From: Building Trades of Alberta: Investing to Secure our Future Conference Jasper, Alberta, Keynote Address by Joseph Ricciuti
KEY NOTE ADDRESS: WORKPLACE MENTAL HEALTH
by Joseph Ricciuti, Co-‐Founder Mental Health International, President SEB-Benefits and HR Consulting
Good afternoon ladies and gentlemen.
I’m pleased to be here with you today and I would like to express my sincerest appreciation to your Executive Director, Warren Fraleigh, for including workplace mental health as part of the Conference program.
I would also like to add a special note of acknowledgement to Bill Wilkerson, who was not able to join with us today. His work in mental health is recognized around the world, and much of what I will talk about today is largely shaped by his involvement and input.
This afternoon, I will speak to a topic that is fraught with challenges for the building trades industry: Workplace Mental Health.
Let me be clear, I will not talk about mental health as a new issue. It is already here-‐ in the form of the very high prevalence rates among new job entrants and longer term workers, who are in their prime earnings and working years. These folks are the backbone of the economy and their economic power is being undermined by medical conditions which often elude our attention and will to act.
Instead, I will discuss why investments in workplace mental health are important to organizations and to the hard working men and women in the construction and building trades.
To start, it is natural to ask and wonder; who and where are these people that are struggling with mental illness?
Well, it could be anyone of us who are here today and those of us who are not: your colleagues and co-‐workers, friends and family. We are the face of mental illness. We are these people. We are them -‐ here and now.
The business case for investments in workplace mental health is shaped by these facts:
1. The cost of mental illness to Canadian Economy is
$51 billion and represents 4% of GDP.
2. The trend in disability prevalence rates are heading in the wrong direction and mental health issues have become the leading and fastest-‐growing cause of workforce disability: 30-‐40% of claims
3. Not only is absenteeism and disability impacted by mental illness but, there is an exponential effect on health care costs, performance issues and occupational injuries.
4. 7 out of 10 people with depression are in the workforce and depression is a chronic disorder that is clinically linked to a number of other physical disorders such as: heart disease, diabetes, arthritis, digestive problems, asthma and thyroid disease.
5. In cases where these conditions co-‐occur the minimal impairment of one is overpowered by the disabling effects of the other, resulting in a compounded rate of disability and absence from work.
6. Job performance is significantly impaired -‐ sevenfold when an employee lives with depression vs. the absence of depression.
7. Long-‐term disability is often the end result of mental conditions which go unrecognized, untreated or improperly treated on-‐the-‐job and in the early sick leave and short-‐term disability periods.
8. The longer workers are off work for any reason, the more likely it is that a mental health problem becomes a secondary diagnosis and the less likely they will return to work at all. After 12 weeks, studies show that 75% return to work. After one year, the rate of those who return to work plummets to a level of no chance of returning,
Consider also that the Alberta Construction and Trades Industry is a critical contributor to Canada’s domestic economy and the prosperity of Albertans. It employs over 256,400 people and represents about 11.3% of the total workforce. Workers under union coverage are well represented at 83.1% and collectively, all people employed in the Trades accounted for 10.8% of Alberta’s domestic product in 2014!
These are critically important economic numbers and they build a compelling business case for targeted investments to ensure sustainable growth and business opportunities for the Province. After all, this is an industry too important to the economy to fail.
And know this, whether we live and work in good times or when times are not as good, the economic climate plays no favourites when it comes to the well-‐being and safety of workers.
When the economy is booming, workers face increased work demands and work strain caused in part by a quick work pace and long inflexible hours, and home pressures to balance family requirements and commitments.
When economic conditions are not as good, the fear of job insecurity and being unemployed are profound.
A recent article in the Calgary Herald, summed up the impact of the current economy this way:
‘Calgarians are stressed, worried and even panicked about job loss, the economy and their financial futures. People seeking help due to stress have nearly doubled -‐ a 91% spike -‐ from the same month last year. It has created a lot of doom and gloom… and they are not just from people who have lost their jobs... it’s from workers and family members stressed about impending job loss’.
As the building trades industry continues to evolve, workers are faced with unprecedented change as they attempt to find new ways to function against a back drop of intensifying work demands, new job skills requirements and a changing economy that may impart additional stress on an industry that reports higher than average rates of substance use and abuse, and consists of occupations that report poorer mental health and in according to a study by Harvard , double the suicide rates than the general population.
