When You Can’t "Tough It Out" Anymore

When You Can’t “Tough it Out” Anymore

January 1, 2017


Here's why employers in some of Canada’s most stressful industries are working to dispel the stigma surrounding mental health issues.

It wasn’t the first time that RCMP Constable Peter Neily had shared his story when he spoke with us, and it will unlikely be the last. His story has become a beacon of hope to those struggling with occupational stress injuries and the stigma surrounding mental health.

Constable Neily doesn’t talk about the incident that led to his own occupational stress injury, just his response to it. In March, 2011, in Surrey, B.C., another officer pulled over a car for blacked-out taillights. The officer noticed a rifle on the back seat. The car fled, and he called for backup. Constable Neily responded. After the car was slowed down by a spike strip, Constable Neily rammed the car to deter the suspect from fleeing, and ended up with his passenger side window lined up with the driver’s side window. He found himself staring down the barrel of a rifle pointed at him by a swearing hostile. He shot first and the suspect was killed. Constable Neily was exonerated by a subsequent inquiry, but the incident stayed with him.

Normally a gregarious networker, Neily noticed at a conference some six months later that he retreated to his room during breaks. He slid into alcohol abuse, spiralling downhill quickly. He feared the stigma associated with asking for help, and was convinced no one cared about him. It wasn’t until the next summer that Constable Neily finally sought assistance.

Why is it so hard to pick up the phone to call for help? Is it the fear of losing one’s job, the stigma of not being strong enough to cope?

Constable Neily isn’t alone in his experience. Employees are increasingly demanding that occupational stress injuries be treated with the same respect as physical injuries, and employers are responding with new mental health programs that attempt to reduce the stigma.

Policing, corrections and health care are three high-stress occupations. We talked to representatives from the RCMP, the Correctional Service of Canada (CSC) and the Michael Garron Hospital to ask them about their mental health programs.

The problem

The culture of many organizations supports a “tough it out” approach over seeking help. Managers often see psychological distress as less legitimate than physical injury. Yet 30% to 50% of disability claims are for mental health or occupational stress injuries. Mental or emotional fatigue is a factor in 28% of absenteeism in police forces.

Occupational stress isn’t limited to high-stress professions. Almost all jobs have become more stressful, as workload is increased, support staff removed, and the mantra “do more with less” is chanted by stakeholders. You are expected to do your job plus more.

Linda Duxbury, a Carleton University professor and expert on workplace stress, identifies the main causes of occupational stress as:

  • Multiple, ever-changing and competing number one priorities — it’s all urgent and important, and whatever you pick will be the wrong choice
  • Understaffing
  • A culture of “suck it up and just do it,” in which seeking help is seen as a sign of weakness
  • The expectation of availability — for example, being expected to respond 24/7 through smart phones, or police officers having court time on their days off

People are now operating at full capacity all the time. So when a peak comes along, they can’t always handle it — they just don’t have the capacity or the resilience. Basically, occupational stress involves pushing people psychologically beyond their capacity to cope.

Duxbury compares it to a rock on the beach. The waves erode the rock, and over time it becomes fragile and brittle, and not able to stand as much stress. So when someone hits the brittle, eroded rock with a hammer, it breaks.

She believes we need to redesign jobs so that staff can manage the day-to-day with enough resilience in reserve to also handle the occasional peak stress or incident.

Louise Bradley, CEO of the Mental Health Commission of Canada, recently wrote in the Ottawa Citizen that, “We don’t need more evidence, we need more backbone… stigma is diluting the political will to shepherd much-needed change… there’s no new money, [it’s] do more with less.”

Sign Up to Our Newsletter
Get content like this in your inbox every two weeks.


The good news, according to the Mental Health Commission of Canada, is that, “If identified and treated early, mental health concerns can be temporary and reversible. Employees who understand normal reactions to stress and how to manage these reactions are more resilient. They have the ability to recover from stress, traumatic events and adverse situations.”

So how do organizations train people to recognize changes in their own mental health, become more resilient and recognize and respond to psychological issues in their employees? A look at some of Canada’s most stressful professions provides insights.

RCMP

The Commissioner’s recent (October 6, 2016) apology to female members who had been harassed was not part of their Mental Health at Work program, but it was part of a larger emphasis on building respect, and a public indication of some of the broader efforts going on behind the scenes. The RCMP is determined to improve how it handles occupational stress issues. For one, they don’t talk about “post-traumatic stress disorder” anymore. It’s “occupational stress injury.” This reflects more than just a name change to reduce stigma. It demonstrates that a psychological injury is as real as a physical injury — it is not a “disorder” but a natural consequence of a highly stressful incident. Constable Neily agrees; he doesn’t use the term either.

