Depression and Work: Can Employers Do Better

1
Depression and WorkCan Employers Do Better?

• Gordon Parker, Executive Director, Black Dog
  Institute, and Scientia Professor, School of
  Psychiatry, University of NSW.

2
The Broadness of Mood Disorders

• In essence, there are few in Australia that
• are not affected by the impact of mood
• disorders
• Sufferers
• Relatives and carers
• Friends
• Employers

3
Impact

• I think it would be easier to come to
• terms with losing your husband to
• another woman, than to a Black Dog.
• - Participant 2006 Black Dog Writing
  Competition

4
Whats in a name?

• Why black dog?

5
Our Logo
6
Organisational Model

7
Community Support/Education

• In addition to more general activities (eg walk
  in centre, community meetings, web), we have
  taken up one narrow task of addressing work
  force crisis issues (eg high rates of suicide
  or depression) in certain organizations.
• Involved by invitation.
• Such work has identified some sentinel issues.

8
The Impact of Mood Disorders

• Distributed widely
• Deadly
• Disabling
• Discriminating
• Detection problems
• Dumbed down in a Dimensional model

9
Distributed Widely?

• Lifetime chance of a mood
• disorder
• 25 for women
• 15 for men

10
Deadly?

• Lifetime chance of suicide 15.
• Of those who commit suicide, at least 80 are
  depressed.

11
Disabling

• A study undertaken by the World Health
  Organization, Harvard University and World Bank
  established that depression was the most
  disabling and Bipolar Disorder the 6th most
  disabling of all medical and psychiatric
  conditions.
• Why? Young onset, repeated and often lengthy
  episodes.
• How? Not getting to work and difficulty in
  working if at work.

12
Discriminating?

• Common pull up your socks response.
• Lack of appreciation by non-sufferers.
• General stigmatization.
• Reaction by some employers.
• Policies of insurance companies.

13
One Observer Comments.

• The most difficult words I have ever had to
• speak are these I have depression.
• In my eyes, these are the most powerful
• words in the English language. With these
• three words you can lose friends that you
• have had for a lifetime, make enemies with
• people you have never met, and lose
• opportunities that would have been laid
• out in front of you had you not had the
• courage to speak these words.

14
Observer (cont).

• .These three words can have you questioning
  your own sanity, have others question your
  sanity, and have many assume you are insane.
  Yes, these are the three most powerful words I
  know. I have depression. And for the first
  time in my life I am not ashamed to stand up and
  let the whole world know.
• - Participant2006 Black Dog Writing Competition

15
Detection Problems

• Depression commonly undetected.
• Bipolar Disorder if diagnosed, average duration
  from onset to diagnosis in Australia 15 20
  years.
• Diagnostic confusion

16
Dumbed Down by a Dimensional Model

• While we argue that there are several
• distinct types of depressions, and that
• the differing types respond quite
• differently to differing treatments, ours is
• not the dominant view. Instead, a
• dimensional view and single cause
• views dominate.

17
(No Transcript)
18
Dumbed down?

• Depression is an it.
• It is operationalised diagnostically as major
  depression, which is then interpreted as
  sufficient to dictate treatment.
• Treatment is then shaped more by the
  practitioners discipline and training than by
  characteristics of the disorder (i.e. the patient
  is fitted to the practitioners treatment model
  rather than the treatment being fitted to
  characteristics of the depressive condition).

19
Imagine if.

• We treated major breathlessness
• according to a similar model..

20
Thus, our Model

• There are differing meaningful conditions.
• The differing conditions benefit from differing
  therapeutic approaches.
• Thus, the need to identify those differing mood
  disorders.
• Management AT ALL LEVELS needs to respect a
  horses for courses model.

21
Meaningful conditions?

• The Bipolar Disorders ups and downs,
• with melancholic depression in the down phases.

