psychiatric – Page 67 – SafetyAtWorkBlog

Self development course contributes to a workplace suicide

What would you do if a work colleague strips, screams, acts “like a child having a tantrum”, starts to sing and then jumps out of a window to her death? That is the situation that was faced by staff at the Sydney office of the Royal Australasian College of Physicians in December 2005.

Only days earlier, 34-year-old Rebekah Lawrence, had participated in a self-development course called “The Turning Point” conducted by Zoeros P/L trading as People KnowHow. The course, according to one media report, the course included a session called “The Inner Child”

“in which those taking part were encouraged to develop a dialogue between their child and adult selves.”

Lawrence’s actions just before her death mirrored some of the course teaching.

PeopleKnowHow’s website has closed down with an announcement that all of its courses are under review. Other organisations that provide similar courses are running for cover. Transformational Learning Australia has said it

“…no longer has a professional relationship, affiliation or any other connection with People Knowhow.” [emphasis added]

TLA also says any relationship ended in 2005. That the company has felt it necessary to make a media statement about the end of the relationship shows the extent of the effect of Rebekah Lawrence’s death on this industry sector.

TLA goes on to say that

Our organisation does not accept participants who have a recent history of chronic mental illness, participants under the care of a treating professional who have not obtained that professional’s consent to participate, or people who demonstrate a propensity towards psychological fragility or a significant lack of cohesion during the introductory sessions of the program.”

The New South Wales Coroner found that in the absence of any history of psychosis in Rebekah Lawrence that,

The evidence is overwhelming that the act of stepping out of a window to her death was the tragic culmination of a developing psychosis that had its origins in a self-development course known as ‘The Turning Point’ conducted by Zoeros Pty. Ltd, trading under the name of ‘People Know-How” on the 14, 16, 17 and 18 December 2005.

The full coronial findings are difficult to read due to the personal details of Lawrence’s life, her relationship with her husband David and the general picture of her personality that comes through. An upsetting and enlightening interview with David Booth is available online from earlier in the investigation process.

The findings also provide considerable detail to the components of the course that Lawrence undertook. There is a greater level of detail than would be expected to be known by someone signing up for such a course and this is where the lessons can be learnt for the OHS professional and safety manager.

It has become common in many corporations who are trying to improve or introduce a positive workplace culture, to supplement their own efforts with “self-help” or “self-awareness” courses. Lawrence’s death has highlighted the lack of regulation or accountability in some sectors of this industry. This also highlights the need for people managers to thoroughly investigate such courses to ensure that good intentions are not likely to increase the risk of harm or damage to the employees who participate.

An audio report on the Coroner’s findings is available online.

Counselling Services

Many workplaces often provide access to counselling services through schemes such as Employment Assistance Programs. The Coroner’s recommendations have some direct bearing on the issue of “counsellors”.

“The Executive Director of the Australian Psychological Society, Professor Lynne Littlefield pointed out that there are no legal restrictions in Australia for practising under the title ‘psychotherapist’ or under the title ‘counsellor’ and therefore no public safeguards against untrained or incompetent practitioners in this field.

Professor Littlefield pointed out that although there were many skilled counsellors and psychotherapists, there were also many whose competence is questionable and without any regulating mechanisms to stipulate the required training and levels of competence, there was no way of protecting the public from these poorly trained practitioners.”

Rebekah Lawrence’s death is receiving considerable media coverage in Australia at the moment and the New South Wales Government is carefully considering the Coroner’s recommendations concerning the regulation of some areas of the self-development industry. Employers and safety professionals are going to have a very different set of criteria shortly from which such workplace-related courses need to be evaluated.

One media report has indicated the start of the ramifications of this unfortunate death:

“The NSW Health Minister, Carmel Tebbutt, said she had asked her department for ”urgent advice” on the case and would consider the coroner’s recommendations. A code of conduct for counsellors and psychologists had already been implemented and the Health Care Complaints Commission now monitored practitioners.

The Royal Australian and New Zealand College of Psychiatrists called for closer monitoring and accountability of self-help and psychotherapeutic courses.”

Kevin Jones

A good book of safety solutions case studies

Australia has many safety awards programs. SafetyAtWorkBlog has reported on some of the practical solutions from the awards and lamented how the prominence of such solutions fades quickly as the mainstream media ignores them. The blog has also shown examples of a hard copy solutions database that existed in Victoria and Australia for a couple of decades.

