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HomemistoryMental Health: Removing the Barriers to Care

Mental Health: Removing the Barriers to Care

Mental health issues exist in the workplace – you can’t just ignore them – they impact your workplace, your employees, your suppliers and customers… and your productivity. Fortunately, barriers experienced by registered health practitioners seeking treatment for some mental health issues, are now being removed.

Mental illness rates among Australian healthcare professionals are worryingly high compared to the national average. They are being driven by emotionally challenging cases, threats of violence, long hours, fears of misconduct allegations and worst of all, stigma around discussing mental health concerns.

These issues are most prevalent in trainee/graduate doctors and nurses, who are twice as likely to report high levels of psychological distress compared to senior peers.1 Approximately a quarter (24.8 per cent) of these medical professionals also reported experiencing thoughts of suicide in the previous 12 months, with two per cent having made an attempt on their lives.1

Encourage them to stay and talk to people, or if they insist on leaving the practice, check to see whether there is someone they can go home to or a loved one they can visit

Marcela Slepica, Clinical Services Director, at AccessEAP, an Employee Assistance Program (EAP) provider in Australia says, “Healthcare organisations need to tackle these unique challenges their employees face, including patient care and mortality, workplace stress and worryingly, a stigma around asking for support with their mental wellbeing.”

“It makes sense for healthcare organisations to invest in the mental health of their staff, as the benefits are seen in reduced absenteeism, sick leave, and work-related psychological injuries,” she added.

A major barrier to registered health practitioners seeking professional help has been the stigma attached to mental health issues. A study by Beyond Blue in 2013, found that approximately 40 per cent of doctors believed medical professionals with a history of mental health disorders were perceived as less competent than their peers, and 48 per cent felt that these doctors were less likely to be appointed compared to doctors without a history of mental health problems. Approximately 59 per cent of doctors felt that being a patient causes embarrassment for a doctor.1

Additionally, there has been the threat of not being able to practice. Right now, registered healthcare practitioners treating another registered healthcare professional for a mental health issue, are legally and ethically obliged to report the patient practitioner to the Australian Health Practitioner Regulation Agency (AHPRA).

However this is about to change. Recognising the significant barrier, Australia’s federal, state and territory Health Ministers met in April this year and assented to a landmark decision that will enable registered health professionals to seek appropriate treatment for most mental health problems without being reported to AHPRA.2

Speaking of the decision, Federal Health Minister Greg Hunt said, “Until now, there have been significant unintended barriers to doctors and nurses seeking the appropriate mental health treatment because of
mandatory reporting requirements.”

What has been agreed is a system that will both protect patients, but critically, remove barriers to doctors and nurses receiving and accessing the mental health treatment that they want.

“Removing barriers whilst protecting patients with important provisions, to ensure that there is not practice which is detrimental to those patients (is) critical.”

The final legislation will be developed in consultation with the States and Territories and medical professionals.

The State of Mental Health in Australia

  • 7.3 million (45 per cent) of Australians aged 16 to 85 will experience a common mental health disorder (such as depression, anxiety or a substance use disorder) in their lifetime.
  • Almost 64,000 people have a psychotic illness and are in contact with public specialised mental health services each year.
  • 560,000 children and adolescents aged four to 17 (about 14 per cent) experienced mental health disorders in 2012–13.
  • Almost one-third (30 per cent) of Indigenous adults have high or very high levels of psychological distress in 2012-13 and were 2.7 times as likely as non-Indigenous adults to have these levels of psychological distress.
  • The Australian Institute of Health and Welfare (AIHW) estimates that around AU$8.5 billion per annum is spent on mental health-related services in Australia. Services include residential and community services, hospital-based services (both inpatient and outpatient), and consultation with specialists and general practitioners.

Reference

ama.com.au/position-statement/mental-health-2018

MAKING THE WORKPLACE MENTALLY SAFE

Australian legislation now requires that practice owners provide their staff with a safe workplace, which includes their physical and psychological safety.

Of course there are some safety issues in the workplace we can control and some we can’t. The trick is to put procedures in place that minimise the risks of a traumatic event occurring and minimise the impact in the event that one does.

WHAT DOES A WORKPLACE TRAUMA LOOK LIKE?

“Trauma in the workplace is something out of the ordinary – it could be a patient coming in with a mental health issue and losing it in the waiting room – getting aggressive, angry, and/or throwing something,” explains Ms. Slepica. “Eye health professionals are generally not prepared for this type of behaviour – it’s
scary – it creates anxiety because it’s hard to know what to do.”

Other examples of trauma might be advising a patient that they have a significant medical problem or witnessing an unexpected medical event occur – such as a seizure or heart attack – in the practice or consultation rooms.

As a practice owner, it’s your responsibility to help your staff prepare for and manage traumatic events like this, realising that people respond to trauma differently. While some like to bury the trauma and get on with their day; others want to run away to be alone. Additionally, people who have experienced trauma before may have a more reasonable, or a more traumatic response… it all depends on the individual.

Step away or stay where you are and put your hands up in front of you so they know you have nothing to threaten them with.

