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Chapter III: Ideas for Workplaces, Sectors and Government

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

Discussion on prevention: March 27th meeting

The group considered the topic of prevention in two ways. Primary prevention strives to prevent or mitigate the occurrence of traumatic incidents in the first place. Prevention also involves better preparing people to deal with traumatic incidents if and when they should occur. At this meeting, Dr. Ash Bender presented on the topic of "Prevention of Psychological Injuries". The range of ideas generated by members in the area of prevention that emerged from the discussions is summarized below.

Building awareness of the risks

Discussions and ideas generated by various roundtable members in this area touched upon possible broad approaches for helping build awareness about the risks faced by a wide range of workers with respect to TMS.

  • MOL could develop a media campaign about the risks of TMS.
  • There should be increased awareness / education of youth about resiliency skills.
  • Make it mandatory for employers to provide critical incidence response and training, such as resiliency training, including psychological safety training.

Educating workers across career cycle

A wide range of ideas were generated by various members on how to educate workplaces and workers at various career stages about the causes, symptoms, and preventative and ameliorating measures related to TMS.

Educating about risks before career

  • Market jobs realistically in schools and in general, to ensure recruits and young people are aware of the risks that they may face in certain occupations.
  • Create a “Day in the Life” video that portrays the job realistically.
  • Applicants could be screened for resiliency factors or qualities before they begin the job.

Educating during career

  • When providing information or messaging to employees about TMS and mental health, care needs to be taken to strike the right tone in terms of being both positive but also realistic. All possible approaches should be considered for educational purposes, such as e-learning and conferences. Possibilities included working through committees and organizations which could help with educating workers, such as Joint Health and Safety Committees or MOL’s Prevention Office.
  • The WSIB and MOL’s Prevention Office could consider producing pamphlets to educate individuals on TMS and to help remove the stigma associated with psychological injuries and mental health.
  • A “Community of Practice” could be struck to focus on the question of how to educate the workforce on the causes, symptoms, preventative, and ameliorating measures related to TMS.
  • Peer-oriented approaches were discussed, including using methods such as peer counselling and testimonials provided by employees with lived experiences, to educate workers about TMS. Testimonials were mentioned as another peer focused strategy which can help with de-stigmatization and can also provide an opportunity to highlight positive experiences people have had with seeking supports.
  • The role of family members was also raised in discussions on education. One view heard was that employees’ families should receive greater supports, for example, through a Family Employee Assistance Plan (EAP), given that EAP does not always extend to families. A family focused Wellness Day was another idea, providing families with an opportunity to talk to one another.

Educating after career

  • Maintaining links with retired workers would allow organizations to draw upon their experiences in order to assist other workers, as well as to continue to educate retirees about TMS through supports such as ongoing educational sessions and informational materials. Some of the ideas suggested for engaging retirees included engagement through association involvement, a member-driven discussion board, and community talks.
  • Another idea presented was to link retirees with new recruits as a way of providing peer support and sharing experiences.

Primary prevention

A range of ideas were generated by various roundtable members on what can assist workplaces to achieve better primary prevention.

Controls

  • In some sectors, it may be possible to prevent incidences from occurring by putting in place certain controls (for example, engineering controls).

Awareness building

  • Helping workplaces attain better primary prevention requires public awareness on why TMS is an important issue.

Inter-sectoral knowledge sharing

  • There could be value in breaking down information silos by sharing information between sectors by, for example, convening cross-sector meetings every six months.

Research

  • Additional research on prevention could support sectors which are more likely to experience traumatic events.

Funding

  • Funding, including possibly from provincial or municipal government sources, might assist workplaces to achieve better primary prevention.

Training and benchmarks for leaders

  • Training and benchmarks should be established which leaders and/or organizations would need to meet.

Peer support

  • Various peer support approaches were discussed, such as Critical Incidence Stress Management programs – a peer-driven program to help people by allowing them to talk about the incident.

Access to resources / supports

  • The creation of a hotline, an easy-to-remember phone number similar to CancerCare Ontario’s, was suggested as one potential way of improving access to resources and information.