The European Union’s Agency for Safety and Health at Work has recently released, online, a publication in support of its risk assessment campaign that shows how safety solutions can be presented and shared without worrying about commercial-in-confidence or intellectual property.

Jukka Takala, Director of EU-OSHA, says in his foreword

“This report supports the campaign by providing information on successful interventions in the workplace illustrating how the hazards identified after a risk assessment can be eliminated or controlled. The report is aimed at those who are responsible for carrying out risk assessments in the workplace and for preparing decisions on risk elimination or control measures.”

The report, “Assessment, elimination and substantial reduction of occupational risks“, also provides a list of some very useful elements for preventative safety

“The employer shall implement the measures (necessary for the safety and health protection of workers) on the basis of the following general principles of prevention:

(a) avoiding risks;
(b) evaluating the risks which cannot be avoided;
(c) combating the risks at source;
(d) adapting the work to the individual;
(e) adapting to technical progress;
(f) replacing the dangerous by the non-dangerous or the less dangerous;
(g) developing a coherent overall prevention policy;
(h) giving collective protective measures priority over individual protective measures;
(i) giving appropriate instructions to the workers”

The report is very useful in its clarification of the role and potential benefits of risk assessment. Each solution is described, in detail, as a case study and the report includes guarding issues, manual handling and psychosocial hazards. On the latter category, here is the summary for psychosocial hazards in hospitals

“Stress in hospitals – assessment of psychosocial and physical risks

Hospital work is known to be physically and psychologically demanding. A pilot project was therefore set up in a hospital with 470 employees to assess workplace risks and organisational aspects. The workers were exposed to physical strain, risks from chemical and biological agents and psychosocial strain. They were also stressed by administrative tasks. After the assessment the results were analysed, action plans drawn up and measures implemented. Risk assessment became a standard part of quality and health management systems, including training.”

One of the particularly interesting element in this program was that one of the first sources of information it used was quality management documentation. Quality management is one of the most under-utilised sources of OHS and strategic planning data. As long as quality managers do not perceive quality as a business element above that of safety, environment or any other, as long as they accept that each element is of equal importance in integration of management system, the quality data will be indispensable.

The quality data is followed up by interviews with middle- or line managers, questionnaires and observations.

Of all of the control measures, this organisational change was very clever:

“The administrative tasks, in particular, were perceived by the nurses to be distracting and onerous. They felt that paperwork kept them away from important care work. Consequently, administrative tasks were delegated to the night shifts, where there was more time to devote to them as the amount of care work fell at night.”

This looked at workload in a peak/off-peak context that fits with the natural rhythm of the clients. The paperwork night-shift may be a suitable solution for other workplaces and the night-shift workers may have increased productivity due to the lack of distractions.

EU-OSHA keeps producing reports and publications that call out for a broader readership than Europe and this is a great example.

Kevin Jones

Leadership – research, mental health and what true leadership is.

Scandinavia produces some of the best research into OHS issues. However, due to the social structure of Scandinavian countries, the research has little direct and practical application outside the region. The research is best taken conceptually as it will need to be evaluated closely to determine local applicability.

(TIP: whenever an OHS researcher says “recent Scandinavian studies show….” remind the researcher which country they are in and ask them to explain the practical application in the local context)

In early 2009, there was a bit of media attention about research that found, according to researcher Anna Nyberg

“Enhancing managers’ skills – regarding providing employees with information, support, power in relation to responsibilities, clarity in expectations, and feedback – could have important stress-reducing effects on employees and enhance the health at workplaces.”

In October 2009 Anna Nyberg’s thesis on the issue was released. According to the abstract to her thesis

“The overall aim of this thesis was to explore the relationship between managerial leadership on the one hand and stress, health, and other health related outcomes among employees on the other.”

Nyberg’s thesis details the needs for some adjustments in the research to allow for “staff category, labour market sector, job insecurity, marital status, satisfaction with life in general, and biological risk factors for cardiovascular disease.” These adjustments are important to remember when reading any of the media statements about Nyberg’s research.

There were five studies within the thesis and, according to the abstract, they found the following:

“Attentive managerial leadership was found to be significantly related to the employees’ perceived stress, age-adjusted self-rated health and sickness absence due to overstrain or fatigue in a multi-national company.”

“Autocratic and Malevolent leadership [in Sweden, Poland, and Italy] aggregated to the organizational level were found to be related to poorer individual ratings of vitality…. Self-centred leadership … was related to poor employee mental health, vitality, and behavioural stress after these adjustments.”

