mental health and wellness in the...

Mental Health and Wellness in the Workplace

Manager Focus Groups and Employee Surveys Report

November 10, 2014


EFAP/PHC Focus Group & Survey Report CONFIDENTIAL 2

Table of Contents Introduction ..................................................................................................................................... 3

Method & Report Format ................................................................................................................ 3

Questions ......................................................................................................................................... 5

Themes ............................................................................................................................................ 6

Question 1 Online Survey (managers & employees)....................................................................... 7

How are you doing in managing your own mental wellness? What does mental wellness look

like for you? ................................................................................................................................. 7

Question 1 ....................................................................................................................................... 8

What are the characteristics of an employee or colleague who is mentally well? ..................... 8

Question 2 ..................................................................................................................................... 10

What are some things you could be doing to become more mentally healthy? ...................... 10

Question 3 ..................................................................................................................................... 12

(Employees) What could PHC do for you as an individual or for the work environment that

would support you to become more mentally healthy? ........................................................... 12

(Managers) What could PHC do for you as an individual or for the work environment that would

support you to become more mentally healthy? .......................................................................... 13

Question 4 ..................................................................................................................................... 14

Do you think there is stigma around mental health issues in the workplace? If yes, how can it

be removed? .............................................................................................................................. 14

Question 5 ..................................................................................................................................... 16

What are you dealing with in your personal life or in the workplace that is impacting on your

work? ......................................................................................................................................... 16

Question 6 ..................................................................................................................................... 18

What tools/resources would help you with having a conversation with leader about your

mental wellness challenges? ..................................................................................................... 18

Question 7 (Managers only) .......................................................................................................... 20

In your role as a leader, what tools/resources do you need to effectively manage or support

your employees who may be experiencing mental health issues? ........................................... 20

Key issues ...................................................................................................................................... 21

References ..................................................................................................................................... 22



Introduction As a values-based organization, Providence Health Care (PHC) is committed to supporting

employee health and wellness and “ensuring that all employees have the resources and supports

that enable rich, healthy, and productive work and personal lives.”

PHC SLT Memo August 6, 2014

To accomplish this PHC undertook a collaborative process to develop a mental health and

wellness program built upon both leadership and frontline employee feedback.

To begin this journey PHC reviewed data from their absence management program, and from it

learned:

close to 30% of LTD open mental health claims were related to mental health concerns

30-40% of OH&S interactions with staff have a mental health component

a significant portion of staff absences were due to mental health issues

many leaders found themselves ill prepared to have conversations about staff mental

health and uncertain about how to provide appropriate support.

As the data clearly identified mental wellness as a key area requiring organizational attention a

Mental Health and Wellness Initiative was launched. Overseen by the Mental Wellness Working

Group composed of Sandy Coughlin, Heather Mak, Justin Karasick and Stella Tsang and

partnering with their Employee and Family Assistance Program (EFAP), to consult and assist in

the gathering of input, PHC set out to design a custom program that would best support

employees in identifying and addressing organizational and individual challenges in the area of

mental health.

To ensure confidentiality and engagement the Working Group built on EFAP’s longstanding

expertise in workplace wellness to run the focus groups, administer the in person and online

surveys and analyze the data. Those introductory findings were presented in a senior leadership

team forum Friday September 12, 2014. This report represents a follow up to those initial

findings and is a more detailed compilation and analysis of the content and common themes

generated from the 7 questions. It provides the content that will be used to inform PHC in the

fulfillment of their vision:

“…To use knowledge and themes that emerge from the focus groups to target specific strategies

that will improve the mental health of our staff.”

The Mental Wellness Working Group

Method & Report Format PHC employees and managers were surveyed in three different ways (in-person employee

sessions with paper survey distribution for completion, in-person manager focus groups, and



online surveys for both employees and managers). Eight (8) Manager Focus Groups with 69

participants and 308 completed/partially completed manager and employee surveys for a total

of 377 participants provides a rich sample of opinion, feedback, and experience.

