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

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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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