“… significant associations in the expected directions between Inspirational leadership, Autocratic leadership, Integrity, and Team-integrating leadership on the one hand and self-reported sickness absence among employees on the other in SLOSH, a nationally representative sample of the Swedish working population.”

“… significant associations were found between Dictatorial leadership and lack of Positive leadership on the one hand, and long-lasting stress, emotional exhaustion, deteriorated SRH [self-reported general health], and the risk of leaving the workplace due to poor health or for unemployment on the other hand.”

“In the fifth study…a dose-response relationship between positive aspects of managerial leadership and a lower incidence of hard end-point ischemic heart disease among employees was observed.”

But what can be done about the negative affects of poor leadership on health, safety and wellbeing? The thesis is unclear on this, other than identifying pathways for further research in this area.

The SafetyAtWorkBlog recommendations, based on our experience, are below

Carefully assess any training provider or business adviser who offers leadership training.
Ask for evidence of successful results in the improvement of worker health and wellbeing, not just a list of client recommendations.
Look beyond the MBA in selecting senior executives. If you expect executives to establish and foster a positive workplace culture, they need to have to be able to understand people as well as balance sheets.
Remember that the issue of leadership as a management skill is still being investigated, researched and refined. It is not a mature science and may never be, so do not rely solely on these skills.
Some say that leadership cannot be taught and cannot be learned. Some say that leadership, as spruiked currently, is not leadership, only good management. Leadership only appears in times of crisis and manifests in response to critical need, not in response to day-to-day matters.

This last point needs a reference – page xiii of “Seventh Journey” by Earl de Blonville

“… leadership cannot be taught. If it is being taught, it may just be management, rebadged at a higher price. The second discovery was that leadership is not about the leader, which will confound those with a needy ego. There were two more things that revealed themselves to me: leadership is all about paradox, which is why it resists attempts to tame it into a curriculum, and at its core leadership is lonely, requiring the strength that could only come from a grasp of its intrinsic paradox.”

Kevin Jones

Annual holidays get a TV makeover

Regardless of concerns over the veracity of data, Tourism Australia’s “No Leave, No Life” campaign is continuing to develop its media presence.

The Seven Network announced this week that “No Leave, No Life” will form the basis of a television program to be broadcast from 5 December 2009. As is the nature of TV shows, when a new successful format is found, it can travel around the world. So, be warned.

The rationale of the “No Leave, No Life” tourism campaign is that employees hold on to their annual leave entitlements and amass many weeks’ leave. The employer groups have supported this campaign, principally, because this reduces the salary reserves each company must carry to cover the entitlements.Individually, employees can convince themselves that they are indispensable. The risk, from the workplace safety perspective, is that the individual is not accessing the mental health and stress relief that can come from being away from a workplace for several weeks.

Having no break from work mode can unbalance one’s life and put considerable strain on personal and family relationships. Just like adequate sleep can have productivity benefits, so can taking annual leave on a regular basis

There is also the organisational benefit that can come from breaking the routine. Just as individuals may come to believe they are indispensable, so an organisation can come to rely too heavily on individuals. A healthy corporate system should be able to cope with the absence of any staff member or executive for a short period of time (the period of annual leave).

Business continuity would dictate that a business can continue without key people permanently. Coping without these people for a short period each year can be considered a trial run of continuity.

In relation to the new television program the Seven Network advised SafetyAtWorkBlog that each episode is structured around the removal of a worker who has a large amount of annual leave from their workplace for a holiday within Australia (hence the Tourism Australia support). The viewer appeal, other than watching someone else have a good time, is that a comedian is used to fill the role of the holidaying staff members. The show is likely to illustrate several points – no one is indispensable, a regular holiday is an important individual activity, and, although not indispensable, the employee and their effort is valued by the organisation.

The show will follow people from these occupations:

a paediatric nurse in a cardiac ward;
a sales manager in a brewery
an ambulance paramedic; and
a charity events manager.

The OHS role and benefits of regular leave are not as overt in the program as they could be but that is not he purpose of the program. It is clearly a program that would not have existed without the Tourism Australia campaign. It has been designed to encourage Australians to take holidays and to holiday within Australia.

It is hoped that if and when people return to work refreshed they may realise how important regular leave is to their own wellbeing and mental health but having stress management or career burnout as a motivation for the employees themselves to take leave would have been more instructional.

Of course, it should be pointed out that businesses are doing themselves no good by allowing for the accumulation of excessive leave in the first place. In fact, it could be argued that by not enforcing the taking of leave the companies are increasing the stress of their employees and contributing to the social dysfunction that can result from such a work.life imbalance.

