The stigma attached to mental health issues persists around the world. Many still find it hard to talk about their condition with their doctor, let alone discuss them in public. Therefore, we need to continue to work on creating an environment where people feel comfortable speaking up and seeking professional support. Around 1 in 4 people will experience a mental health problem this year yet the shame and silence can be as bad as the mental health problem itself. Your attitude to mental health could change someone’s life. It’s never been more important to tackle mental health stigma in the workplace. Organisations have a crucial role to play in supporting the health and wellbeing of their employees, whether the problems are related to work or not. Evidence shows that there are several simple, cost effective ways to support and encourage a mentally healthy workplace. You can find out more about some of these below. Strong leadership Fundamental to creating a mentally healthy workplace is strong leadership. As well as noticing changes in employees and providing support, line managers also need to be aware of their own behaviour. This can have a strong impact on others. Tackle stigma and discrimination Challenging stigma and discrimination against mental health problems in the workplace can result in employees
Scotland's anti-stigma campaign, See Me, have information and free resources on their website to help you better understand stigma and discrimination in the workplace. Visit the See Me site for tools and resources Provide training There are several training opportunities available online and via FD Consultants. These can help you and your employees
Signpost to useful resources You should make sure employees are aware of any employee assistance or occupational health programmes you provide. You could do this in several ways, such as
Provide support to employees off work If an employee takes time off work due to work related stress or a mental health issue, there are several steps you can take to encourage and support them to return as quickly as possible. Steps include
Join the movement We need your help to change the way people think and act about mental health problems. Join thousands of campaigners in workplaces, schools, communities and online who are making stigma and discrimination a thing of the past. Join the Time To Change Movement today.
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As mentioned last week, the BBC World News programme discussed the topic of mental health for aid workers. I was asked to provide statistics to support the segment, which were taken from research in my book. The below figures highlight the need for organisations to implement a good trauma management programme and best practice psychosocial support:
Programme guest Michael Bociurkiw, a global affairs analyst, agrees that these statistics are shocking in themselves and that organisations are not doing enough to support their staff on the front line. There are more conflicts happening and people jump from one placement to another without any time off, compounding already overworked and stressed staff. Donors need to press organisations to support staff, giving them enough funds so people can have time off to recuperate and get access to much-needed counselling. Watch the full interview below. Today at 12.30pm the BBC World News Channel ran a piece talking about the mental health of aid workers. As my regular followers know, this is an area I am extremely passionate about and feel that wider discussion is needed on the subject to support humanitarian aid workers, and those working in the armed forces or as first responders. We should be educating, not only individuals working in these roles to be better prepared to manage their own mental health and look out for those around them, but also to educate organisations so they can implement strategies to support and protect their staff/volunteers. Unfortunately I wasn’t available for the interview on the programme but I was very pleased to provide them with interesting statistics to support the discussions. The statistics come from my own research for my book, Psychosocial Support for Humanitarian Aid Workers and are as follows:
Organisational support of relief workers deserves more systematic and thorough research. Ongoing exposure to trauma creates occupation-specific health needs. Despite known occupational hazards, anecdotal reports indicate that employers offer little social or psychological support in the field or after assignment. Explanations differ. Nongovernment organisations may have unrealistic expectations of workers’ adaptive capabilities, combined with limited resources. One survey of non-government organisations’ human resources staff found that psychological support of workers was considered less important than that of the local population. Furthermore, workers themselves may feel that their suffering is less relevant as well. These findings have implications for humanitarian agency employee practice as well as research. Prior to service, workers—both expatriate and national staff—should be informed of the risk of potential exposure to trauma and related psychological effects. Organisations should develop and facilitate appropriate evidence-based support services in the field. Humanitarian agencies should offer culturally appropriate medical and psychological support for national staff during service, and they should put systems in place for ongoing support following agencies’ departure from the site and expatriates’ return home. I also carried out a survey on the types of critical incidents we managed over three years (Dunkley, 2018)
There has been other research carried out which was used to support the findings in my book, including:
There is a significant body of evidence to demonstrate that workers directly exposed to traumatic events, including transportation disasters, physical attack, shootings, harassment and accidents, during the course of their work have an increased risk of developing PTSD, major depression, anxiety and/or drug dependency (Breslau, 1998). A study that examined the mental health of national humanitarian aid workers in northern Uganda concluded that over 50 per cent of workers experienced five or more categories of traumatic events. Additionally, respondents reported symptom levels associated with high risk for depression (68 per cent), anxiety disorders (53 per cent) and PTSD (26 per cent), and between one-quarter and one-half of respondents reported symptom levels associated with burnout (Ager et al., 2012). A recent longitudinal study indicated humanitarians are at increased risk for depression, anxiety and burnout during deployment and after returning; aid workers also had lower levels of life satisfaction compared with pre-deployment levels, even months after returning from the field (Cardozo et al., 2012). Overall, as the demand for humanitarian relief work continues to grow, continual trauma exposure has important implications for occupational mental health. Research on psychological effects of relief work is limited and should look more broadly at trauma-related mental health outcomes, including depression, anxiety, and alcohol use in addition to PTSD. Having conducted a lot of research in this area and with many