Applications in Human Resources Mental Health in the Workplace HEABC Annual General Meeting – June 24, 2008

1. Applications in Human Resources Mental Health in the Workplace HEABC Annual General Meeting – June 24, 2008 Peter Coleridge Vice President, Education and Population Health BC Mental Health & Addiction Services Dawn Palmer Corporate Director, Employee Wellness & Safety Provincial Health Services Authority

2. Applications in Human ResourcesMental Health in the WorkplaceWho We Are PHSA's primary role is to ensure that BC residents have access to a coordinated network of high-quality specialized health care services. PHSA operates eight agencies that provide province-wide health care services, including: PHSA also provides provincial leadership around system-wide improvements and works closely with the five regional BC Health Authorities on this collective goal.

3. Applications in Human ResourcesMental Health in the WorkplaceOverview • Why be concerned about workplace depression? • The Business Case • PHSA Workplace Mental Health & Addiction Strategy - Peter Coleridge • How can organizations & researchers partner to guide workplaces in addressing mental health & addiction? • External Partnership Development – Intervention development, Research & Knowledge Exchange – Peter Coleridge • PHSA Internal Activities for 2007/08 – Dawn Palmer • PHSA – Creating Healthy Workplaces

4. Applications in Human ResourcesMental Health in the WorkplaceWhy be concerned about depression in the workplace? • Canada – estimated cost of mental illness in the workplace is over $20 billion • BC – mental illness accounts for 13% of long-term benefit claims for health care workers • approximately 5% of employees are working with depression (Harvard University study) • impacts on quality of care and patient safety • Employees are becoming more aware of their rights regarding mental health problems

5. Applications in Human ResourcesMental Health in the WorkplaceWhy be concerned about depression in the workplace? • Supports Recruitment and Retention • increasing number of retirements and shrinking pool of “new” workers (particularly highly skilled knowledge workers) • employer of choice for future reduced workforce includes: • culture of performance, output, and work and family balance set by organization leadership • supportive manager (two-way communication, positive feedback, respect, consistency, coaching, output and not hours worked)

6. Applications in Human ResourcesMental Health in the WorkplacePHSA Workplace Mental Health & Addiction Strategy Background • June 2004 - BC Auditor General’s Report - PHSA Executive Subcommittee on Workplace Mental Health & Addiction • June 2005 - Comprehensive PHSA Workplace Mental Health & Addiction Strategy • 2005–2006 - Implementation Planning • 2007 - Early stages of implementing 3 to 5 Year Strategy - Communications roll out • 2008 - Ongoing implementation

7. Applications in Human ResourcesMental Health in the WorkplacePHSA Workplace Mental Health & Addiction Strategy Plan Highlights • Based on “Best” or “Promising” practice • Demonstrated Executive commitment • Integrated – Organizational Culture and Primary, Secondary, Tertiary Prevention • Included in overall Healthy Workplace Strategy • Partnerships – Intervention Development, Research and Knowledge Exchange • Staged implementation of activities based on established criteria

8. Applications in Human ResourcesMental Health in the WorkplacePHSA Workplace Mental Health & Addiction Strategy Implementation Criteria • Availability of “Best” or “Promising” practice tools/interventions • Alignment with PHSA and agency priorities, and needs (e.g. risk assessment based on LTD data analysis) • Resources and capacity to respond

9. Applications in Human ResourcesMental Health in the Workplace How can organizations & researchers partner to guide workplaces in addressing mental health & addiction?

10. CIHR WCB OHSAH BC Business and Economic Roundtable HBT Alberta RHAs NQI Universities Scientific Committee Global Business and Economic Roundtable Partnership Development International National Province PHSA CMHA HR Unions MH&A Harvard Study

11. Applications in Human ResourcesMental Health in the Workplace Antidepressant Skills at Work Primary/Secondary/Tertiary Prevention

12. High workload and little control Lack of perceived support and recognition Change (positive or negative) Organizational culture and function (poor communication, low levels of support, lack of definition of objectives) Role in the organization (role ambiguity, role conflict, role insufficiency) Home - work interface (conflicting demands of work and home) Work environment/equipment (reliability, availability, maintenance/repair issues) Task design (fragmented or meaningless work, high uncertainty) Work load/workplace (overload or underload, time pressures, lack of control over pacing) Work schedule (shift work, inflexible hours, long hours) Career development (career stagnation, poor pay, job insecurity) Decision latitude/ control (lack of autonomy, low participation in decision making) Interpersonal relationships (poor relationships, social isolation, interpersonal conflict, violence) Applications in Human ResourcesMental Health in the WorkplaceAntidepressant Skills at Work Workplace Factors

