Return To Work and Mental Health - mbchamber.mb.ca · Return To Work: Collaborate •Best practices for successful return to work requires collaboration in good faith by all parties

Return To Work and Mental Health

Dr. Prabhath Avadhanula

Consultant Psychiatrist

Mental Illness

• In any given year, 1 in 5 people in Canada will personally experience a mental health problem or illness.

• Mental illness affects people of all ages, education, income levels, and cultures.

• By age 40, about 50% of the population will have or have had a mental illness.

• Suicide accounts for 24% of all deaths among 15-24 year olds and 16% among 25-44 year olds.

• https://cmha.ca/fast-facts-about-mental-illness

Mental Illness

• The economic burden of mental illness in Canada is estimated at $51 billion per year. This includes health care costs, lost productivity, and reductions in health-related quality of life.

• Mental illness is a leading cause of disability in Canada • In any given week, at least 500,000 employed Canadians are unable to

work due to mental health problems. This includes: • approximately 355,000 disability cases due to mental and/or behavioural disorders • approximately 175,000 full-time workers absent from work due to mental illness.

• The cost of a disability leave for a mental illness is about double the cost of a leave due to a physical illness.

• https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics

Mental Illness is caused by :

• ????

• Insert Stigma . . . Misinformation . . . Judgement Here:

BIO PSYCHO SOCIAL

Social

Biology

Psychology

Genetics/Epigenetics Neurotransmitters

Brain Circuits Physical Health

Temperament Self-Esteem

Coping Skills Social Skills

Perceptions Beliefs

Cognitive Distortions Resilience

Adverse Childhood Experiences

Stressful Life Events/Trauma

Parental Style Quality of Relationships

Isolation Poverty

Mental Illness

Mental Illness

• A complex interplay of genetic, biological, psychological, and social/environmental factors causes mental illnesses.

• Stigma or discrimination attached to mental illnesses presents a serious barrier, not only to diagnosis and treatment but also to acceptance in the community and successful employment.

• Almost one half (49%) of those who feel they have suffered from depression or anxiety have never gone to see a doctor about this problem.

https://cmha.ca/fast-facts-about-mental-illness

Mental Illness: Depression

• Chronicity of symptoms decreases the likelihood that treatment will result in full symptom remission.

Stabilization Vs. Full Recovery - “There seems to be this idea that you’re not going to go back to work

before you recover – when in fact you’re not going to recover before you go back to work.”

- consultant psychiatrist Dr Dielle Felman RACP Quarterly “Mental Illness in the Workplace”, pg. 27

- An injured worker may go back to work when he is no longer disabled from

employer assigned tasks or activities though he may still be impaired

- Risk, Capacity, Tolerance should be assessed

Why Return to Work ?: Behavioural Activation !

• Feel Better

Depression/ Anxiety/PTSD

Negative Reinforcement

Positive Reinforcement

Stay Home Return

To Work

Cycle of Avoidance Cycle of Engagement

Behavioural Change

Return to Work : Gone Wrong !

• Return Home

Depression/ Anxiety/PTSD

Negative Reinforcement

Punishment

Stay Home Return To

Work

Cycle of Avoidance Cycle of Disengagement

Behavioural Change

Return To Work: Human Work Culture

The Return to Work Process Begins Before The Hiring Process Begins !

- Kind - Supportive

- Respectful - Nonjudgemental

- Empathetic - Compassionate

- Appreciative - Empowering

- Trust - Fairness

- High expressed negative emotion is a risk factor for mental illness

- Purpose, Meaning, Validation, and Self-Efficacy is protective

Return To Work: Human Work Culture

• The 13 organizational psychosocial factors that impact organizational health, the health of individual employees, and the financial bottom line:

- Psychological Support - Involvement & Influence

- Organizational Culture - Workload Management

- Clear Leadership & Expectations - Engagement

- Civility & Respect - Balance

- Psychological Competencies & Requirements - Psychological Protection

- Recognition & Reward - Protection of Physical Safety

- Growth & Development

• www.guardingmindsatwork.ca – Simon Frasier University/Great West Life

Return To Work: Human Work Culture: National Standard for Psychological Health and Safety • Developed by the Mental Health Commission of Canada in order to provide workplaces with a

systematic approach to creating a psychologically healthy workplace. Incorporates 13 organizational psychosocial factors.

