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HomemistoryMental Health: Confronting the Issues

Mental Health: Confronting the Issues

The incidence of depression in the broad community continues to rise. In your practice there could be a colleague battling with a mental health issue and every week one or more of the patients who walks through your door is suffering from a mental health issue as well.

Rachel Clements, Director of Psychological Services and Principal Organisational Psychologist, recently spoke about mental health issues at Optometry New South Wales’ Super Sunday conference. We caught up with her to find out more about the signs of mental health you can watch for and how best to approach a person in your practice – whether it’s a colleague or patient – who is experiencing concerns with their own mental health.

Whether it’s a colleague, a patient, a family member or friend… or even yourself… most of us have been touched by mental health issues. Yet mental health issues remain one of the great unspoken conversations of our time.

With 20 per cent of Australians expected to experience a mental health condition in any one year, mental health is a serious issue to be addressed. Yet, perhaps surprisingly, many practice managers aren’t aware of the signs or how to broach the topic when they suspect a staff member is experiencing an issue with their mental health.

According to a report produced by PriceWaterhouseCoopers (PwC), the mental health conditions most common in the workplace and the broader community are anxiety disorders, affective disorders (comprised of mood disorders such as depression) and substance misuse disorders.

With 20 per cent of Australians expected to experience a mental health condition in any one year, mental health is a serious issue to be addressed

  • Affective conditions involve mood disturbance, or change in affect
  • Anxiety conditions generally involve feelings of tension, distress or nervousness
  • Substance use conditions involve the harmful use and/or dependence on alcohol and/or drugs.

The cost of these mental health conditions to Australian businesses is AU$10.1 billion every year in absenteeism, presenteeism and compensation claims.1

Rachel Clements, Director of Psychological Services at the Centre for Corporate Health in Sydney, is on a mission to increase awareness about mental health issues and improve our ability to manage those impacted.

“We need to increase awareness that mental health is very prevalent and a serious business issue – it needs to be put on the corporate radar. Staff and patients are all impacted by mental health issues – as is a business,” said Ms. Clements.

Indeed around 45 per cent of Australians between the ages of 16 and 85 will experience a mental health issue in their lifetime (usually during their working life), with some professions – such as lawyers – experiencing rates as high as one in three. Within the healthcare and social assistance sector, PWC estimate that 25.7 per cent of employees have experienced a mental health issue within 12 months of the report being produced.

Why the Increase?

Ms. Clements said the ever increasing numbers are in part due to lifestyle factors “We are all working harder and faster; there are more demands and pressures, and we are less connected as societies, as workplaces, and families… research into these areas shows that relationships are key to maintaining resilience and yet as a society we are becoming disconnected.”

Changes to parenting styles have also impacted our mental health by decreasing levels of resilience. “Fifteen years ago there was a big push to change parenting styles – to focus on building self-esteem and as a result, our personality structure has shifted. So we now have young people who are very high on self-esteem but low on beliefs of self-efficacy – the belief in myself that I can handle it – that I can come through it. That means that when challenges come our way, people are experiencing more heightened reactions, even anxiety or depression,” said Ms. Clements.

In response this this, resilience is now being taught at schools in the hope that we can prepare future generations to confront challenges with greater strength.

“This is about prevention and we need it as a core competency – just as we provide training to improve leadership capabilities and normal workplace capabilities, we need to increase people’s capability to be resilient and to stay well,” Ms. Clements said.

Fortunately for us all, the community as a whole is becoming more aware of, and more likely to talk about, mental health issues.

“There has been a positive cultural shift, and as a result people are more comfortable talking about their mental health. Some organisations have put mental health programs in place and they’re walking the talk. Typically, these are the higher risk organisations that have been on this journey for 10 years – they’ve been talking about mental health, they’ve upskilled their leaders, they run workshops and they have programs in place. In these organisations, people are tending to come forward – people feel safe and are more open to talking about it. And because of those courses, because of the level of understanding, people now recognise / know themselves if they’re struggling.

“However, there is a still a stigma – the majority of people still aren’t comfortable with putting up their hands; they don’t feel they can tell the people they work with that they are not travelling well.”

Ms. Clements said these people will be more likely to tell someone other than their leader or practice manager that they have a mental health concern.

Then there are those people who don’t feel comfortable telling anyone in the workplace about their mental health, usually because they are fearful that this might have negative implications – they might fear they may be judged or hold the belief that their ill-health may impact career prospects.

Creating a Safe Environment

Ms. Clements said it is important to ensure practice staff feel safe to speak out in their working environment before their mental health spirals out of control.

“Managing mental health in the workplace starts when people are well – so it’s about getting to know people at work and a little bit outside of work as well. That doesn’t mean you have to socialise with people, but that you need to take the time on a reasonably regular basis to ask questions.”

She said asking simple questions when things are going well can make it easier to have more difficult conversations when things get tougher. It’s about embedding those conversations early – about building the emotional credits in the bank account, and it doesn’t need to be formal. If we’re used to catching up every couple of months or so then we have a relationship established so that people can feel more comfortable about coming forward. If the emotional deposits are empty, there is no way people will come forward in a moment of vulnerability.”

