default.aspx

DSM-5: Depression screening(individual)

1. Little interest or pleasure in doing things 2. Feeling down, depressed, or hopeless 3. Trouble falling or staying asleep, or sleeping too much 4. Feeling tired or having little energy 5. Poor appetite or overeating 6. Feeling bad about yourself—or that you are a failure or have let yourself or

your family down 7. Trouble concentrating on things, such as reading the newspaper or

watching television 8. Moving or speaking so slowly that other people could have noticed? Or

the opposite—being so fidgety or restless that you have been moving around a lot more than usual

9. Thoughts that you would be better off dead or of hurting yourself in some way

http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Level2DepressionAdult.pdf

Mental Injuries Tool (MIT) Group:

The Mental Injuries Tool group was established in 2009 out of a stakeholder sub-committee of worker representatives and the Occupational Health Clinics for Ontario Workers who were charged with “supporting worker representatives in taking action on prevention and workers’ compensation”.

This sub-committee held a workshop in 2010 to select projects which could be developed jointly to address common concerns. The topic which received the most interest was mental injuries (workplace psychosocial risk factors; recognition & compensation for mental injuries).

MIT group - who’s involved: Terri Aversa, OPSEU - Chairperson Laura Lozanski, CAUT Sari Sairanen, UNIFOR David Chezzi, Andréane Chénier, CUPE [Bridget Pridham]* Nancy Johnson, Erna Bujna, ONA Valence Young, ETFO Gerry LeBlanc, Sylvia Boyce, USW Janice Klenot, UFCW 175/633 Jane Ste. Marie, John Watson, OSSTF Kathy Yamich, Workers United Union Charlene Theodore, OECTA Tom Parkin, Workers Health and Safety Centre (WHSC) Sophia Berolo, University of Waterloo Ashley McCulloch, Carleton University Jenna Novess, Brock University Andy King, LOARC (Labour, OHCOW, Academic Research

Collaboration) Maryth Yachnin, IAVGO Alec Farquhar, Kristen Lindsay, OWA Patricia Phillips, Brenda Mallat, Curtis VanderGriendt, Ted Haines,

Mark Parent, Andre Gauvin, John Oudyk (OHCOW)

MIT Group Reviewed Available Tools

Looked at theories of jobs stress: Job Demand – Control model (Karasek) Effort – Reward Imbalance model

(Siegrist) Transaction Process model (Lazarus &

Folkman) Organisational Justice (Kivimäki et al)

Looked at survey instruments and tried them out – compared experiences UK-HSE, JCQ, GM@W, SOBANE and

others …

COPSOQ

Copenhagen Psychosocial Questionnaire

(COPSOQ II – short version)

http://www.arbejdsmiljoforskning.dk/Sp%C3%B8rgeskemaer/Psykisk%20arbejdsmilj%C3%B8.aspx?lang=en

COPSOQ Psychosocial Hazards:

COPSOQ health measures:

Self-rated overall health status Burnout Stress Sleeping troubles Somatic stress symptoms Cognitive stress symptoms

Physical safety factors:

safety hazards workstation ergonomics physical factors (noise, lighting) thermal comfort air quality dangerous chemicals biological hazards radiation (ionizing and non-ionizing) driving hazards working alone

Other additions:

two more offensive behaviours: “discrimination” (undefined – ask

respondent for definition) “vicarious offensive behaviours” (ask

respondent to identify all)

a global question rating the psychological health & safety climate

questions about behaviour based safety attitudes

How do we do it?

1. Recruit a coordinator/champion in each unit (knowledgeable on workplace stress)

2. Get buy-in (union, employer, establish steering committee)

3. Administer survey (define units, collect e-mail lists, Dilman’s 5 contact survey administration, spreadsheet report production, identify top 3 issues)

4. Begin dialogue to improve top 3 issues

Collecting responses Send URL link to participants who fill

out survey online (5-15 minutes) Response confidential; downloaded

by Clinic

workplace psychological H&S climate

Results:

A toxic workplace

workplace psychological H&S climate

Things we’re learning:

difference between the psychological approach compared to the sociological

no regulatory “stick”, so we have to work strategically

bullying can be a symptom don’t rush in without a plan (are you

ready?) learn, organize, assess, change, evaluate

population comparisons vs. symptom associations

MIT Tools:

Website http://www/ohcow.on.ca/MIT Guide Survey (often use Survey Monkey) You-Tube videos Posters, cards [training materials]* [mini-MIT: shortened guide for

workplaces]* App http://www.ohcow.on.ca/MITApp

http://www.youtube.com/watch?v=LREe5M5Q8co

http://www.youtube.com/watch?v=hzk9t3T32wk

Guidebook:

Poster:

Videos:

Survey Co-ordinator Information

Package:

http://www.opseu.org/bps/social/workplace_stress/index.htm

http://www.ohcow.on.ca/mit

http://www.youtube.com/watch?v=k26T28scAyg&feature=youtu.be

http://www.youtube.com/watch?v=0bWnO3hemCQ

https://www.youtube.com/watch?v=F49TF_aSClk

… the survey in app format … In partnership with

the CCOHS, we’ve created an app that allows you to do the survey and have your own personal score

http://www.ohcow.on.ca/MITApp

Pre-contemplation (Not Ready) – “what problem? That’s just the way things are in this line of work – always has been, always will.”

Contemplation (Getting Ready) – “maybe things could change but I don’t know if I’m prepared to change? It is easier though, just going along with things the way they are, but maybe …??”

Preparation (Ready) – “things could be better and I think it’s worth the effort to try – let’s get together and figure out how to do something about this …”

Action – “we’re going to make the following changes and hope things will improve – I’m glad we’re finally doing something about this!”

Maintenance – “so, we’ve made the changes, they might need a bit of tweaking, but I think this is going to work out in the long run”

Are You Ready to Do It?Stages of Change

Drivers (sticks and carrots):

1. Costs ($51 billion)2. Risk (do you want to read about your

workplace in the newspaper?)3. Legal liability (Martin Shain’s work)4. Worker retention and recruitment (good

place to work)5. Excellence and sustainability6. The right thing to do – “law is the

conscience of those who have none” (James Ham, 1983 IAPA Conference)

What can you do?

Taking Action on Workplace Stress

Occupational Health Clinics for Ontario Workers Inc.

John Oudyk, Occupational HygienistOccupational Health Clinics for Ontario Workers (OHCOW)

http://www.ccohs.ca/products/webinars/workplace_stress/

http://www.ohcow.on.ca/mit

Prevention

individual organization

prevention

level

primary - coping and appraisal skills

primary -

secondary - wellness, relaxation techniques

(mindfulness)

secondary - awareness, screening

(MHFA)tertiary - therapy,

counselling, medication, support

tertiary - Employee Assistance Programs (EAP), Return to Work

MIT tools

Thank you!