Willing To Work Australian Human Rights Commission

“Willing To Work” Australian Human Rights Commission – Part 1 – General overview of issues Ms Ingrid Ozols, B. Sc, Grad Dip Bus Mgmt, Grad Dip Comm MH Master MHSc, Grad. Dip. MHRecovery & Social Inclusion (UK), Master of Suicidology Managing Director of Mental Health At Work (mh@work®) [redacted] Nov-Dec 2015 1

General Issues presented: mh@work® will consider the following : (a) evidence of the low rate of workforce participation of people with mental illness, the social and economic costs involved; (b) identification of the barriers that people with mental illness experience in gaining and retaining employment; (c) the respective roles of, and collaboration between, local, state and Commonwealth governments, business and community organisations in supporting the workforce participation of people with mental illness; (d) the effectiveness of programs that aim to improve the workforce participation of people with mental illness, including best practice models; (e) opportunities for tailoring education and vocational training for the needs of people with mental illness; (f) effective measures to support employers to recruit, employ and retain people with mental illness; and (g) the role of mental health services, and general health and community services in improving the workforce participation of people with mental illness Nov-Dec 2015 2

Case 1 – A Personal Story • Ingrid Ozols – A journey back to work and life • RTW: graduated process • Kindness, compassion, humaness@work • Importance of work to wellness Nov-Dec 2015 3

Case Study - 2 Michael – An Employee perspective • Married male, late 30’s. Worked in a demanding senior government role for many years; experienced years of unexplained aches and pains, irregular heart palpitations, chest pain, perspiration, shortness of breath, high levels of anxiety and frustration. Relief came through drinking high levels of alcohol. • Endless physical tests for a range of health symptoms. Doctor prescribed anti – inflammatory medications, sleeping tablets. • No- one looked for a psychological/emotional cause or illness. • Michael wore his disguise that all was well at work & home so that no one would know his inner torment and shame. Nov-Dec 2015 4

Case Study – 2 (cont’) Michael - An Employee perspective Lesson’s learnt; • Educate workers in basic mental health literacy. – How to identify early warning signs and provide assistance; – How to listen non-judgmentally; – Where to refer someone for help; – Understanding and empathy towards those who may have an issue; – What some of the triggers may be; – The do’s and don’ts regarding someone with a mental health illness. • Make seeking help easy and available. Make sure everyone is aware that help is easily accessible and available in a private and respectful environment. • Make help available outside of the immediate work area. Nov-Dec 2015 5

Case Study – 3 Ms. M – An Employer perspective • Ms. M had been with a professional service organisation for approx 3 months. Ms M successfully completed her probation period. She worked successfully for a further 8 months. • Ms M was not meeting the standards required, not was she meeting the agreed performance measures. • Ms M was showing tardiness, absenteeism, a lack of communication, was often absent from meetings or work, and often without notification. Nov-Dec 2015 6

Case Study – 3 (cont’) Ms. M – An Employer perspective • Employer engaged in confidential discussions with team leader. Ms. M claimed she was struggling with serious family issues, compounded by her own health concerns. • One–on–one counselling by manager over 1 – 2 months showed no improvement, behaviour remained erratic, with mood swings. • Manager followed company performance management process with a formalised, appropriately documented process. • Employer offered EAP (Employee Assistance Program). Nov-Dec 2015 7

Case Study – 3 (cont’) Ms M. – An Employer perspective Did workplace help? • Employer had EAP, but this relies on employee seeing help voluntarily. Employer does NOT receive feedback on individual cases in order to protect privacy. So how does employer, EAP or employee know if it is effective? • EAP included up to 3 visits without cost to employee. Using flexible working arrangements, employer arranged for Ms M. to have time off from work to attend counselling without penalty. Ms M chose to access & pay for ongoing counselling after initial allocation exhausted. Effectiveness? • Medical certificate provided for sick leave No specific reason disclosed at discretion of employee. How does employer manage unknown health issue? Impact of non-disclosure? Nov-Dec 2015 8

Case Study – 3 (cont’) Ms M. – An Employer perspective • Eventually Ms M disclosed she suffered from depression. Ms M. was prescribed a change/adjustment to her medication which caused emotional symptoms & an inability to concentrate. Ms M. reported that completing routine work tasks such as note taking & reports became challenging. • Employer explored flexible work arrangements/working from home. • Outcome: Ms M. eventually resigned. • Team reaction/impact: Disgruntled. Team felt they where picking up the pieces & completing additional work. In the absence of any explanation, they saw person not doing job without understanding. Once team aware, more empathic but resources stretched so pressure to perform was felt by all. Nov-Dec 2015 9

