Category: psychiatric

Environmental tobacco smoke, workplace stress – podcast 2006

In 2006, one of the earliest editions of the SafetyAtWork podcast featured several speakers on issues that remain topical.  The podcast is available for download

Anne Mainsbridge, currently a Solicitor with the Public Interest Advocacy Centre talks about her report on environmental tobacco smoke.

This is followed by Associate Professor Tony LaMontagne of the University of Melbourne talking about a systematic approach to managing workplace stress.  This was a report that was published by the Victorian Health Department and, as such, slipped by many OHS professionals.  The report is now available for download

The audio production is rough for such an early podcast, and I apologise, but I think you will find the content of interest.

Kevin Jones

Audit report says “could do better”

Cover of 20090603_workcover_full_reportOn 3 June 2009, the Victorian Auditor-General released the audit report, CLAIMS MANAGEMENT BY THE VICTORIAN WORKCOVER AUTHORITY.  The objective of the audit was to assess the effectiveness and efficiency of VWA’s claims management.

The report found that the current claims management model 

“has not substantially improved RTW [return-to-work] outcomes, or the effectiveness of agents’ case management practices”

Although the report notes that the system has not deteriorated.

The report also says

“Agents’ case management practices, on average, were considered generally adequate, however, there is substantial scope for improving agents’ performance.”

“Adequate” is not a ringing endorsement of the system and the workers’ compensation agents should pay particular attention to criticism of their performance.

Safety managers and professionals have been trying to incorporate psychosocial hazards into their safety management processes but it seems that agents are having similar problems:

“Agents did not systematically consider psychosocial barriers to RTW such as attitudes toward recovery, stress, anxiety, workplace issues, substance abuse, and family matters, when assessing the injured worker’s status, needs and risks to recovery. In most cases assessments were narrowly focused on the physical injury and its impact.”

The report notes that many issues raised are already being addressed by the Victorian WorkCover Authority.

Almost the only statements made on the workers’ compensation scheme by the State Ministers over the last decade have related to premium fluctuations, how the business costs of the system are being controlled or unavoidable.  However it seems now that the system has only been cruising, but not improving, or keeping up with the contemporary workplace hazards and employee needs.

The white collar public service, in particular, has a high incidence of stress-related claims.  The reality of the hazard has been acknowledged through preventative guidance notes from the OHS regulators and the general growth in the work/life balance movement.  Yet in 2009, the workers’ compensation agents  are criticised for giving this hazard insufficient attention.

Even when an audit report is politely critical, it remains critical and demands attention.

Kevin Jones

Decency at work

In 2001 the House of Lords was presented with a Dignity At Work Bill.  This seemed a great idea for unifying different elements of the workplace that can contribute to psychosocial hazards.  This would be a similar approach to using “impairment” to cover drugs, alcohol, fatigue and distraction.  However, it never progressed.

Regular readers of SafetyAtWorkBlog would note an undercurrent of humanism in many of the articles but it is heartening to see this in other articles and blogs.  Maud Purcell of Greenwich Times provides an article from early May 2009 on dignity in the workplace in a time of economic turmoil that you may find of interest and use.

Kevin Jones

Fatigue is the biggest threat to a person’s safety

Not so long ago, it was considered a legitimate criticism to blame the individual for “doing the wrong thing” at work.  Depending on the type of worksite, this was considered “human error” or “bloody stupid”.

Fatigue is an interesting illustration of how occupational health and safety must cope with new perspectives on established hazards.  Australian OHS legislation operates on a responsibility to manage the systems of work in a workplace, of which only one element is the worker.

A good incident investigation goes beyond the incident to see what led up to a worker acting the way they did, the reasons behind the decision.  Instead of “tell me about your childhood”, OHS practitioners can legitimately ask “tell me about your sleep patterns”, or “tell me about your second job”, or “tell me about your relationship with your partner”, as these can be contributory factors to the decision made on the day or the work environment at the time of the incident.