Cohort Number of

Responses/Attendees

Manager Focus Groups 69

In-person Employee Survey 135

Online Managers Survey 62

Online Employee Survey 111

Total 377

As EFAP presented and explained at ELF, surveys and responses were reviewed thoroughly,

interpreted, coded and placed within the 16 themes that emerged. This qualitative approach is

a way to provide understanding and context, point to gaps in knowledge, confirm current

understanding, uncover communication needs, and help establish possible priorities, etc.

However, this approach is based on interpretation and not quantitative, and so should be

considered as such. Multiple themes are often indicated in single employee response, and

therefore an employee who offered a detailed lengthy response will have more “weight” than

an employee who offered a one word response. For example, a response to “what are the

characteristics of an employee or colleague who is mentally well?” includes, “someone who

doesn’t take work home with them, responds well to conflict, exercises and meditates,” will fall

under three themes (Physical, Emotional Intelligence and Work/Life Balance) and therefore has

more impact.

Again, the feedback offered in this way will help in identifying employee and management

issues as well as mental wellness challenges and gaps, but should be taken into consideration

with other data, organization and industry experience, and expertise for solutions, planning and

next steps.

The format of this report is organized by the Survey / Focus Group Questions 1-7. Employee and

manager responses are categorized under themes and presented in descending order.

Noteworthy items (insights and information) are then presented. The last section of the report is

in a summary list of the key issues based on those responses.



Questions The following are the employee and manager survey and focus group questions offered in the

following formats: online, paper and in-person:

1. How are you doing in managing your own mental wellness? What does mental

wellness look like for you? (Online Survey only)

1. What are the characteristics of an employee or colleague who is mentally ‘well’ or

healthy?(In-person/ Paper Survey)

2. What are some things YOU could do to become more mentally healthy? (What has

worked for you? What tools/resources would assist you to do this?)

3. What can PHC do for you as individual or for the work environment that would

support you to become more mentally healthy?

4. Do you think there is stigma around mental health issues in the workplace? If yes,

how can it be removed?

5. What are you dealing with in your personal life (e.g. elderly parents) or in the

workplace (e.g. unapproachable colleague/boss) that is impacting on your work?

6. What tools/resources would help you with having a conversation with your leader

about your mental wellness challenges?

Specific for Managers:

7. In your role as leader, what tool do you need to help you in having a conversation

with/supporting your employee with mental wellness challenges? (What would help

you recognize when an employee is struggling? What barriers and challenges are

you experiencing in providing support for your employee with mental health

difficulties? What tools/resources would help you provide this support?)



Themes As presented at ELF, 16 themes emerged from the employee and manager surveys and manager focus groups. Seven (7) themes were identified based on factors related to individual mental health, primarily drawn from survey questions 1-3 above. Nine (9) themes were identified in relation to organizational health and primarily drawn from survey questions 4-7 above. These organizational themes are reflective of the workplace factors affecting psychological health and safety from the National Standard of Canada for Psychological Health and Safety in the Workplace.

The National Standard of Canada for Psychological Health and Safety in the Workplace (‘the Standard’) is championed by the Mental Health Commission of Canada (MHCC), and developed by the Canadian Standards Association (CSA Group) and the Bureau de normalisation du Québec (BNQ). ‘The Standard’ is a voluntary set of guidelines, tools and resources focused on promoting employees’ psychological health and preventing psychological harm due to workplace factors. ‘The Standard’ is adapted from the 13 psychosocial factors from “Guarding Minds @ Work.”

Individual

Work/Life Balance

Resiliency (the ability to bounce back, cope with change)

Emotional Intelligence (Self Awareness, Self-Regulation, Social

Awareness and Social Skills)

Engagement (engaged at work)

Physical (Active, Attitude, Appearance)

Social Connection (connected with friends, colleagues, family)

Spiritual/Value Alignment

Organizational

*Clear Leadership & Expectations

*Workload Management

Scheduling Flexibility

*Recognition & Reward

*Supporting Work/Life Balance

Teambuilding

Organizational /Cultural Change

Education & Awareness

*Psychological Support & Protection

*from 13 Psychosocial Factors (Guarding Minds @

Work)



Question 1 Online Survey (managers & employees)

How are you doing in managing your own mental wellness? What does mental

wellness look like for you?

