has learned Col Rakesh Jetly OMM,CD,MD,FRCPC. Lots of Ground to - - PowerPoint PPT Presentation

Mental Health In the Workplace: What CAF has learned

Col Rakesh Jetly OMM,CD,MD,FRCPC.

Lots of Ground to Cover!!

• Why am I here?
• Lessons learned from

Military medicine

• CAF in Kandahar
• MH Lessons Learned
• MH in The Workplace

“The only winner in war is medicine”

• 100 years since WWI
• Interesting to reflect on medicine over the

century and how war seems to have accelerate advances

Walter Yeo meets Sir Harold Gillies (1916)

HMS Warspite in 1916 during the Battle of Jutland.

GAS: A Psychological Weapon

WWI

• Surgical advances
• Triage
• 80% mortality after

successful abdominal surgery

• NO antibiotics

ANTIBIOTICS AND WWII

• By late 1943, mass production of the drug

had commenced - only four years after the first mouse experiments

• Where once pneumonia killed 60 to 80

percent of the people who came down with the lung infection, penicillin lowered the rate to 1 to 5 percent

D-DAY

• In 1943 Florey travelled to

North Africa to test the effects of penicillin on wounded soldiers.

• His trials were seen as a

miracle.

• Instead of amputating

wounded limbs or simply leave them to heal, he suggested soldiers' wounds be cleaned and sewn up, and that the patients then be given penicillin.

GOLDEN HOUR OF TRAUMA

Afghanistan

2001-02 Kandahar 2003-05 Kabul 2006-11 Kandahar

2011-14 Mazar-e-Sharif, AFAMS Kabul

KANDAHAR

HOT/DUSTY

THREAT IS REAL

adrenalin cortisol

CRF vasopressin ACTH,

• pioids

Hypothalamus/ hippocampus

pituitary adrenals

Locus Coeruleus

Frontal cortex - planning, control Amygdala – emotion, fear Hippocampus - memory, context

‘appraisal’/anticipation

Stress - amygdala Facilitation of memory formation, consolidation Regulation of respiration, HF, energy mobilisation, GI-function, immunological function

Remembrance

THE COMBAT BRAIN ?

IS WINNER OF THIS WAR MENTAL HEALTH?

STIGMA REDUCTION EDUCATION TRAINING /RESILIENCE LEADERSHIP TRAINING RESEARCH DSM 5 (definition of PTSD has changed) AS WELL as surgical advances and huge increase in interest in mTBI/concussion

What we now know

Its not about PTSD its about workplace Mental Health Ours is a workplace just like everyone else A great deal is generalizable In 2018 this is not a doom and gloom story…there are practical every day things we can do

500,000

Canadians will not go to work because of mental illness this week

$51 Billion

Annual cost

Mental Health in Canada

Work is a leading source of stress among Canadian workers

3 9

Source: Statistics Canada’s General Social Survey. Respondents aged 25 to 64 yrs of age, working 26 or more weeks in the last 12 months who reported most days were a bit stressful

• r greater

Some days feel like this

Not just for the battlefield!!

CJOC J3 Ops 3-2-2

So What can we do?

Demystify mental illness Its “just” illness . No more, no less. It is real..we have the biology to prove it Seek opportunities to demonstrate this

SACRIFICE MEDAL

Same medal for a double amputee and for someone suffering from PTSD as a result of hostile enemy action

How to address the issue

• Cultural change
• Organizational elements
• Leadership factors
• Individual training and education
• Peer training and education
• ? Family approach

2018 opportunities for cultural change

• Huge interest in MH in workplace
• Mandate letters from PM
• Renewed interest in PTSD MH in first

responders

Awareness Campaigns: Potentially Helpful

State and Impact of Mental Illness in CAF and Canadian Society

Cultural change (starts at the top)

CAF “be the difference campaign” Bell: George Cope Create a culture that encourages help seeking and ensure help is there !

Organizational elements

Understand scope of problem in your population Create a psychological safe workplace (“the standard” ) Consider mental health impact of day to day decisions (workload, shifts, missions ie Kandahar vs Sierra Leone/Ebola) Enhance treatment Screen especially after high risk situation Have timely access to evidence based care (CAF has built a huge clinical MH capabilty)

16.5 8.0 5.3 3.4 4.7 2.0 2.5 2 4 6 8 10 12 14 16 18 20 Any Dep PTSD Panic GAD Soc Phob Alc Dep Alc Abuse Past-year prevalence (%) 2002 2013

Prevalence of some past-year disorders has increased in the Reg F since 2002

2002 – 2013 rates are fully comparable 2002 – 2013 rates are not comparable Not assessed in 2002

Zamorski, Bennett, Rusu et al., (Can J Psych, submitted) * = p < 0.05 after full adjustment

2002 – 2013 rates are not comparable Not assessed in 2013

* * *

“the standard”: a commitment

Psychological support Organizational culture Clear leadership and expectations Civility and respect Psychological job fit Growth and development Recognition and reward Involvement and influence Workload management Engagement Balance Psychological protection Supportive physical environment

The 13 Psychological Factors

From Ottawa Public Health, National Standard Linda Cove, R.N., B.Sc.N

Mental Health team…DEPLOY if needed

Leadership factors

Difficult Job Deadlines—job has to get done Does an employee need a “pat on the back” or a “kick in the ass” Train leaders to understand mental illness, genuine caring of subordinates Practically better to give an afternoon off than have a stressed employee at work

Mental illness is…… the Elephant in our Room

Leaders Need Confidence and Competence

Individual training and education

We know lots from sports psychology and elite military training Ex R2MR (Road to Mental Readiness) Starts at basic training Research : increases confidence in stressful situations and increases help seeking (perfect combo)

