Mental Health And Wellbeing In Workplaces by Omesh Jethwani

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MENTAL HEALTH AND WELLBEING IN WORKPLACES Omesh Jethwani, Government Projects & Programs Manager, held an in depth conversation with Mrs Lucy Brogden, Chair of the National Mental Health Commission on mental health and wellbeing in workplaces.

Issue Three | June/July 2018 | MBA NSW

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On 2 August 2017, the Turnbull Government announced your appointment as ‘the next Chair of the Australian Government’s National Mental Health Commission’. How has your journey been so far as the National Mental Health Commissioner? I was actually appointed to the commission in 2014 as a Commissioner and the announcement in August last year was to move into the role of Chair of the Advisory Board of Commissioners. I have had nearly 4 years in the Commission and about 6 months in the chair role. In the four years I have certainly learnt a lot and been able to contribute a lot to the Commission. There is a strong appetite across Australia for reform within the mental health sector. We can acknowledge that we have made a lot of progress in the last 30 years or so to improve access to care for people and quality of care but we've still got a very long way to go. In 2014, I was part of the Advisory Board of the Commission that put the big review of the system to the Government with a series of recommendations for improvement and we were very pleased that the Government accepted all but one of those recommendations. Along with many others, we are working on the implementation of those recommendations which see Governments across the country both State and Territory level moving to a proper step care model in mental health. We see the cultural shift and the structural change to a truly personal model of care in mental health. In that respect it is quite an exciting time. We are also monitoring the role of the Insurance Scheme. So there is really an awful lot that's going on in terms of mental health in this country.

Are the above initiatives solely targeted at the workforce?

All of these initiatives are what we call structural and system reforms and we are taking a whole of life lifespan approach. So actually our philosophy and our modelling and our design starts at prenatal care for

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both mothers and fathers prior to conception, pregnancy support in the perinatal stage in terms of mental health and well-being right through the lifespan to our elderly. It also surprises people that the highest rate of suicide by age in this country is men over 85. We need strategies right across the lifespan to support people. In terms of the cultural reform that I talked about, in terms of a person-centred approach, the workplace sits very close to the centre of that circle. We spend the majority of our waking hours at work and so our workplace has a strong role to play in both prevention and recovery. In terms of why men over 85 kill themselves, as with all suicide, it’s a multi-faceted situation but there is strong evidence that loneliness has a role to play, a sense of burden can also be an issue, failing physical health can also be an issue. It is a complex area but it needs to be well understood and well supported.

To a classroom of six-year-olds in a show and tell, how would you describe your role and responsibilities? That's a great question! I have three children, ages 14, 12 and 10 and I spend a lot of time trying to explain to them about mental health. I have spoken at their schools about what I do. It is interesting because most people are very comfortable with me talking to children about mental illness but there is the occasional person who still thinks that this is something that shouldn't be talked about but our own children talk about it very openly. But In terms of telling, what I would say to a 6 year old is that, we have to look after our physical health. We need to eat well, we need to exercise, and we go to the doctor when we don't feel well. We all have to look after our mental health and how we feel on the inside in terms of being happy, or sad, or just not sure about how we feel.

We can do that by making sure that we certainly eat and sleep well, which is good for our physical health and mental health and that we get the right amount of sleep and that's why our mums and dads try to put us to bed at a good bedtime. Sometimes if that doesn't work, we need to go and see the doctor because we are having trouble understanding how we might be feeling on the inside and that is OK too, to get that kind of help. My role is to make sure that systems and services are there for those people too.

Have you ever been confronted with a question raised by students on the definition and meaning of mental health? Lots of kids are interested but I’ve got to say there is a really good awareness in terms of children understanding broadly the concept around being depressed or anxious. When you get further down the illness spectrum, things like eating disorders and schizophrenia etc, there is less awareness. But equally, children are really good at asking questions and are sponges of knowledge. They are happy to lead a conversation and learn more all the time.