From the online surveys, 111 employees responded, and 62 managers responded. From this 66

or 38% of respondents indicated they are not managing well (21 managers and 45 employees),

95 indicated they are managing well, and 12 did not indicate. The majority of the responses fell

within the following themes, in descending order:

Managers

1. Physical

Feels rested, walks, eats well, gets

massages, goes to the gym

2. Work / Life Balance

Has outside interests

3. Emotional Intelligence

Is self-aware, has compassion for

self and others, has less guilt

about self-care

4. Social Connection

Shares, decompresses, interacts

with colleagues, enjoys social

interaction, engages with

colleagues, spends time with

friends and family

5. Resiliency

Can cope with stressors, doesn’t

carry stress

Employees

1. Physical

Is happy, exercises, has energy to

participate, feels serene and at

peace


Has good home/work balance


Is self-aware, looks forward to

challenges, is empathetic

4. Resiliency

Able to bounce back

5. Engaged

Looks forward to coming to work


Spends time with friends and

family

Noteworthy: The overwhelming responses fell within the themes of Physical and Work / Life

Balance followed by Emotional Intelligence. The majority of responses to “what does mental

health look like to you?” point to someone who eats, sleeps, exercises, has a positive attitude

and is happy, calm, and can manage their emotions. Additional comments include compassion

and empathy as important, as well as being able to balance work and life.

The people who are struggling indicated that sleep, balancing work and life (eldercare and

childcare), and workload pressures are concerns.



Question 1 Survey (employees) and Focus Groups (managers)

What are the characteristics of an employee or colleague who is mentally

well?

The majority of the responses fell within the following themes, in descending order:

Managers

1. Resilient

Is able to bounce back, can handle

change, can roll with the punches

2. Emotional intelligence

Has a range of emotions, is

motivated, knows boundaries, is

confident, empathetic, can listen, is

self-aware/reflective/regulated, is

stable and helpful, can deal with

conflict well, is responsible for self

3. Engagement

Has good attendance, proactively

responds to work, enjoys work and

contributes, engages respectfully

4. Physical

Doesn’t suffer from fatigue, looks

healthy, is groomed, is happy, gets

enough sleep, has a consistency of

mood


Is well rounded, has a positive

balance, has a life outside work


Has relationships outside work, has

support outside work

Employees


Is self-aware, problem solvers, is self-

directed, manages/regulates own

moods, knows limits and boundaries

2. Physical

Is happy, well dressed, upbeat,

energetic, eats well, exercises, gets

enough sleep

3. Engagement

Likes work, is focused at work, has a

positive attitude about work,

demonstrates care for

patients/clients/residents/co-workers


Has a good work/life balance


Has friends at home and work,

participates in outside activities

6. Resilient

Bounces back, handles change readily

Noteworthy: PHC employees and managers share common beliefs, observations and attitudes

about the characteristics of a mentally well employee with the exception of managers

articulating the word “resilience” more often than employees as a descriptor of wellness.

Quotes from managers regarding resilience include: “An ability to handle stressful situations and



change and uncertainty,” “An ability to roll with the punches and go with the flow,” “An ability

to cope with changing priorities at work,” “Capable of responding flexibly to the demands put

upon them,” etc. This may serve as a possible indication from managers that “resiliency” is an

important quality needed for themselves and the employees they serve. “Resilience” is a word

that seems to resonate with managers and might be well utilized in promotions.



Question 2

What are some things you could be doing to become more mentally healthy?


Managers

1. Physical

Practice yoga, exercise, eat well,

rest


Have great relationships, have

friendships, create friendships at

work, share experiences with

colleagues, share lunch breaks

with colleagues at work


Have hope, recognize triggers,

take the opportunity to reflect and

think before acting


Take vacation, take breaks, don’t

email outside of work

5. Spiritual Value Alignment

Work that fits core values, having

purpose and meaning, maintaining

a spiritual perspective

Employees

1. Physical

Get more sleep, exercise, better

diet, walk, bike


Create “me” time, leave work at

work, take vacation


More time with friends and family


Open up to others, recognize

triggers, know boundaries, be

patient, compassionate to myself

and others

5. Spiritual / Value Alignment

Prayer, ask for guidance

Noteworthy: The overwhelming response to this question for both managers and employees is to engage in physical activity, e.g., exercise, walking in nature, going to the gym, going for a workout, riding a bike, practicing yoga, swimming, hiking, etc. to become more mentally healthy. Other leading responses were sleep hygiene, a balanced diet, accessing counselling (EFAP & Centre for Practitioner Renewal), and practicing mindfulness and meditation. Work/Life balance and setting boundaries and limits is a struggle for many. To support work/life balance employees suggested taking vacation, taking time off, taking a day for ‘me,’ taking breaks and leaving work at work. Social connection is important to managers and employees;