Working within the industry can entail working in isolated locations, long hours, and irregular schedules -‐ all of which may lead to eventual burnout and increase the risk of on-‐the-‐job injuries. It is for these reasons that investments in mental health are essential to secure the future.
I have described what mental illness does, Here is what mental illness is – and is not.
Mental illness is not a function of character, weakness or laziness.
Mental illnesses are the result of a complex interaction of genetic, biological, personality and environmental factors with the brain as the final common pathway for the control of our behaviour, cognition, mood and anxiety.
Let me explain in more detail:
· Most mental illnesses are found to be more common among family members, suggesting a genetic basis to the disorders.
· Personal factors also weigh in…age, gender, and lifestyle choices can contribute to the onset of mental illnesses.
· Environmental factors, such as a family situation, and workplace factors can precipitate the onset or recurrence of a mental illness.
· Mood disorders can have or contribute to a common pathway with physical illnesses, such as cancer, heart disease and diabetes.
· Genetics research, also suggests that the risk of developing a mental illness may be related to defects in multiple genes rather than any one gene…. likely the result of an interaction between genetic and environmental factors. This offers hope in that the modifiable environmental factors can be identified and become targets of prevention. More on this later.
Depression and anxiety disorders have physical origins in the brain and physical properties that affect virtually every part of our body, from our immune system to our cardiovascular health.
In terms of what constitutes ‘mental illness’, depression and anxiety disorders are the most common family of conditions. For example, depression sub-divide into dysthymia, a milder form, unipolar serious depression, and bipolar disorders, also called manic depression, that manifests itself in extremes of great highs and lows.
Generalized anxiety disorder – extreme and persistent worrying and fear – is part of a family of conditions consisting of panic, obsessive-‐compulsiveness and post-traumatic stress disorders. Combined, the depression and anxiety families constitute more than 90% of the actual number of cases of mental illness in the Canadian work force.
Mental Illness is recognized in law and the Supreme Court has rendered discrimination against persons suffering mental illness unlawful. Insurance contracts today do not and cannot discriminate between physical and mental illness as a source of disability. And employers have a duty to accommodate a worker’s return to work from a mental disability and/or addiction.
And hear this:
-‐ none of the mental health issues are associated with permanent disability, unless treatment is not available...
-‐ none of these conditions turn people into damaged goods...
These conditions can be successfully treated – in clinical studies, the success rate is 80%. However, fewer than one in five of those who experience these disorders seeks or get the medical help they require.
This is a social tragedy. Instead of getting help, the issue manifests itself and can lead to poor work concentration and job performance, risk of injury and poor social interaction with peers and ultimately the economic cost of mental disability in the Canadian labour force –
The culprits that prevent people from receiving treatment can be attributed to two key issues: Stigma and Access to care.
So let me say a few words about each:
Stigma:
Stigma sticks and it is the root cause of workplace reprisals against workers known to be suffering from these conditions. As a result, workers often go to great lengths to ensure that supervisors and co-‐workers do not find out about their illness.
Stigma is a complex social process with many components, including negative imagery, fear, intolerance, social inequity, where people are not given the same opportunities, and unfair treatment and discrimination.
In a recent survey, conducted by Moods Magazine, in which they undertook to understand attitudes of working Canadians, the results indicate that 64% of respondents would be concerned about how work would be affected if a colleague had a mental illness.
Of these, about 43% explain their concern as fear for their safety, and the safety of others. They also talk about fear that the co-‐workers with mental illnesses will not be reliable.
The problem with this type of fear is that it can also prevent people from seeking help. In the same survey, 39% of workers indicated they would not tell their managers or supervisors they had a mental health problem; of these, more than half said disclosing it will hurt their career and job security.
The conundrum plays out like this:
Mental ill health can impact productivity at work, so support at work is critical for workers who seek help because they are finding work challenging...at the same time they risk losing the support because of prejudices and stereotyping against people dealing with a mental health issue. As a side note, much progress is being made in anti-stigma training, thanks to the work right here in the Province of Alberta, by a collaborative effort of the University of Calgary and the Mental Health Commission of Canada, through the Working Mind Initiative.