Ms. Clements said simple questions, like, ‘How are you going? What are you enjoying about your work? I know you’ve been working hard lately how are you travelling?’ Are enough to start a conversation that will lead to a greater understanding of the person and anything inside or outside work that may be impacting them.

“Unfortunately, a lot of leaders will ask how your workload is and the conversation stops there. But it’s the quality of workplace relationships that will reverse the trend of people not wanting to come forward – that makes the conversation much easier when things are tougher,” said Ms. Clements.

Looking for the Signs

As with any relationship, once you get to know someone, you get to know their normal response to demands and pressures – and so it becomes easier to notice a shift – to recognise when they are under pressure.

Text book signs of depression are fatigue, weight loss or gain and withdrawal.

You might notice that a staff member who normally likes coming to practice meetings and likes to contribute ideas has suddenly become more reserved, more disconnected – they keep to themselves. They may look fatigued and they’ll make excuses for why this is the case, but at the same time you might notice they’ll be withdrawn, pale, and experiencing significant weight loss / gain (Ms. Clements said one of her clients lost 15kg in two weeks).

“People can, to some degree, mask or hide their mood and behaviour, but they can’t mask cognitive behaviour – their memory and ability to produce output. So sometimes depression manifests in performance issues – you’ll notice a drop off; mood shifts – the person is angrier, irritable, more reactive; more pessimistic; they may become down or anxious.”

Additionally, she said, when it comes to depression, there tends to be more presenteeism than absenteeism – people come to work because they believe their depression will be less obvious. “Some people will work incredible hours – because it is a distraction for personal issue or because when you’re not as effective as usual the days blow out. Or they do it to make people think they’ve got a lot on and they’re going really well.

Sometimes, people develop unhelpful habits consuming high levels of caffeine to pick them up and alcohol to wind down or taking pharmaceutical medications to block out or change the way they’re functioning.

How Long is Too Long?

The rule of thumb for mental health is that if a person is feeling depressed, down or anxious all day every day for two or more weeks, they may benefit from seeking professional assistance.

“You don’t want to pounce on someone who is having a bad day, but if they’re not bouncing back and they’ve behaving uncharacteristically for four or five days, they might already be travelling down a mental health line,” said Ms. Clements.

“Don’t wait until they come to you because often people won’t be inclined to share how they feel, make sure the person feels safe, comfortable and confident about talking to you. Be proactive and initiate a conversation with someone you are concerned about.”

Asking open questions about how the person is, mentioning that you’ve noticed a change, and listening without judgement are important before demonstrating your support and leading the person to help, whether that be a family member, a GP or a counselling service.

“Take a deep breath and step up to the conversation. They’ve invited you, they trust you, they want you to participate, so be prepared to listen, refer on and reconnect now and again to see how they are travelling,” said Ms. Clements.

When referring on, Ms. Clements said it was important to discuss the options first. “if it is a young person, you would usually link in a with family member; perhaps a parent, but you have to be very careful to discuss this with the person. At the very least, link into an expert, such as Lifeline or an Employee Assistance Program; and if you’re really concerned – if the person is suicidal, call an ambulance.

“You don’t have to be an expert in this area to talk to someone about their well-being or mental health. A lot of people think ‘I’m not a psychologist so I’m not going to have this conversation’, but this is about interconnectedness – and it’s an amazing gift.”

The Risk of Suicide

Practice owners have duties under work health and safety laws to do whatever is reasonably practicable to eliminate or minimise risks to staff members’ mental and physical health.

If suicide is mentioned by a staff member, colleague or patient, as a health care professional, it is mandatory that you report the incident. Even if you are a practice manager, you are immediately under a duty of care to let someone know.

Ms. Clements said the fact that the person has shared their plans tells you they want help and that they have chosen you to trust.

As difficult as it is, asking gentle and open questions about their thoughts and plans for suicide will help you determine whether they are simply thinking of the suicide or have firm plans set in place. This in turn will help you decide whether it is important to seek immediate assistance or whether there is time to refer the person on to a counselling service.

“Thank the person for sharing their feelings and explain that you are going to get assistance. It is important to link them into support through a GP or counselling service for instance, and if you are really concerned about their immediate safety, call an ambulance,” Ms. Clements said.

1. Creating a mentally healthy workplace Return on investment analysis. www.headsup.org.au/docs/default-source/resources/beyondblue_workplaceroi_finalreport_may-2014.pdf?sfvrsn=6

The 4 Rs: Recognise; Respond; Refer; Review

How to start having a conversation – you don’t need to be a doctor / psychologist/ HR or mental health expert.

1. Ask the question.

The most obvious question to ask is ‘Are you OK?’ but if you start off with this question, you’ll often find that people will mask the truth with a response like ‘yeah I’m fine’. So instead, try making a gentle statement about your observation: ‘I just wanted to check in with you and see how you are travelling, I’ve noticed a change in you, you don’t seem to be quite yourself – are you OK?’ Often the person hasn’t realised their change in behaviour is noticeable – so asking the question will bring it to their awareness.