Knowledge exchange

Several ideas were generated by various roundtable members on how to encourage greater knowledge exchange amongst organizations including workplaces, government and other organizations. The ideas on knowledge exchange in this area could also pertain to the other two stages of the continuum – response and follow-up and support.

  • Hold an annual stakeholder summit on TMS.
  • Encourage knowledge exchange and sharing via organizations such as labourunions, professional associations, employer groups, Section 21 Committees, and Health and Safety Associations.
  • Use electronic media tools for knowledge exchange, such as webinars.
  • Post video clips on the MOL website.
  • Piggy-back on/build on the annual February 12th Mental Health Awareness Day to promote awareness.
  • Consider the role that government – for example the MOL and its Prevention Office – could play in knowledge exchange, including a leadership role in education. The discussion on the role of government in knowledge exchange was extended into the area of legislation or standards development.

Discussion on response: May 1, 2013 meeting

One of the key issues that emerged during the discussion on response was that, at present, there may be many barriers that get in the way of responding to TMS incidents early, quickly, and effectively. Barriers start at the individual level, where affected workers may not seek help for a variety of reasons, such as a fear of being judged and stigma. Another barrier that was identified related to the issue of confidentiality – it was noted in discussions that managers need to be aware of confidentiality concerns. During the discussion it was suggested that barriers at the system level may include a lack of a coordinated or automatic response following a workplace traumatic event. During the discussion, many questions were raised around who should be involved in a response effort and what this might look like.

Discussions also centred on a related question of how to support workplaces with early identification and treatment and what resources should be drawn upon or developed for this. A variety of resources or instruments were discussed, ranging from informational resources at one end of the spectrum to mandatory requirements at the other. Roundtable members also discussed the question of how to build awareness of how the psychological injury may evolve, to mitigate its further development.

At this meeting, Dr. Ash Bender presented on the topic of "Interventions for Psychological Injury".

The range of ideas generated by members in the area of response that emerged from the discussions is summarized below.

Response system

A range of ideas were generated by members centred around what role various stakeholders have in the response effort following an event or cumulative traumatic events experienced by employees.

Coordinated approaches

  • Concerns were raised about the lack of a unified, coordinated, and automatic response following a traumatic event in the workplace, as well as the need to address the silos within the response system (e.g. psychiatrists, psychologists, family physicians).
  • Several questions were raised with respect to what a coordinated and immediate response might look like. For example, should the coordinated response be a team or a quick response process? Might there be different responders, depending on the event? Is it appropriate to think in terms of a primary response team that has the knowledge of the whole system, or that acts as a centralized knowledge base?
  • The issue of the lack of coordination of treatment following an event could be addressed by, for example, looking at WSIB processes (claims process and once a claim is allowed).

Health system response

  • A number of ideas were generated on what a response from the health care system might look like. In terms of an immediate response, one idea that came up was to create a Ministry of Health and Long Term Care (MOHLTC) Crisis Centre/Response Team similar to MOHLTC’s Emergency Management Unit which ensures a state of readiness to respond to emergencies that have health implications such as power outages. Also, should there be a roster of physicians ready to respond? In discussions, concerns were expressed about the lack of availability of treatment and the prolonged wait for treatment, as well as lack of expertise. In responding to a traumatic event, early intervention and recognition by health care providers was mentioned as key.

Mental health professional response

  • The discussions also touched on an idea to engage the community of mental health professionals in a response effort such as through a Critical Incident Response (CIR) team that would be ready to provide support after an event. A CIR team was described as a team that would provide critical incident intervention to workers and employers who have experienced a traumatic event in the workplace. These services would be provided by a qualified mental health professional located in the employers’ / workers’ community. Concerns were expressed that there is a lack of this kind of critical response team.

Inter-ministry response

  • Comments were heard on the challenge of a cross government response to traumatic events. Specifically, it was acknowledged that there may be a need to consider the barriers that may exist if various ministries are involved, given the legalities that may exist around sharing personal information between ministries.