Access to care:
The challenge of long wait times to see medical specialists, like a psychologist and psychiatrist, are prevalent because there is more demand than supply for mental health services. There is also the challenge of distance if you happen to live and/or work in remote areas where the nearest doctor’s office can be many miles away. This is a reality for a lot of Canadians, and in particular for workers and families in the Building Trades of Alberta.
The good news on this front has been the new world of mobile self-‐help apps and virtual medical clinics, which provides the user of the services with access 24/7, anywhere.
Some of these new tools are capable of providing effective psychotherapy. The patient effectively becomes the navigator, co-ordinator and manager of their care.
This empowers the patient to engage and adhere to the care journey most suited and preferred by them. The services are private and confidential. Some of the excellent tools that exist to assist are: Feeling Better Now, Equinoxe Life Care, Meschino Health and ‘Check up from the Neck Up’ through Moods Disorders of Canada.
And just as important, early detection is critical to the effective treatment of mental disorders. The warning signs are too important to ignore.
Research by the National Institute of mental Health determined that mental disorders can reduce a person’s life expectancy by a staggering 25 years!
This is not a scare tactic -‐ it’s a wake-‐up call.
Mental health is not just a mood disorder, it’s a cognitive disorder and it affects the way we think and perform.
It is also not just an anxiety problem, it’s a breathing problem, a blood problem, a suppressant of our immune system and an amplifier of chronic pain.
Depression can make the heart work harder, reduce heart rate variability and increase the risk of heart attacks, and increase the rate of stroke among women.
Whether we work in the building trades, manufacturing and transportation industry, in the corporate world or in the new technology work-space, we are all working in an economy of mental performance.
This is an economy:
- Where mental health and safety have tangible, functional value to all businesses, public and private, union and non-‐union, and communities.
- Where white collar, and blue collar workers use information and work in teams.
- Where the person of every collar uses his or her brain more than their brawn, where the minds of people, not their backs do the heavy competitive lifting in today’s market economy.
- Where, today, it makes as much sense to promote and protect the mental health of the labour force as it was in the 70’s and 80’s to do so for workers’ physical health.
In the 21st century, as a workplace health priority, mental illness has become what respiratory illness, back injury, vision and hearing loss, carpel tunnel and dangerous plant sites were for the 20th century.
In fact, the cost of short and long-‐term disability in many organizations and with trustee plans, exceed the cost of workers’ compensation.
This demonstrates the shift from work-‐related physical illness and injury to mental health and safety, wherein home and job stress is synergistic, and causation may not be solely work-‐related but the effects are -‐ and that’s what counts.
A recent survey by StatsCan revealed that 33% of trades helpers and labourers reported poor mental health (Marchand 2007), and some have turned to substance abuse to cope with the stress....and substance abuse is associated with higher rates of accidents, absenteeism, lower productivity and morale, and higher costs related to workers’ compensation and disability insurance.
For Owners, Contractors and Labour Leaders alike, mental health issues in the workplace are too important to be overlooked and it imparts a special onus on them to understand the issues and to work in harmony towards a common cause: the mental well being of workers and their families.
Therefore, to be disinterested of the relevant information and the trends they fortell....is to either be negligent of a duty to care by turning a blind eye to the issue or blinded by the mythology of mental illness.
I hope it is not the former, so let me take a moment to address the latter and dispel some of the myths and encourage hope for the future.
Myth #1: Employees suffering from depression are damaged goods and can’t recover or come back.Wrong - on every count! They can, they do and with appropriate treatment, management and labour support, they will.
The evidence to support this is strong: In a Community Health Survey, it was reported that 69% of Canadians 25-‐ 64 years of age suffering bipolar disorder are employed
This is only 9% below the corresponding proportion of people without the disorder. What is key to this promising statistic is the support from friends, family and co-‐workers/colleagues.
Myth #2: Employees suffering from depression and anxiety pose a risk to their co-‐workers. This is nonsense.
Myth #3: Employees suffering from mental health problems are unreliable employees. Wrong big-time.
Myth #4: Most mental health disability insurance claims are fake. Wrong. About 20% involve malingering.
Myth #5: Mental health problems give employees an excuse for taking time off work. Wrong.
In fact, those that are most frequently diagnosed with depression tend to be in the 10th to 12th year of service with the same employer. Most try to work through their health problems until they crash.