Case Study – 3 (Ms M – An Employer’s perspective) • • How was team managed? Manager was professional, understanding with good interpersonal skills. Org had increased focus on management & coaching of performance, service to customer was being affected negatively, action was required. Lessons learnt for both parties; Employees need confidence/trust that they can be honest about what is happening in their lives Employer’s can’t be supportive if they are not aware of the individual’s situation. Humanness can work alongside policies and procedures but employers must still operate within bounds of policy and legal obligations & balance issues such as duty of care and privacy rights of individuals Nov-Dec 2015 10

Case Study - 4 Mr. T – A positive outcome • 30+ professional male, recent appointment to role. Disclosed bipolar disorder, advised treatment & medication changes may impact ability to perform role at the same high level he had been used to. • Mr, T showed anxiety in meeting project deadlines. • Employer/manager held regular discussions, communication channels remained open and flexible work practices were introduced. • Mr. T took some sick leave; as required. • Mr. T was able to fulfil role requirements and satisfy his role requirements, thus keeping his job. • Situation regarded & treated as confidential. Privacy was maintained. The team leader was supportive, informed and tolerant. Nov-Dec 2015 11

Case Study – 5 Return to work: Not that easy for Ms. E • Ms. E, mid 40’s middle manager, state government department. Has been on Workcare for 2 years for psychological injury (major depression, allegedly a result of workplace bullying (note that the claim was accepted) • Ms E. has now been certified as fit to work, and remains willing and able to return to her pre-existing injury duties, effective 5/3/2012. Medical certificates also declare fit to work from this date. Medical professionals + case manager recommend two basic agreed return to work adjustments for Ms E. for her to return to work. These were: 1. Sitting away from alleged bully; & 2. Direct head welcomes her back to work & the team on her return to work. • Nov-Dec 2015 12

Case Study – 5 (cont’) Return to work: Not that easy for Ms. E • We are advised the employer has since informed Ms E. she is not welcome to return to work as the required accommodations could not be met. • Distressed, Ms E. indicated she was well enough to return to work, has the ability and right to work, needs to work to earn an income and feels the accommodations are not that difficult as the office is large and that sitting arrangements can be changed relatively easily so as the 2 parties can be seated apart • Ms E. has since sought advice from both Work. Safe Victoria and Legal Aid. Despite the significant distress this response has caused her, Ms E has every intention of going to work this week. She remains committed to returning and to performing to the best of her ability. • Outcome is awaited. Nov-Dec 2015 13

Setting the Scene • 1 in 5 Australian’s will experience a mental illness within any one year • (1997 & 2007 Nat Health & Wellbeing Survey) • $20 billion a year cost to community through mental ill-health • 6 million workdays each year lost to depression alone • Increased stress claims – varies amongst workplaces • By 2020 the World Health Organisation estimates that Depression will be the 2 nd highest burden of disease & disability in the world Nov-Dec 2015 07/03/2012 14

Setting the Scene (cont’d) • More than 2000 suicides in Australia each year • 7 people every day, 1 every 3 hrs in a day • Lifeline takes 1500 calls per day every day • Weekend waiting time can be 40 mins • Can strike at any stage of lifespan from childhood to old age • Impacts on a person’s ability to function in life, work & relationships Nov-Dec 2015 07/03/2012 15

Setting the Scene cont’d • Medibank 2008 study: Cost of work place stress to Aust: $14, 8 billion per year Absenteeism & presenteeism, costing $10. 11 billion/yr 3. 2 days/worker lost/ yr due to workplace stress • Comcare Research last 12 months: 54% increase in mental health stress claims since 2006 -2007 Other injuries are decreasing 22% of all serious claims – stress related *Workplace Stress fast becoming # 1 of the BIGGEST THREATS TO WORKPLACE OHS Nov-Dec 2015 07/03/2012 16

Setting the Scene (cont’) American Psychological Association (2011): • 1/3 surveyed felt stress or tense DURING WORKDAY, • 40% Heavy job load caused stress, • 43% lack of opportunity for growth within workplace. Workplaces need to consider what ‘mental health friendly’ ERGONOMIC ADJUSTMENTS & /or ACCOMMODATIONS are needed Nov-Dec 2015 07/03/2012 17

