1. How to Manage Mental Health
Problems in the Workplace
Infonex: Managing Your
Duty to Accommodate
9:10 – 10:10 Aug 30, 2011
Calgary 985
Chris Hylton, MA
CG Hylton & Associates Inc.
800 449-5866 chris@hylton.ca 1

2. Agenda
2
 What is mental health?
 Types of mental health concerns: addictions and
other mental health issues
 Solutions for a mentally healthy workplace
 Managerial and supervisory support
 Identifying problems with addiction: know the
early warning signs
 Key indicators of substance abuse

3. 3
Do you have any workplace issues we
can try and solve for you in this
session?

4. What is Mental Health?
4
 World Health Organization defines mental
health as "a state of well-being in which the
individual realizes his or her own abilities,
can cope with the normal stresses of life,
can work productively and fruitfully, and is
able to make a contribution to his or her
community”

5. What is Mental Health?
5
 People learning and be able to cope with:
 Stress
 Changes in life and the workplace
 Demands in the workplace
 Home life
 Work life

6. What is this?
6

7. Freud
7
Love and work
are the
cornerstones
of our
humanness
http://www.freud.org.uk/

8. and you wonder why we work?
8
 “No other technique for the conduct of life
attaches the individual so firmly to reality as
the emphasis on work; for his
 work at least gives him a secure place
in a portion of reality,
in the human community”

9. “Therein we have one of the
fundamental paradoxes we face today:
9
Work is good for your mental health
and work can make you crazy”
Out of the Shadows at Last: Transforming Mental Health, Mental Illness and
Addiction Services in Canada (2006), Standing Senate Committee on Social
Affairs, Science and Technology, Honourable Michael J. L. Kirby, Chair

10. 10

11. Mental Health – Overlapped by
11
Addictions
 25% of adults in a year have anxiety, phobias, panic attacks,
depression, bipolar/manic depression, OCD, ADHD,
schizophrenia, or suicide, with half having multiple MH
conditions at same time
 45% of mental health cases have medical conditions – pain,
heart disease, COPD, diabetes, asthma, hypertension,
cancer, sleep problems
1 in 3 mental health cases also have substance or other
addiction problems at the same time

12. Abusers in Past Year as
12
Percentage of Adults (Canada)
20 19 15 14 2
Alcohol Tobacco Medications Marijuana
Illicit Drugs
 Source: Attridge & Wallace (2009), MacMillan et al.
(2009)

13. Behavioural Addictions
13
Increasing
Addiction Rate in Adult Historical Trend
Population
Gambling 5% problem; 2% Increasing
pathological
Sex 3% to 6% Increasing
Food / Eating 5% women, <1% men Increasing
Internet Use 1% unknown Increasing
Workaholism 1% unknown Increasing

14. Addictions are in the Workplace
14
 Most people with addictions have jobs and are
actively in the workforce
 Alcoholand drug use tends to be higher among
smaller size employers and in certain
industries:
◦ construction and oil/gas mining
◦ transportation
◦ installation, maintenance and repair
◦ arts, entertainment and recreation
◦ accommodations and food services
◦ retail service occupations

15. Workplace Demographics
15
 It Starts Young. Younger age workers are most at risk for
developing mental health and substance abuse problems, as these
often start in the teens and early adulthood. This age group is most
relevant for prevention activities, early screening and brief
interventions.
 It Gets Complicated. Older age workers may experience declining
health status due to the cumulative effects from undertreated
mental health and addiction problems. This age group is most
relevant to integrated care approaches.

16. Alcohol and Drug Addictions Costs
16
to Society: Canada
Combined costs of:
health care
law enforcement
work productivity
disability
premature death
Average $1,267 per
every citizen
Source: Single et al (1996); Rehm et al (2006)

17. Other Workplace
17
Consequences
 Majority of all addiction
related costs (61%) are in
area of diminished on-the
job work productivity and
unscheduled work absence.
 Addictions also are also
associated with higher
health care costs, worker
injuries, disability claims,
workgroup morale problems,
job turnover, and company
risks for safe work
environments, equipment
loss and lawsuits.
Source: Attridge (2008), Attridge (2009)

18. Case Study - Jack
18
 Safety-sensitive, oilfield
construction
 Knee surgery due to work accident
several years before
 Military Veteran, previous
treatment for PTSD
 Missing work — leaving early,
coming in late, called in sick, spoke
to Manager
 Expressed Suicide wish, disclosed
drug use, asked for help

19. Response to Jack
19
 Immediate appointment to
assess safety and stabilize
 Immediate EAP or substance abuse specialist
 Employer input to counsellor
• Observations of behaviour
• Performance
• Previous assessments/testing
• Any other pertinent work history

20. Two-Year Relapse Prevention Program
20
 In cooperation with EAP Program
 Set schedule of counselling appointments
over 24 months
 Review and monitoring of compliance with
substance abuse recommendations, e.g.
inpatient treatment, abstinence, & 12-step
programming
 Regular reporting of attendance
 Option to coordinate on-going substance
testing

21. Why is the problem to difficult and
21
complicated?
ANY IDEA WHAT
CAUSES ADDICTIONS?

22. Various Theories
22
Moral Model – only a “bad person” gets
addicted and can’t quit
Disease Model – what are the genetic
and neurobiological factors involved?
Behavioural Model – what is rewarding to
the person about their addiction?
Early Environment Stress – what kinds of
toxic stress (abuse, trauma, low SES)
was experienced as a youth or in past?

