FIFO Mental Health

A/Prof Edward Petch State Forensic Mental Health Service Industrial Relations Society WA Rottnest

November 2014

Dr Edward Petch and Dr Natalie Pyszora

Contents •  Why am I here?

•  What is mental health?

•  What are the common psychiatric disorders?

•  Why employment is important

•  Factors in working environment important to mental health

•  FIFO - Escalating concern

•  Possible Factors in FIFO/Effects of FIFO

•  Future challenges – what to do

•  Discussion and questions

Stats •  $4.7bn cost of absenteeism per year in WA due to MH issues

•  MH leading cause of long term workplace absence

•  $146m in MH comp claims per year

•  1 suicide per day in WA

•  10% substance use + MH condition in Australia

•  22% of serious mentally ill people are in employment

•  15-30% employees are affected

•  50% managers believe none of their workers will be affected

•  45% of people 16-85 who are affected

•  2% ongoing issues/ 3% severe

Mental Health

• Wellbeing

• Confidence

•  Self esteem

• Enjoyment

•  Satisfaction

• Contentment day to day

•  Security

• Relationships

• Work

• Resilience

• Potential

• Hope/happiness

Absence of mental health

Personal •  Personal costs

•  Poor work/life balance

•  Lack of engagement

•  Decreased safety

•  Loss of interest

•  Loss of motivation

Work •  Loss of productivity

•  Financial costs

•  Sickness/absence

•  Poor morale

•  Negative culture

•  Staff turnover

•  Complaints

•  Workers comp

Common Mental Disorders

Schizophrenia

Depression (and mania)

Anxiety

Personality Disorder

Substance misuse

9

Mental disorder

•  A mental disorder is a clinically recognisable set of symptoms or behaviours associated with distress and with interference with personal functions

•  Social deviance alone is not a mental disorder if it is not associated with interference with other personal functions and other symptoms

10

Schizophrenia

•  Is NOT a split personality

•  It is an illness that affects one in every 100 people

•  Affects men and women equally

•  More common in cities

•  Affects people worldwide

11

Symptoms of schizophrenia •  Hallucinations

•  when you hear, smell or see something that isn’t really there

•  most commonly ‘voices’

•  seem very real

•  may be experienced as coming from radio, TV

•  Delusions

•  unusual beliefs, held strongly without evidence

•  may be about persecution or radio, TV referring specially to them

12

Manic depressive illness/Bipolar affective disorder

•  Affects one in 100 adults

•  Affects men and women

•  Sufferers experience high phases (mania) and low phases (depression)

•  Sufferers are usually well between episodes

•  Some people only have manic episodes, some a mixture and some only depression

13

Symptoms of mania •  Energy +++

•  Excitement

•  Irritable with others who seem slow

•  Overactivity

•  Not sleeping

•  Making grandiose, unrealistic, reckless plans

•  Speaking very quickly

•  Making odd decisions, sometimes disastrous

•  Hearing voices

•  Head full of thoughts and ideas

•  Bizarre behaviour

•  Spending money recklessly

•  Sexual disinhibition

Depression

•  Core symptoms are:

•  Low mood

•  Loss of interest and enjoyment

•  Reduced energy and fatiguability

•  Mood typically unreactive to circumstance or only briefly

Depression -symptoms •  Other symptoms:

•  Reduced concentration and attention

•  Reduced self esteem and self confidence

•  Ideas of guilt and unworthiness

•  Bleak and pessimistic views of the future

•  Ideas or acts of self harm or suicide

•  Disturbed sleep

•  Cognitive and motor slowing (psychomotor retardation)

•  Agitation/ fearfulness

•  Irritability/ social withdrawal

•  Exacerbation of pre-existing physical pain and physical symptoms

•  Social withdrawal

•  Increased alcohol consumption

Effect at work •  Drag others down

•  Miserable

•  Irritability over minor things

•  Unnecessary conflicts/ disagreements – worsening relationships

•  Increased bad days at work

•  Looks miserable

•  Unable to laugh

•  Self isolation

•  Over reliance on alcohol

•  Cant reach decisions

•  Feel overwhelmed – cant cope with demands

•  Constant worry

Causation •  Very common – worst in accommodation and food industries,

personal services, arts, professional, technical sectors

•  Construction industry high rates of suicide – higher than accidents

•  Predisposing or vulnerability factors

•  Genetics

•  Adverse childhood experiences

•  Personality factors

•  Precipitating factors

•  Current social circumstances interact with vulnerability factors and adverse life events to trigger depression

•  Poverty, homelessness, unemployment, chronic pain, domestic violence

•  Three or more young children, not having a confiding relationship, no paid employment outside the home

•  Stressful live event

Depression - suicide and disability

•  Suicide

•  Accounts for 1% of deaths

•  Two thirds of suicides are depressed

•  Degree of disability directly related to severity of depression

Symptoms of anxiety •  Psychological symptoms

•  Feeling worried, frightened

•  Feeling tense/stressed/on edge

•  Irritability

•  Inability to concentrate

•  Poor sleep

•  Fearful thoughts

•  Physical symptoms (too much adrenaline)

Types

•  Phobic anxiety disorder

•  Generalised anxiety disorder

•  Panic disorder

•  Post traumatic stress disorder

Anxiety and disability

•  Distress –

•  Lost work days

•  Social impairment

•  Avoidance can be very disabling

•  Increased alcohol use

•  Suicide

Alcohol and Other Drugs

•  Most common in mining, construction, accommodation and food services sector

•  Complex relationships with mental illness

•  AOD causing psychotic symptoms e.g. amphetamines, cannabis

•  AOD being used to self medicate in the presence of psychosis, depression etc

•  AOD and mental illness co-existing

Alcohol and Drugs in FIFO

•  Zero tolerance and testing programs

•  Many use stimulants (not detectable for so long)

