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Chapter II: Summary of Themes Discussed

  • Issued: October 2014
  • Content last reviewed: October 2014

Several themes emerged from the discussions of the roundtable. Many of these themes cut across the prevention, response, and follow-up and support stages of the continuum. The key themes are presented below, and many of these themes were also reflected in the individual ideas that are summarized in the next chapter.

Cultural change

Cultural change - both in the work environment as well as society at large - was seen as being key to addressing the issue of TMS in workplaces. Discussion focused on the need for cultural change in order for workplaces to recognize and respond to TMS events so that workers get the help they need after an experience of mental trauma. There was also a strong view that changing workplace culture is largely about removing stigma. Roundtable members felt changing attitudes cannot be achieved without ensuring proper supports are in place.

Roundtable members had many ideas on how to overcome the problem of stigma and bring about cultural change, including peer counselling and testimonials from those with "lived experience", and requiring those in leadership roles in organizations to move from stigma to acceptance of TMS.

What was also raised in the discussions was that the strategies and ideas to change workplace culture are about mental health more broadly, and not only about traumatic mental stress.

"It’s possible to shift a culture… but the movement needs to be top-down as well as bottom-up in an organization."
- Dr. Rakesh Jetly, Psychiatrist / National Mental Health Leader

Peer-oriented approaches

The importance of peer-oriented approaches was highlighted throughout the discussions. Peer-oriented approaches were seen to represent a cultural change. It was suggested that these approaches sometimes need to be enabled by employers and at other times are more informal. During discussions interest was expressed in furthering the use of peer support approaches.

Ideas for peer-oriented approaches included, for example, a “Train the Trainer” model as an effective approach to educate workplaces about how to support colleagues who are returning to the workplace following a traumatic event. Another idea was for peer support teams to be part of the response after a traumatic event to ensure that issues are identified and treated early. It was indicated that peer support is emerging as an approach used in some sectors, such as in fire services.

“Peer support may play a role in encouraging treatment seeking and providing support during recovery…and provide additional support during the process of returning to work.”
Dr. Ash Bender, Occupational Psychiatrist / Mental Health Leader

Organizational leadership

The important role of organizational leadership in bringing about changes in the area of mental health was also cited. It was noted, for example, that a commitment is needed from organizational leaders in order to build an organizational culture that promotes recognition and acceptance of mental health issues such as TMS. Comments included the need for organizations to institute genuine caring leadership, as well as a need to set out expectations, benchmarks, and quality performance indicators for leaders and organizations to meet in this area. Discussions touched on the importance of senior management accountability and moral responsibility to their workforce. In this vein, it was suggested that criteria / expectations could be set out in CEO accountability agreements to ensure TMS issues (such as PTSD) are addressed.

“We need to emphasize the return on investment at workplaces – it’s a case of financial support at the start, or spend $100,000 if the person doesn’t return to work. Isn’t it better to invest in helping the person recover?”
Dr. Ash Bender

Policy and government leadership

Throughout the discussions, ideas were mentioned by a number of roundtable members on the role of government in the area of TMS and mental health, including possibilities for government to take a leadership role, engagement of different government ministries, and the involvement of the WSIB given its role in administering and adjudicating TMS related claims.

Issues and questions that were heard on this theme included the following:

  • Given that the WSIB may be a point of contact for workers affected by traumatic events that occur in the workplace, might there be a role for the WSIB in helping workers to navigate supports and services available within the system before and after a claim is established?[5]
  • Legislative approaches were proposed, such as the idea to make it mandatory for employers to provide critical incidence response and training, including psychological safety training. It was mentioned also that, in some cases, legislative requirements around primary prevention (specifically around preventing traumatic incidents from occurring) might be needed.
  • With respect to the involvement of other ministries, comments came up on possible roles for the Ministry of Health and Long Term Care (MOHLTC). An idea was to have a MOHLTC “Crisis Centre/Response Team” that would be ready to respond once a traumatic event has occurred. It was also suggested that MOHLTC and Local Health Integration Networks could incorporate expectations related to traumatic mental stress into CEO accountability agreements in the health care sector.
  • With the mandate for the prevention of workplace injuries being transferred from the WSIB to MOL and with the creation of the new position of Chief Prevention Officer (and recognizing that MOL is engaged on this issue through this roundtable process), there were requests for the MOL’s Prevention Office to participate in addressing this issue.

Access to resources and support

  • Discussions stressed the need for better access to resources and support immediately following a traumatic event but also in an ongoing way such as when an affected individual comes back to work following an event. Employers and workersmay not know where to turn to get help. It was noted that access to resources is not uniform across the province (especially in non-urban areas) and that it is necessaryto involve regional organizations to ensure help is available, regardless of where workers live.
  • Several questions and ideas were raised about what this support might look like. For example, should there be an automatic response mechanism to provide immediate assistance after an event has occurred (recognizing that not all events are immediately identifiable or catastrophic, such as in the case of cumulative trauma)? Should there be a central phone number to call after an event has occurred to improve access to services and information, a contact number similar to CancerCare Ontario’s?
  • There was interest in the Department of National Defence (DND) / Canadian Armed Forces (CAF) model of addressing mental health, while recognizing that the CAF has a specific organizational structure and its efforts need to be understood in that context.

"Are career paths in our organizations built to acknowledge cumulative exposure? Do we have the ability to progress our staff so they don’t become overexposed to trauma?"
- Dr. Ash Bender

Education and training

Roundtable discussions emphasized the need for education and training on work-related TMS for workplace parties, organizations and sectors, and the general public. What emerged in discussions is the idea that workers need to be educated at all stages of their career, including before entering and exiting careers about the risks, causes, symptoms, preventative, and ameliorating measures related to TMS.

Also raised was the view that there should be ongoing awareness training at the organizational leadership level. It was noted that education is also needed for employers on a variety of topics such as how to support those returning to work (for example, training on supportive and flexible approaches; promoting recovery; supporting recovery; and preventing recurrence and disability). Beyond the workplace parties, it was felt that educating the general public on TMS is also important.

Knowledge sharing

Ideas about how to share knowledge came up throughout the discussions. These included ideas about how to share knowledge across sectors as well as across organizations within sectors.

For instance, one idea was for a Community of Practice that could focus on educating workplaces and workers about the causes, symptoms, preventative, and ameliorating measures related to TMS and/or share knowledge about what return to work disability prevention principles, supports and recovery practices may work. Another idea raised for fostering knowledge sharing was for sectors to meet every six months to discuss and share information on relevant issues such as prevention of TMS.

Communication

The importance of communication was frequently stressed during discussions – this included communicating information about TMS issues faced by various sectors, and fostering communication among those impacted by traumatic events.

For example, a focus of discussion was on TMS risks associated with certain professions and careers and how that could be communicated realistically to potential new recruits. Also mentioned was the idea to foster communication among affected families about the causes, symptoms, preventive, and ameliorating measures related to TMS, such as by hosting a family-focussed wellness day, where families can get together to talk about their issues related to TMS.

“Remember that a person’s family is on the periphery but they are instrumental in recovery...Families often have an instrumental role in encouraging treatment seeking and providing support during recovery.”
- Dr. Ash Bender

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[5] According to the WSIB, it does not see all cases related to traumatic mental stress events in the workplace as not all workplaces in Ontario are covered by the WSIB and not all traumatic incidences are reported.