spending time with family, a strong support network at work, and spending time with happy people were often noted. There were a number (approximately 10-15% of comments) that were not reflective of what the employee could be doing, rather they were comments about what PHC or colleagues could be doing to improve their mental health, so these were included in question 3.



Question 3

(Employees) What could PHC do for you as an individual or for the work

environment that would support you to become more mentally healthy?


Employees

1. Organizational Change

Review AWP, address sick time, provide an onsite gym, provide an onsite lounge/space for quiet time, e.g. meditation

2. Psychological Support & Protection

Address staffing levels for safety, increase awareness of EFAP, provide debriefs, provide leadership support, establish anti-bullying policies and practice

3. Scheduling Flexibility

Review the vacation policy, allow employees to take ‘Mental Health’ days, allow employees to work from home, allow for scheduling flexibility

4. Workload Management

Hire more workforce, reduce workload, more hours, more support, equal work distribution, review staffing levels

5. Recognition & Reward

Offer wellness awards, more verbal appreciation 6. Clear Leadership & Expectations

Management should provide clear direction and, take time to listen

Noteworthy: The bulk of employee responses came from the first three themes indicated above and included a request to address ‘sick’ and ‘vacation time’ policies and processes, AWP, and the inclusion of mental health challenges/wellness within sick time and AWP. Disrespectful colleagues or leaders, workload sometimes due to ineffective colleagues, respectful workplace issues, and requests for Wellness or Mental Health Days were also significant themes. There were 25+ responses asking for a mental health, wellness, flex, family, self-care, personal, or ‘me’ day. Various suggestions were made to accommodate this day, for example, 2 days out of sick bank, donated vacation days, accrued sick time or banked time. One of the primary complaints within the Scheduling Flexibility category was PHC’s current vacation policy and the need to book far in advanced. 10+ requests to bring back EDO’s were indicated here.



(Managers) What could PHC do for you as an individual or for the work

environment that would support you to become more mentally healthy?

The majority of the responses fell within the following themes in, descending order:

Managers


Implement an email policy (expectation of response rate after work hours), establish an hours worked per work week policy, address performance management for managers managing large numbers of staff, hire more staff to delegate to


Address sick time policies, allow for time to meet with staff, allow for time to meet with leader, address HR/Help Desk/IT response time for onboarding new staff, consolidation issues for FHA managers (FHA’s differing culture and vision from PHC, meetings that are only held at 1190 Hornby or SPH, feeling pulled between FHA & PHC)


Don’t avoid conflict, tackle tough issues, call out disrespect in the moment, address bullying, need an effective “Anti-Bullying” policy, more awareness and education around EFAP and counselling

4. Clear Leadership & Expectations

hours per work week, workload, email response rate/times, transparency of decision making


Flex time, work from home 6. Supporting Work / Life Balance

Onsite gym, onsite daycare, food trucks, support in leaving work at work, support coping with stressors in our lives (babies, parents, work), education around setting boundaries, limits, etc.

FAQ webpage re: family illnesses, maternity leave, processes, etc.

Noteworthy: The top 4-5 themes above are mostly equal in distribution in terms of manager response, meaning there were close to as many comments around workload management as there were around the need for organizational change, scheduling flexibility and clear leadership and some overlap. There was an overwhelming response and discussion around workload management and the need for clear leadership and expectations regarding work capacity, hours worked per week, answering email on weekends etc. This is an important issue as expressed by many, if not most, managers.



Question 4

Do you think there is stigma around mental health issues in the workplace? If

yes, how can it be removed?

