Depression in the Workplace Dr Paul Litchfield OBE OStJ FRCP FFOM Chief Medical Officer BT Group plc
Railway Health & Wellbeing Conference London – 20 October 2014
Mental illness is part of a chronic disease epidemic Mental Ill Health (OECD) Lifetime up to 50% affected 20% at any one time Common in all age groups Fastest growing disability 3% - 4% of EU GDP
Depression (EC) Half the MH disease burden 86% in working age adults 1 in 2 cases unrecognised Knowledge based economy Presenteeism & Absenteeism A business issue!
Cumulative lost global output 2011-2030 by disease (Bloom et al., 2011)
By 2020 mental illness will be the No. 2 cause of disability worldwide - WHO © British Telecommunications plc
Depression is much more than sadness A range of disorders of varying severity - often associated with Anxiety
Predisposing Factors Genetics / Environment / Biochemistry
Precipitating Factors Adverse Life Events / Bereavement / Physical Illness
Perpetuating Factors Social Support / Financial Pressures / Embitterment
Impact: Low Mood Low Energy Low Self-Esteem
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Poor Appetite Weight Loss Fatigue Poor Concentration Hopelessness Guilt Presenteeism & Extended Absence
Insomnia Indecisiveness Suicidal Thoughts
Depression impacts on business regardless of cause Work is not normally the main precipitating factor
People’s perception may be different Business Focussed Approach: • Address perceptions as well as reality - don’t medicalise issues • Maintain active line management – disengagement is negligent! • Focus on practical employment matters – they make a difference © British Telecommunications plc
Developing a workplace mental health framework
Primary Engagement Promote Good Health
Secondary Intervention Support when Health at Risk Tertiary Resolution Managing Health Issues © British Telecommunications plc
Shift in focus with maturity
From framework to Mental Health action grid Education & Training
Monitoring & Assessment
Products & Services
Primary Engagement
General awareness training of issues and stigma avoidance
Risk assessment to control psycho-social hazards
Agile working to help balance work and home commitments
Secondary Intervention
Training of managers to recognise signs of distress and signpost sources of help
Stress audits to identify at risk workers or business units
Provision of confidential employee assistance programme
Tertiary Resolution
Guidance on rehabilitation and return to work adjustments
Access to occupational health to assess work fitness and adjustments
Access to cognitive behavioural therapy services
Good Work – Good Health: Guidelines for the European Telecommunications Industry © British Telecommunications plc
From action grid to Mental Health Toolkit • Promoting good mental health Positive Mentality Managing Pressure
Management Competencies Achieving the Balance
• Support when mental health at risk STREAM Resilience training
Health & Wellbeing Passport Employee Assistance Programme
• Managing mental health issues Open Minds – Head First Occupational Health Service Managing Mental Health CBT Service
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Making resources accessible
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Feedback through management information
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Keeping people in employment
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Keeping people in productive employment Average Clinical Outcome Data Pre
Post
16.00 13.44
14.00
Mental Health Service*
12.20
Score
12.00 10.00 8.00 6.00
4.04
3.67
4.00
• Company funded therapy
2.00 0.00 PHQ
GAD Measure
• Major health improvement Work Status Pre/Post Psychological Intervention Referral
Discharge
700
632
• Major work improvement
600
Cases
500 400 300
274
245 177
200 100
9
55
* Economic evaluation underway
0 Off Work
Restricted Duties Work Status
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Full Duties
Making the investment • Depression is a business issue
• Interventions need structure • Managers need help to understand it • Most interventions are low key • The economic cost of failure is high • The human cost can be far higher http://targetdepression.com/#intro
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