•  Synthetic cannaboids – increased then descreased

•  Steroid use – performance image enhancing drugs

•  Increased prescription drugs

Risk factors for suicide – compare with FIFO population

•  Men, young

•  Isolated, family/relationship stress

•  Aboriginal and Torres Straight Islander people

•  Gender/sexually diverse people

•  Rural remote communities

•  Mental illness

•  Previous suicide attempt/self harm

•  Bereavement by suicide

•  Childhood abuse/neglect

•  CaLD backgrounds

Work and mental health

Stable meaningful employment

• Confidence

•  Self esteem

•  Security

•  Sense of Purpose

• Challenges/thought

• New skills

• Personal development

• Goal attainment

• Value to society

• Contribution

• Network

•  Support

•  Sense of belonging/social inclusion

• Comradeship

•  Structure

FIFO

Why go into FIFO?

• $40,000

• Contraction of local economy/loss of job

• Post financial change (eg divorce)

•  Seeking to boost superannuation/savings

• Rising debt levels

Emerging issue – hot debate

•  Different perspectives

•  Discussions = conversation – I am here

•  Awareness -rising

•  Research – still poor but emerging

•  Inquiry - ongoing

•  Media - interest

•  Concern – different groups

•  Call for action

Most research

•  Most FIFO workers healthy

•  Good communication

•  Good cohesion

•  Satisfying lifestyle

•  But – some problems may exist

What are the risk factors

•  Negative working culture – type of workplace/type of leadership

•  The way businesses value their workforce

•  Impacts on individual, spouse, children

Negative working environment

•  Robust

•  Male/macho image – tough, strong, resilient, blokey

•  Bullying

•  Intolerance to perceived weakness

•  Intolerance to difference

•  Work hard/play hard

•  Reluctance to seek help – massive stigma

Contributing factors to poor MH at work

•  Long hours

•  Time pressure

•  Unrealistic demands/targets

•  Monotonous dull unvaried work

•  Low levels of control/autonomy

•  In adequate support from supervisors/colleagues

•  Cynical manager

•  Lack of role clarity

•  Low levels recognition/reward

•  Poor change management

•  Exposure of death/suffering

•  Rosters + night shifts

•  Verbally aggressive customers

•  Bullying/harassment

•  Discrimination

•  Harsh conditions

•  Hot

•  Fatigue

•  Boredom

Potential impact on wellbeing of worker •  Loneliness/isolation - sadness/hopelessness

•  Exertion/fatigue

•  Can worsen preexisting difficulties in social, personal, relationship problems

•  Periodic separation/reunion – with change of pattern of engagement/lifestyle – adjustment

•  Some can be insular on return to family or engage – social withdrawal/reduced communication

•  Parenting – consistency, role models, help, accessibility

•  Rosters v family/social/school/services rhythms

Potential impact on spouse

• Parenting alone

• Practicalities

• Difficult to work

• Loneliness

• Reduced social opportunities

• Absence in emergencies

Potential impact on children

•  Anxiety/Crying/Sadness

•  Behavioural problems at school and home

•  Bullying

•  Pressure to succeed academically

•  Absence of parent at school events

•  Some see the positives of spending more time with parent when home

Most manage

•  Most manage their mental illness well

•  No/minimal impact on work

•  Maybe require support for a while

•  Some require other strategies

•  Overcome reluctance to seek help

Parliamentary inquiry

•  WA Education and Health Parliamentary inquiry into FIFI DIDO workforce after 9 alleged suicides in Pilbara

•  Focus on factors relating to mental illness and suicide – isolation, disconnect

•  Legislation

•  Regulations

•  Practices/services

•  remedies

What can be done •  FIFO not for everyone

•  Welcome/orientation at each site – to support systems and sense of community

•  Mental health first aid officer at each site

•  Treatment and prevention work – stigma

•  Improved systems of peer support

•  Remove barriers to accessing support

•  Create a Customised mental health action plan – for example

•  Enhance suicide prevention strategies eg in construction

Formal programs

•  With Mental Health Commission

•  Govt and community driven initiatives

•  Eg Heads Up (beyondblue and Mentally Healthy Workplace Alliance)

•  PwC $2.30 return for every $1 in strategies – which improve productivity, participation, compensation claims

Pre-employment preparation

•  For the individual

•  Economic/financial

•  Social

•  Personal

•  Family

•  Health

•  For the family

•  Orientation

•  Support networks/services

•  Awareness of personal challenges to lifestyle

Communication

•  Regular

•  Private

•  Effective

•  Spontaneous

Places for support

•  Mental Health Commission – Supporting Good Mental Health in the workplace: a resource for agencies (mentalhealth.wa.gov.au)

•  Heads Up – run by Mentally Healthy Workforce Alliance (govt funded Australian workplace programme) headsup.org.au

•  Workplacementalhealth.com.au

•  Thisfifolife.com (MHC)

•  Miningfamiles matters

•  Change doable – no excuse not to

Acknowledgements to Western Psychiatry

•  Dr Gemma Edwards-smith and colleagues

•  Psychiatric and psychological specialists

•  Expert advice in occupational psychiatry to industry

•  Evaluation of workforce

•  Development of mental health support programmes