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Occupational Health
Clinics for Ontario
Workers Inc.
PREVENTION, INTERVENTION
AND COMPENSATION IN
REGARDS TO MENTAL INJURIES
AND MENTAL HEALTH
Definitions:
 Mental Injury:
 Mental Disorder:
 Mental Illness:
 Mental Disease:
 Mental Condition:
 Mental Health:
Mental injuries/disorders/illnesses
Anxiety Disorders
Attention Deficit Disorders (ADD)
Bipolar Disorder
Depression
Eating Disorders
Mood Disorders
Psychosis
Schizophrenia
Self-Injury
Suicide
Violence
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5)
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Check-Up from the Neck Up:
http://www.mooddisorders.ca/sites/mooddisorders.ca/quiz2/checkup.php
What is normal?

does “abnormal”
start here?
or here?
 
exactly
average
what about
out here?
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The effects of labelling:
 If you given a diagnosis of “soft bones”
(osteoporosis) what effect does that
have on your quality of life?
 If you are given a diagnosis of “manic
depressive” (bipolar disorder), what
effect does that have on your quality of
life?
 What are the attitudes to mental
illness in your workplace (stigma)?
A workplace issue
Economic burden:

“10 to 25% of Canadian workplaces effectively
mentally injurious – not good for the mental health
of their employees” … “leading cause of short-term
disability and long tern disability – it’s the biggest
single reason people are off work for periods of
time”
 “estimated at $51‐billion” … “ up substantially over
the past decade”
http://www.youtube.com/watch?v=5qfTFxOc6Xo&feature=player_embedded
Speech of the Honourable Michael Kirby
“What’s
stressing
the
stressed?
Main
sources of
stress
among
workers”
by Susan
Crompton
(Stats Can)
2011
“In Canada, in 2010, 27% of
working adults reported that, on
most days, their lives were ‘quite’
or ‘extremely stressful.”
http://www.statcan.gc.ca/pub/11-008-x/2011002/article/11562-eng.pdf
the new
CSA
Standard
Z1003-13
http://shop.csa.ca/en/canada/occupational-health-and-safety-management/cancsa-z1003-13bnq-97008032013/invt/z10032013/?utm_source=redirect&utm_medium=vanity&utm_content=folder&utm_campaign=z1003
Vision
A workplace that promotes workers’ psychological well-being and allows no harm to workers mental health...
Key Drivers
Cost Effectiveness
Risk Management
Recruitment & Retention
Excellence & sustainability
Strategic pillars
Prevention (1°)
Promotion (2°)
Resolution (3°)
Psychological
& social support
Organizational
culture
Clear leadership
& expectations
Civility and
respect
Psychological
demands
Growth and
development
Recognition
and reward
Involvement
and influence
Workload
management
Engagement
Balance
Psychological
protection
Protection of
physical safety
Tracking the Perfect Legal Storm
(Shain, 2010)
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Labour relations law
Employment standards
Human rights legislation
Law of torts (negligence)
OH&S law (violence & harassment)
Workers’ compensation changes (BC)
Awards up 700% over that last 5 years
… recent opinion (22/10/2013) that CSA standard sets the
legal criteria for a psychologically safe system of work
… no specific legislation …
http://www.mentalhealthcommission.ca/English/node/506?terminitial=30
WSIAT/Charter Decision:
WSIAT/Charter Decision:
WSIAT Decision No. 1945/10
 “The distinction is, therefore, substantively
discriminatory against injured workers who develop a
mental disability.
 Mental disability is an enumerated ground in
subsection 15(1) of the Charter.
 Subsections 13(4) and (5) of the WSIA therefore
infringe subsection 15(1) of the Charter.
 The provisions of subsections 13(4) and (5) of the
WSIA are not saved by section 1 of the Charter as a
reasonable limit demonstrably justified in a free and
democratic society.”
Biomedical Model:
…disease the result of disruption of
psychological processes wherein
subjective perceptions, behaviors
and personality factors ( e.g.,
neuroticism) are of primary
importance (i.e., disease proceeds
from the individual to the
environment).”
Focus on what’s going on
between the ears
Occupational Psychology
P. Schnall, Session # 1 – Part 1: Introduction to “Work
and Health”, UCLA SPH EHS 270/CHS 278 Spring 2009
(March 31, 2009)
Social Epidemiological Model:
“negative health outcomes (illnesses) are due
to the impact of social epidemiologic factors
(in general class, work, race and gender)”
– Occupational Sociology
Focus on the interaction between the social
environment and the person
P. Schnall, Session # 1 – Part 1: Introduction to “Work and Health”,
UCLA SPH EHS 270/CHS 278 Spring 2009 (March 31, 2009)
prevention level
Prevention
individual
organization
primary - coping and primary – changing
appraisal skills
the workplace
secondary - wellness,
secondary relaxation techniques awareness, screening
(mindfulness)
(MH 1st aid)
tertiary - therapy,
tertiary - Employee
counselling,
Assistance Programs
medication, support (EAP), Return to Work
soooooo….