Some recent AAP articles provide interesting examples of the different contexts in which fatigue as a workplace issue can manifest:

“Ambulance Employees Australia (AEA) said weary paramedics had fallen asleep at the wheel and administered wrong drugs because they did not have enough time off between shifts.

They have called for a minimum 10-hour break between shifts, compared with eight hours under the current award.

But Ambulance Victoria has said the fatigue issue was one of 175 union claims, which it said sought $800 million from pay talks.”

“Investigators examining the near-catastrophe at Melbourne Airport last month are exploring whether fatigue was a factor after being told the pilot had barely slept the day before the flight.

Emirates pilots are permitted to fly a maximum of 100 hours each 28 days and the pilot was also almost at the legal threshold of the number of hours he was able to fly.

Emirates has issued a statement saying safety was a top priority for the airline.”

A higher priority than a good night’s sleep apparently!  Clearly it is the spread of hours that is the issue not the total over a fixed period.

Both these examples relate to workers’ interactions with the public and reflect the complexity of OHS’s spread to public safety.  

It seems that every investigation now automatically assesses the fatigue level, or impairment, of the participants in incidents in the same way mobile phone records are checked in car accidents and blood-alcohol levels or drug testing in some industrial events.

If your OHS professional does not consider psychosocial issues in developing safety management plans or incident investigation, seek a second opinion, or better yet, make sure the first opinion is comprehensive.

Kevin Jones

“Getting back on the (trauma) horse”

Mental health in the workplace is one of those recent manifestations of psychosocial hazards.  It continues to evolve and during this process one is never quite sure where the best and most relevant information can be obtained.

Cnfusion for the safety professional can come from new, slightly off-topic, issues that can skew the public perception and understanding of exactly what it is one is trying to manage.

Is it reasonable to take inspiration (if that is the right term) from studies of Iraq War sufferers of post traumatic stress syndrome in providing clues to handling mental health issues at work?  

During tertiary risk management courses the debt owed to the armed forces and their planning processes is acknowledged but soldiers operate in a unique culture of accountability, clearly defined duties and a rigid hierarchical structure.  In most circumstances only the broadest of concepts could be translated to the real (non-militarised) workplace.  In a similar way studies of Scandinavian workforce management are interesting but are highly unlikley to be transferable outside the cultural geography.

A very recent example of this problem of getting excited about innovation and then wondering about its genuine applicability, can be seen in the TV show, Catalyst, (video available online for a short time) broadcast by the Australian Broadcasting Corporation on 16 April 2009.  

The program provides a profile on a computer simulation program that purports to aid the rehabilitation of war veterans by returning them to traumatic events of the war zone.  It seems that the theory is the same as “getting back on the horse that threw you”.

In OHS terms, the applicability for firefighters, emergency response personnel etc is obvious but SafetyAtWorkBlog has reservations.  The use of video simulations and games by the armed services before, during and after combat is discomforting.  

Managers and health care professionals may need to carry some of the responsibility for the cloudiness of mental health and trauma by applying the hyperbole of trauma to relatively benign workplace issues.  Many elements of work are being described as traumatic when they are not.  They maybe disturbing, disconcerting or even harmful but there is a big difference between being punched in the face by a psych patient and driving over a car of civilians in an armoured vehicle.

In other industry sectors, such hyperbole would be described as spin.  It is the responsibility of OHS professionals to cut through the spin and not be distracted by “exciting”, but indirect, innovative solutions.  Let’s look for the evidence and operate from what we know works.  At least until new evidence appears.

Kevin Jones

Mental Illness and Workplace Safety

Reports in the Australian media this week indicated that “nearly half the population has a common mental health problem at some point during their lives”.  Safety professionals and HR practitioners should take note of these statistics and hope that it does not manifest in their shift, even though it is likely.

The difficulty with trying to manage or anticipate mental health issues is that they seem to have evolved over time and multiplied.  There is the common phrase of “trying to herd cats” and it seems that mental health issues are the cats.  One could apply lateral thinking and propose the solution is to get a dog but will the dog herd a cat that doesn’t look like a cat, smell like a cat, or worst scenario of all, a cat that resembles a dog!