Resource and information support

  • Discussions pointed to a need to consider how to help workplace parties navigate available resources after a traumatic event has occurred. For example, could there be a phone number to call following an incident in order to get information or to get assistance with accessing and navigating services?
  • The MOL (and the WSIB, where applicable under its mandate) could have a role in helping those affected to find resources. It was also suggested that MOL could develop resources.
  • The employer and health and safety specialists in the workplace, in the early stages after an event, could have a role in assisting those affected to navigate available supports and resources.

Workplace response following a traumatic event

  • Early recognition and intervention was mentioned as being important, including employers having a role.
  • Employers need to have awareness of the symptoms of trauma related to mental stress injuries in order for them to better support early recognition, through for example, requiring use of a screening tool.
  • Workplaces could be equipped with the resources to respond following events, such as through training union representatives.
  • Workplaces could start peer-support programs where peers are trained in how to respond following a traumatic event. It was noted that there is an absence of peer support teams, at present.
  • After an incident, individuals affected may face personal barriers such as denial and stigma which could be ameliorated through, for example, employer-enabled peer support, communication, and information campaigns.
  • Regardless of the size of the workplace, co-workers and supervisors need to be trained, and communication needs to be encouraged on how to respond to issues that may arise. In isolated workplaces, it is important that there is recognition of the mental health issues that may occur and for unions and management to have a good relationship, where the environment is unionized.
  • An additional comment made was that response programs include monitoring and evaluation mechanisms.

Individual response

  • Self-screening tools could support individual workers to take action in responding to their experience of trauma.

Resources for responding to trauma

A range of ideas were generated on existing resources that could be utilized, and new resources that could be developed, to support workplaces and employees with early identification of a psychological injury triggered by a job-related traumatic event, as well as support those impacted to seek treatment early on.

Media attention

  • Could consider how the media could help to “get the word out” on TMS by building on the current media attention to mental health.

Workplace information campaigns

  • Informational campaigns in workplaces, such as “Warning Labels” or poster campaigns, may draw attention to the importance of recognizing these issues early on and seeking the help that is needed.

Consolidate and develop resources

  • Have resource information on early identification and treatment available in one place. This could be through a web portal.
  • MOL, in conjunction with mental health experts, could develop and provide a list of currently available resources.
  • Health and Safety Associations could develop resources, such as posters.

Joint Health and Safety Committees

  • Joint Health and Safety Committees could be considered as a resource to support early identification and treatment.

Services and supports

  • Consider whether or how the tele-health model of assistance may apply in this area.
  • Consider whether or how Health and Safety Associations, which deliver health and safety services and supports to employers and employees, could have involvement in this area.
  • Consider how the WSIB could be utilized as a resource as the WSIB may come in contact with injured worker claimants following a traumatic event or experience of cumulative trauma. In this context, it was suggested that WSIB could play an education role in supporting and encouraging early identification and treatment. WSIB processes, it was mentioned, need to be less stringent if WSIB is to support and encourage early identification and treatment.[6]

Mandatory requirements

  • It was proposed that the voluntary National Standard of Canada on Psychological Health and Safety in the Workplace should be more than a guideline. (This is a voluntary standard intended to provide systematic guidelines for Canadian employers that will enable them to develop and continuously improve psychologically safe and healthy work environments for their employees.)

Awareness building of how injury develops

Various roundtable members came up with ideas on how to build awareness of how the psychological injury may evolve, in order to mitigate its further development.

Education in workplaces

  • Awareness building, with a focus on stigma reduction, could be provided for all organizations, managers, and employees. Education sessions might be offered through an orientation at the beginning of one’s career, and then in an ongoing way (e.g. lunch and learn sessions).
  • Another idea proposed as a subject for education was around the “Mind Your Own Business” issue. Rather than co-workers “minding their own business” when their colleagues are suffering from TMS, it was suggested that management could encourage colleagues to speak to their colleague directly. This could be supported through guidelines on managers’ responsibilities and formal HR training to staff on how to connect with individuals experiencing mental injuries.