The RCMP rethought their approach in 2014. Their strategy has three goals: reducing stigma, taking proactive steps, and improving the management of psychological health and safety.

The new RCMP process, as described by Assistant Commissioner Stephen White, has been to:

  • Get senior management to buy-in
  • Set up a network of Mental Health at Work Champions, with White as the lead
  • Develop and implement a strategy and an action plan.

The elements of that action plan are designed to get the topic out from the shadows, and to create the capacity amongst staff to manage mental health issues.

A key step is enhancing knowledge of mental health by providing a “mental health tool kit,” which teaches staff how to react and provides modules about a healthy workplace. Some training is done through specific courses, and some is done through a module in other training, so the message can be spread more quickly and effectively.

The “Road to Mental Readiness” training is scheduled to be given to all 30,000 staff by early 2018. Over 7,000 have already completed it — including all new recruits. So there will be an interesting dynamic for a while, with new recruits expecting and demanding understanding from their superiors, some of whom have yet to take the training.

“Ten years from now, it will be natural. Now, we need to stop and think,” says White.

Ensuring the availability of support is a key strategy. There are 300 officers trained in peer-to-peer support, led by a team of 11 full time coordinators, one in each region. There are in-house specialists, a connection to Health Canada’s EAP program, access to Veterans’ Affairs clinics and involvement with the Canadian Forces. They currently have a pilot project developing an RCMP-based support system, and 30 disability managers are being hired to facilitate support at an early stage.

For organizations considering adding an emphasis on mental health at work, “It’s critical,” says White, “Surveys suggest 60% of staff are affected by psychological health issues, but only 23% of them are willing to talk about it or seek resources. So there is a need to engage and be proactive. The starting point is to reduce the stigma, then make sure the support and services are there, and make them easy to use.”

White believes the results are worth it: “A healthy organization, with healthy members, performs better.”

Constable Neily reflects: “I wouldn’t like to think about what would have happened to me without this help.”

Correctional Service of Canada

In 2015, concerned about the impact of work stress and mental health issues on their staff, the Commissioner and top management at CSC decided to increase their focus on this area.

Nathalie Dufresne-Meek, Director General, Executive Secretariat and Manager of Wellness Programs at CSC advises that there are two crucial steps to implementing such a program:

  1. LEADERSHIP FROM THE TOP
    The Commissioner chairs the mental health committee, making it clear that this is one of his priorities.
  2. ENGAGE STAFF AND UNIONS
    on the goals and strategies of the program, and recognize that diverse groups of employees have distinct needs and risks.

Realizing that in any one year, one in five Canadians experience a mental health problem or illness (while only a third of them seek services and treatment), the Commissioner, in his consultations within the organization, sought out what CSC could do to support employees living with mental health injuries. He set up and chairs a steering committee, which has representation from management, staff and unions.

Their focus is centred on the rollout of the Mental Health Commission’s Road to Mental Readiness program. A total of 2,200 of their 17,000 staff have been educated and, by the end of 2017, all staff will have received training. They are developing CSC-specific videos to accompany and support the instruction, as well as a smart phone app, the development of which is being crowd-sourced.

Tamara Carly, a parole officer at Beaver Creek Correctional Institution, benefited from this approach. Not all workplace occupational mental health injuries are post-traumatic. Hers was due to repeated impacts over a 16-year career, starting with her first case. On reviewing the file she saw a picture of the crime scene, drawn by a young girl, who had witnessed her father murder her mother. Several events combined with a high-stress work environment resulted in Carly not sleeping and not eating. She suffered debilitating anxiety, constant irritability with friends and loved ones and marital trouble. “One day I was sitting in my doctor’s office and it hit me — ‘holy crap, I’m experiencing depression and anxiety.’ When I saw the doctor, I broke down and she put me off work immediately. It finally felt like I wasn’t going crazy. I felt like there might be hope for me yet,” says Carly.

Two years of stress leave followed. Carly is now back on the job, with accommodations and support. She shares her story in the hope that she can help others do the same. “If you need help, it is available. Don’t be afraid of the stigma. I fight the stigma every day and together we can break it. Mental illnesses are just like any other disease. Someone with diabetes or a heart condition can talk openly about their issues, and it’s time that we do the same for this,” says Carly.