13. Applications in Human ResourcesMental Health in the WorkplaceAntidepressant Skills at Work The BCMHAS (PHSA), in partnership with the Centre for Applied Research in Mental Health & Addiction (CARMHA) created a self-care guide for depression in the workplace. Benefits: • Workplace-focused • CBT- based • User-friendly (brief, clearly presented) • Accessible (free download) • Brief

14. Applications in Human ResourcesMental Health in the WorkplaceAntidepressant Skills at Work What is Self-Care? • An approach to management of a disorder that is guided by the individual and complementary to existing care and rehabilitation • Increasingly being incorporated within chronic disease management (CDM) best practice guidelines for a number of disorders e.g. arthritis, chronic pain and…depression • Cost effective and efficient: can be made available to individuals exhibiting early symptoms or functional signs of a disorder or recurrence of an episode

15. Applications in Human ResourcesMental Health in the WorkplaceAntidepressant Skills at Work • CBT is an effective depression treatment • CBT has specific benefit for recovery of work function • Fosters the worker’s active coping with workplace issues “[CBT] has a direct effect on psychosocial functioning through therapeutic work on issues that have relevance to psychosocial functioning, such as the building of social skills.” Hirschfeld RM et al (2002), Biol. Psychiatry 51. …however, CBT is minimally available in the public health system, so workers rarely can access this form of non-drug treatment Why develop a cognitive behaviour therapy (CBT) self-care Workplace depression guide?

16. Applications in Human ResourcesMental Health in the WorkplaceAntidepressant Skills at Work Intended for: • Working people with low mood, who may be at risk for developing depression • Working people who have developed a mild or major depression • Individuals who have been off work for a period of time, and are re-entering the workplace • Partners, family members, friends or workplace colleagues who want to help an individual suffering from low mood or depression • Employers, supervisors or managers concerned about the well-being of their staff • Treatment providers who would like a tool to use as an adjunct to their clinical treatment

17. Applications in Human ResourcesMental Health in the WorkplaceAntidepressant Skills at Work Designed to: • Deal with workplace problems so they are less likely to cause depressed mood or lead to depression. • Reduce the effects of depression and depressed mood on work satisfaction and performance • Actively participate with disability prevention, early intervention, treatment and sustained return to work.

18. Applications in Human ResourcesMental Health in the WorkplaceAntidepressant Skills at Work Antidepressant Skills: • Solving Problems Effectively Identifying useful actions Evaluating (pros & cons) Planning, implementing • Realistic Thinking Identifying distorted thinking Challenging, replacing, practicing • Reactivating your Life Social, self-care, interests Goal-setting

19. Applications in Human ResourcesMental Health in the WorkplaceAntidepressant Skills at Work Other Topics  Preventing Relapse • Planning ahead for stress • Mood emergency plan  Making Decisions about Depression • Should I tell people at work about my depression? • Should I take time off work? • How can I return to work successfully? • What lifestyle changes might be helpful (sleep, diet, use of alcohol & drugs, physical activity)

20. Applications in Human ResourcesMental Health in the WorkplaceAntidepressant Skills at Work How can the AS@W guide be used? Primary Prevention • Stand-alone (make manual accessible to employees) • Implement workshops focused on how to use the guide (e.g., manager training; widespread employee training) Secondary Prevention • Stand-alone (for mild to moderate depression) • Adjunct to other treatment (psychologist, EFAP, medication treatment – for more severe depression) Tertiary Prevention • Disability / rehabilitation management • Promotion of sustained return to work • Relapse prevention/management

21. Applications in Human ResourcesMental Health in the WorkplaceAntidepressant Skills at Work AS&W at PHSA • Copies of the self-care guide were sent to all managers throughout the organization, as well as all HR staff • EFAP counselors have received training on proper use of the AS@W • Disseminated at Health Fairs, JOHS training days, team building days, etc. • Available free for download on the BCMHAS or CARMHA websites • Employees can order free copies from Employee Wellness & Safety

22. Applications in Human ResourcesMental Health in the Workplace PHSA Employee Health Survey • Partnered with HBT to develop and administer an Employee Health Survey across the organization. • Gathered info on: demographics, physical and psychological health risks in the work environment, personal health risk behaviours and self reports on absenteeism and presenteeism • Collected information will support implementation planning and provide a baseline for evaluation of various activities in the PHSA workplace mental health and addiction strategy. • The PHSA used the Healthcare Benefit Trust Employee Health Survey in order to minimize costs and ensure issues such as employee confidentiality are addressed (HBT will analyze data and produce reports at no cost). The survey was accessible to PHSA employees in a paper and a web based format.