Tapping into existing initiatives

  • It could be beneficial to “piggy back” on initiatives such as Mental Health Week and Mental Health Works to build awareness of TMS.
  • Another suggestion was to consider leveraging Mental Health First Aid programs. (Mental Health First Aid Canada is a program that aims to improve mental health literacy, and provide the skills and knowledge to help people better manage potential or developing mental health problems in themselves, a family member, a friend or a colleague.)

Funding

  • Additional funding could support awareness building – for example, for more specialists and for more EAP supports, given that some EAP programs only provide one-on-one support.

Peer-oriented approaches

  • Comments were heard on the value of both formal and informal peer-oriented programs in workplaces for building awareness and providing supports. Examples were given of organizations with excellent peer support programs that could serve as models for other organizations. Another suggested peer-oriented approach is to organize health and safety campaigns where co-workers are involved in the delivery.

Build action teams

  • Action teams could be used to build awareness on psychological injuries and prevent injuries from worsening.

Inter-agency cooperation and sharing

  • Successful approaches could be shared across organizations or could be undertaken cooperatively.

Discussion on follow-up and support: June 19th meeting

The discussion on the topic of follow-up and support was centred around how to best support people who are returning to work following a job-related traumatic experience, in a way that prevents recurrence. Considerable attention was given to discussing the means and methods for awareness building, education, training, and knowledge sharing on how to appropriately support individuals when they come back to work following a job-related traumatic experience.

At this meeting, Dr. Bender presented on the topic of "Recovery and Return to Work after Psychological Injury" and Dr. Rakesh Jetly presented on "Mental Health Care in the Canadian Forces."

The range of ideas generated by members in the area of follow-up and support that emerged from the discussions is summarized below.

Raising awareness about return to work supports

Several ideas were generated by roundtable members on how sectors and workplaces might raise awareness about how to support those returning to work in a way that prevents recurrence.

Education and training

  • Awareness building on how to support those returning to work could begin early in people’s careers, for example, by targeting educational institutions. The idea of sharing testimonials, as one effective awareness building approach, was also raised.
  • Workplace parties could be educated through well designed and specially tailored courses on how workplaces can prevent recurrence and support reintegration.
  • A specific example of education and training efforts already taking place is the Occupational Disability Response Team (a not-for-profit project set up by the Ontario Federation of Labour to provide workers and their representatives with workplace insurance and disability prevention training and advisory services). “Paving the Way 2: Facilitating Work-Reintegration” is an education initiative of the Occupational Disability Response Team available to educate workers about mental health and recurrence issues.
  • Employers need to be educated on how to support those returning to work. One idea was to provide training to large employers. The roundtable heard an example of this where the Occupational Disability Response Team (mentioned above) has been invited by a large employer, Niagara Health, to provide training.
  • Several ideas were provided on potential education / training topics related to recovery, recurrence prevention, and return to work supports. Ideas in this area included a focus on overcoming stigma, especially among those in charge; educating on building resiliency as a strategy for preventing recurrence; educating on proper return to work (this could include the use of disability prevention principles); and educating on the dangers of avoidance.

Outreach

  • Outreach approaches were touched upon, in discussions, as a way of raising awareness about how to support those returning to work and support people to prevent recurrence. An example offered in this area was that in the fire services sector, health and safety staff are working with labour and management and giving a presentation on supporting those with TMS at a health and safety conference.

Organizational leadership and management

  • A number of ideas focused on the role organizational leadership and management have in raising awareness on how to support those returning to work. In the discussion, we heard that it is important to institute genuine caring leadership. Others noted that there is a need to encourage management styles that are supportive of those returning to work and that recognize mental health issues.
  • Another approach suggested was to set out expectations of managers / leaders in performance criteria related to how leaders support a workplace environment that eases the return to work process.

Human Resources

  • An idea around the role that HR could play in this area was for HR to develop protocols on how to support those returning to work. Discussions suggested that guidance may be needed on how to approach privacy issues (e.g. the challenge of disclosing to colleagues why someone is off work), as knowledge of an issue can help ease the transition back to work.

