Mental Health Issues in the Workplace

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Mental Health Issues in the Workplace

• The Village Hotel Leisure Club, Bury
• Bury Employment Support Training
• 1st June 2006

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What does work mean to the individual?

• Work is one of two kinds. One, moving particles
  of matter around at or near the earths surface.
  Two, telling other people to do so. The first is
  unpleasant and badly paid. The second is
  enjoyable and well paid
• Bertrand Russell

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Salus Northwest

• OH provider, based at the medical centre at the
  former ICI plant at Hillhouse near Fleetwood
• Portfolio of local authorities, chemicals
  manufacturing Branch of Lanarkshire Health Board
• Part of NHS Scotland, Lanarkshire Health Board

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Mission Statement

• Provide the highest quality Occupational Health
  safety to the NHS and Industry
• Contribute to improvements in Public Health by
• Facilitating access to OHS services
• Reducing inequalities in health through research
  and development
• Generate income which supports NHS patient care

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Personal perspective

• How I got into this.
• GP 1979 to 1991
• DSS Liverpool 1991-1995
• why some people work others dont?
• DH Policy 1995-2000
• No policy interest in RTW/VR

• DfEE 2000-2003
• JRRP first policy
• initiative since 1960s on rehab/retention
• Occupational Medicine
• Difficult dirty and dangerous
• English Economic inactivity
• Scottish Public Health model

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What is the place of work in society?

• Work
• generates self esteem and reduces dependency
• Enhances social identity and status
• Work environments
• develop social networks and creative activity
• retain, develop and acquire skills
• work of Jahoda and others

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Geography of Incapacity Benefit vs Unemployment
in Males
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What is the answer?
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Some thoughts on PATHWAYS to WORK

• Pathways NW- Merseyside, east west Lancashire,
  Greater Manchester, Cumbria Furness
• Residual single industry population
• No longer reason for the people to be there
• Low housing equity cant move out
• Relatively poor transport infrastructure and
  getting worse so cant travel out
• Relatively poor educational infrastructure
• Fewer universities, sixth form colleges
• Drain of talent

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What do you see in your patient or employee?

• Struggling own job or redundancy candidate
• Go off sick dont get better as expected
• Colds, aches and pains work instability?
• Happens over 6/52 to -6/12 from med 3
• Convince people they are sick by being sick -
  inactive lifestyle
• Incapacity - illness behaviour or doctor
  sanctioned eg hypertension
• Place for guidelines

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Context of Mental Health in the WORKPLACE

• Stress
• Common mental health conditions
• Mental health disablement
• Presenteeism
• Returning to work
• Other mental health conditions
• Learning disability
• Severe and enduring mental illness
• Dementia
• Physical illnesses

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Stress - Definitions

• Stress describes a physical process not a disease
  but, if excessive/goes on for long time, can lead
  to physical mental ill health (HSE)
• Doctors look for minor mental illness signs of
  anxiety, depression, phobia, etc.
• Precipitating cause can be inside or outside work
  or both
• Stress is a natural reaction to excessive
  pressure ( HSE)
• PRESSURE is the stimulus in the STRESS equation
• STRESS is a negative imbalance in the system
• when perceived DEMAND(s) exceed ability to COPE

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Core features of stress

• stress is a process that happens over time and to
  people
• individual perception cognition very important
  (perception of control ?)
• Imbalance 1 - demand v coping capacity (Karasek
  Theorell)
• Imbalance 2 - effort-reward paradigm (Siegrist)
• Influences
• flexible workforce/short term contract
  culture
• Managerial challenges to professions
• Consequences are physiologicalbehaviouralcognit
  iveemotional

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Stress - Myths

• "managers only get stressed" - not so
• "it's my own fault" - predisposition ?
• "it's good for you" - arousal "yes"...stress "no"
• same as job dissatisfaction - people with high
  level of job satisfaction can also be greatly
  stressed

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Soft mental illnesses in the workplace

• Anxiety, depression, panic attacks, phobia
• Reduced concentration
• Disturbed sleep pattern
• Excessive forgetfulness
• Long hours/short hours
• Social distance
• Bad temper/loss of humour
• Physical symptoms palpitations, breathlessness
• Frequent minor illnesses

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Retention/return toolkit Flags the barriers
to Recovery
(Andrew Pemberton of Human Focus)

• Identifying the barriers enables you to work on
  them!

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Workplace Health Services

• NHS
• GPs
• Hospital Services
• Psychiatrists
• Therapists
• Occupational Health
• Preventative
• Assessment
• Pensions
• Fitness for work

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GPs and the workplace

• Patient advocacy
• Not trained in workplace health
• Sacking
• pensions
• Certificates
• Confidentiality
• Access to-
• Pathways to Work
• Condition Management Programme

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What does the GP feel like?

• Certificates are
• boring, but quick!
• Better things to do
• Feels taken
• advantage of
• But doesnt want to
• do lots of reports

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Workplace pressure points and NHS services

• GP dentist and hospital appointments
• Liaison
• Delays and health beliefs
• Specific resources, especially access to-
• Psychiatrists
• CBT
• MRI scans
• Knee operations
• Nerve conductions studies
• Roles on Trust boards?

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Legal Aspects

• Health and Safety at Work Act
• Disability Discrimination Act
• Employment Law
• Common Law
• Tensions
• Information
• Confidentiality
• Rehabilitation and return to work

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What is Occupational Health?

• People
• Doctors
• Nurses
• Managers
• Therapists
• Technicians
• Reports
• Gatekeeping rehabilitation
• Telephone

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What does work?

• Conditionality regime 9/03 3 shouts out of
  company sick pay
• Soft landing due to-
• increased rehabilitation resource and OH to
  manage it
• Team leader training
• NHS liaison
• No adverse PR effect or conflict with Trade
  Unions

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Retention/return toolkit Mental Rehabilitation

• Stress
• Is there a mental health diagnosis?
• Internal or external
• Epidemiology
• Works counsellor
• Drugs/alcohol
• Psychologist
• Severe enduring
• mental illnesses

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Blessed is he who has found his work let him
ask no other blessedness Thomas Carlyle
Work is the curse of the drinking classes Oscar
Wilde
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Rome wasnt built in a day