Managing Aggression

While it may be unusual for patients to become aggressive in your practice, it can happen. Increasing use of methylamphetamine (ice) may be one reason – researchers have found a direct link between the use of the drug ice and violence, with a six-fold increase in violent behaviour when chronic users take the drug.3

Additionally, a growing number of people living with Alzheimer’s Disease may mean that you encounter  patients who are confused, upset and can become aggressive.

Then there are those who’ve simply had a bad day and are unable to control their emotions.

Ms. Slepica says in most circumstances, the way you handle the aggression will influence the flow on effect.

“It’s a natural response to shout back at people when they shout at you, however it is important not to argue when someone is being aggressive and not to give them a response, such as ‘it’s not my fault’, which will only make them feel more aggressive towards you,” advises Ms. Slepica. “If you can, invite them to sit down, away from other patients in the practice, to talk about what they need. Try to de-escalate their anger by offering your help, but politely ask them to calm down first. If the aggression continues, advise them that you are unable to assist while they are feeling as they do and calmly ask them to leave the practice.“Typically an aggressive person wont respond to any request straight away, so you’ll need to repeat yourself in a calm voice.”

Managing a person who is agitated having taken drugs is another story entirely. It’s a traumatic situation that is unpredictable and there’s no one strategy that will work for everyone. However, Ms. Slepica advises, there are some verbal and physical cues that may help calm the person.

“Most importantly, you don’t want them to feel threatened, so step away or stay where you are and put your  hands up in front of you so they know you have nothing to threaten them with. Then, in a calm but firm voice say, ‘its ok, we’re going to help you’. Sit them down and try to move any other people from the area. While this is happening, someone in your practice should be phoning the police. At the end of the day, you need to look after own well being and safety – and of course the safety of patients in the waiting room.”

Australia’s Work Health and Safety Act

In 2012, Australia’s state and territory governments developed model laws (WHS Act and Regulations), on which they could base their health and safety laws. These replaced Occupational Health and Safety laws, which differed across states and territories.‘Health’ is defined in the WHS Act as both physical and psychological health.

According to the WHS Act, a “workers’ psychological and physical health can be adversely affected by exposure to a poorly designed or managed work environment, a traumatic event, workplace violence, fatigue, bullying or harassment and excessive or prolonged work pressures. Any of these factors can increase the likelihood of workers experiencing a stress response.

“Stress responses describe the physical, mental and emotional reactions which arise when workers perceive that their work demands exceed their ability to cope. Job stress is not in itself a disorder, illness or psychological injury. If job stress is excessive or prolonged it may lead to psychological or physical injury.

“Increased frequency or duration of stress responses have been linked with high levels of unplanned absences including sick leave, staff turnover, withdrawal and presenteeism and more task errors. It can be a significant cause of injury or illness which may lead to depression and anxiety in the long term.”

Reference

www.safeworkaustralia.gov.au/doc/preventing-psychological-injury-under-work-health-and-safety-laws-fact-sheet

PSYCHOLOGICAL FIRST AID FOR TRAUMA

“There is a variety of responses to traumatic experiences like these, and every response is OK, every response needs to be recognised,” says Ms. Slepica. “Typically, the person will feel shocked and numb, and
they won’t be able to think straight. So, we can’t expect them to go back to work under these circumstances because they’re at risk of making a mistake”.

She said helping staff to cope with trauma involves acknowledging their feelings, reassuring and calming them.

“When appropriate, reassure them that the trauma over, that everyone is safe and there to support each another. Recognising that everyone responds differently, ask the person what they need.”

While leaving the practice to go home may at first appear to be a sensible plan of action, it is important that the person is supported.

“Encourage them to stay and talk to people, or if they insist on leaving the practice, check to see whether there is someone they can go home to or a loved one they can visit.”

I worry about people relying solely on anti-depressants because you need to make other changes in your life

MANAGING PATIENT GRIEF AND LOSS

While there aren’t too many deaths involved in eye care – unless its due to an ocular tumour – optometrists and ophthalmologists often have to advise or manage patients with serious, sight threatening eye disease.

Understandably, this can be traumatic for both you and patient, especially if the patient has been in your care for many years.

“Managing a patient’s grief is hard,” says Ms. Slepica. “When we give someone bad news, most of us want to make them feel better, so we try to say something to help the situation.

“Sometimes that’s not helpful because the person in shock won’t hear it, all they will focus on is, ‘I’m going blind’ and what that loss means for them and their loved ones. The more effective strategy is to sit with the person, provide them with the information in a way that is simple and easy to understand, and let them know the details can be talked about later, at a follow up appointment.”

Additionally, Ms. Slepica said, it is important to remember that again,everyone’s response to a trauma will be different.

I would encourage people to say, “I can’t imagine what that’s like, but I’m sure it’s very hard”, rather than saying, ‘I know what you’re feeling'”

Ms. Slepica describes the stages of grief as “a roller coaster of shock, sadness pain, anger, helplessnessand powerlessness, and then acceptance”. Along the way, we go up and down and the only thing that makes it better is time. She says it’s wise to keep in mind that if a person loses his or her eyesight today the emotions will be at their strongest. A year later, although they will less strong, the feelings will still be there and still need to be acknowledged.