years of experience Fiona discusses how organisations can prepare their staff before deployment in her new book “Psychosocial Support for Humanitarian Aid Workers”. Get your copy today to find out more, available from Amazon. Mindfulness is a useful tool for managing anxiety and stress. Regular mindfulness exercises can change our brain functioning and enable us to remain more rational and become less reactive and emotional. ‘Research shows that mindfulness helps to stabilise our moods, improve sleep, reduce anxiety, deepen concentration, and improve self-compassion’ (Brown et al. 2007). Some organisations are now seeing the benefits of mindfulness exercise for staff and are including this in resilience training days. ‘Research on the benefits of mindfulness in the workplace demonstrated increased job performance, job satisfaction, improved work-life balance, and enhanced focus & concentration’ (Rebb & Atkins 2015). The initial stage of trauma and acute stress therapy is often referred to as ‘stabilisation’, and includes normalisation, psycho-education and building resources. Many techniques can be introduced to manage symptoms and re-triggering, including mindfulness, which enables a client to learn how to relax and ground themselves when dealing with the more difficult feelings that may come up during the ‘processing’ stage of the therapy. In this fourth and final short clip of my presentation for the BACP Conference I wanted to share with you a simple mindfulness exercise that everyone can do at any point during their day. References
The third blog in this series shares a short snip of my presentation at the BACP Conference which focusses on developing a ‘trauma management programme’ part of a critical incident plan. The Trauma Management Programme should define every stage of a critical incident, from early intervention, trauma-specific treatments, follow-up, right through to recovery. A well thought-through critical incident plan saves lives and helps people recover quicker. Staff need training, guidance, knowledge and clear policies. The reality is that major incidents almost always catch us unaware; therefore, forward planning is essential. I would recommend that a Trauma Management Programme include the following: Immediate Crisis Management The situation is often chaotic in the initial stages of a critical incident. Thus the immediate stage of any crisis is all about practical support, and deescalating and defusing the situation. Five points to consider in the immediate crisis phase: 1.) Safety and Practical support; 2.) Non-judgmental communication; 3.) Offer empathy, not sympathy; 4.) Empower the individual impacted; 5.) Offer information and implement clear administration processes. Screening Most people will recover from a traumatic event naturally, but having an evidence-based screening process, one that is culturally and ethically appropriate, can monitor individuals who may need further support. Screening should be carried out on a regular basis, ideally within the first week following an incident, then at one month, six months and one year follow ups. Family liaison support Family Liaison officers are necessary when a member of staff has died or they are unable to speak for themselves, perhaps through a kidnapping incident or being unconscious. The family liaison officer’s responsibilities include: being the point of contact between the family and the organisation, keeping the family informed, listening to the family’s needs, providing practical guidance, signposting for further support where necessary, and helping the family deal with the reality of the situation. The family liaison officers also need supervision and psychosocial support when necessary. Peer support Peer support programs are a great resource and support to national staff as they are versatile, cost-effective, and can offer support to staff that are harder to reach. Peer supporters are volunteers within the organisation. They will be assessed regarding skills and resilience, before being trained and offered supervision. This training should consist of trauma awareness & Psychological First Aid, management of sexual assault, stress & resilience, and training of the trainer (where necessary). It is often colleagues that notice the first signs of a peer struggling and are well placed to offer early psychosocial support, and by doing so, can improve an individual’s recovery. Psychological First Aid (PFA) PFA focuses on understanding trauma symptoms and building coping strategies and resources. PFA is educational, does not explore the incident in detail, and therefore can be offered to individuals who experienced the same event, but had different levels of impact and exposure to the traumatic incident. It can also be offered whilst an incident is still on going, such as working in a war zone etc. PFA offers a chance to triage and assess staff. The advantage of PFA is that peers can be trained to facilitate groups, making it an economical and accessible option. Psychological Debriefing Debriefing focuses on processing an event in detail and bringing a sense of closure to the traumatic incident. Individuals would be assessed to decide which debrief group they would be best suited depending on the level of exposure to an event. It is important to place individual’s who have had a similar experience and level of exposure together in the same group, so those who were less impacted are not exposed to further traumatic material. Although there is some controversy of using debriefing many organisations such as emergency first responders, Employment Assistant Programs (EAPs), NHS foundation trusts, various NGOs and United Nations departments are continuing to use various forms of psychological debriefing. Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) have endorsed psychological debriefing (Tuckey & Scott, 2014). Initial trauma assessments Some staff members may choose not to attend a psychosocial group, or it may not be beneficial to them, depending on the nature of the traumatic incident. Therefore an initial individual trauma assessment, which can be carried out remotely, and covers elements of the PFA model, can be helpful. Specialist trauma counselling If an individual’s symptoms persist after 4-6 weeks we would recommend trauma specialist treatments. The main two treatments are Eye Movement Desensitisation and Reprocessing (EMDR) and Trauma-Focused Cognitive Behaviour Therapy (TF-CBT), both of these models have been culturally adapted to be effective globally, although many countries do not have access to specialist trained therapists in these approaches. It is therefore useful not to overlook other trauma therapies that are also getting good results globally, such as Narrative Exposure Therapy (NET), and the Tree of Life Model (Denborough, 2008). Additionally, clinicians can offer these services remotely through various software applications and webcam. Follow up/closure It is good practice to offer follow up appointments one month, six months and one year after a traumatic incident, so staff feel that their experience of having been through a distressing situation is acknowledged, and that they are supported and valued by their organisation. Watch the presentation here: |
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