Diane Kunyk

Employers’ perceptions and attitudes toward the Canadian national standard on psychological health and safety in the workplace: A qualitative study

The estimated societal and economic costs of mental illness and psychological injury in the workplace is staggering. Governments, employers and other stakeholders have been searching for policy solutions. This qualitative, exploratory study sought to uncover organizational receptivity to a voluntary comprehensive standard for dealing with psychological health and safety in the workplace. A series of five focus groups were conducted in a large Western Canadian city in November 2013. The seventeen participants were from the fields of healthcare, construction/utilities, manufacturing industries, business services, and finance. They worked in positions of management, consulting, human resources, health promotion, health and safety, mediation, and occupational health and represented organizations ranging in size from 20 to 100,000 employees. The findings confirm and illustrate the critical role that psychological health and safety plays across workplaces and occupations. This standard resonated across the represented organizations and fit with their values. This alignment posed challenges with articulating its added value. There appears to be a need for simplified engagement and implementation strategies of the standard that can be tailored to the nuanced differences between types and sizes of industries. It appears that organizations in the most need of improving psychological health and safety may be the least receptive.

Help seeking by health professionals for addiction: A mixed studies review

BACKGROUND When health professionals practice with active and untreated addiction, it is a complex occupational and professional issue impacting numerous stakeholders. Health professionals are responsive to evidence-based addiction interventions and their return-to-work has been demonstrated to be achievable, sustainable and safe. Facilitating help seeking in health professionals with addiction is a priority for reducing associated risks to their health and to patient safety. AIM The purpose of this study was to identify the process by which health professionals seek help for addiction, and factors that facilitate and deter help seeking, through a review of the qualitative and quantitative literature. METHODS Both phases of this sequential mixed studies review followed the standard systematic review steps of: (1) identifying the review question, (2) defining eligibility criteria, (3) applying an extensive search strategy, (4) independent screening of titles and abstracts, (5) selecting relevant studies based on reviewing the full text, (6) appraising the quality of included studies, and (7) synthesizing the study findings. Our two searches of five databases from 1995 to 2015 resulted in the inclusion of eight qualitative and twenty-three quantitative studies. We first conducted a meta-synthesis of the qualitative literature to garner an understanding of the help seeking process for health professionals for addiction. We then conducted a narrative synthesis of the quantitative studies to generalize these findings through examining the data for convergent, complementary or divergent results. RESULTS Synthesis of the included qualitative studies revealed that the professional and experiential context of healthcare compromised the health professionals readiness to seek help for addiction. Typically, a pivotal event initiated the help seeking process. The studies in the quantitative review identified that help seeking most often resulted from reports of adverse events to formal organizations such as their employer and regulatory bodies. This process does not adequately address the scope of health professionals requiring help for addiction. Informal sources such as colleagues and family, often aware of the addiction earlier, preferred referral to voluntary, confidential treatment programs. CONCLUSIONS Facilitating the help seeking process for health professionals with addiction in as effective strategy to reduce the associated risks to the health professional, their families and colleagues, their employers and regulatory bodies, and to the general public. Our findings suggest that intervention is possible at multiple points in the help seeking process for health professionals with addiction. Confidential, compassionate and supportive alternatives offer potential for closing this gap.

Health Care Under the Influence: Substance Use Disorders in the Health Professions

Substance use disorders are expressed within most age, economic, cultural, gender, and occupational groupings. They come to expression in individuals who may be considered vulnerable on biological, psychological, social, family, or spiritual levels. As with other mental disorders, vulnerability differs between individuals with both nature and nurture influencing their risk. Some health care professionals will also develop these chronic disorders regardless of any special knowledge or experience they may have. When substance use disorders are expressed within the health care professions, the delivery of safe, competent, compassionate, and ethical care is threatened. The health of the health care professional is also at risk as the substance use disorders typically progress in severity and may result in premature death. This is often a sensitive issue to address yet its importance demands the concerted attention of the health care professions. The following chapter begins with background on the issue of substance use disorders within the health care professions, followed by a discussion of mitigating associated risks, and an exploration of disciplinary and alternative to discipline policies. This chapter is focused primarily on literature on physicians and nurses because of the predominance of research in these disciplines. The argument will be made that creating conditions that encourage early identification, reduce barriers to treatment, and that include long-term monitoring programs provide the best conditions for ameliorating the risks resulting from substance use disorders amongst the health care professions to patient safety and health care professional health.

Workplace Functional Impairment Due to Mental Disorders

Psychiatrists are commonly expected to conduct disability assessments. These include an assessment of the worker’s functioning, putative impairment, risk, and capacity to work. Employers and other third parties, either administrative or judicial, subsequently make disability determinations based on such assessments. This assessment also forms the foundation for return-to-work determinations, or for determining the employer’s duty to accommodate to the point of undue hardship. To the extent the general psychiatrist becomes involved in assessing these occupational matters, the psychiatrist is practicing forensic psychiatry. The role and responsibilities of the treating psychiatrist, within in the context of a traditional physician-patient relationship, differ vastly from one conducting an occupational or forensic evaluation. Yet, the boundaries between these distinct and often irreconcilable roles are not always clearly delineated, properly understood, or abided by. The forensic aspects of psychiatric practice are often viewed as intrusive and challenging by non-forensically trained psychiatrists, representing a role conflict many psychiatrists find themselves poorly equipped to navigate. This chapter outlines the common psychiatric disorders encountered in clinical and occupational settings. It discusses the concepts of impairment and disability, as well as the benefits of working. The most commonly requested opinions in occupational psychiatric assessments are that of a psychiatric diagnosis, causation, impairment, fitness to work (FTW), and disability, along with recommendations for further investigations and treatment. The importance of objectively measuring impairment is outlined, along with reliably establishing a diagnosis (if any), along with the non-linear relationship between mental disorder, impairment and disability. For the purposes of this chapter, any reference to mental disorders are implied to include the broad range of disorders captured in the Diagnostic and Statistical Manual of Mental Disorders, the DSM IV-TR, which includes the substance-related disorders (i.e. Substance Abuse, Substance Dependence, or Addiction, and others). This chapter addresses the main pitfalls and risks associated with Independent Medical (i.e. Psychiatric and Addictions) Evaluations (IME), and provides a template for conducting these. The potential cost saving associated with implementing evidence-based interventions drives a sound business case for addressing mental disorders in the workplace. This chapter offers a pragmatic approach to treatment matching and disability management for workers with mental disorders (i.e. including substance-related disorders). It outlines the principles of vocational rehabilitation in the context of psychopathology, mental disorders, impairment and disability, ensuring safety, as well as optimal clinical and economic outcomes.