23. How does someone get addicted
23
 Traditional Continuum Model of Progression
Toward Substance Abuse (Alcohol/Drug):
Source: Attridge & Wallace (2010)

24. Epigenetic Neuroscience Research
24
 “This is an extraordinary moment in the
science of mental disorders. The intellectual
basis of psychiatry is shifting, from reliance
on psychological principles and theory to
research findings and understanding the
brain through neuroscience.”
Dr. Thomas Insel, Director of the National Institutes of
Health (NIH – US) (Journal of Clinical Investigations,
2009)

25. New Research - Epigenetics
25
 Links Addictions to a Combination of Genetic
and Biological Factors that Interact with Early
Child Development Experiences
 The Greek prefix epi- in epigenetics implies
features that are "on top of" or "in addition to"
genetics; thus epigenetic traits exist on top of or
in addition to the traditional molecular basis for
inheritance.

26. 26
 development in utero and in childhood,
environmental chemicals, drugs and
pharmaceuticals, aging, and diet
 Results in cancer, autoimmune disease,
mental disorders, or diabetes among
other illnesses. National Institute of Health
 Source Wikipedia: National Institute of Health

27. 27

28. Care and Prevention
28
 Can the problem be treated or prevented?

29. Range of Treatments
29
 self-help (often multiple failed attempts) = weak evidence
 group-based peer-support programs (AA) = modest evidence
 talk therapy - cognitive behavioral therapy (CBT) = best
evidence
 brief residential detox with counseling = good evidence for
severe cases
 Rx medications and general medical care = mixed evidence
 harm avoidance programs = emerging good evidence
TRENDS = Gender differences & Holistic treatment model
best

30. Addiction is a
30
Life-long Condition
The Addiction Cycle Often Repeats Over Time, Even with
Treatment and Can Worsen
Source: Cleck & Blendy (2008)

31. Solution
31
 Screening
 Brief intervention
 Referral for treatment
 Study by Institute for Health Economics and
Alberta Health last year
 Organizational Interventions for the prevention
of Workplace Stress Jan 2009
http://www.ihe.ca/documents/Interventions_for_p
revention_of_workplace_stress.pdf

32. Workplace Solutions - Morale
32
 Make the work place a positive place!
 Celebrate birthdays
 Celebrate holidays
 Team building exercises: staff day at the movies,
staff day in the park, etc
 Sit fighting co-workers down and help solve the
issues between them
 Teambuilding workshops
 Have a zero tolerance policy

33. Workplace Solutions – HR Forms
33
 Performance Appraisal
 Make it employee focused
 Career path
 Training
 Tools they need
 Job description updated

34. Workplace Solutions – HR Policies
34
 NO BULLYING!
 Bullying any co-worker on or off the workplace
is still an offense
 Creates low self-esteem and toxic work
environment

35. Workplace Solutions – HR Policies
35
 Absenteeism Management
 Establish average absentee rate
 Place those x% above, in an Absenteeism
Management Program

36. Workplace Solutions: Manager Training
Agenda
36
What do substances look like?
What do they do?
Policies are only as
good as their Enabling, Privacy, Rights
communication ER and EE Obligations
Managers need
Treatment, Support,
support on how to
Accommodation
act and react
Performance Management
Prevention, Recognition,
Response Skills

37. What is an
37
“Employer of Choice”?
 Any employer of any size in the public, private
or not-for-profit sector that attracts, optimizes
and retains top talent… because the
employees choose to be there

38. What is an EAP?
38
 Mental health assistance for EEs and their
families
 So EEs may concentrate on work
 Short service model
 Coordinates response to critical incidents in
the workplace
 Deals tangentially with addictions

39. Typical Reasons for Calls to EAP
39
Work
place Family
18% 8%
25%
Alcohol Substance Abuse
25%
Depression
22% Stress

40. Reasonable Cost
40
 EAP costs fraction of average medical or
dental plan
 $200 per ee per mo for Dental insurance
 $5 per ee per mo for EAP
What Price?