Kevin Jones

Unpaid overtime is the new danger money

In Australia there is increasing pressure to work more hours than what one is paid for. Many different organisations use this fact to push for various improved benefits, in many circumstances the statistics are used in support of wage improvements.

But working beyond contracted hours will certainly affect one’s work/life balance as there are only so many hours in the day and if work dominates one’s life, family time or rest will be sacrificed. The imbalance leads to a range of negative psychological and social actions. An article in Wikipedia on working time summarises this.

“In contrast, a work week that is too long will result in more material goods at the cost of stress-related health problems as well as a “drought of leisure.” Furthermore, children are likely to receive less attention from busy parents, and childrearing is likely to be subjectively worse. The exact ways in which long work weeks affect culture, public health, and education are debated.”

Australia has yet to have the debate on the matter of working hours that has been seen in Europe and England but the issue exists very much in Australia, although it has yet to gain any traction.

According to a media report by the Australian Council of Trade Unions a new research report by the Australia Institute

“… found that each year, the average full-time Australian worker does 266.6 hours of unpaid overtime, or an extra six-and-a-half working weeks…. The think tank estimates that through unpaid overtime, workers are forgoing a total of $72.2 billion in wages or 6% of GDP.”

The Australian Institute report found the following

Forty-five per cent of all Australian workers, and more than half of all full-time employees, work more hours than they are paid for during a typical workday.

Unpaid overtime is more common among people who work a ‘standard’ business workday (that is, not shift work) and among white-collar workers.

Workplace culture is a dominant contributing factor, with 44 per cent of people who work unpaid overtime saying that it is ‘compulsory’ or ‘expected’ and another 43 per cent saying that it is ‘not expected, but also not discouraged’.

Across the workforce, the average employee works 49 minutes unpaid during a typical workday.

Full-time employees work 70 minutes of unpaid overtime on average, while parttime employees work 23 minutes.

Men work more unpaid overtime than women (63 minutes versus 36 minutes a day). Men with young children work a great deal more than women with young children (71 minutes compared with 30 minutes).

Unpaid overtime increases with income: people in low-income households work an average of 28 minutes of unpaid overtime a day compared with 61 minutes for people in high-income households.

When asked what would happen if they didn’t work unpaid overtime, most say that ‘the work wouldn’t get done’, suggesting that the demands placed on employees are too much for many people.

A majority of survey respondents who work additional hours said that if they didn’t work overtime they would spend more time with family, and many said that they would do more exercise.

The report clearly states that allowing “unpaid overtime” has a strong cost in social and individual health but there is an OHS perspective that over gets overlooked due to public health and industrial relations dominating the issue.

In a media statement from October 2009, as an example, Deloittes quoted some scientists, in support of a anti-sleep device, on statistics that have been bandied around for some time:

“…scientists equate fatigue to blood-alcohol levels: if a person has been awake for 18 hours, it’s the equivalent of having a .05 level of alcohol in their body; if they have been awake for 21 hours, it’s equivalent to a.08 level.”

There are several further examples on negative health impacts in the Australia Institute report.

It can be strongly argued that by allowing, or expecting, “unpaid overtime”, employers may be encouraging workers to travel home while impaired and that employers are creating a work/life imbalance by requiring “unpaid overtime”. Certainly it could be argued that even during unpaid overtime, the cognitive function of the employee is less than expected, or even have the worker unfit for work.

Arguing about unpaid overtime clearly makes the debate one of money not safety or wellness or the social contract, and this is the argument’s inherent weakness.

Arguing for compensation for “unpaid overtime” is arguing for “danger money” – how much money will a worker accept in order to keep working into the unhealthy and dangerous hours beyond their regular contracted hours? This type of argument disappeared almost twenty years ago in Australia when the Australian awards system was reformed to remove allowances in relation to working at heights, picking up roadkill, or working in excessive heat. It was agreed that “danger money” was inappropriate and that OHS principles demanded the risks involved with these tasks be reduced rather than “paying workers” to place themselves at risk.

ACTU Secretary Jeff Lawrence, in his media statement in support of Go Home on Time Day, and The Australia Institute in its media statement on its report both underplay a major point in the debate on working hours when they argue in economic terms. Lawrence says

“If the work demands are too much to complete in a normal working day, then employees should be paid for their extra hours, or their employer must hire more staff.”

The institute mentions wellness in passing but emphasises in its media release

“..the 2.14 billion hours of unpaid overtime worked per year is a $72 billion gift to employers and means that 6% of our economy depends on free labour.”