Myth #6: Depression reflects a weaker disposition. This is wrong. Professional Athletes are treated for depression – in their case, it is a disorder of the strong.
War heroes suffer depression. Rescue pilots who put their lives in danger everyday suffer depression. In their case, it is a condition of the brave. Abe Lincoln and Winston Churchill all dealt with major depressive disorder and both were considered the best leaders of their time.
Research has also shown that our work environments continue to affect workers’ mental and physical health and according to a recent survey conducted by Towers Watson, job stress has been cited as the number one issue. The Impact is profound:
· The annual cost of work time lost to stress is $12 Billion
· According to a Chrysalis study, stress contributes to at least 60% of workplace accidents
· In a separate US study, by the University of Iowa, when depressive symptoms were present, workers had a 41% increase risk for injury, after controlling for anti-depressant use, gender, prior injury, income and sleepiness.
· Other studies consistently show that frequent conflicts with supervisors or colleagues, and high psychological demands more than double the risk of being injured in an occupational accident.
And while job stress can make an existing mental health disorder worse or lead to job strain and the onset of a mental health condition, it can be a health and safety hazard -‐ on par with dangerous equipment, polluted air and criminally poor maintenance.
Work related stress is the response people may have when presented with work demands and pressures that are not matched to their capabilities and which challenge their ability to cope. Stress occurs in a wide variety of work circumstances and it is often made worse when workers feel they have little support and control over work processed.
There is often confusion between work pressures and stress. When work pressures and challenges are perceived as acceptable, they may keep workers alert, motivated and able to work and learn (depending on available resources and personal characteristics).
However, when pressures become excessive and chronic, it leads to unhealthy stress and poor performance.
Across most occupations, and in particular the construction and building trades, work overload, decision latitude, long hours, workplace conflict and poor work-‐ life balance sow the seeds of worker distress and ultimately their health and performance.
So how is stress a risk factor to our clinical mental health?
In short, stress produces a hormone called cortisol which mobilizes our bodily resources in the ‘short-‐run’ as a reaction to a threat, fear, worry or pressure, and then returns to normal: for example when someone is faced with a flight or fight situation during a robbery.
However, when there is sustained stress that continues for long periods of time, the production of cortisal can destroy neurons in our brain and this can result in depression. This said, scientific research is giving us new hope...with evidence pointing to signs that the brain is plastic and the effects of stress reduction and psychotherapy encourage new neurons to grow and reverse the damage. Creating a healthy work environment is one way to reduce stress and support healthy minds.
But let’s be careful when we talk about stress and the work environment. We hear a lot about the importance of workplace culture to work performance. Which is fine and dandy in a corporate setting but in the construction and building trades workplace, which is very mobile and where tradesmen and tradeswomen in any given year can work with multiple employers, workplace culture is simply this – it is how we treat each other on the job, how we behave and what behaviour we tolerate or nurture, and how we can make a positive difference in our work environment and in the communities we serve.
It is also a culture where workers are encouraged to embrace health and health promotion as a priority and make it part of their working lives.
These principles have no fixed boundary - they exist in workplaces with walls and work-spaces without walls. The absence of these basic principles increase the risk of chronic stress and chronic stress not only affects workers health but it is emerging as a new workplace issue called: mental injury.
Mental Injury is not the same as mental illness, although it could be. Certainly, workers do not always or even often have to prove a diagnosable mental illness to win a claim for mental suffering or injury at work. These days, even excessive work demands can lead to successful legal action if a worker can establish that the demands led to mental suffering of a predicable nature. Long gone are the days when only gross acts of violence, harassment and discrimination form the basis of such claims.
Mental injury, according to most modern day courts and tribunals, is simply meant as harm to mental health (mental suffering) that significantly affects the ability of workers to function at work and at home.
And thanks to ongoing developments in the law, workers have a right to a psychologically safe and healthy work environment -‐ one in which every practical effort is made to protect the mental health of workers.
In case law in Canada, employers/unions have a duty to care about the mental health of their working populations and recognize that the conditions of chronic job stress on the health of workers is like a super flu bug and a dynamic boiling pot of environmental, personal life experiences and brain response that can pose a risk to the mental health of workers.
