Occupational Mental Ill Health With a Focus on Work Related Stress

Clint RamasirMBBS: MSc. Occ. Med.

Occupational Health Physician

Hazard – the potential of the chemical, biological, physical agent to cause harm.

Risk – the likelihood of harm occurring in actual circumstances of use.

Important Terminology – Hazard and Risk

Physical – Noise, vibration, ergonomic, radiation or lighting, heat

cold, manual handling, accidents (cuts, falls, burns)

Chemical – Dusts, fumes, gases, aerosols, fibres, liquids, vapors

Biological – Bacteria, viruses, fungi and moulds, yeasts, insects

Psychosocial – Job stress, job autonomy, job organisation, unsocial hours

Simple Hazard Checklist

The Range of Problems

Occupational Mental Health

Stress & Adjustment reaction

Brain Injury & Learning Difficulties

Psychosis

Including

Schizophrenia

Organic Disorders & Neurotoxicity

Anxiety & Depression

Phobias

Personality Disorders

Post Traumatic

Stress Disorder

Dementia

Alcohol & Drugs

Estimated incidence rates of self-reported work-related illness, for people working in the last 12 months

all illnesses musculoskeletal disorder

stress, de-pression or

anxiety

Other Illnesses0

500

1000

1500

2000

2500

2001/02 2003/04 2004/05 2005/06 2006/07

Rate per 100 000

I 95% confidence interval

HSE statistics 2006/07

Incapacity Benefits claimants by primary medical condition

1996 1998 2000 2002 2004 2006 20070%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

nervous system

injury and poisoning

circulatory and res-piratory

musculoskeletal

other

mental and behavioural

year

Source:DWP Administrative data

Hearing Problems

Breathing or lung problems

Stress, depression or anxiety

Lower limbs mainly affected

Upper limbs or neck mainly affected

Back mainly affected

Any musculoskeletal disorder

0 200 400 600 800 1000 1200

Estimated prevalence of self-reported work-related illness, by type of complaint, 2006/07

Estimated prevalence (thousands) I 95% confidence interval

HSE statistics 2006/07

6. Alzheimer's/Dementia

5. Trachea/Bronchus/Lung Cancer

4. Chronic Obs. Pulmonary Disease

3.Alcohol Use Disorder

2. Ischaemic Heart Disorder

1. Unipolar Depression

0 2 4 6 8 10 12

3.01

3.07

3.65

4.08

6.76

10.3

US and CanadaBurden of Disease: Leading Individual

Disease/Disorder Contributors

Percent of Total DALYs: US & Canada

Data courtesy of WHO

2004Disease or Injury

As % of total DALYs Rank

Lower Respiratory infections 6.2 1

Diarrheol diseases 4.8 2

Unipolar depressive disorders 4.3 3

Ischaemic heart disease 4.1 4

HIV/AIDS 3.8 5

Cerebrovascular disease 3.1 6

Prematurity and low birth weight 2.9 7

Birth asphyxia and birth trauma 2.7 8

Road traffic accidents 2.7 9

Neonatal infections and other 2.7 10

COPD 2.0 13

Refractive errors 1.8 14

Hearing loss, adult onset 1.8 15

Diabetes mellitus 1.3 19

Ten Leading Causes of Burden of Disease,World, 2004 and 2030

RankAs % of total DALYs

2030Disease or injury

1 6.2 Unipolar Depressive disorders

2 5.5 Ischaemic heart disease

3 4.9 Road traffic accidents

4 4.3 Cerebrovascular disease

5 3.8 COPD

6 3.2 Lower Respiratory infections

7 2.9 Hearing loss, adult onset

8 2.7 Refractive errors

9 2.5 HIV/AIDS

10 2.3 Diabetes mellitus

11 1.9 Neonatal infections and other

12 1.9 Prematurity and low birth weight

15 1.9 Birth asphyxia and birth trauma

18 1.6 Diarrheol diseases

WHO GBD 2004

Number of Diagnoses With Disorders of the Brain in Europe

Headache

Anxiety disorders

Sleep disorders

Mood disorders

Somatoform disorder

Addiction

Stroke

Dementia

Child/Adolescent disorders

Psychotic disorders

Personality disorders

Mental Retardation

Traumatic Brain Injury

Epilepsy

Eating disorders

Parkinson's disease

Multiple Sclerosis

Neuromuscular disorders

Brain tumor

152.8

69.1

44.9

33.3

20.4

15.5

8.2

6.3

5.9

5

4.3

4.2

3.7

2.6

1.5

1.2

0.5

0.3

0.2

(million)

