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Safeguard OSH Solutions - Thomson Reuters

Safeguard OSH Solutions - Thomson Reuters



Safeguard Magazine

From promotion to prevention

Are mental health issues really part of health and safety? Yes, says CARLO CAPONECCHIA, who explains how they can be managed using familiar risk prevention and consultation methods.

Mental health is a hugely complex health and social policy area, but in the context of work and workplace safety, two key issues appear to prevent us from moving forward. The first is that people tend to view mental health as being only about major diagnosed conditions such as depression or an anxiety disorder. These disorders are of course a big part of “mental health”, but we need to think more widely about the nature of symptoms and outcomes.

Everyone has “mental health” in the same way that everyone has “health”. At various times, regardless of the presence or absence of some major diagnosable condition, the nature of our mental health can change. This is really a scoping problem. We sometimes refer to this element of health with several terms including psychosocial or psychological health and/or wellbeing.

The second, related issue is that mental health is often viewed as the province of the individual. This view, which is implicitly relied upon in workplaces, seems to ignore that the organisation can have an effect on people’s mental health (both their major diagnosed conditions, and their psychosocial wellbeing).

It’s a view that simply needs to be challenged.

FROM AWARENESS TO PREVENTION

In part, some of these problems may have been exacerbated by mental health awareness programmes which have started to become more common in large organisations. They are of course necessary and should continue. They focus on the disorders people may have, the symptoms, and how to get assistance, and they attempt to normalise getting that assistance, either through health services or employee assistance programmes. Such activities represent the use of work as a site for health promotion, as has been used successfully for many other health promotion issues. Examples in Australia include RUOK day (ruok.org.au) and the use of materials at Beyond Blue’s very informative Headsup website (headsup.org.au).

However awareness days and promotional activities risk being hollow and tokenistic without a deeper, more committed organisational strategy. The challenge is to move from the starting blocks of promoting awareness through to ongoing workplace prevention, acknowledging the role organisations can have in influencing people’s psychosocial wellbeing.

Workplace health and safety is the framework under which this should occur.

IT’S YOUR H&S DUTY

Controlling the impact that work may have on people’s psychological health (ie their mental health) is part of every organisation’s H&S duties. The new HSW Act in New Zealand, similar to the Australian Model Act, includes mental health in the definition of health. Mental health was always implicitly included – it’s been part of the WHO’s definition of health since 1948 and, and pre-harmonisation, the prevention of psychological harm used to be included in some state-based H&S regulations in Australia.

However, inclusion of mental health in legislation doesn’t necessarily mean that knowledge, attitudes or practices have caught up with the intentions of the legislation. Psychosocial issues remain the next frontier in health and safety: despite being talked about for a very long time, we’ve not seen major advances in how they are dealt with.

Why are psychosocial issues still being left behind? Reasons include:

  • • 
    The traditional engineering framework of H&S, which has necessarily focused on physical harm.
  • • 
    A consequent slow recognition of psychosocial issues as being part of the H&S remit, despite regulation and legislative change.
  • • 
    Educational and experiential gaps in understanding and dealing with psychosocial issues, as well as language and semantic gaps which prevent the relationships between these concepts from being fully appreciated.
  • • 
    A perception of fundamental differences between physical hazards and psychosocial hazards, and how they can be accommodated (or not accommodated) within traditional H&S frameworks and models.
  • • 
    An over-emphasis on compliance with existing systems, templates and “rules”, rather than a more flexible approach based on the principles of H&S, which helps render psychosocial issues as different to other H&S concerns.
  • • 
    A lack of known or perceived sanctions for not managing psychosocial issues well.

Ongoing education in the key principles, frameworks and assumptions of health and safety is required to ensure that new challenges are appropriately managed, in the spirit of continual improvement, rather than dismissed as out of scope or as being too hard.

MOVING UP THE HIERARCHY

Psychosocial hazards and mental health at work have received some strategic attention internationally. Progress is being made. In Europe, a risk management framework for psychosocial hazards has been developed, and extensive material is available regarding the current status of the treatment of psychosocial hazards at work at the PRIMA-EF website, prima-ef.org.

A British standard on the management of psychosocial risks at work is available (PAS1010:2011), and Canada has a national standard for psychological health and safety in the workplace. More locally, Safe Work Australia and WorkSafe New Zealand have guidance on preventing and managing workplace bullying. They all follow a familiar risk management paradigm applied to psychosocial risks.

This kind of strategic advice is really important, but is less useful at the individual organisational level. Employers already know they’re supposed to manage risks. They don’t need more risk assessment forms and more checklists: the operational issues of exactly how to manage psychological risks is what really needs to be exemplified.

All of the standards and guides in this area point to what could be called changes in work design. Arguably, this places action on psychosocial hazards much higher on the hierarchy of controls than most activities that are undertaken currently (such as resilience programmes, referral to employee assistance providers, stress management activities and more generalised health and fitness promotion).

IT’S ABOUT WORK DESIGN

Changes in work design are intended to control the major stressors known to affect people at work. These are sometimes termed “psychological hazards” within the workplace safety context. Exactly what experiences are characterised as psychological hazards depends a little on theoretical tradition and background, but include:

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    A lack of control and autonomy;
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    Role conflict and role ambiguity;
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    Poor supervision and support;
  • • 
    The nature of interpersonal relationships at work;
  • • 
    Issues in workload, job pace and schedule.

Telling an organisation that it needs to re-design work, jobs, tasks, or the organisation itself can be a really scary prospect. However, these things can be achieved over time through consultation. They make a real difference, not only to the psychosocial impact of work, but to physical aspects of safety, job commitment and productivity.

Changing the design of work can include, for example

  • • 
    Meaningful consultation on schedules.
  • • 
    Allowing flexibility and staff input into the order of task completion.
  • • 
    Encouraging consultation on work flow, relative roles, and changes over time.
  • • 
    Supportive supervision with practical feedback.
  • • 
    Competency-based professional development, and innovative methods of training, learning and assessment.
  • • 
    Rethinking aspects of the physical layout of the work environment, including technology and equipment that can enable work to be performed differently (activity based work is a notable example).

CONSULTATION AT CORE

None of these things can occur quickly, but they all share a core element of consultation. This is already a core element of health and safety practice, so meaningful consultation should be very familiar to any organisation that claims to have a good safety practice and record.

In reality, of course, we take consultation for granted: it is not practiced with anywhere near the skill or commitment demanded of it in codes of practice. But it remains a key way forward in all aspects of workplace health and safety.

Improving mental health at work requires a shift from a public health promotion mode to an embedded workplace health prevention mode. It is a significant shift, but one that can not only improve people’s work lives, but also their work output, commitment and satisfaction.

Dr Carlo Caponecchia is a senior lecturer in the School of Aviation at the University of New South Wales.

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