1. 1 st June 2006Mental Health Issues in the Workplace- Bury EST Mental Health Issues in the Workplace The Village Hotel & Leisure Club, Bury Bury Employment Support & Training 1 st June 2006

2. What does work mean to the individual? “Work is one of two kinds. One, moving particles of matter around at or near the earth’s surface. Two, telling other people to do so. The first is unpleasant and badly paid. The second is enjoyable and well paid” Bertrand Russell

3. Salus Northwest OH provider, based at the medical centre at the former ICI plant at Hillhouse near FleetwoodOH 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 BoardPortfolio of local authorities, chemicals & manufacturing Branch of Lanarkshire Health Board Part of NHS Scotland, Lanarkshire Health BoardPart of NHS Scotland, Lanarkshire Health Board

4. Mission Statement Provide the highest quality Occupational Health & safety to the NHS and Industry Contribute to improvements in Public Health by: –Facilitating access to OH&S services –Reducing inequalities in health through research and development Generate income which supports NHS patient care

5. Personal perspective Personal perspective How I got into this…. –GP 1979 to 1991 –DSS Liverpool 1991-1995 why some people work & others don’t? –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

6. 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

7. Geography of Incapacity Benefit vs Unemployment in Males

8. What is the answer?

9. Some thoughts on PATHWAYS to WORK Pathways NW:- Merseyside, east & west Lancashire, Greater Manchester, Cumbria & Furness Residual single industry populationResidual single industry population –No longer reason for the people to be there Low housing equity – can’t move outLow housing equity – can’t move out Relatively poor transport infrastructure and getting worse – so can’t travel outRelatively poor transport infrastructure and getting worse – so can’t travel out Relatively poor educational infrastructureRelatively poor educational infrastructure –Fewer universities, sixth form colleges –Drain of talent

10. What do you see in your patient or employee? Struggling own job or redundancy candidate Go off sick & don’t 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

11. 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

12. 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

13. 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 ConsequencesConsequences are physiological;behavioural; cognitive;emotional

14. 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

15. “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

16. Retention/return toolkit: Flags – the barriers to Recovery Persons own beliefs about their condition or pain Pain / physical impairment preventing a RTW Social & vocational circumstances surrounding person e.g.. happy at work, culture, home life Financial and employment policies / facts of life (Andrew Pemberton of Human Focus) Identifying the barriers enables you to work on them!

17. Workplace Health Services NHS –GPs –Hospital Services Psychiatrists Therapists Occupational Health –Preventative –Assessment Pensions Fitness for work

18. GPs and the workplace Patient advocacy Not trained in workplace health –Sacking –pensions Certificates Confidentiality Access to:- Pathways to Work Condition Management Programme

19. What does the GP feel like? Certificates are boring, but quick! Better things to do Feels taken advantage of…… But doesn’t want to do lots of reports

20. 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?

21. Legal Aspects Health and Safety at Work Act Disability Discrimination Act Employment Law Common Law Tensions –Information –Confidentiality –Rehabilitation and return to work

22. What is Occupational Health? People –Doctors –Nurses –Managers –Therapists –Technicians Reports Gatekeeping rehabilitation Telephone

23. 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

24. R etention/return toolkit: Mental Rehabilitation “Stress” –Is there a mental health diagnosis? –Internal or external –Epidemiology –Works counsellor Drugs/alcohol Psychologist Severe & enduring mental illnesses

25. “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

26. Rome wasn’t built in a day……