From the 173 online surveys, 37 employees indicated “no” or “I don’t know” to the question, “is there a stigma around mental health issues,” 24 did not respond, and 112 responded “yes” there is a stigma.

Managers 1. Education & Awareness

Sharing personal stories, people with influence should share their stories, tools to have the conversation, a signs and symptoms checklist, education surrounding stress and mental illness, mandatory training


Involve the affected employee in how they would like to communicate to colleagues (off work, return to work, etc.), increase empathy and trust at work, mental health issues need to be recognized in the same way that physical health issues are recognized and treated


Make PHC a safe place to share their stories

Employees

1. Education & Awareness

Talk about it, keep the conversation going, be open, tell personal stories, create dialogue, provide the statistics of prevalence and commonality, stop ignoring the issue, provide resources, allow for an education day, promote EFAP & CPR, provide leadership training, provide required wellness courses


AWP /Sick time process review, EARL Review, PHC should deal with mentally ill homecare /long term residents in a different way


More counseling support, formalize mental wellness programs, end the gossip, there is a fear of repercussions to disclose

4. Clear Leadership

Managers need to be proactive about mental health concerns, stop showing favourtism

Noteworthy: Of those who responded “yes,” the following themes were indicated, in

descending order, as primary ways to address or remove mental health stigmas: sharing

personal stories, education (sessions for all staff, resources, manager training, etc.), and

protection (a guarantee against repercussions, job loss, further stigma). Further comments

included the need to understand mental wellness, mental illness, signs, symptoms, and the



difference in individual experiences and struggles. Also indicated was a request for an increased

acknowledgement of the role stress plays – “stress leave should be within mental wellness.”

Respondents asked that PHC address mental health leaves as a part of sick time or AWP. This

may indicate a need for increased education and awareness regarding mental health and mental

illness “leaves” within policy. Finally, many employees feel that the stigma will never be

decreased or reduced.



Question 5

What are you dealing with in your personal life or in the workplace that is

impacting on your work?

The majority of the responses fell within the following themes in, descending order:

Managers


Elderly parents, children,

commute, daycare, not

enough time


Bullying by Physicians,

respectful workplace issues

going unreported


Outdated HR staffing

policies, physicians working

in “separate” system,

retirement planning for

staff members


Do more with less

Employees


Elderly parents, children, family and

relationship issues, stress, finances,

special needs child, health,

depression, chronic pain, sleep,

mental illness in family, commute


Unapproachable/disrespectful boss,

staff, colleagues, bullies, toxic work

environment


Lack of structure to communicate

with staff, lack of direction from

leaders, leaders are too busy


Consolidation, bottom line driven,

fear of job loss, wages

5. Recognition & Reward

Lack of appreciation, recognition,

acknowledgement


Unrealistic workloads

Noteworthy: Work/Life balance is a key area for employees and managers, with 39+ employee indications of dealing with elderly parents (sick, mentally ill or aging issues) almost doubling all other themes in terms of responses. Psychological Support & Protection is another theme where employees indicate disrespectful colleagues, passive aggressive coworkers, saboteurs, aggressive colleagues and disrespectful, difficult bosses are a concern. Managers also have provided much feedback around disrespectful behavior, adding Physicians as part of the bullying/harassment issues at PHC. *Consolidation issues are noted as “really” challenging and said to be fueling disrespectful work environments, favouritism, and lack of engagement for both employees and managers. A



specific difficulty noted multiple times is vacation no longer being approved by a direct manager, having to book vacation a year in advance, and the lack of flexibility there.

*Further Information Regarding Consolidation Issue:

Further Consolidation issues reported for Managers and Employees include and in no hierarchy:

- Lack of connection to PHC vision, culture and organization

o What is PHC true north and how does it align with what we do?

o FHA & PHC have a very different culture

o There is an appetite for more engagement and recognition by PHC for

employees/managers at FHA

o Multiple emails received on same topic from leaders, site leaders, managers etc.

proves confusing and time consuming

o Meeting conflicts – might be scheduled in two different meetings at the same

time because of sites (FHA/PHC) and lack of communication/knowledge

between them

o Direct managers do not approve vacation is a concern

o “[Consolidation was] very stressful, moving, outsourcing there is a constant fear

among staff about how secure our job is”

o “Consolidation has had a big effect on employee stress”

o “There is a real disconnect with our Employer”