On 2 February 2018, the Australian Institute of Health and Welfare’s (AIHW) web report estimated 4 million people having experienced a common mental disorder in 2015. That is nearly 20% of the country’s population and it is predicted to increase quite significantly. What are the main factors, in your opinion, causing the numbers to increase? This is a hideous term but it is the term that health policy people use. That is the burden of disease. That is what we would expect in a population like Australia, around 20% of the population to experience a mood disorder, at the very mild to moderate end of the spectrum. In terms of the increase, the increase they are talking about is not the proportion of the population but as the population grows more people will be seeking support. It's a good thing and is a reflection on the work that is being done by many people to reduce stigma. People are getting more comfortable to put up their hand and seek help and say that they are struggling with an issue, that they are not sure what's going on for them. So there

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is a plus side in that. People are prepared to seek help and identify the issues they are struggling with.

of the population affected by mental illness and you look at the proportion of budget spent, Government money spent on the issue, it's certainly significantly less.

On the other side, we as a society need to manage the known risk factors that are likely to lead someone to experience a mood disorder, particularly depression and anxiety. We need to create a stronger sense of hope in society. We are very good in Australia at being critical of things rather than actually providing people with a message of hope. Young people often hear that they won't get a job and will never be able to afford a house. These are stresses. As a society, we need to create more opportunities to convey the hope and talk about the positive. We need to understand the risk factors and what is stressful for people and that is where particularly the workplace has a role to play because there are stresses in the workplace that can be managed and mitigated.

Do you think the way media has reported mental health has been one of the major factors that has created negativity and caused society to be critical and less supportive? I don’t know that there is a direct correlation to the media but I think the media certainly has a positive role to play. The Mindframe media guidelines that the Commonwealth Government funds and supports has a program that goes out and trains journalists and media students around issues to do with mental illness so that they can improve the quality of their reporting and how they describe issues to do with mental health and suicide. We have seen a really big improvement in that regard. There is still a sense that bad news sells and good news doesn’t. I am not convinced that that is the truth but there seems to be a perception out there. I would like to see people putting a more positive lens on the society that we live in. It is ok to be critical and identify issues but to put some balance in there that it is not all bad, it is not all negative and that it is not all broken. There are many good things going on in society, there are many good things going on in our community that we should be highlighting some of the positive too.

Do you think the R U OK National Day is an action that should be practised regularly rather than a

yearly event? The R U OK theme would encourage everybody to regularly check in on friends, family, and colleagues, particularly if they think there is a reason for concern and that the day itself is a good reminder that we should be doing this quite regularly. We do hear great stories of people outside of the R U Ok Day actually checking in with people and feeling more confident about asking someone if they're okay and this is all great progress that we are making. There are people who often say “I'm worried about asking someone if they're ok, just what if they say no”. We know there is no harm in asking someone if they are ok. The R U OK model doesn’t expect people to all become psychologists overnight. It just asks us to be truly human and sit with that person if they are struggling and be a support to them, listen to them and be present. If people want to know more, there are great tools on how to have conversations. There is a website “Conversations Matter” (www.conversationsmatter.com.au/) they can go to if they feel they need some skills, but really we can all reach out and be human to our friends and colleagues.

AIHW’s recent update web report stated that $9 billion or $373 per person was spent on mental health-related services in Australia during 2015-2016, an increase from $354 per person in 2011-12. While the lump sum seemed extremely high, on average per person, it seems to barely scratch the surface and it does not emphasise the importance of these services. Why do you think this is the case? You have made a very valid point and this is something we talk about quite a lot. If you look at the burden of disease and the amount

But at the same time, a lot of this is not just about money or more money — while more money would be fantastic. It is also about doing things that we know work and doing them well. There is catch up to be made in terms of the investment that we make as a society into mental illness. That reflects possibly the stigma of the past where people with mental illness were not talked about, they were often hidden away in asylums. There is certainly catch up to be made but there is certainly opportunity to spend the money that we do have more effectively.

Has any research been carried out previously which has listed the top 3 industries to suffer most from mental health issues? If yes, which are the top 3 industries? There is a lot of research by industry and occupation. I am not sure how helpful it is to put a ranking on industries because I think to someone suffering, it does not matter where they are suffering, they are all suffering. Depending on where we work, we all have a role to play in reducing that suffering in terms of prevention and recovery. We know that there are issues for first responders, we know there are issues for our military and some of those are quite obvious in terms of the trauma they encounter. But equally the trauma encountered by people working in professional services can be just as debilitating and just as stressing. I prefer to take a view that says that there are risks in any occupation and that we have a legal responsibility across all occupations but we also have a moral responsibility to support our colleagues irrespective of the profession that we work in.