41. Stitch in time
 If mentally, employees
believe “I am disabled” is
their natural state = difficult to
cure
 “I am temporarily having
some difficulties that I with
help of the EAP I will be able
to overcome!” = easy to cure
 Prevention key
41

42. EAP Cost
 We offer an EAP
 No cost to set up
 $125 per hour cost
 For more info
contact me
42

43. Drug & Alcohol Testing
 Discrimination rules  Safety sensitive
 No pre-employment position is one
testing where impairment
 No random drug due to drug or
testing alcohol use could
result in injury to self
 No alcohol testing
or others
for non-safety
sensitive positions
43

44. When can you test?
 Random alcohol testing for
safety sensitive positions ok
 Drug or alcohol testing for
“reasonable cause” or “post-
accident” is ok
44

45. How nice should you be?
Consider:
is it better to fight discrimination suit than
injury or death claim caused by a drunk
or impaired employee?
45

46. Face to face Therapy
46
 Mental health and addiction problems are
common to the workforce, overlap with many
medical conditions and have negative
consequences for the person and the
company
Research conclusively shows that
traditional face-to-face (FTF)
psychotherapy is generally effective for
mental health issues
 Source: Lipsey & Wilson (1993), NICE (2008), Seeling & Katon (2008)

47. Access not always possible
47
 But, access to and use of FTF treatment
is problematic. Less than 1 in 3 people
affected get quality care
 FTF care also is not uniformly effective
for all patients even when received

48. 48
•Telephonic therapy for mental health has been
tested in more than 30 research studies.
•The general conclusion is that telephonic therapy
is effective or at least promising in most of the
empirical tests conducted. Cognitive Behavioral
Therapy (CBT) has been the most commonly used
form of intervention.
•Telephonic therapy services are effective for many
conditions: Anxiety, depression, panic disorders,
substance abuse, trauma, PTSD, and others.

49. Summary of Research
49
Internet Counselling
• Internet-based forms of psychotherapy (e-mail and
web tools) also shows initial support in over 20 research
studies; many with RCT study designs.
•Online therapy services and tools appear to work best for
certain kinds of patients, when used to support other
ongoing therapy, and for use as self-care and relapse
prevention.
•Positive clinical outcomes have also been obtained with
therapist use of the Internet to interact via e-mail for
patients with depression, anxiety, social phobias, PTSD,
eating disorders, and panic disorder.
•Source: Griffiths & Christensen (2006), Reger & Gahm (2009)

50. Summary of Research
50
Internet Counselling
Conducted in UK by Kessler et al. (Lancet, 2009)
It used an online, real-time CBT intervention for 113 patients, compared to
97 cases with care as usual by a general medical practitioner.
In-person assessment of diagnosis and symptom severity, followed by a
series of ten hour-long sessions of online text-based (e-mail) interaction
with a mental health therapist.
After treatment, more patients recovered from depression in the online
treatment group (38%) than in the control group (23%). This effect also
was found at 8-month follow-up (42% and 26%).
Source: Kessler et al. (2009)

51. EASNA’s 2009 Purchaser’s Guide to
EAPs
Selecting and Strengthening
Employee Assistance
Programs:
A Purchaser’s Guide
51

52. W
52

53. Resources
 America’s Health Insurance Plans - www.ahiphiwire.org/wellbeing
53  Centers for Disease Control - www.cdc.gov/nchs/fastats/hinsure.htm
 Canadian Institute for Health Information - www.cihi.ca
 EASNA www.easna.org/purchasers.php
 Gallup-Healthways Well-Being Index™ - www.well-beingindex.com
 Health Canada – Healthy Living - www.hc-sc.gc.ca/hl-vs/index-eng.php
 Health Promotion Advocates http://healthpromotionadvocates.org/sources_detail_documents.htm
 IHPM - Institute for Health and Productivity Management - www.ihpm.org
 Mental Health Commission of Canada - www.mentalhealthcommission.ca
 National Wellness Institute - www.nationalwellness.org
 WorldatWork: global human resources association focused on compensation, benefits, work-life and
integrated total rewards - www.worldatwork.org

54. Our offer to you
54
 Please call if you have any HR, or workplace
issue that you are overwhelmed with
 We can help you
 We also are pleased to do Free Workshops for
your organization (some limits apply) Let us
know what your needs are and we will make it
happen!

55. CG Hylton - Services
 HR Consulting
 Benefits,
Pensions,
 Job Descriptions
EAP
 Salary Grids
 Strategic Planning
 Wellness at Work
 Drug and Alcohol
 Staff Morale
programs
 Training and  Dept re-orgs
Workshops
 Leadership
compensation
Tel 403 264 5288
chris@hylton.ca
55

56. Thank you for the opportunity to
56
meet today!
Tel 403 264 5288
or 800 449 5866 (800 4hylton)
chris@hylton.ca