- Travel & Locations

o Travel time to Hornby

o Training needs to be offered outside of downtown

o “No one is able to make the trip – I’m still waiting to see if anyone will make the

trip out East”

o “A huge issue is that we don’t have the resources out here”

o “We’re trying to help our staff but we’re not being supported ourselves due to

location”

o “It’s so hard to get people to come out to our sites”

- Responsiveness of support services HR, IT, Help Desk, coverage

o New hires set up is very time consuming, inefficient, frustrating

o Responsiveness of support services needs to be better – 2 months to 2 year

waits reported for email responses to questions, setting up new hires, etc.

o Coverage inefficient utilizing Staffing

- Psychological Support & Protection

o Issues between PHC staff and VCH staff

o “Disrespectful work environment. This a consolidation issue. We are employees

under one manager and we occupy space under another manager, we feel like

we are trespassing”

Note: 10+ responses indicated supportive, effective, management in the area of psychological support



Question 6

What tools/resources would help you with having a conversation with leader

about your mental wellness challenges?


Managers


A structure, framework and script

to have this conversation, more

resources, equipment, staff,

budget to for teambuilding


• “A secondary reporting process if

the manager is the bully or

wouldn’t receive the information

well, may use it against you,”

need to feel safe to have this

conversation


Awareness of resources


Time to discuss


Managers don’t have time,

pushed to limit, overworked

Employees


Counselling resources, paid

time for appointments, a

Mental Wellness Policy, a

toolkit on how to have this

conversation, retreats, a

confidential neutral person to

talk to, time, room to

meditate/decompress


Confidential communication


Time to discuss


Manager trainings


Flex time for appointments

Noteworthy: 25+ employee / 8+ manager respondents indicated they would not feel comfortable talking to their leader about their mental health concerns. Reasons, when indicated, include fear of repercussions, lack of confidentiality, unapproachable leaders, leaders wouldn’t listen, issue might be held against complainant or fear of being judged, and potential implications for career advancement. 16+ employee / 8 manager respondents indicated they feel comfortable in talking to their leader about their mental health concerns and do not require tools: “My boss is easy to talk to,” “My boss is understanding,” “My supervisor is supportive,” “My manager is approachable, communicates well,” “My leader is great.”



Many responses indicated the manager was not capable or qualified to help with mental health concerns. This may indicate a lack of understanding of the manager’s role in mental health in the workplace.



Question 7 (Managers only)

In your role as a leader, what tools/resources do you need to effectively

manage or support your employees who may be experiencing mental health

issues?


Managers


Understand/recognize signs and symptoms of mental health issues, know

“how to reach out to a struggling employee,” a script or toolkit to guide

these conversations, definition and clarity around “mental health issues,”

prevention tools, a list of resources, articles in PHC newsletters, training

boundaries between support and counselling for managers, increase

awareness of EFAP


Time, clear policies (surrounding mental wellness, illness, disrespect and

violence in workplace), equal in-person training opportunities across all

locations (Chilliwack to Surrey to downtown)


A mandatory “Respect” course, create a safe environment across the

organization to start these conversations, a safe place for employees to

report and discuss, support for leaders


Clear expectations between manager and employee, protocols


Time

Noteworthy: 11 out of 49 online responses indicated “time,” “more time,” or “allowance of time to sit with employee” as a resource to effectively manage/support employees experiencing mental health issues.



Key issues Key issues noted from 377 responses that had an effect on employee and manager emotional health and mental wellness:

o Psychologically safe and respectful workplace issues o Work / Life balance – eldercare, childcare, boundaries between work and home o Workloads - lack of time to support employees who are struggling o Education & Awareness – lack of knowledge of roles, resources, responsibilities

around mental wellness challenges in the workplace



References Bilsker, D., M. Gilbert, J. Samra, M. Shain. “The 13 Psychosocial Factors in GM@W: Psychosocial

Factors.” Guarding Minds @ Work. Centre for Applied Research in Mental Health and Addiction

(CARMHA), 2012. Web. 03 Aug. 2014.

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