In March 2017, you presented at Mates in Construction Workplace Mental Health Conference addressing Industry Leadership. What are your personal views of the Mates in Construction model and do you think this is a model that should be introduced for all industries? Issue Three | June/July 2018 | MBA NSW

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Mates in Construction was introduced and Mates in Mining and in Energy too. It’s really up to the industry to know what works best for it.Certainly the Mates model is working very well in the industry that it is in. But equally there are similar groups doing similar kinds of work in other industries. I take a view that these things are best ironed and accepted when they are evolved out of the community or the profession that sits behind it. Each industry needs to look at itself and work out what is going to work best for the people in that industry, what model they are going to be most receptive to. We are doing some really interesting work at the moment through every mine based in Newcastle. Icare in New South Wales is looking at small and micro businesses and what they might be able to do. I know that the accounting profession is looking at what they can do for their members and vets are looking at what they can do to improve wellbeing. It is a matter of knowing your community and designing a program with your community that is going to work best for you.

Organisations are encouraged to develop a comprehensive mental health and wellbeing strategy. What are some of the strategies that you could recommend to our readers?

community and members to address some of those issues. We’ve got the LifeSpan trials in New South Wales funded by the Paul Ramsay Foundation looking at a systemised approach and we have got the Aboriginal & Torres Strait Islander Suicide Prevention Program.

their journey and for their wellbeing. It’s about providing the right support and some of these things are for larger organisations to look at. Do they have an Employee Assistance Program (EAP), are they addressing issues to do with bullying, are they addressing issues to do with instability in the workplace. There is a range of things that organisations can do. But what we also know is that it is important that organisations address the negative before they start looking at the positive if that makes sense. So if there are examples of bullying and intolerance in the workplace that they are working in, to manage those issues first, before they bring in the shiny fun stuff.

Suicide and suicidal behaviour in the Australian construction industry is costing $1.57 billion dollars each year, as much as 98 per cent of which is borne by government. In your opinion, is Australia on a par with the rest of the world in reducing suicides?

I would suggest to readers that they look at the Heads Up website (www.headsup.org.au/), which is an initiative of “The Mentally Healthy Workplace Alliance” and hosted by Beyond Blue. There are some things that businesses of all sizes can look at to do. But the No.1 recommendation for business that we say they need to look at is their job and work design.

In terms of reducing suicide, our rate did come down slightly last year, year on year to the prior year but it does still sit at stubbornly high levels. Suicide is a complex issue and very multi-factored. Mental illness plays a part in that but also issues to do with impulsivity, drug and alcohol addictions etc play a part. We are working to do the right thing.

A lot of people think it is about yoga and fruit bowl; that is kind of my hashtag, beyond yoga and fruit bowl. That’s just playing at the margin. It is really about good job and work design; so how are you structuring the work of your team, how are you structuring the day, are people able to get enough sleep, is it a safe environment for them physically and mentally. Or would someone be safe to disclose that they are struggling with a mental illness.

We’ve got the Fifth National Mental Health Plan, which for the first time actually now includes suicide prevention. So it is the Fifth National Mental Health and Suicide Prevention Plan (www.coaghealthcouncil.gov.au/Publications/ Reports). So that is a welcome step at the highest level.

Sleep is the No.1 issue — are you allowing people to get sufficient sleep and recovery for

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We have seen fantastic community level projects being developed across the country. Things like Mates in Construction is a terrific response from a sector that knows it has got issues and is wanting to help work with the

There are a lot of people from grassroots right through to leading academics all working together with Government to try and address the rate. The goodwill is there, the knowledge is there, the programs and structures are there. At the end of the day, a lot of this comes down to people feeling connected to their community and feeling a sense of help and being able to access care when they need it.

Certain industries and workplaces are seen employing Mental Health First Aid Officers to promote good mental health, prevent mental illness and have the tools to support people with mental health issues. In your opinion, would this scheme work to reduce the number of cases? If yes, do you think government would provide employment incentives to assist organisations? In principle, the more people trained around Mental Health First Aid is a fantastic step but it is one step in a number of steps. If we go back to that earlier answer, if we started things like good job and work design and good work practice, that is going to be a strong mitigating factor to actually reducing issues to do with mental health. Having people trained to help people is really important and is an important contribution. But to me it should be no different to the physical first aid officers that organisations have. Some of these things need to be ironed out by the business themselves and by the industry themselves. They have a legal obligation under Workplace Health & Safety legislation to provide a workplace that is not just physically safe but psychologically safe. Look, if it takes Government incentives, then maybe you need to look at that but really these are just the basic responsibilities of the employer to provide these services and supports to people.