Setting the Scene: The Price of Severe Mental Illness In a 2010 report, Functioning of this cohort showed: • 51. 2% with psychotic illness were assessed to be functioning well in work & socially prior to onset of illness. • 70. 8% of the total had been in either paid or unpaid work or studying. • 68. 7% had good adjustment within these roles • 63. 9% reported good social functioning before the onset of first symptoms. • Most people (90. 4%) reported deterioration of functioning after illness onset. • 1/3 (32. 3%) were assessed as having a significant level of impairment to self -care in the previous 4 weeks. ttp: //www. health. gov. au/internet/main/publishing. nsf/Content/353 E 10 EE 8 8736 E 02 CA 2579500005 C 211/$File/psyexe. pdf) Nov-Dec 2015 07/03/2012 18

Setting the Scene (cont’): The Price of Severe Mental Illness • Almost 1/5 (18. 4%) accessed were unable to complete a simple chore such as cleaning their room. • 2/3’s (63. 2%) were assessed as having a significant level of dysfunction in their capacity to socialise over the past year. • People with psychotic illness experience very high rates of unemployment & low rates of labour force participation. • They are also at greater risk of homelessness. • Factors contributing to these high rates include social isolation, family breakdown, stigma, discrimination need for acute care, including hospital admissions. Nature of illness is up and down – can be well for long periods and then unwell. It is not a stable path. (http: //www. health. gov. au/internet/main/publishing. nsf/Content/353 E 10 EE 88736 E 0 2 CA 2579500005 C 211/$File/psyexe. pdf) Nov-Dec 2015 07/03/2012 19

Setting the Scene (cont’d): The Price of Severe Mental Illness Government disability pensions were the main source of income for 85. 0% of people. • 1/3 (32. 7%) in paid employment, 30. 5% full - time employment. • 1/3 of participants (32. 7%) were in paid employment over the past year versus 72. 4% of general working age population as @ July 2010. • Workplaces do not know how to retain, support and manage a person with a psychotic illness and tend NOT to employ them because of this fear and stigma that they will be difficult to manage and may not be reliable and could potentially be violent. (http: //www. health. gov. au/internet/main/publishing. nsf/Content/353 E 10 EE 88736 E 02 CA 257 9500005 C 211/$File/psyexe. pdf) Nov-Dec 2015 07/03/2012 20

Working Well. . (1) • WORK is IMPORTANT TO WELLBEING, but can also hinder with inappropriate practices – organisations need to have advise, strategy and training to know what to do and what not to do. • PROMOTION, PREVENTION, EARLY INTERVENTION APPROACH needs to be a the way we do business! • PEOPLE with Mental Health issues Want to work, Need to Work, Can Work, have the Right to work. . • Work gives structure, belonging, purpose. • Connection important for wellness. . . Nov-Dec 2015 07/03/2012 21

Working Well. . (2) • Workplaces need to address & manage Psychosocial hazards &/or Risk factors: Work culture - eg Bullying & harassment – intent versus impact, conflict, office politics, relationships, morale, turnover. Physical environment – e. g. noise, lighting, overcrowding. Organisational practices – e. g. leadership style, unclear roles & responsibilities, unclear roles, poor communication, lack of autonomy, lack of control, outdated discriminating policies & procedures, unreasonable work pressure/loads, demands, long hours, job designs, lack of training, lack of support, change management processes. Nov-Dec 2015 07/03/2012 22

An Evidence Based Strategic Long-term Approach. • • • • Integrated sustainable long-term multi – layered ongoing education using LIVED EXPERIENCE/QUALIFIED PEER SUPPORT with quality assurance. Encourage culture change, need leadership commitment & engagement, internal champions constantly working at promoting PPEI Simple supportive/management approaches based on the lived experience. Incorporate adult learning principles & interactive workshops & education campaigns tools. Not about diagnosis (not our role). Prevention, early intervention. Recognising signs & symptoms when not doing well, something isn’t right with self or others, when resilience is slipping. Not about fixing or managing other peoples’ problems (we can’t anyway). Providing tools for people to take responsibility for their own wellbeing. Work is important to wellness. Creating supportive understanding & tolerant work environments. “This is the way we do business”. Embed humanness into policies & practices. Nov-Dec 2015 07/03/2012 23