Because of the fluctuating psychiatric states of everyone everyday how does one recognise when a mood swing becomes a mental health issue.  Does one take everything as a mental health issue and waste time on frivolous matters?  Or is there no such thing as a frivolous matter?

In the one article there are these confusing and inconsistent terms for mental health:

  • “common mental health problem”
  • “mental condition”
  • “non psychotic psychiatric problems”
  • “mood disorder”
  • “anxiety disorder”
  • “mental health disorder”
  • “substance abuse or dependency”
  • “mental disorder”
  • “mental illness”
  • “psychiatric condition”

In this report it is unlikely that the synonyms have been generated by the journalist as the data quoted is from the Australian Bureau of Statistics, but it indicates the confusion that safety professionals can feel when they need to accommodate more recent workplace hazards – the psychosocial hazards.

The list above does not include the “established” hazards of bullying, occupational violence or stress.  The fact that there may be a clear differentiation between mental health symptoms and mental disorders but that needs to be clearly communicated to those who manage workplaces so that control resources can be allocated where best needed.

The article referred to above provides interesting statistics and there are gems of useful information in the ABS report but the article provides me with no clues about how to begin a coordinated program to address the mental health issues in the workplace.  It is an article without hope, without clues, without pathways on which the professional can act.

There is no doubt the psychosocial hazards at work are real but the advocates of intervention need to clarify the message.

Kevin Jones

(This blog posting does not discuss the recent changes to compensation for defence personnel and soldiers for mental health from combat, but mental health in that “industry” is a fascinating comparison to what occurs in the private sector.)

OHS context of leave entitlements

Family-friendly work initiatives always get increased attention around International Women’s Day.  This is a shame as work/life balance is not gender specific, however the dominant Western family structures make the application of the concept relative to gender.  As long as the matter is perceived as a “women’s issue”, it will struggle for attention in a basically patriarchal society.

Family-friendly work structures are predominantly associated with hours of work and leave entitlements.  These don’t seem to be OHS matters as they are mostly handled through HR or the pay department however there is a link and it is a link that work/life and work/family advocates may use as a strong argument for their cause.

Leave is a worker entitlement for several reasons:

  • Situations may occur where the employee is required to stay home to look after an ill relative;
  • The employee may stay home as they are too sick to work; and
  • The employee may feel they need time away from work to rebalance their lives.

The second point has an OHS relevance because going to work while sick may introduce a hazard to your work colleagues – presenteeism.  In many jurisdictions it is a breach of an employee’s OHS legislative obligations to not generate hazards for their work colleagues or members of the public while at work.

The third point relates to an individual’s management of stress and/or fatigue.

In Australia, some workplaces allow for “doona days” (or for those in the Northern hemisphere’s winter at the moment “duvet days”).  These are days where a workplace and the employee would benefit psychologically from some time-out in order to “reboot”.

It may also be a valid fatigue management mechanism where long hours have been worked to the extent where attending the workplace may present hazards to others, or to themselves by feeling impaired, or have the employee working well below the appropriate level of attentiveness for the job to be properly done.

Leave entitlements, to some extent, form part of the employer’s legislative obligations to have a safe and healthy work environment.  But they also support the worker’s obligations to look after themselves and not present hazards to others.

The OHS element of leave entitlements should be emphasized when discussions of family-friendly workplaces occur.  Not only does it legitimately raise the profile of OHS in business planning, it can add some moral weight to an issue that can get bogged down in industrial relations.

Some readers may want to check out recent presentations to the US Senate in early-March 2009, by various people on the issue of family-friendly work structure.  These include

Eileen Appelbaum, Director of the Center for Women and Work at Rutgers University,

Dr Heather Boushey, Senior Economist at the Center for American Progress Action Fund,

Rebia Mixon Clay, a home health care worker who cares for her brother in Chicago. (Rebia’s video is below)

Kevin Jones

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