Eur. Neuropsych. (2011) 21, 718-779

8.4

15.1

2.4

sickness absencereduced productivity at workstaff turnover

£billion

The Economic Burden of Mental Illness

© The Sainsbury Centre for Mental Health, December 2007

Business costs of mental ill health at work

Costs Per Average

Employee

Total Costs to UK Economy

% of Total

Absenteeism £335 £8.4 billion 32%

Presenteeism £605 £15.1 billion 58%

Employee Turnover

£95 £2.4 billion 9%

Total £1,035 £25.9 billion 100%

Costs to employers of mental ill health

© The Sainsbury Centre for Mental, December 2007

Common areas of impairment

-Impaired concentration and attention

-Impaired motor skills

-Impaired communication and social skills

-Risk to self and others

-Effects of abnormal illness behaviour

How Mental Problems Might Interfere With Work

Multiple and complex

Suggested by other behaviors……-Sickness absence

-Work disputes

-Avoidance behavior

Work is associated with better mental health Reduced risk of common mental health disorders compared with

unemployment or economic inactivity(1)

……. Reasons for association are complex and debatable

Presentations may be :-

Reference: (1) “Is work good for your health and well being”, HMSO; Waddel & Burton; 2006

Definitions of StressWork Related Stress is…

“The adverse reaction people have to excessive pressures or other types of demand placed on them at work”(1)

Stress occurs when(2) … An individual perceives … …They are unable to cope .. …With the demands placed upon them, … … Causing a negative outcome for them.

Work Related Stress

(1) Definition (UK Health and Safety Executive,1999

(2) Centre for Organisational Health and Development, University of Nothingham.

1999 2000 2001 2002 20030

200

400

600

800

1000

1200

1400

1600

1800

2000

stressmusculoskeletal

OPRA 1999 - 2003

Work Related Stress

Risk Assessment

Work Related Stress- Outcomes

STRESSORSINTERACTION

OR TRANSACTION

OUTCOMES

WITHIN DIRECT MANAGEMENT CONTROL

•Demands (hours, shifts, job content)•Control (degree of autonomy)•Support (advice, training)•Role (well defined?)•Relationships (colleagues, supervisor)•Change (anticipated, agreed, oppose)

OTHER•Home/work Interface•Career

ORGANISATION

•Sickness absence•Labour relations•High staff turnover

INDIVIDUAL

•Mental illness•Other illness•Sickness absence

INDIVIDUAL

Work Related Stress- InterventionsSTRESSORS INTERACTION

OR TRANSACTION

OUTCOMES

WITHIN DIRECT MANAGEMENT

CONTROL

• Demands• Control• Support• Role

• Relationships• Change

OTHER• Home/work Interface

• Career

ORGANISATION• Sickness absence• Labour relations• High staff turnover

INDIVIDUAL• Mental illness• Other illness

• Sickness absence

INDIVIDUAL

SECONDARY• Education• Awareness• Support

INTERVENTIONS

PRIMARYChanging the Environment

TERTIARYDealing with the

consequences• Counseling

• Occupational Health• Case Management PROACTIVE - REACTIVE

Risk Assessment- The HSE Management Standards 2004

Management Standard Employees indicate that they (are)….

DEMANDS Workload , work patterns and the work environment

Able to cope with the demands of their job

CONTROL The way employees do their work Able to have a say about the way they do their work

SUPPORT Encouragement, sponsorship and resources

Receive adequate information and support from their colleagues and superiors

RELATIONSHIPS Avoidance of conflict and the management of unacceptable behaviour

Not subjected to unacceptable behaviors , eg: bullying at work

ROLE Ensuring people understand their roles and the avoidance of conflicting role

Understand their roles and responsibilities

CHANGE Management of change and how it is communicated

The organization engages them frequently when undergoing organisational change

Gail’s Story Gail is 44 and works as a social worker for a local authority,

managing a case load of clients. She has suffered from anxiety and depression in the past. She recently told her manager that she is feeling very anxious and has been suffering from panic attacks. She has been finding it hard to concentrate on writing client reports when she is back in the busy, open-plan office and has difficulty prioritizing her workload. Gail has been to see her GP and is now receiving therapy from the practice’s counselor.

Case Studies

There is no capacity within the team for Gail’s caseload to be reduced but her manager suggests that they increase her monthly supervision to weekly to discuss client cases and help Gail to prioritize her workload. Gail’s manager also reminds her that she can book a quiet room for a couple of days a week so that she can concentrate on report writing – an option available to all employees. As Gail already has flexitime agreement, her manager agrees for her to come into work later on the day of her therapy. Gail and her manager agree to review these adjustments in a couple of week’s time to see if they are working.

What can you do?

Mahinder is 35 and as an IT Support Technician for a large company. He has bipolar disorder and has been hospitalized in the past. He has been off work with depression for eight weeks and has kept in contact with his manager over this time. Knowing that Mahinder was considering a return to work his manager referred him to occupational health for advice on what support he may need to return to the workplace. Mahinder attends a back to work meeting with his manager to agree adjustments.

Mahinder’s Story

The Occupational Health physician suggests that Mahinder returns to work on a phased return, graduallybuilding up his hours to full time over 4 weeks. She also suggests that Mahinder introduces his work tasks slowly, concentrating on desk work in the first few weeks and gradually reintroducing customer query facing work which is more demanding.

Although Mahinder is feeling a lot better his medication makes him drowsy in the mornings which means that he is unsafe to drive. They agree the adjustments in a live document and agree a provisional date for Mahinder to return to work.

What can you do?

HAVE A GREAT DAY

THE END