How would you
go about
measuring
stress?
If you can’t measure it …
 Misquote from Deming
 Some of the most important things at
work (in life) can’t be measured (e.g.
Valentine’s)
 Objective and Subjective measures:
objective bias (more scientific)
Stress Check App (Azumio)
(measures heart rate variability)
https://play.google.com/store/apps/details?id=com.azumio.android.stresscheck&hl=en
https://itunes.apple.com/us/app/stress-check-pro-by-azumio/id439500612?mt=8
time
work
7:00 AM
5:30 AM
97%
4:00 AM
roller blading
at lunchtime
2:30 AM
1:00 AM
2%
1%
11:30 PM
27%
20%
17%
bedtime
supper
wake-up: rarin’ to go!
commute – traffic jam
62%
60% work
58%
55%
50%
49%
48%
45%43%
42%
37%
10:00 PM
8:30 PM
7:00 PM
5:30 PM
4:00 PM
2:30 PM
1:00 PM
11:30 AM
10:00 AM
8:30 AM
7:00 AM
5:30 AM
0%
4:00 AM
10%
2:30 AM
38%
31%
30% work 24%
18%
16%
20% 17%
1:00 AM
40%
11:30 PM
50%
watching a scary movie before bedtime
100%
10:00 PM
60%
8:30 PM
70%
7:00 PM
80%
commute
supper & dishes
90%
5:30 PM
4:00 PM
HRV (in %)
Measurements over a 40 hr period
woken up by
job offer call
90%
77%
67%
7%
Psychological “Subjective”
Measures:
 Remember, perceptions/symptoms
are the “gold standard” (DSM-V)
 Diagnoses made on the basis of answers
to a series of questions (some of which
are observable by others; some not)
 Some questions don’t work directly (… are
you depressed?) and thus need to be
questioned indirectly
http://www.dsm5.org/Pages/Default.aspx
DSM-5: Depression screening
(individual)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself—or that you are a failure or have let yourself or
your family down
Trouble concentrating on things, such as reading the newspaper or
watching television
Moving or speaking so slowly that other people could have noticed? Or
the opposite—being so fidgety or restless that you have been moving
around a lot more than usual
Thoughts that you would be better off dead or of hurting yourself in some
way
http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Level2DepressionAdult.pdf
Mental Injuries Tool (MIT) Group:
 The Mental Injuries Tool group was established
in 2009 out of a stakeholder sub-committee of
worker representatives and the Occupational
Health Clinics for Ontario Workers who were
charged with “supporting worker
representatives in taking action on prevention
and workers’ compensation”.
 This sub-committee held a workshop in 2010 to
select projects which could be developed jointly
to address common concerns. The topic which
received the most interest was mental injuries
(workplace psychosocial risk factors;
recognition & compensation for mental injuries).
MIT group - who’s involved:
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Terri Aversa, OPSEU - Chairperson
Laura Lozanski, CAUT
Sari Sairanen, UNIFOR
David Chezzi, Andréane Chénier, CUPE [Bridget Pridham]*
Nancy Johnson, Erna Bujna, ONA
Valence Young, ETFO
Gerry LeBlanc, Sylvia Boyce, USW
Janice Klenot, UFCW 175/633
Jane Ste. Marie, John Watson, OSSTF
Kathy Yamich, Workers United Union
Charlene Theodore, OECTA
Tom Parkin, Workers Health and Safety Centre (WHSC)
Sophia Berolo, University of Waterloo
Ashley McCulloch, Carleton University
Jenna Novess, Brock University
Andy King, LOARC (Labour, OHCOW, Academic Research Collaboration)
Maryth Yachnin, IAVGO
Alec Farquhar, Kristen Lindsay, OWA
Patricia Phillips, Brenda Mallat, Curtis VanderGriendt, Ted Haines,
Mark Parent, Andre Gauvin, John Oudyk (OHCOW)
MIT Group Reviewed Available Tools
 Looked at theories of jobs stress:
 Job Demand – Control model (Karasek)
 Effort – Reward Imbalance model (Siegrist)
 Transaction Process model (Lazarus & Folkman)
 Organisational Justice (Kivimäki et al)
 Looked at survey instruments and tried
them out – compared experiences
 UK-HSE, JCQ, GM@W, SOBANE and others …
COPSOQ
Copenhagen Psychosocial
Questionnaire
(COPSOQ II – short version)
http://www.arbejdsmiljoforskning.dk/Sp%C3%B8rgeskemaer/Psykisk%20arbejdsmilj%C3%B8.aspx?lang=en
COPSOQ Psychosocial Hazards:
COPSOQ health measures:
 Self-rated overall health status
 Burnout
 Stress
 Sleeping troubles
 Somatic stress symptoms
 Cognitive stress symptoms
Physical safety factors:
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safety hazards
workstation ergonomics
physical factors (noise, lighting)
thermal comfort
air quality
dangerous chemicals
biological hazards
radiation (ionizing and non-ionizing)
driving hazards
working alone
Other additions:
 two more offensive behaviours:
 “discrimination” (undefined – ask respondent for
definition)
 “vicarious offensive behaviours” (ask respondent
to identify all)
 a global question rating the
psychological health & safety climate
 questions about behaviour based safety
attitudes
How do we do it?
