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
Frontal cortex - planning, control Amygdala – emotion, fear Stress - Hippocampus - memory, context amygdala ‘appraisal’/anticipation Hypothalamus/ Locus hippocampus CRF Coeruleus vasopressin pituitary ACTH, opioids Facilitation of memory formation, consolidation Regulation of respiration, HF, energy mobilisation, GI-function, immunological adrenals adrenalin function cortisol
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
Mental Health in Canada 500,000 Canadians will not go to work because of mental illness this week $51 Billion Annual cost
Work is a leading source of stress among Canadian workers 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 or greater 3 9
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)
Prevalence of some past-year disorders has increased in the Reg F since 2002 20 18 16.5 2002 – 2013 2002 – 2013 Not assessed in rates are not 16 2002 rates are fully comparable comparable 14 Past-year prevalence (%) 12 Not assessed 2002 10 8.0 in 2013 2013 * 8 * 5.3 * 6 4.7 3.4 4 2.5 2.0 2 0 Any Dep PTSD Panic GAD Soc Phob Alc Dep Alc Abuse Zamorski, Bennett, Rusu et al., (Can J Psych, submitted) 2002 – 2013 * = p < 0.05 after full adjustment rates are not comparable
“the standard”: a commitment
The 13 Psychological Factors Clear Psychological Organizational leadership Civility and support culture and respect expectations Psychological Growth and Recognition Involvement job fit development and reward and influence Supportive Workload Psychological Engagement Balance physical management protection environment 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 REACTING HEALTHY INJURED ILL Clinical disorder Normal functioning Common and reversible Severe and persistent Severe functional distress functional impairment impairment • 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 The Big 4 + Recover Perform • Goal Setting • Visualization • Self Talk • Tactical Breathing • + Focus and Attention Control • + Emotion Regulation Prepare • + Acceptance
Monitor Health HEALTHY REACTING INJURED ILL Anger Normal mood fluctuations Irritable/Impatient Angry outbursts/aggression Anxiety Calm & takes things in Nervous Excessive anxiety/panic Pervasively sad/Hopeless stride Sadness/Overwhelmed attacks Depressed/Suicidal thoughts Negative attitude Good sense of humour Displaced sarcasm Poor performance/Workaholic Performing well Procrastination Overt insubordination Poor concentration/ Can’t perform duties, control In control mentally Forgetfulness decisions behaviour or concentrate Restless disturbed sleep Can’t fall asleep or stay Normal sleep patterns Trouble sleeping Recurrent images/ Few sleep difficulties Intrusive thoughts asleep nightmares Nightmares Sleeping too much or too little Increased aches and pains Physically well Muscle tension/Headaches Physical illnesses Increased fatigue Good energy level Low energy Constant fatigue Avoidance Physically and socially Decreased activity/ Not going out or answering Withdrawal active socializing phone Increased alcohol use/ No/limited alcohol use/ Regular but controlled Alcohol or gambling addiction gambling – hard to control gambling alcohol use/gambling Other addictions
Normalize Reactions After an adverse event … Not to be distressed It’s OK To be distressed 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 Christiane Routhier, Ph.D. (2007)
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