Employing more staff is preferable but removing the culture of unpaid overtime is far more important. Arguing on the basis of economics, ie “being paid for their extra hours”, may expose the worker to greater risk of injury or illness at the workplace or on the way home. Quality of life, work/life balance and personal health and safety are stronger arguments for “going home on time”, arguments supported by The Australia Institute and the Australian Greens.

Kevin Jones

Work-related suicides in Europe

The Irish Times has reported on a speech made by Dr Jukka Takala, Director of EU-OSHA, in Spain in November 2009.

“[Dr Takala] said since the publication of a recent study showing a very high level of work-related suicides by French Telecom workers, there was an urgency about getting this information. “Personally, I favour a system such as they have in Japan where the families are compensated for the suicide of a relative, and the debate has already started in this organisation and in the commission and some of the member states,…”

It is not uncommon in OHS to hear calls for further research and more research on work-related suicide is definitely needed. (Australia has some very good work in this area.)

Caution has to be voiced on the risk that suicides be seen as the mental health version of workplace fatalities. Research and OHS statistics often focuses on fatalities for various reasons including that the statistics are easy to quantify. If a worker dies from being crushed by a machine, its a workplace fatality. There is a trap in terms of suicides where the cause and effect is not so clear, or mechanical.

Only recently have workplace fatalities begun to be investigated with consideration of the social or non-work contributing factors. If the machine operator was pulled into the machine because they were inattentive, why were they inattentive? In terms of suicides, the agency of injury will be fairly obvious but the contributory factors could be far more complex. And if the suicide victim has not left a note explaining the reasons for their action, it is even harder to determine “cause”.

Looking at suicides runs the risk of not paying enough attention to the mental health issues that have not reached the suicide level. The focus should not be researching suicides but researching the combination of issues leading to suicide. It is a much greater challenge but is likely to have more long term benefits.

Takala’s comments about family compensation and the need to acknowledge the reality of work-related suicides gained the attention of The Irish Times because they meet the imperatives for a newsworthy angle. Takal’s speeches at the Healthy Workplaces European Summit 2009 covered much greater territory than the Irish Times article and should be read to better understand the comment’s context.

There are hundreds of work risks that require assessment and psychosocial hazards is one of those areas. A full list of speakers at the conference is available by looking at the program. Abstracts of most presentations are available for download.

Kevin Jones

Managing stress the Wall Street Journal way

When a financial newspaper or website posts an article about workplace safety, it is worth reading. The fact of such an article does not mean, though, that safety management is the focus of the story.

A 17 November 2009 article in the Wall Street Journal, ” Workers Denied Company Help Due to Stress-Related Complaints” understandably reports on new workplace stress statistics in a way attractive to its readers. Sadly it reports on “how can the problem be managed?” rather than the next step that OHS professionals should always take, “how can this problem be eliminated?”

The paragraph that clearly illustrates this myopia is

“Companies are now faced with critical decisions over how to tackle stress. The first step, according to Dr. Wright, is to provide workers with access to a dedicated help line service. “Picnics, parties … those things are nice to have when the times are good, but it is the fundamental things – like making sure your role fits your skills and having the support of your manager – that matters the most now.”

A help line as a first step? The article is full of statistics that illustrate the reality of the hazards. Talking to a sympathetic counselor throws the responsibility (blame?) onto the individual and away from the organisation.

Earlier in the article Aviva’s Dr Wright said that workers are

“…being pushed to work harder, longer hours, in roles they are often not trained for…”

He acknowledges that workload and excessive hours is a contributory factor but makes no recommendations for changing these hazards. Dr Wright accepts the traditional wisdom that harsh economic times leads to these pressures and individuals must cope, with some assistance from the employer.

It is probably unfair to expect the Wall Street Journal to publish an article that proposes fundamental change to the corporate order on the basis of valuing the mental health of employees. But OHS professionals and advocates, those speaking from a position of independence, must keep reminding business, and (sadly) some OHS regulators, that long-term sustainability will only come from valuing the workforce as human beings and not as cogs in the race for executive performance bonuses.

Category: psychiatric

Self development course contributes to a workplace suicide

Counselling Services

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A good book of safety solutions case studies

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Leadership – research, mental health and what true leadership is.

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Annual holidays get a TV makeover

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Unpaid overtime is the new danger money

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Work-related suicides in Europe

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Managing stress the Wall Street Journal way

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Counselling Services

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