Rather than waiting for staff to self-identify as needing help after a critical incident, management identifies and provides support and follow-up to those directly involved. They are backed up by a return-to-work program. Still, cumulative effect cases, like Carly’s, need to be encouraged to come forward.

CSC has a mental health injuries web site, a peer support program is under development and staff stories about mental health (like Carly’s) are being shared.

All of this is backed up by CSC’s EAP, the Return-to-Work program, recognition programs, critical incident stress management, and the Duty to Accommodate program (removing barriers to employment and accommodating employees when such barriers cannot be removed). It is also part of each executive’s performance agreement. And, as Louise Bradley advises, the organization has made a financial investment in workplace mental health initiatives.

Meek’s advice to others seeking to respond to this need in their organization is to get support from the top, and engage staff and unions in the development of the goals and strategies. Improving staff well-being is everybody’s business. “The work is demanding, and we are proud of our staff, as they work in support of public safety,” says Meek.

At the broader Public Service of Canada level, James Kelly of the Treasury Board Secretariat advises: “A healthy workplace is the foundation of an effective, productive, and engaged federal public service that is best able to serve Canadians.” The federal government is developing a workplace mental health strategy, to be released shortly.

Even though the RCMP and CSC will be part of that strategy, they have already started on their own.

Michael Garron Hospital (formerly Toronto East General Hospital)

Unlike the RCMP and CSC, Michael Garron Hospital has had a mental health program in place for some time. In 2004, the hospital launched an initiative to improve patient care and job satisfaction. They decided to use a management framework developed by Excellence Canada, which focuses on building a healthy workplace. In 2008, the team put forth its first Mental Health Strategic Plan.

Michael Garron Hospital has built up some impressive results: They have been recognized by the Mental Health Commission of Canada as an early adopter and industry leader in psychological health and safety in the workplace. Staff engagement is now tops among community hospitals, overall health care costs have been reduced by 7%, absenteeism is reduced to 6.55 days per year (from 10.66), patient satisfaction scores are up, emergency room wait times cut in half and clinical metrics have improved.

The CEO is deeply involved. She signs a Statement of Commitment each year to protect the psychological health and safety of staff. Champions have been assigned responsibilities. The hospital participates in national campaigns such as Bell’s “Let’s Talk,” Partners for Mental Health’s “Not Myself Today” and Mental Health Week. Staff are trained in emotional intelligence — to promote effective interpersonal skills.

Their wellness specialist, Christine Devine, says: “Quality and value are inextricably linked. Partnering with Excellence Canada to use their frameworks for excellence, innovation and wellness, and for mental health at work, has helped embed our mission, vision, values, strategic success factors and philosophy of wellness in everything we do.”

Their results are clear, and significant. Michael Garron Hospital has moved from a hospital that was under monitoring by the province regarding concerns about performance, to one of the best-performing community hospitals in the province. Their programs indicate that a focus on employee wellness can produce extremely positive results.

The mental health programs adopted by these three organizations suggest that the drivers behind increased attention to mental health in the workplace appear to be a combination of economics (the high costs of sick leave and absenteeism), concern for employees’ health and happiness and the belief that healthy, happy employees provide better service.

The key success factors for effective programs involve top management commitment, employee engagement and involvement, and the use of a conceptual model, adapted to their situation, to guide the process, such as the Mental Health Commission of Canada’s Road to Mental Readiness or Excellence Canada’s Mental Health at Work.

In the case of the RCMP and CSC, it is too early to measure positive results, but anecdotal evidence suggests that reducing stigma and providing resources allows staff to drop their “tough guy” attitude and seek the help that is there, while providing managers with knowledge of the resources available. Constable Neily recalls, “One of the things I found easy to do at first was sit back and be negative. You hear in the media there is no support — but that’s just not true.”

These are high-stress jobs, and management is now looking at how to help employees recognize problems and accept help. For too long, a culture of “buck up, don’t show you’re hurt” prevailed. Now, by reducing the stigma and increasing the resources available, help is reaching those who need it.

 

Related Articles

No review process is perfect, but performance reviews can be improved.
In the attempts to overcome racism and sexism, there is another kind ...
Every spring, the workforce is flooded with students, but don’t get fooled ...



ABOUT THE AUTHOR
Paul Crookall
Dr. Paul Crookall is a researcher, writer and management consultant. He was formerly an executive with the Correctional Service of Canada.

Related Articles

No review process is perfect, but performance reviews can be improved.
In the attempts to overcome racism and sexism, there is another kind ...
Every spring, the workforce is flooded with students, but don’t get fooled ...