Mental support research

In SafetyAtWorkBlog in 2008 there have been several posts concerning suicide.  There is a growing research base on the matter and The Lancet adds to this through an article published in December 2008.

Researchers have found that the type of mental health services provided to the community can affect the rate of suicide.  This is important research even though SafetyAtWorkBlog regularly questions the applicability of research undertaken in Scandinavian countries to the rest of the world.  Bearing the cultural differences in mind, the research will stir debate and, hopefully, localised research along the same lines.

Below is the text of the press release about the research:

WELL-DEVELOPED COMMUNITY MENTAL-HEALTH SERVICES ARE ASSOCIATED WITH LOWER SUICIDE RATES

Well-developed community mental-health services are associated with lower suicide rates than are services oriented towards inpatient treatment provision in hospitals. Thus population mental health can be improved by the use of multi-faceted, community-based, specialised mental-health services. These are the conclusions of authors of an Article published Online first and in an upcoming edition of The Lancet, written by Dr Sami Pirkola, Department of Psychiatry, Helsinki University, Finland, and colleagues.

Worldwide, the organisation of mental-health services varies considerably, only partly because of available resources. In most developed countries, mental-health services have been transformed from hospital-centred to integrated community-based services. However, there is no decisive evidence either way to support or challenge this change.

The authors did a nationwide comprehensive survey of Finnish adult mental-health service units between September 2004 and March 2005. From health-care or social-care officers of 428 regions, information was obtained about adult mental-health services, and for each of the regions the authors measured age-adjusted and sex-adjusted suicide risk, pooled between 2000 and 2004 – and then adjusted for socioeconomic factors.

They found that, in Finland, the widest variety of outpatient services and the highest outpatient to inpatient service ratio were associated with a significantly reduced risk of death by suicide compared to the national average. Emergency services operating 24 hours were associated with a risk reduction of 16%. After adjustment for socioeconomic factors, the prominence of outpatient mental-health services was still associated with a generally lower suicide rate.

The authors conclude: “We have shown that different types of mental-health services are associated with variation in population mental health, even when adjusting for local socioeconomic and demographic factors. We propose that the provision of multifaceted community-based services is important to develop modern, effective mental-health services.”

In an accompanying Comment, Dr Keith Hawton and Dr Kate Saunders, University of Oxford Department of Psychiatry, UK, say: “The message to take from these findings must be that while well thought out and carefully planned new developments that increase access to secondary care services for mental-health patients are to be encouraged, measured progress towards flexible community care, not rapid ongoing change, should be the order of the day.”

 

Bullying, duty of care and compensation

The growth of attention to psychosocial hazards in Australia received a considerable boost from a stress survey undertaken by the ACTU some years ago.  During the survey of union-members, it became clear that bullying was a major generator and perpetrator of workplace stress.  The unions went to town on this data and set the agenda for some time in OHS.  Their success was echoed and mirrored in the United Kingdom and Europe. (In fact, Europe seems to be the jurisdiction that has kept the momentum)

The survey and campaign got the attention of regulators and OHS professionals to the presence of, perhaps, the next generation of occupational health and safety activity.

Since that time psychosocial hazards have splintered into sub-groups of stress, occupational violence, workload, fatigue management, shift work, dignity at work and a range of other matters. However bullying persists as the front runner.

As with many elements of OHS, risk management and cultural studies the defence forces provide signposts to future civilian issues. Yesterday the Australian Defence Force agreed to pay ex-gratia payments to family members of defence personnel who had committed suicide as a result of bullying suffered at the hands of their colleagues.  There are many significant signposts from these incidents but one of particular note was that the payments were not made to dependents but to other family members.

According to the ABC radio report by Karen Barlow:

“The suicides date back up to 12 years, when Lance-Corporal Nicholas Shiels killed himself after accidentally shooting his best friend dead during Army training.

Private John Satatas hanged himself at Holsworthy Barracks, in western Sydney, five years ago after being bullied and racially taunted.

Private David Hayward committed suicide four years ago after he was injured and had gone AWOL.” 

The Defence Minister, Joel Fitzgibbon, was interviewed on this issue, and others, on Radio National on 23 October 2008 and  has referred the matter to a general review of the defence forces. Fitzgibbon acknowledged that “shortcomings in the defence force system” contributed to the situation and could have been better handled after the event.

The day before the media attention the Australian Defence Force released the findings of its annual attitudinal survey of personnel.  The 2007 survey found, according to a media statement:

“… a marked improvement in knowledge of mental health issues as well as members’ assessments of their own mental health. Since 1999, the data also shows an increasing proportion of personnel who believe that unacceptable behaviour is well managed.”

As Australia moves to a national OHS and workers compensation system, or at least a harmonised system, more attention should be given to some of the responses and OHS initiatives in Commonwealth departments as these will be just as influential on OHS law and management as any State initiative.

When managing stress, are safety managers looking at the wrong thing?

Today is World Mental Health Day and the media, at least in Australia, is inundated with comments and articles on mental health.  This morning, Jeff Kennett, a director of beyondblue, spoke on ABC Radio about the increasing levels of anxiety that people are feeling in these turbulent economic times.  Throughout the 5 minute interview, Kennett never once mentioned stress.  This omission seemed odd as, in the workplace safety field, stress is often seen as the biggest psychosocial hazard faced in the workplace.

SafetyAtWorkBlog spoke with Clare Shann, the senior project manager with beyondblue’s Workplace Program, about the role of stress in the workplace and its relation to mental health.  She clarified that stress is not a medical condition but a potential contributor to developing a mental illness, such as anxiety disorders or depression.

To put the situation into context, there is a fascinating interview with a Darren Dorey of Warrnambool in Victoria.  The 20 minute interview was conducted on  a regional ABC Radio station on 9 October, and describes the personal experience of depression and anxiety that stems, to some extent, from work.

It seems that in trying to manage stress, OHS professionals may be focusing on the wrong element in worker health.  Perhaps what are considered workers compensation claims for stress should be re–categorised as claims for mental illness.  This may result in a better acceptance of the existence of this workplace hazard.

An exclusive interview with Clare Shann can be heard clare_shann_mental_health

Politician who attempted suicide is “sacked”

In early August 2008, Paula Wriedt, Tasmanian MP, tried to commit suicide.  Six weeks later the Tasmanian Premier has sacked her from Cabinet, according to an ABC report.

Premier David Bartlett denies this is a sacking, more a “withdrawal of commission”.  He says it is for the good of the government and for the good of Ms Wriedt.

Ms Wriedt was asked to resign her Cabinet position but the Premier says she was “not in a position to make such a decision”.

An audio interview with the Premier put to him that his decision was “despicable” and “reflects the way the state deals with people with mental health problems”.

Ms Wriedt’s suicide attempt had already raised discussion on the workplace issues of stress, compensation, workloads and mental health.  The listener’s question in the audio interview will reflect the majority of the community’s response to the Premier’s decision and Premier Bartlett will have a difficult time explaining how his decision was for Ms Wriedt’s benefit.

Ms Wriedt’s current situation and future career decisions will provide an interesting illustration on how the public service and Tasmanian politics manages an employee with mental health issues, particularly when, on OHS matters, the public service should be exemplars.