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With the Federal Budget announcement, what, in your opinion, are some of the positive changes we can expect to tackle mental health issues in Australia? Consistently over the past 10-15 years, we have seen increased investment in mental illness in this country which has been fantastic both at Commonwealth and State levels. This year the Federal Government’s budget made mental health a priority with an additional $338.1 million over the next 4 years. The Commission has a suicide target towards zero. A lot of money has been allocated to Lifeline and beyondblue to support suicide prevention services. Digital mental health services were boosted and already this year we’ve seen a lot of money support the Royal Flying Doctors service, childhood mental health issues and ongoing and increased support for organisations like Headspace. There is every indication that these good programs will maintain their support by both Government and oppositions. This is something that we have good bipartisan support on in this country is improving the mental health and wellbeing of Australians.

In your opinion, will government funding be available to Industry organisations in the near future to assist on behalf of the government in addressing mental health issues in workplaces. In terms of mentally healthy workplaces, we are not advocating that workplaces are the source of treatment for someone. But we would ask employers that they have a responsibility, they have a responsibility for physical safety and psychological safety. There is no difference. A lot of the things you are doing to provide physical safety for your employees will also provide psychological safety. If you are looking at doing good job and work design, then the outcome of good job and work design is physical safety and psychological safety. In terms of the risk, whether someone develops a mental illness or a physical illness or injury at work, it is not something that you can screen for, it is the risk that you take by

having a workforce. Someone could easily hurt themselves at work, someone could easily develop diabetes or cancer while they are working for you. You still have an obligation to support that person whether it is a mental illness or a physical illness. If people are trying to separate the two then that reflects a lack of understanding around mental illness that we need to overcome.

What are some of the mental health services that may be provided on a larger scale and some that may be cut back based on demand and budget. As far as I know and I haven’t seen any real cutbacks in services at a Commonwealth level. There is certainly shifting focuses and investments while we transition to primary health networks with various devolution of responsibilities to the primary 31 health networks to take responsibility for budget allocation but in terms of cutbacks to services, there is no recommendations to cutbacks for services.

Susan David, PhD, an award winning Psychologist on the faculty of Harvard Medical School and author of the new #1 Wall Street Journal best-selling Emotionally Agility, quoted that “normal, natural emotions are now seen as good or bad. But when we push aside normal emotions to embrace false positivity, we lose our capacity to develop skills to deal with the world as it is, not as we wish it to be.” Do you agree or disagree with this statement? I am familiar with Susan’s work and I think she makes a really valid point and it touches on an issue that I try and talk to. I am not a big fan of the term ‘resilience’. I prefer the concept of resourcefulness. Resilience implies that you have a deficit to be overcome somehow whereas resourcefulness reflects that we all

have capacity to overcome issues that we personally find hard to manage. Some of us have a greater capacity to respond to difficult situations than others, some of it is just our basic social problem solving that we have grown up with and had role models for us, some of it is just our physical capacities as much as our cognitive capacities to overcome but we really do need to have some conversations that help us understand the new kinds of emotions and actually equip, particularly young people going forward, to be able to tap into their own capacities. We need to problem solve and to manage issues and that is where I agree that we try and medicalise some issues but at the same time we need a little bit more empathy that not everybody has the same skills and capacities and for some, perhaps its more capacity building than the illness or a treatment that is required.

In addition, Susan David also stated that “Tough emotions are part of our contract with life. You don’t get to have a meaningful career, or raise a family, or leave the world a better place without stress and discomfort. Discomfort is the price of admission to a meaningful life.” Do you think as a nation, we cannot seem to differentiate between a real problem vs a hurdle to overcome and the difference between being sad and suffering from depression? Actually, I think we can. There are sceptics that say everybody is claiming depression now but most people can tell the difference between being sad and actually depressed. If they can’t, then that actually is a reflection that perhaps they need insight support into understanding the difference. But it is easy for critics on the outside to say that people can't distinguish but for someone sitting with those feelings, we know how hard it is for people to ask for help. But if they are actually asking for help, then there is something going on for them that needs to be respected. If you need support in the industry please contact your Employee Assistance Program or call Mates In Construction on 1300 642 111. Issue Three | June/July 2018 | MBA NSW