• Framework of four tasks that organizations can take:

1. Identify and eliminate hazards in the workplace that pose a risk to psychological health

2. Assess and control of the risks associated with hazards that cannot be eliminated

3. Implement structures and practices which promote good mental health and psychological safety

4. Foster a culture which endeavours to sustain good mental health and psychological safety

www.mentalhealthcommission.ca/English/implementing-standard

Mental Health In the Workplace: An Accomodation Guide for Managers and Staff - CMHA Ontario and Mental Health Works, Pg. 17

Return to Work: Employers Should Maintain Contact

With Injured Worker During Leave

Identify the most appropriate person to maintain contact with

worker.

The following can help ensure employees feels supported:

• Be patient/kind- Ask if there is anything you can do to help.

• Avoid questions that may be interpreted as an investigation of the

employee's absence.

• Share information about organizational events and news that are not

specifically related to the employee's job or tasks.

• Communicate in the way the worker prefers – phone calls, voicemail

messages or e-mails.

• As the worker becomes well, ease transition back to work by including the

employee in workplace events and celebrations.

• Ensure that an employee off work due to mental illness receives the same

acknowledgement (cards, flowers, or greetings) as an employee off work

for a physical illness.

Return To Work: Be Sensitive

- Mishandling dialogue with an injured worker can compound a perception by the employee of unjust treatment. Research has linked such perceptions to increased time off work, higher compensation claims, and a need for the employee to express claims of injustice to others as a means of punishing their employer.

- RACP Quarterly “Mental Illness in the Workplace”, pg. 27

Return To Work: Collaborate

• Best practices for successful return to work requires collaboration in good faith by all parties involved including the returning worker, employer (manager, human resources), and treating healthcare professionals.

• Each party has a shared responsibility in the return to work plan.,

• Work collaboratively to determine suitable work and accommodations for the individual, the situation, the team, and the workplace involved.

Return To Work: Collaborate – Listen For Understanding • Show Interest: Throughout the conversation consider adopting a ‘mirroring’ technique to signal to the

speaker that you are listening. Relax your posture (arms uncrossed, face the speaker) and offer some short verbal affirmations that you are still engaged with what they have to say. Another important step, especially when discussing mental health, is to ensure you are not distracted. This means putting the phone on mute and in your pocket!

• Demonstrate Their Value: Before you begin the conversation, think about what you value in this employee. Your people are your most valuable resource, this should ground any conversation. Use concrete examples of work they have done that is valued in order to boost self-esteem. Be honest, and reaffirm their worth.

• Ask One Question at a Time: Mental health concerns are invariably complex phenomena. Due to this fact, we often ask many questions of the person at once in order to get a better understanding. This, however, can confuse the speaker and lead to misunderstandings. Focus on one question at a time and let the employee dictate the tempo of the conversation.

• Pause: As a leader in your workplace, you are used to being active; taking charge of the situation. This, however, can mean that you don’t allow time for the employee to think about your question. Remember to let pauses in conversation occur — often this enables the employee to think about what they want to say and better articulate their thoughts, feelings, and behaviours.

• Mental Health In the Workplace: An Accomodation Guide for Managers and Staff - CMHA Ontario and Mental Health Works, Pg. 21

Return To Work: Collaborate – Listen For Understanding • Do not Interrupt: Interrupting someone who is talking about sensitive personal

issues, even when your intent is to offer support, can delegitimize their feelings. This also steers the conversation in your direction, which defeats the purpose of being an active listener!

• Listening for the Employee’s Interests: While we are listening, one way to stay engaged is by listening for the employee’s interests. This means that you are actively seeking out what is important to the employee. From what the employee is saying, what do you figure the employee values, believes, and endeavours for?

• Seek Out Clarification: At some point, you will begin to get a better picture of what the employee is going through. Once this occurs, seek clarification in order to affirm that you understand where they are coming from and what they are experiencing. It’s ok if you need to talk longer, often times you won’t retain all the information being provided.