Peer support

  • Several members indicated that “Train the Trainer” is the most effective approach to educating workplaces about how to support colleagues who are returning following trauma.

Mandatory requirements

  • Members indicated that raising awareness starts with the MOL since, without general awareness, there may be no broader buy-in. Also mentioned was that MOL ought to consider using legislative and enforcement tools to place requirements on employers, and that buy-in may be needed from all Ontario Ministries for employer requirements, with support from the MOL, for disability prevention programs. It was also acknowledged in the discussion that any mandatory approaches need to be sensitive to the challenges of adapting regulations to diverse workplaces.

Health care system

  • Discussions touched on ideas for how the health care system might be involved in raising awareness about how to support those returning to work and support people to prevent recurrences. Several ideas were heard around the table about the role of MOHLTC, such as wanting MOHLTC to take on a leadership role, deliver messaging, support early intervention, make available funding for programs and services, and also consider aspects of the model in terms of supports and services the Canadian Armed Forces provides to those impacted by psychological trauma while serving. It was also suggested that MOHLTC and Local Health Integration Networks could incorporate expectations about traumatic mental stress into CEO accountability agreements in the health care sector.

Workers compensation system

  • A viewpoint heard at the roundtable is that the WSIB needs to be a key partner, and change its policies in order to not exacerbate individuals’ TMS condition.

Knowledge sharing on recovery practices

Several Ideas were generated on how sectors and organizations might share knowledge about what return to work disability prevention principles, supports and recovery practices work.

These included the ideas listed below.

  • Web tools such as webinars, for information sharing amongst sectors and organizations.
  • Communications materials such as newsletters and case studies.
  • Academic sources such as journals and think tanks.
  • Professional networks such as a Community of Practice.
  • Outreach through identifying ways to reach different audiences and look for alliance opportunities.
  • Mandatory annual training to update key staff on return to work disability prevention principles, supports and recovery practices.
  • A central repository for information such as return to work disability information. Information needs to be where it is expected to be and be easily accessible to workers and employers across Ontario – for example, should it be with the WSIB or the MOL Prevention Office?

Workplace culture of acceptance

Roundtable members had a dialogue and generated ideas on how to build organizational cultures that promote acceptance and recognition of issues related to work-related traumatic mental stress. This discussion on workplace culture pertains to all of the stages on the continuum.

Organizational leadership

  • One view heard in the discussion was that building an organizational culture that promotes acceptance and recognition of issues related to mental stress, requires support from the top. This includes a commitment from leaders, providing organizational flexibility and creating a compassionate environment.
  • Another suggestion was to set out criteria for organizational leaders to ensure action is taken in support of building an accepting workplace that recognizes work-related traumatic stress issues.
  • Concern was heard about leaders who might put up obstacles to cultural change efforts and about how to address those leaders who are being a "stick in the mud".

Organizational policies / expectations

  • Comments were also heard on the need for organizations to set out expectations, such as setting priorities, standards, objectives, and policies, and that in order to build organizational cultures that promote acceptance and recognition of mental stress issue, there needs to be a breaking down of barriers.

Resources / tools for front line managers

  • Ideas for supporting front line managers included having specialized teams that support front line managers; well-defined job requirements to ensure managers are capable of promoting a culture based on acceptance and recognition of mental health issues; and the provision of evidence-based, transitional work programs during the return to work phase. Disability prevention principles were also subsequently mentioned as an important tool for front line managers as they support those returning to work.

Workplace education and promotion

  • Ideas for strategies to promote a culture of acceptance and recognition in the workplace included promoting good practices and positive reinforcement of exemplary behaviours; sharing successes and case studies; showing the business case for Return on Investment for wellness initiatives; educating the workforce on issues, processes, and outcomes; and ensuring workers are aware of what to expect in terms of how the organization approaches issues related to work-related TMS.

[6] For those who report their injury and have their TMS claim allowed, the WSIB at present plays a role in arranging the worker's treatment.

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