What does evidence based practice really mean when thinking about mental health at work?

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1 What does evidence based practice really mean when thinking about mental health at work? Dr Adrian Neal- Consultant Clinical Psychologist Head of Employee Well-being ABUHB Chair - Division of Clinical Psychology Wales (BPS)

2 As a rule we are not educated or socialized to understand mental health no wonder we struggle to understand how to improve it at work.

3 Are we talking about diagnosis?

4 Mental Health Or are we talking about a spectrum? Mental Illness

5 But If we don t understand our own mental health (our emotional world), can we begin to understand that of others?

6 Do we use our understanding of physical health as a yard stick? If only I had a broken leg Understanding mental health even from a how does it work perspective is not straight forward, you then add social meaning and decades (centuries) of assumptions and stereotypes its complicated.

7 CIPD Survey responders, 22% report MH is the primary cause of long term sickness absence (>9%) Presenteeism & Leavism and work related stress (37%) increasing 55% increases in common MH problems (>14%) Prevalence of people struggling with their MH at work 14.7% to 60% (Averaging 25%). Relevance in numbers UK is facing a mental health challenge at work that is much larger than we thought Thriving at work report (2017)

8 Making sense of mental health The Diagnosis debate. Acknowledge biopsychosocial factors The Stress Vulnerability Model

9 Degrees of evidence Statistics, reliability, validity and reality. Who s evidence Evidence

10 Outside of Public Health it is focused on illness. What works for whom? NICE based evidence (RCTs) health economic and effectiveness = evidence based therapies. Limitations of RCTs practice & limitations in the real world. What works? (in the clinical world) Matrics Cymru.

11 Are we aiming to prevent or minimise the risk of people developing Mental Health problems? (Prevention) Or Or Both? Are we aiming to simply support and help those who are struggling with their Mental Health? (Reaction) What works at work

12 What works at work: Reactive Brief psychological therapy Counselling. Outcomes are useful but not definitive. Mindfulness no long group term effect unless practiced regularly and takes time. Return to work support often time rather than BPS formulation based how do we know? Group training psychoeducation can be useful but does not offer long term protection. Put simply you can t just rely on reactive methods, interventions and initiatives to best protect your most valuable assets. Resilience training 2015 meta analyses show some short term gains, but not over time. All of these forms of help can be valuable for many, but we lack robust evidence to support their clinical effectiveness beyond simple evaluation.

13 Dr Joanna Wilde, author of The Social Psychology of Work.

14 Even with a well resourced and considered reactive model of support, you are inadvertently sending a message. You are source of the problem, once we fix you - all will be well. The unintentional narrative

15 A dilemma: The power of work A good experience of work is now considered a positive health outcome it ll support your physical and mental health. A bad experience of work will harm you, and is now known to be worse for your health than unemployment. Weinburg & Doyle Psychology at Work (2017) BPS

16 What works at work: Prevention? We know that we can no longer sustain a narrative where illness resides entirely within individual employees. We need to consider that the work may also be having an impact on mental health via well-being. The modern workplace is rich in psychosocial threats to our well-being (just as physical threats such as toxic chemicals, exploitation, and other overt dangers once were).

17 Changing the narrative The evidence to change how we proactively improve mental health at work is strong and compelling we change the narrative and focus on improving psychosocial wellbeing, thus reducing the harmful demands, pressures that we know trigger and maintain poor mental health. Change the experience of work

18 So how can you do it? Changes in seven areas will improve, and protect the mental health of all employees

19 1. Making the workplace psychologically safer breaking the cycle Has work become associated with threat? Human threat response. Threat activation becomes normal.

20 These experiences activate our hard wired threat response Injustice & inconsistency Belittlement or coerrtion (bullying) Shaming, Social rejection, cruelty & humiliation Loss of social position being undermined Disempowerment (loss of autonomy) Loss of value / worth

21 2. Purpose, meaning & Identity

22 3. Understanding the real demands of the work What are the psychosocial demands of the work? Once you understand the demands you can develop the resources (personal and systemic) Enthusiastic employees excel in their work because they maintain the energy they give and the energy they receive Prof Arnold Bakker (2018) Job Demand - Resource Model

23 4. Peers, teams and relationships

24 5. Role clarity What is the work & who s work is it?

25 Emotional and organisational literacy vs Management Competency Understanding the psychosocial function of the manager? NICE Guidelines Who supports the manager s wellbeing? 6. Management & Leadership

26 7. Fairness and justice

27 Take home messages Good individual MH at work is supported through strategic organisational well-being. Focusing entirely on Reactive interventions doesn t work and may pose an ethical dilemma. Mental health is a nebulous and socially sensitive with less in common with physical health than we assume. Diagnosis can be useful but not necessarily the best way to make sense of a person s difficulties. Shame & stigma are powerful and can make matters worse.