• Mental Health In the Workplace: An Accomodation Guide for Managers and Staff - CMHA Ontario and Mental Health Works, Pg. 21

Is there a difference between RTW programs and mental health RTW?

• Guiding principles similar • focus on functional abilities of the worker, not the symptoms of the injury

or illness, or the causes. • Do not need to create a separate RTW program but be sure your existing

program will accommodate workers returning from mental illness related absences.

• Returning workers may have concerns about being a bother to others or feel rejection, isolation, and shame. They may also fear potential harassment and associated stigmas. During the planning stages, it should be discussed how the absence will be explained and what will be shared with the rest of the team.

• Person-Centered Approach • Mental Health In the Workplace: An Accomodation Guide for Managers and Staff - CMHA Ontario and Mental Health Works, Pg. 5

Return To Work: Planning

• Medical confidentiality must be respected at all times

• Consider recommendations from treating professionals. Sharing job descriptions and assessments as appropriate with the health care professional can be helpful in determining the best “fit to work” status.

• Allow scheduling to attend medical appointments and treatment

• Provide re-orientation or re-training that may support the employee's success.

• Communicate with the team that the worker will be returning so the individual can be welcomed back. Be available to support the team as needed. Do not allow gossip and other uncivil behaviours to occur which can lead to stigma and unsupportive work environments.

• Frequently Review. Iterative Process.

• The website Mental Health Works provides sample workplans.

Return To Work: Common Accommodations For People With Mental Health Problems • Flexible Scheduling:

Flexibility in the start or end of working hours to accommodate effects of medication or for medical appointments/treatment. Consider the energy and concentration levels of the individual and schedule the work accordingly throughout the day. Part-time shifts (which may be used to return a worker to a full-time position) and/or more frequent breaks may help.

• Changes in Supervision:

Modifying the way instructions and feedback are given. For example, written instructions may help an employee focus on tasks. Having weekly meetings between the supervisor and employee may help to deal with problems before they become serious. Mental Health In the Workplace: An Accomodation Guide for Managers and Staff - CMHA Ontario and Mental Health Works, Pg. 33

Return To Work: Common Accommodations For People With Mental Health Problems • Changes in Training:

Allow extra time to learn tasks. Allow the person to attend individualized training courses. Review training needs and provide any necessary re-training or reorientation.

• Modifying job duties:

Exchange minor tasks with other employees.

• Using Technology:

Allowing the person to use a lamp instead of fluorescent lights to eliminate a flicker which may be irritating or cause a reaction. Providing the employee with a tape recorder to tape instructions from a supervisor, training programs, and meetings if they have difficulty with memory. Allowing an employee to use headphones to protect them from loud noises.

Mental Health In the Workplace: An Accomodation Guide for Managers and Staff - CMHA Ontario and Mental Health Works, Pg. 33

Return To Work: Common Accommodations For People With Mental Health Problems • Modifying Workspace or Changing Location:

Changes to the workspace that consider the needs of the individual with regards to noise, space, and light and other factors that may impact mental health, concentration, and wellbeing. Allowing an employee to relocate to a quieter area where they will be free from distractions. Allowing an employee to work from home.

• Job Coach Assistance in Hiring and On-the-Job:

A job coach may be someone from an outside agency that assists the employee in the workplace. Alternately, someone within the workplace, such as a peer or human resources staff person might perform this role.

The job coach can help in a number of ways such as assisting the person to fill out applications, helping them to reduce their anxiety by providing feedback, observing their work and making suggestions about accommodation. Mental Health In the Workplace: An Accomodation Guide for Managers and Staff - CMHA Ontario and Mental Health Works, Pg. 33

Return To Work: Common Accommodations For People With Mental Health Problems • Help the individual prioritize work and activities: This step may

involve breaking work into small, achievable tasks, or to remove any non-essential tasks. This will increase positive reinforcement.

• Identify and remove triggers: Collaborate with the returning worker to identify any triggers to mental health and accommodate to avoid exposure.

Thank You !