“Creating A Mentally Healthy & Supportive Workplace” • Currently working on ebook version for Work. Safe Victoria • >100, 000 copies distributed • Co – badged with clients + CEO Sign – off • Other clients: ANZ, Coles Group Nov-Dec 2015 07/03/2012 24

mh@work® client’s learnings • Program requires support from most senior management, internal champions, contemporary leadership • Sustainable long –term on going regular multi – layered education campaign • Evaluate evaluate ‘ I am so proud I work for a company who has the courage to bring us this program’ ‘I wish I had this information years ago’ Nov-Dec 2015 07/03/2012 25

Recommendations (1) • • • Improve collaboration of different mental health sector stakeholders to work together with businesses/workplaces/corporate. mh@work® has endeavoured to be a conduit One size DOES NOT FIT ALL! Schizophrenia is DIFFERENT to depression, sometimes they occur together, we need to educate workplaces about these differences. Provide employer assisted training around accommodations and adjustments workplaces need to recruit and retain person’s with a mental illness. Increase incentive programs for training /education and ongoing support; especially with the episodic nature of illness, peaks & troughs, constant monitoring of & knowing people. Social media/technology is not the be all and end all; not the silver bullet, need high tech, high touch combination. Increase awareness in workplaces that long term strategic tailored programs need to drive behavioural Nov-Dec 2015 culture change; 26

Recommendations (2) • To gain engagement from insurers/worker’s compensation linkages as part of prevention, early intervention initiatives to provide financial incentives for their client’s to implement appropriate evidenced based mental health interventions. • GP Training to reconsider stress leave certificate approach of “ 6 weeks away” – in crisis people can’t work, but connection however small is key to RTW. Consistent messaging collaboration is required, better education about the importance of connection and work (graduated work, job redesign etc) • E. A. P- Employee Assistance Programs, NOT A REGULATED INDUSTRY, NO QUALITY ASSURANCE, Services, quality of professionals ad hoc, hit & miss & expensive to employers, difficult to gain appts & difficult to gauge effectiveness & outcomes. Need tighter regulation Nov-Dec 2015 27

Recommendations (3) • • Mental Health First Aid & the beyondblue work place programs, headsup are good, however they are being perceived as the fix all and adequate solution to complex ongoing issues. Do not address disability or work towards culture change. Facilitator quality is a concern with MHFA – No quality assurance, no record of messages being delievered or skill checking. Open to anyone to be a trainer. Quality inconsistent and varies from individual to individual trainers Suicide Prevention needs to be included; teaching managers and employers skills & competence to have “brave conversations®” to approach, support & manage these difficult issues. More data needs to be collected around Suicide Prevention in the Workplace & it’s impact – anecdotal evidence tells us this is a huge taboo in workplaces with no systems of support in place. More research in Prevention Promotion & Early Intervention with respect to mental health, mental ill health, suicide prevention and resilience of persons, teams and organisations. Encourage businesses to go beyond tokenism, work to change culture. Developing a naturally mentally healthy, diversity welcoming philosophy to how work is done here. Nov-Dec 2015 28

References The Conference Board of Canada 2011 “Building Mentally Healthy Workplaces Perspectives of Canadian Workers and Front-Line Managers. ” Canada • Comcare 2010 http: //www. comcare. gov. au/data/assets/pdf_file/0004/103288/Submission_to_public_he aring_on_mental_heatlh. pdf • Comcare 2008, “Working Well - An organisational approach to preventing psychological injury, A GUIDE FOR CORPORATE, HR AND OHS MANAGERS” Canberra • Comcare 2009 “PUTTING YOU FIRST. BEYOND WORKING WELL: A BETTER PRACTICE GUIDE. A practical approach to improving psychological injury prevention and management in the workplace” Canberra • http: //www. workingforhealth. gov. uk/Carol-Blacks-Review/ • http: //www. health. gov. au/internet/main/publishing. nsf/Content/353 E 10 EE 88736 E 02 CA 25 79500005 C 211/$File/psy 10. pdf • Mental Health Council of Australia, 2007 “Let’s get together - A National Mental Health Employment Strategy for Australia: ” Canberra • Medibank Private 2008 “The Cost of Workplace Stress in Australia” • http: //www. hreoc. gov. au/disability_rights/publications/workers_mental_illnessguide/work ers_mental_illness_guide. pdf “ 2010 Worker with Mental Illness; a Practical Guide for Managers” http: //www. centreformentalhealth. org. uk/pdfs/mental_health_at_work. pdf • Ozols, I & Mc. Nair, B (First edition 2003, tabled version 2007) “Creating A Mentally Healthy and Supportive Workplace” Canberra. • Nov-Dec 2015 29

THANK YOU Nov-Dec 2015 30