Evidence-based Mental Health (MH) education throughout career & deployment cycles Goals: increase MH literacy; decrease stigma and barriers to care; enhance well-being, performance, coping & resilience Skill-focused, practical application, sports performance psychology skills, tailored interventions for rank/occupation/environment

There is no clear line

HEALTHY ILL

Mental Health Continuum Model

ILL

HEALTHY REACTING

INJURED

Clinical disorder Severe functional impairment Severe and persistent functional impairment Common and reversible distress Normal functioning

• Normalizes mental health fluctuations
• Movement in both directions: expectancy of recovery
• Earlier recognition & intervention leads to better outcomes

Explanatory: How and Why?

stress =  likelihood of choosing a risky alternative stress =  tolerance for ambiguity stress =  tendency to make hasty choice stress =  productive thoughts stress =  in distracting thoughts stress =  distortion in perception

The same skills that improve performance, also mitigate long term mental health problems

Building Mental Resilience: Skills

Prepare Perform Recover

The Big 4 +

• Goal Setting
• Visualization
• Self Talk
• Tactical Breathing
• + Focus and Attention Control
• + Emotion Regulation
• + Acceptance

Monitor Health

ILL

HEALTHY

REACTING INJURED

Normal mood fluctuations Calm & takes things in stride Good sense of humour Performing well In control mentally Normal sleep patterns Few sleep difficulties Physically well Good energy level Physically and socially active No/limited alcohol use/ gambling Irritable/Impatient Nervous Sadness/Overwhelmed Displaced sarcasm Procrastination Forgetfulness Trouble sleeping Intrusive thoughts Nightmares Muscle tension/Headaches Low energy Decreased activity/ socializing Regular but controlled alcohol use/gambling Anger Anxiety Pervasively sad/Hopeless Negative attitude Poor performance/Workaholic Poor concentration/ decisions Restless disturbed sleep Recurrent images/ nightmares Increased aches and pains Increased fatigue Avoidance Withdrawal Increased alcohol use/ gambling – hard to control Angry outbursts/aggression Excessive anxiety/panic attacks Depressed/Suicidal thoughts Overt insubordination Can’t perform duties, control behaviour or concentrate Can’t fall asleep or stay asleep Sleeping too much or too little Physical illnesses Constant fatigue Not going out or answering phone Alcohol or gambling addiction Other addictions

Normalize Reactions After an adverse event …

When it is all over you may question yourself and this is normal

If you find resolution - this is good If you keep ruminating - get help early

It’s OK

To be distressed Not to be distressed

Christiane Routhier, Ph.D. (2007)

Individual Responsibility

ILL

HEALTHY

REACTING INJURED

Maintain healthy lifestyle Focus on task at hand SMART goal setting Controlled breathing Challenge negative self talk Visualization/Mental rehearsal Nurture a support system Recognize limits; take breaks Rest, relaxation, recreation Talk to someone; ask for help Tune into own signs of distress Make self care a priority Get help sooner, not later Maintain social contact, don’t withdraw Follow care recommendations

Improve Social Support

Be a good friend Listen attentively Ask questions Validate feelings Don’t judge Delay offering advice Suggest other resources

• f support as appropriate

Informed Leaders

The health and well-being of members is the shared responsibility of the individual, the leadership and Health Services. Our family, friends, peers and co-workers also play a critical role in our health and well-being.

ILL

HEALTHY

REACTING INJURED

Chain of Command Health Services

Chain of Command

Chain of Command

Chain of Command

Health Services

Health Services

Health Services

Leadership Responsibility

ILL HEALTHY REACTING INJURED

Lead by example Get to know your personnel Foster healthy climate Identify and resolve problems early Deal with performance issues promptly Demonstrate genuine concern Provide opportunities for rest Provide mental health first aid after adverse situations Provide realistic training

• pportunities

Lead to BE the Resilience Reserve Watch for behaviour changes Adjust workload as required Know the resources & how to access them Reduce barriers to help- seeking Encourage early access to care Consult with CoC/HS as required Involve MH resources Demonstrate genuine concern Respect confidentiality Minimize rumours Respect medical employment limitations Appropriately employ personnel Maintain respectful contact Involve members in social support Seek consultation as needed Manage unacceptable behaviours

Shield Sense Support

R2MR Throughout Career

Re enforced during pre-deployment The language is given, explicit permission to have dialogue after difficult situation (NOT CISD..but leader lead discussion) Clinic in theatre “doc my guys are looking “orange”

ARE things working ?

We think so Mental illness persists….. 1.R2MR research is demonstrating Increased confidence in stressful situations and increased helpseeking

• 2. Members of CAF seek care at a much higher

rate that civilians

• 3. Around deployment: in 2000 avg wait to seek

care was 7 years, now most in care within months

Past-year Services Use for Mental Health, CAF and General Population, 2002 – 2012/13: Prevalence Rates

Fikretoglu & Liu, 2014 (MVHRF)

5 10 15 20 25 FP/GP Psychiatrist Psychologist SW Nurse OSISS PSC Religious advisor Co-workers, supervisor Family Friends

% with past-year care

CF 2013 CF 2002 Comparable civilians 2012 Comparable civilians:

• Age 17 – 60
• Full-time

employed

• Not recent

immigrant;

• No

exclusionary chronic physical health conditions

• These

findings not adjusted for differences in need

Professionals Para- prof. Non-prof.

Whats the biggest remaining challenge

Even after removing all the barriers to care…treatment is not good enough Clinical research is crucial We need to better understand the biology and psychology of illness Better understand what works and what doesn’t work for individuals…personalized medicine

NOT IN CARE

get in care Reduce barriers stigma “lets talk” R2MR

IN CARE

Improve care Understand responders Personalized medicine advance therapy

50%

Thank You