1. Recruit a coordinator/champion in each
unit (knowledgeable on workplace stress)
2. Get buy-in (union, employer, establish
steering committee)
3. Administer survey (define units, collect
e-mail lists, Dilman’s 5 contact survey
administration, spreadsheet report
production, identify top 3 issues)
4. Begin dialogue to improve top 3 issues
Collecting responses
 Send URL link to participants who fill
out survey online (5-15 minutes)
 Response confidential; downloaded by
Clinic
workplace psychological H&S climate
Results:
A toxic workplace
workplace psychological H&S climate
Things we’re learning:
 difference between the psychological
approach compared to the sociological
 no regulatory “stick”, so we have to
work strategically
 bullying can be a symptom
 don’t rush in without a plan (are you
ready?)
 learn, organize, assess, change, evaluate
 population comparisons vs. symptom
associations
MIT Tools:
Website http://www/ohcow.on.ca/MIT
Guide
Survey (often use Survey Monkey)
You-Tube videos
Posters, cards
[training materials]*
[mini-MIT: shortened guide for
workplaces]*
 App http://www.ohcow.on.ca/MITApp
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Survey
Co-ordinator
Information
Package:
Videos:
Poster:
http://www.opseu.org/bps/social/workplace_stress/index.htm
Guidebook:
http://www.ohcow.on.ca/mit
https://www.youtube.com/watch?v=F49TF_aSClk
http://www.youtube.com/watch?v=LREe5M5Q8co
http://www.youtube.com/watch?v=hzk9t3T32wk
http://www.youtube.com/watch?v=k26T28scAyg&feature=youtu.be
http://www.youtube.com/watch?v=0bWnO3hemCQ
… the survey in
app format …
 In partnership with the
CCOHS, we’ve created
an app that allows you
to do the survey and
have your own personal
score
http://www.ohcow.on.ca/MITApp
Are You Ready to Do It?
Stages of Change
 Pre-contemplation (Not Ready) – “what problem? That’s just
the way things are in this line of work – always has been,
always will.”
 Contemplation (Getting Ready) – “maybe things could change
but I don’t know if I’m prepared to change? It is easier
though, just going along with things the way they are, but
maybe …??”
 Preparation (Ready) – “things could be better and I think it’s
worth the effort to try – let’s get together and figure out how
to do something about this …”
 Action – “we’re going to make the following changes and hope
things will improve – I’m glad we’re finally doing something
about this!”
 Maintenance – “so, we’ve made the changes, they might need a
bit of tweaking, but I think this is going to work out in the long
run”
Drivers
(sticks and carrots):
1. Costs ($51 billion)
2. Risk (do you want to read about your
workplace in the newspaper?)
3. Legal liability (Martin Shain’s work)
4. Worker retention and recruitment (good
place to work)
5. Excellence and sustainability
6. The right thing to do – “law is the
conscience of those who have none”
(James Ham, 1983 IAPA Conference)
What can you do?
Occupational Health
Clinics for Ontario
Workers Inc.
Taking Action on
Workplace Stress
John Oudyk, Occupational Hygienist
Occupational Health Clinics for Ontario Workers (OHCOW)
http://www.ccohs.ca/products/webinars/workplace_stress/
http://www.ohcow.on.ca/mit
prevention level
Prevention
individual
organization
primary - coping and
primary MIT tools
appraisal skills
secondary - wellness,
secondary relaxation techniques awareness, screening
(mindfulness)
(MHFA)
tertiary - therapy,
tertiary - Employee
counselling,
Assistance Programs
medication, support (EAP), Return to Work
Thank you!