2. Wait for a response.

If the person opens up, fantastic, listen without judgement. You don’t need to have the answers. The secret is to take off your work-related hat – often we’re in the position of finding solutions, troubleshooting, however in this case, the most important thing you can do is not judge, not try to find solutions – it’s that moment of connectedness. Listening without judgement is an amazing thing you can give someone, it’s about providing empathy, letting that person talk and share. You might be the only person in that person’s life, so honour the moment.

3. Refer on.

Lead the person to action, gently and inclusively to demonstrate your support. Make suggestions about where could we go to from here – what would be a good first step we can do together to assist you right away – perhaps it’s a GP / a friend / family member, a treating healthcare professional / human resources or trusted manager in the workplace or a community resource – a lifeline or a counselling service. This is where your language should change from ‘I’ – as in ‘I have noticed’ and ‘I am here to support you’ to ‘we’ – the language of connection and of support. It is so important that people feel supported and that there is someone there to help them. Don’t leave a person feeling alone with their problem, help them to feel there is a first step.

The Costs of Mental Health Issues

Absenteeism: $4.7 billion

Absenteeism is the cost is the average wage assessed against the amount of time taken off due to sick leave. According to PwC absenteeism resulting from employee mental health conditions costs Australian businesses $4.7 billion per year, equivalent to 1.1 million days’ sick leave.

Presenteeism: $6.1 billion

Presenteeism was assumed by a reference group to be 50 per cent of the average wage which is a proxy for the person being at work but half as productive as normal. The more acute a person’s mental health condition, the less productive they are likely to be. Presenteeism is estimated to cost Australian business $6.1 billion a year.

PwC estimates that an employee with a severe mental health condition results in 378 hours of presenteeism per year. Moderate mental health conditions are assumed to cause 150 hours of presenteeism per employee a year, and mild mental health conditions approximately 30 hours of presenteeism per employee a year.

Compensation claims: $146 million

Compensation claims resulting from mental health conditions are estimated to cost Australian businesses $146 million a year. Of 569,583 employees in the healthcare and social services (private) sector, there were 1,70 compensation claims during the period reviewed by PwC, with an average value of AUS $16,200.

According to PwC, Across Australia, if the impacts of mental health conditions through absenteeism, presenteeism and compensation are reduced by one third as a result of effective actions, there is an average positive return on investment of 2.3.


Digging Deeper for the Patient

When a young patient confessed she was considering ending her life, optometrist Malinda Halley was spurred into action.

“The patient was just about to turn 16 and I had seen her two years previously. Like many patients her age, she had asked her mother to wait outside the consulting room and we’d just finished the eye examination. We were having a general discussion about vision and glasses and her visual ability in the classroom. She mentioned that, depending on how she was feeling, there were some days when she didn’t want to go to school, said Ms. Halley who has owned and operated her own optometry practice in Dapto on the NSW south coast for 20 years.

“Sometimes, as an optometrist, you get a feeling about a patient and you know you should dig deeper with your questions. That was how I felt with this patient. I asked her a few more questions and she told me that when she felt sad, her vision was at its worst. She said she wasn’t too worried about how her vision would be in the future, or how she’d feel in the long term because she couldn’t imagine that she’d be around in four or five years’ time.

“As healthcare professionals, we need to develop a huge amount of compassion for people we come across who are in emotional pain, and we should consider what we can do to help. In this case, I wasn’t sure how far I could go – how much I could ask without her shutting down (young adults can detect an emotional probe at 100 paces, they practise on their parents). I didn’t want to be the last adult that she spoke to, I needed to maintain her trust.”

Having determined that the patient was not considering self-harm in the immediate term, Ms. Halley asked whether this was the first time she had voiced her feelings. “She said I was the first grown-up she had spoken to and that she’d decided to talk on that day because she felt safe in my rooms. Essentially her story just came out.

“I explained to her that I was not a psychologist and could not make a diagnosis, and then I started to talk to her about whether there was someone I could talk to on her behalf or where she could go for support. She said her mother was too stressed to be able to handle the situation and that she did not feel it was timely to talk to her school councillor. So we sat down and went online. I pulled together the details of some counselling services, like Beyond Blue, and we entered them into her phone so that she could ring when she felt the need to talk. I also offered a follow up appointment, under the guise of a review so as not to alert her mother, in case she felt the need to talk further.”

The following day, Ms. Halley contacted Optometry NSW for advice and following discussions with Andrew McKinnon, called two mental health departments at her local hospitals and, without mentioning names, called the girl’s school councillor.

“Having made these phone calls I was reassured that the strategy I’d taken was most appropriate. One of the mental health specialists told me that because the patient was not suicidal, breaching the girl’s privacy by advising her mother or giving details to the school councillor might have done more harm than good.”

Ms. Halley said that with such a high incidence of mental health issues in the general community, it was surprising that more situations like this were not encountered. “Sometimes we encounter people who are angry or sad or rude. I try to be kind all the time and give people grace – you don’t know where they’re at, you don’t know what’s going on for them or why they are behaving as they are.

“I just feel humbled that somebody wanted to share that part of their life with me – whether we like it or not we create safe places when we do eye exams and so we need to be prepared to give the time when people feel the need to open up.”