23. Applications in Human ResourcesMental Health in the WorkplaceEmployee Health Survey Challenges • Concerns over confidentiality • Difficulty disseminating & collecting surveys across an organization of 10,000+ working across the province. • Majority of respondents used the online survey; however as some staff don’t have access to computers at work, paper copies needed to be available • Electronic survey through external provider, occasional glitches in reporting • Incentive Troubles • We offered an SPF lip balm to everyone who completed the survey • 10 names drawn at random from respondent pool received iPods • First 1,000 people to answer received a water bottle • Little did we know they contained…Bisphenol A!

24. Response • EHS is a census survey, meaning all employees surveyed • 52.3% of regular employees responded • 13.3% casual employees (under represented) • Highest response group  non contract employees at 80.1% • 100% response rate from BCCDC (excluding casuals) • 75% electronic responses

25. Demographics • Respondents: 80% female, 20% male • PHSA Workforce: 81.2% female • 25-34, 34-44 & 45-54 age groups represent relatively equal proportions of the PHSA workforce, and responded equally to the survey.

26. Chronic Work Stress • 34.4% met criteria for chronic work stress (most days over last 12 months were quite or extremely stressful) • Benchmark is 30.6% (2002 Canadian Health Survey, Dewa et al, 2007) • BC Women’s experiencing the highest rate of chronic stress (43% or 1754 ees). This may be due to the fact that chronic work stress is most frequent among FT females in the 45-54 year old age group. • Management/Leadership group – 46.5% • Union members – 36%, BCNU - 42.6% • Further assessment is required to ascertain the sources of chronic work stress in high risk groups (data from Employee Engagement Survey & Patient Safety Survey should be correlated with EHS)

27. Job Satisfaction • High job satisfaction score - 72.1%. • The job satisfaction score is a reliable measure and good indicator of job turnover. However, there are a number of groups who have less job satisfaction and a greater desire to leave PHSA. • Stress Satisfaction Offset Score – 0. This means that work stress offsets job satisfaction. • Corporate Services, Nursing and Management/Leadership have the most negative SSOS scores. We need to modify the work environment or work practices to achieve improved productivity.

28. Personal Health Risks • Average of 2.75 personal health risk factors • Top 3 Health Risks: • Lack of Exercise • Poor Sleep • Poor Diet • 56% of respondents indicate they would be moderately or very interested in participating in employer sponsored health promotion programs. • Top 3 “Ready to Change” • Lack of Exercise • Over weight • Excess Stress

29. Depression • 38% screened positive for depressive symptoms • PHQ-9 was used to screen for presence and severity of depressive symptoms • 1000+ employees scored between 5-9 on the PHQ-9 scale, indicating they may have a mild major depressive disorder. An additional 544 screened been 10-27 indicating moderate to severe depression. • 5.3% or 216 employees were considering hurting themselves in the 2 weeks prior to the completion of the survey. • We need to make employees aware of resources that are available: FBN, ADS@W, EFAP, Physicians, etc

30. Chronic Health Conditions & Productivity • The Standford Presenteeism Scale (SPS) was used to determine the prevalence of chronic mental & physical diseases. SPS assesses productivity loss associated with chronic conditions (presenteeism accounts for 60-80% of productivity losses) • Top 5 Chronic Conditions • Allergies • Back/Neck Disorders • Arthritis/Joint Pain • Migraine/Chronic Headaches • Stomach/Bowel disorder • Depression (6th) and Anxiety (9th) are closely linked and both tend to cause more work impairment and productivity loss.

31. Chronic Health Conditions & Productivity continued… • 66% have 1 or 2 chronic conditions, many of which are under-treated. 41% have 2 or more chronic conditions. • Healthcare costs increase as chronic conditions increase. This suggests that selective workplace-based chronic disease management interventions may be required. • We could have monthly articles in Pulse on how to deal with these chronic conditions (eg. Allergies in April issue when pollen levels rise)

32. Co-morbidity & Work Impairment • Work impairment is amplified when chronic work stress is added to the chronic physical condition. • PHSA Corporate is ranked number 1: the location with the lowest composite health & productivity index (least healthy and least productive based on 5 health and productivity metrics). • HEU is ranked #1 among unions.

33. Integrated Health Profile The results Employee Health Survey will be combined with: • PHSA’s Engagement Survey • PHSA’s Patient Safety Survey to create an Integrated Health Profile. Pilot will be conducted in one of PHSA’s agencies. Need to communicate the results out to staff and to demonstrate what activities are taking place based on their feedback…. Other indicators to consider: WCB/LTD/Absenteeism

34. Applications in Human ResourcesMental Health in the WorkplaceFeelingBetterNow.com Secondary Prevention Supporting the PHSA Workplace Mental Health & Addiction Strategy The College of Family Physicians of Canada has reviewed and approved FeelingBetterNow ® as a practice management tool available to assist family physicians in patient care.