Across Canada, on-‐the job physical and mental injuries from acute stress are now being covered by Workers Compensation Boards, but there has been a reluctance by them to accept claims for compensation of mental injury resulting in whole or in part from gradual onset of workplace stress (chronic stress).
However, successful rulings through Canada’s Charter of Rights and Freedoms advance the definition of chronic job stress as an on-‐the-‐job injury, and workers compensation boards have been compelled to pay for absence away from work.
The court decisions are clear, in that the dismantling and sometimes deadly effects of mental illness cannot rely solely on medical treatments or psychological care alone. Prevention of environmental risks are essential and that includes dismantling the sources of chronic job stress through effective education and training. In response, the Mental Health Commission of Canada led the development of the National Standard for psychological health and safety in the workplace. It’s a robust tool to assist businesses and unions to improve the psychological health and safety of workers in the workplace.
So, where do we go from here? First there is good news to report.
Leaders of private and public sector organizations, union and non-union alike, have begun to recognize the importance of workplace mental health and they are implementing programs for improvement across the continuum of care. From prevention programs to support programs and effective return-‐to-‐work programs, their initiatives include: mental health awareness training, alcohol and drug guidelines and testing, personalized medicine, wellness programs, access to EAPs and accommodation support. Not to be forgotten is the work and resources provided by the Government, and from the provincial and local community groups, universities, and science and business partnerships in research, who all recognize the need to find better solutions to improve the mental health care and safety of workers and the general population at large.
While awareness of mental illness is growing, awareness of solutions is less so.
Adequate care is available and thanks to new technology it’s becoming more accessible and affordable than ever before. I believe that investments made today will pay themselves back tenfold in the future and if I were to dispel another myth today, it’s that, the investments in mental health are not as large as some might think.
Tools exist to assist and many of them are even free! In the context of all of this, I encourage you to:
Build your business case for mental health investments on known facts governing the impact of mental illness on the economy and the well-‐being of workers and their families. Educate yourself on this topic and give workers in your organization every conceivable opportunity to inform themselves and their families.
· Start by knowing what you don’t know: More research is required in the Building Trades industry. I encourage the BTA to survey its building tradesmen and tradeswomen to better understand the gaps in knowledge and the barriers which impede the progress to improve mental health conditions.
· Make resiliency training part of skills training
· Kick start an anti-‐stigma campaign and consider the Working Mind Initiative.
· Improve the delivery of covered behavioural and mental health services in health benefit plans. Get your arms around your group drug plan and disability insurance as a single construct. If the costs of drugs are going up and disability rates due to mental illness are going up too, something’s not right. A ‘portfolio management’ approach is called for in these matters.
· Consider using available DNA tests, to improve the accuracy and quality of prescribing psychotropic medications.
· Create a mental health peer support network and implementation framework, so workers have access to someone who can be empathic and assist when guidance and support is needed. This will be a huge help to workers who are both at work or who may be returning to work.
· Modernize and gain access to confidential e-‐health self-‐help tools and virtual medical clinics to ensure early detection, privacy and access to care, no matter where workers live and work.
· Adopt the National Standard and if possible enshrine it as part of CBAs.
Most of all start somewhere. As I said earlier, the tools exist to assist. Google exists. The Mental Health Commission of Canada can assist. Moods Disorders of Canada can help get you started. I will help you. My phone rings when my number gets dialed...and I have a habit of answering the call. Warren Fraleigh, your executive director is eager to help....and I know from experience that he picks up when called too.
AS A FINAL THOUGHT, LET ME USE A QUOTE FROM A FRIEND WHO WISELY SAID: WHERE THERE IS HOPE FOR THE FUTURE, THERE IS POWER IN THE PRESENT.
So let me challenge you to this– why not create a vision of a richly imagined future and start today with a proactive approach to mental health – as an opportunity to seize, rather than a problem to dodge.
This would be a great act of leadership.
Labour Unions and Contractors alike – leadership by example.
In that light, let me invite you to a special celebration party in the very near future – not one with hoopla and noise-‐makers – but one where we are the party to the success of the investments made now that secured the future– a future that has embedded in its culture, the importance and value of workplace psychological health and safety, to ensure the well-being of all building trades workers and their families.
Thank You
Delivered by Joseph Ricciuti: September 30th, 2015, Jasper Alberta Building Trades of Alberta Conference. Not for commercial reproduction.