“I would encourage people to say, “I can’t imagine what that’s like, but I’m sure it’s very hard”, rather than saying, ‘I know what you’re feeling’ – because you don’t know how an individual is feeling and they may get angry or feel you’re being condescending or insincere.

MANAGING YOUR OWN HEALTH AND WELL BEING

Our own mental well being impacts our performance, our productivity and the way in which we interact with and respond to others. Understandably, if you’re mentally exhausted it will be a struggle to show compassion to patients, staff and suppliers.

There are a number of components that contribute to mental fatigue; the successes, failures, challenges, recognition and responsibilities of our work; the pressures of our lifestyle and whether we exercise, sleep and eat well enough; positive and negative social connections and the demands of family for instance.

Ms. Slepica emphasises the need to focus on taking control of what you can in the workplace, to take breaks, and to talk about challenging cases with colleagues, family and friends.

“For me, social isolation is a key issue impacting mental health. I think it’s a problem that will grow in the future because we’re so connected to our technology, which means we’re not connecting socially. In the old days, we sat down in the lunch room and talked, we got involved in team sports, and at home, we talked around the dinner table and sat together to watch a TV show then talked about it. Now everyone’s doing their own thing on their individual screens. We don’t talk about day to day stuff, which helps get worries and negative thoughts out of our heads.”

There’s also an increasing temptation to reach for a ‘quick fix’. “When things go wrong and we feel  vulnerable, anxious or depressed, we may believe the easiest, fastest path to recovery is to ask your GP to prescribe medication. This is not necessarily the easiest way to regain mental health… I worry about people relying solely on anti-depressants because you need to make other changes in your life.

“As psychologists we make suggestions about lifestyle, sleep etc but primarily we work with our patients’ thoughts, ie, the way they think about things, because this can significantly impact their mental health.

“A ‘glass half empty person’ – someone who thinks quite negatively about things – may be vulnerable to mental health issues. Although challenging, it is possible to help retrain them to think positively, which is great for their mental well being.”

Becoming conscious of negative thoughts then challenging them are essential in this retraining process. A simple example would be the case of a person who finds the rain negatively impacts their mood. They would be encouraged to think about how they could view the rain differently, in a way that generates more positive thoughts about its benefits.

For me, social isolation is a key issue impacting mental health

“Whether you believe the thoughts is not important in the beginning, however over time, the more you challenge negative thoughts and turn them into positives, the more positive your thoughts will become. It takes time and it is hard work, which is why people choose counselling,” said Ms. Slepica.

She said other ways to challenge negative thoughts include writing them into a journal then trying to rewrite them in a positive language. “Again, in the early stages, it is all about trying to change the words not the feelings. If we challenge people to change their feelings they’ll become anxious because negativity is what
they feel familiar and safe with; it’s what’s they know. It’s hard to let go of the familiar, even if it isn’t working for them.”

IDENTIFYING THE SIGNS

Although more people talk freely about issues surrounding mental health than ever before, and despite forthcoming changes to legislation surrounding the health professions, the stigma is likely to remain for some years to come. However, there are some things you can do to promote mental health and well being in your practice.

Regularly checking in with staff to make sure they are OK provides an opportunity to open lines of  communication, which will be especially important in the event of a mental health issue or traumatic event.

Openly discussing mental health in group meetings; inviting experts, such as Beyond Blue, to speak to your staff; and displaying information about how to maintain positive mental health and available counselling services are other ways you can help break down the barriers.

Observation is also a powerful tool. There are a number of behavioural and physical changes that may alert you to a colleague, family member or friend who is experiencing a mental ill-health issue. Perhaps the person used to take an interest in their appearance but now they’re looking dishevelled and wearing the same clothes on multiple days; or maybe they’re arriving late to the practice, whereas previously they were always on time. Other indications may be social withdrawal, increasing anger, making statements like, “what’s the point?”, worrying about things unnecessarily, taking more sick leave than normal, or losing/gaining weight.

“If you see these signs, it doesn’t necessarily mean there’s something hugely wrong, so rather than jumping to conclusions; find an appropriate time to have a conversation with them,” advises Ms. Slepica. “Begin by stating your observation, ‘I’ve noticed…’ then ask them if they want to talk. And importantly, let them know they won’t be judged, criticised or at risk of losing their job if they are experiencing challenges to their mental health.”

Marcela Slepica

If you or anyone you know needs help:
Lifeline on 13 11 14
Kids Helpline on 1800 551 800
MensLine Australia on 1300 789 978
Suicide Call Back Service on 1300 659 467
Beyond Blue on 1300 22 46 36
Headspace on 1800 650 890

References
1. Beyond Blue: National Mental Health Survey of Doctors and Medical Students, 2013 www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report—nmhdmss-full-report_web
2. ama.com.au/ausmed/ama-cautiously-welcomes-movesmandatory-reporting
3. www.anu.edu.au/news/all-news/ice-use-directly-linkedto-violence