How can we care for our carers? An early intervention approach to mental health for health professionals
There’s no question that mental health in the workplace is an extremely important, yet complex and often misunderstood issue. At the Aon Health Symposium, Associate Professor Samuel Harvey from Black Dog Institute addressed the correlation between workplace and mental health issues, with particular focus on health professionals who are identified as being particularly high risk. He outlined compelling evidence that our valued doctors and other health workers have higher rates of depression, anxiety and other mental health concerns in comparison to other groups of workers, with three key factors identified:
- High number of symptoms related to repeated exposure to high stress workplace pressures and trauma
- Inability or resistance to ask for help when they need it, with a number of barriers including concerns about being reported to regulators
- Access to the means for self-medicating or committing suicide
Growing our understanding of workplace and individual risk factors
A range of recent research studies have established workplace and individual factors that can interact and contribute to adverse outcomes, including increased risk of mental illness, long-term sickness and workplace absence.
From a workplace perspective, research has determined a link between how demanding your job is and your level of control over decision-making (‘job strain’). A combination of high demand and low control is associated with particularly high risk – a combination which is undeniably observed frequently among health workers. Indeed, current modelling suggests 1 in 7 cases of common mental disorder could be prevented if this combination is eliminated. On an individual level, contributing factors include coping styles, personality, perception of health / vulnerability, attitude and even parental work history.
From symptomatic treatment to holistic solutions
Past approaches to more symptomatic treatment of mental health issues (such the ‘debriefing’ movement which encouraged ventilation and discussion following a traumatic incident) have since been proven to cause increased harm and even contribute to post-traumatic stress.
Through a greater evidence-based understanding of workplace and non-work risk factors, positive new techniques and tools are emerging to facilitate more holistic solutions that address early intervention, prevention and treatment for mental health disorders.
Associate Professor Samuel Harvey outlined a model which overlays the stages of an individual’s mental health journey with workplace prevention and treatment strategies. Developed for First Responder organisations in NSW, it provides workplaces with a practical framework for proactively assessing and addressing gaps to support their employees.
Stage 1: Healthy worker (Primary prevention)
- A risk algorithm has been developed for men, predicting propensity for developing common mental disorders. This algorithm works as well as the most popular cardiovascular risk algorithms and allows interventions to be targeted.
- Resilience training based on mindfulness and cognitive behavioural therapy has been proven to be a beneficial early intervention tool if practiced regularly. Through online tools such as RAW (rawmindcoach.com), resilience training aims to address ‘mental fitness, not illness’ by focusing on developing practical skills.
Stage 2: Symptomatic or at risk worker (Secondary prevention)
- With this stage focused on helping people to get well early, Manager training has been observed to have positive impact, such as Aon’s Mental Health First Aid training courses. By increasing the mental health literacy of managers and building their skills and their confidence in identifying and communicating with employees suffering from mental illness, their teams exhibit reductions in absences and compensation claims.
- RESPECT Manager training is conducted face-to-face via Black Dog Institute, while an online version of the training (‘Head Coach’) is being developed in conjunction with beyondblue.
- A smartphone app is currently in development to assist in early treatment of people with established symptoms and risk factors.
Stage 3: Mental illness (Tertiary prevention)
- Aimed at treating rehabilitation and symptoms early on with good quality care; world-first guidelines into diagnosis and treatment of post-traumatic stress disorder (PTSD) for first responders have been developed, along with materials for clinicians and emergency service workers.
As the evidence grows and our understanding of mental health continues to develop, the evidence is being translated into practical tools to support workplaces and individuals to proactively manage their mental health, while also being adapted for workplaces outside of the health industry. Although there is no ‘magic bullet’, it’s clear that the movement towards early intervention and prevention is a positive step towards mitigating and preventing mental health conditions before they become an organisational issue.