Dr Harvey spoke to us about ‘Promoting mental health and wellbeing in a mental health workforce’ and outlined what the current research tells us about four questions:
- Can work make you mentally ill?
- What does this mean for health professionals?
- How can we make workplaces mentally healthy?
- What does this mean for consumers and clients?
So, can work make you mentally ill? Dr Harvey outlined a number of studies that suggest it can. In 2013 an Australian study indicated that a large number of people feel that they are stressed, and that they are more stressed than they used to be. Research also suggests that while mental ill health among the working population is a huge problem, rates of underlying mental health symptoms are not rising, so simple cause and effect models are unlikely to reflect the complexity of the situation.
So, how can work make you ill? Dr Harvey demonstrated there has been an enormous increase in studies on this issue. A meta-review conducted with Beyond Blue identified a substantial body of evidence pointing to the fact that work can contribute to people becoming unwell. Risk factors identified include: psychological and social factors in the workplace; organisational change; exposure to trauma events; and job dissatisfaction. However, these are not simple factors, and the way work environments impact on an individual’s mental health is complicated. The negative impact of some risk factors can to some extent be mitigated by other work factors, and organisational level factors such as poorly managed change can also be important determinants of whether workers become unwell.
Dr Harvey introduced Karasek’s job strain model which describes a work situation according to how much psychological demand and how much decision making latitude a worker (where lower levels of demand and decision making means higher job strain). Job strain is associated with higher levels of obesity, cardiovascular and death. Thus, interventions are looking to give people more control over what they do in the workplace, e.g. employee participation groups, self-scheduling of shifts, flexible hours. But what about trauma? Organisational factors are important including: good leadership and team cohesion; practical support, and facilitation of their usual coping skills and peer supports.
Dr Harvey also spoke about the military as a good opportunity to study trauma and a large epidemiological study comparing people who had and hadn’t been to Iraq found that in both groups over time there was less than a quarter of people with a common mental disorder and only 4% with PTSD. This suggests that the majority of people exposed to trauma are resilient, and only a proportion may have longer term problems.
Dr Harvey spoke about the limited evidence that health professionals are at greatly increased risk in comparison to other professions and that often, it is systemic and organisational factors that cause issues for workers. In addition, health workers specifically have to cope with suicide, the impact of performance, barriers to help seeking and the role of the regulator. Health professionals will often not seek help for themselves because of stigma, or do it in odd ways and may not be treated as patients. A white paper called Invisible Patients has recommended specialist health services for doctors and in response, free health programs have been started up which have received an enormous number of referrals and are showing really good results.
So, how can we make workplaces more mentally healthy? A mentally healthy work place alliance has been created to try and pull a strategy together and there will be a launch of a number of resources including a website for organisations about how to answer this question. A focus needs to be taken away from the ‘endpoint’ to the point where people progress from being healthy to symptomatic, and also away from a focus on the individual to consider the role of organisations in becoming more resilient. Resilience involves surrounding yourself with protective factors that enable you to respond to traumatic or other experiences in a healthy way. Early workplace based resilience training suggests evidence for interventions using CBT and ACT which allow individuals to intervene with controlling techniques early, however there needs to be ongoing support which can be very time consuming. The possibility of the role of e-health is being considered and a recent RCT shows early evidence that e-health may provide techniques to cope, and may prevent future issues through education at the beginning of a career.
So what can organisations do to become more resilient? Dr Harvey spoke about the importance of organisational justice (relational, procedural and distributive) and the role of managers. However, there is not much research around how an organisation can increase their organisational justice. Training for managers around how to be confident and have conversations with staff about mental health issues has been developed and will be evaluated using a RCT.
Final points included the distinction between symptomatic improvement and functional improvement (where one doesn’t necessarily mean the other) and that if we don’t have a healthy workforce it has negative impacts on the level of care provided.
Invisible Patients: Report of the Working Group on the health of health professionals