Mania
Hypomania
Melancholia
22
www.blackdoginstitute.org.au
23
Online Self-testing
CREATIVITY
MYSTICISM

• More confident
• See things in new light
• Creative ideas plans
• Things vivid/crystal clear
• Spend more money
• Increased libido

• Lots of coincidences
• Feel at one with nature
• See special meaning in
• things
• Mystical experiences

DISINHIBITION
IRRITABILITY

• Talk over people
• Feel angry
• Thoughts race
• Feel irritated

• Say outrageous things
• Feel high as a kite
• Laugh more
• Do outrageous things

24
Online Bipolar DisorderEducational Program
25
Depressive disorders multiple types
26
Depressions

• Some (e.g. psychotic depression, melancholic
• depression) are categorical diseases, others
  more
• environmental reflecting stressors alone, or in
  conjunction
• with certain personality styles.

27
(No Transcript)
28
Melancholic depression
The real black dog
29
Treatment of Psychotic and Melancholic Depression
and Bipolar Disorder Involves

• A range of drugs prescribed by a medical
  practitioner PRINCIPAL STRATEGY.
• Stay-well plans.
• Other self-management strategies exercise,
  involving family in consultations, often
  negotiating with employers.

30
By Contrast.

• A range of non-melancholic disorders
• reflecting the impact of certain
• stressors on certain personality styles.

31
An ICONnoclastic neuronal line-up relevant to
the non-melancholicdepressive disorders
32
Patterns of Non-melancholic Depression

• Acute and chronic stress-related.
• Emotional dysregulation related
• Anxious worrying, Anxious irritability,
  Self-critical, Sensitive to rejection
• Shyness related
• Socially avoidant, and Personally reserved
• Perfectionism-related
• Explosive, impulsive related

33
Clinical Management

• Medication may help some non-melancholic
  disorders (totally or as contributor)
• Benefit from counselling/problem solving/empathic
  support
• Benefit from attention to predisposing
  personality contributions (eg psychological
  therapies).

34
Impact on Work

• Melancholia

35
(No Transcript)
36
Impact on Work

• Bipolar Disorder

37
Meaningful conditions?

• The Bipolar Disorders ups and downs, with
  melancholic depression in the down phases.

Mania
Hypomania
Melancholia
38
Impact on Work.

• Non-melancholic disorders.

39
Impact on Work.

• Non-melancholic disorder examples
• High anxiety group internalising anxious
  worriers and externalising irritability.
• Shyness (and unassertiveness)
• Rejection sensitivity
• Perfectionists

40
Importance of Work for Those with Mood Disorders

• Ranges from beneficial (eg distraction, support
  from others for those with non-melancholic
  disorders) to toxic (eg for those with unipolar
  melancholic or non-melancholic depression,
  extremely stressful work can sometimes be
  counter-productive in precipitating them into new
  episodes).

41
Managing a Worker with Depression

• Scenario A Escalating downhill trajectory where
  the depression accentuates harassment and
  bullying (most often observed in organizations
  that are downsizing, offering VRs, or are very
  hierarchical).

42
Managing a Worker with Depression

• Scenario B Line boss (not HR) takes
  responsibility, offers support and flexibility.

43
How to Intervene

• Intervene yes vs no. (ie can still support
  without issue being discussed openly).
• Who to intervene?
• How to intervene?
• Intervention options?
• Controlling the boundaries (ie limiting who
  knows, documentation, preventing secondary
  discrimination).

44
Impact of Premier Gallops Resignation

• Consistent with public and media empathy
  increasingly evident in Australia.
• Did raise the issue that depression could cause
  people to need to give up their position. Right
  or wrong message?
• Another message can depression, like any other
  crisis, encourage people to review their
  priorities and trajectories?

45
Organizations that get it Two Case Studies

• Core values ongoing model Organization has
  customs (more than procedures) in place to handle
  depression akin to any other acute and/or chronic
  problem.
• Problem-based model Organization responds to
  particular situation rapidly, responsively and
  confidentially.

46
Final Message - I

• Mood disorders can be managed and are treatable.
  Most people can be given a good prognosis and
  expect their episodes to cease or brought under
  good control.
• No single condition depression. As we do in
  clinical management at Black Dog Institute work
  to a horses for courses model.

47
Final Message - II

• The way in which an
• organization deals with those
• with depressive disorders
• will define the true value of
• the organization.