35. Applications in Human ResourcesMental Health in the WorkplaceFeelingBetterNow.com Voluntary, anonymous, and confidential • Interactive web based screening tool • Provides the individual with a self-directed opportunity to assess their mental & emotional health status • Empowers an individual to get the best mental health care from the existing Canadian public mental health care system

36. Applications in Human ResourcesMental Health in the WorkplaceFeelingBetterNow.com Medical Validity • Designed and endorsed by a group of internationally recognized mental health experts in each field • Reviewed and approved by the Canadian College of Family Physicians • Follows the current Best Practices medical guidelines • Clinician tested in offices • Diagnostic modules are based on DSM IV statistical manual

37. Applications in Human ResourcesMental Health in the WorkplaceFeelingBetterNow.com Organizational Benefits • Offers self-directed, voluntary mental health support and resources to employees • Organization receives a customized aggregate report that provides an opportunity for targeted program impact • Demonstrates that the organization values the employees well-being • Synergizes and enhances existing programs e.g. EAPs, Wellness

38. Applications in Human ResourcesMental Health in the WorkplaceFeelingBetterNow.com Individual Benefits • Voluntary, Confidential & Anonymous • Self-directed opportunity to assess their own personal mental & emotional health • Provides a non-threatening environment • Offers links to many resources to understand mental health disorders and existing medical and cognitive interventions • Offers a road map for an individual to follow to make the treatment steps more manageable • Can be completed from home, work, library etc.

39. P: including given detail?

42. Applications in Human ResourcesMental Health in the WorkplaceFeelingBetterNow.com • PHSA FBN Pilot program ran November 2007 – April 2008 • 1,074 employees from the 7,476 pilot participant group utlilzed the program • Expected utilization 10-15%, PHSA’s projected annual utilization rate is 32% • 79 people printed care maps • 4.2/6 pilot registrants who completed the program were at diagnostic risk for a disorder (71%) • Indicator that the program impacted the target high risk population

43. Applications in Human ResourcesMental Health in the Workplace How can we reduce discrimination and stigma about depression in the workplace?

44. Applications in Human ResourcesMental Health in the WorkplaceResponding with Respect – Manager Training Secondary Prevention - In partnership with the Canadian Mental Health Association

45. Applications in Human ResourcesMental Health in the WorkplaceResponding with Respect – Manager Training CMHA – Vancouver-Burnaby Branch http://vancouver-burnaby.cmha.bc.ca • Delivers workplace training and education in mental illness including a Mental Illness First Aid course and a Life-Work balance Workshop • PSHA contracted CMHA to create this course, based off of the MIFA workshop, to meet the specific needs of PHSA • Two focus groups have worked through this course, course will go live in June to PHSA managers

46. Applications in Human ResourcesMental Health in the WorkplaceResponding with Respect – Manager Training At the end of the three hour workshop, managers should be able to: • Identify the signs & Symptoms of low mood & depression • Have a system for responding to employees displaying signs of low mood and depression • Understand the impacts of the workplace on depression • Access the PHSA Workplace Mental Health & Addiction Strategy and related programs

47. Applications in Human ResourcesMental Health in the WorkplaceResponding with Respect – Manager Training Workplace Stressors: • Work Overload or Under load • Role Uncertainty and Role Conflict • Responsibility for Others • Isolation • Lack of Job Satisfaction • Lack of Job Security • Workplace Violence EXAMPLE SLIDE

48. Applications in Human ResourcesMental Health in the WorkplaceResponding with Respect – Manager Training Signs & Symptoms of Depression at Work: • Inability to make decisions • Decreased productivity • Inability to concentrate • Decline in dependability • Lack of enthusiasm for work • Unusual increase in errors at work EXAMPLE SLIDE

49. Applications in Human ResourcesMental Health in the WorkplaceResponding with Respect – Manager Training Responding with Respect Framework Having a framework for response helps us feel more comfortable talking to friends, family members and colleagues about our concerns. • Recognize • Respond • Refer EXAMPLE SLIDE

50. Applications in Human ResourcesMental Health in the WorkplaceResponding with Respect – Manager Training How to support staff experiencing low mood or depression • Continue to treat them with respect – believe they can recover • Acknowledge their value and point out their positive contributions • Offer encouragement and support • Make accommodations as needed • Encourage staff that you are concerned about to visit their doctor, contact EFAP or Employee Wellness & Safety EXAMPLE SLIDE