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Workplace Mental Health (WMH)

Workplace Mental Health (WMH) is a sub-discipline concerned with psychological illness, injury and disability and the role of work as a causal or contributing factor. But, unfortunately, WHO announced that WMH is a ‘Cinderella’ subject. So, it is one of the most urgent demands facing the occupational health services (OHS).

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Workplace Mental Health (WMH)

  1. 1. Dr. Dalia El-Shafei Assoc.Prof. of Occupational Medicine Faculty of Medicine, Zagazig University Workplace Mental Health: Breaking the Silence
  2. 2. CONTENTS
  3. 3. INTRODUCTION
  4. 4. MENTAL HEALTH Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community (WHO, 2004). Actually, It is a discipline that raising attention worldwide (Howatt, 2015).
  5. 5. Workplace Mental Health (WMH) is a sub-discipline concerned with psychological illness, injury and disability and the role of work as a causal or contributing factor. But, unfortunately, WHO announced that WMH is a ‘Cinderella’ subject (Cox et al., 2004). So, it is one of the most urgent demands facing the occupational health services (OHS) (Leão & Gomez, 2014). Workplace Mental Health (WMH) http://uttermpaperfneu.woodshallcraftshop.com/mental-health-in-the-workplace-vytowoxas4793.html
  6. 6. https://www.paho.org/hq/index.php?option=com_content&view=article&id=13739:world-mental-health-day-2017&Itemid=42091&lang=en
  7. 7. WMHP FROM DIFFERENT PERSPECTIVES
  8. 8. Worker - Long-term sick leave. - Exclusion from work. Employer Productivity problem. Health care Passive sick listing & drug ttt without any active ttt (Jansson & Gunnarsson, 2018)
  9. 9. THE IMPACT OF WORK ENVIRONMENT ON THE MENTAL HEALTH
  10. 10. Chemical Metals “Pb- Organic Hg- Al” Organic solvents “CS2” Pesticides Physical Lighting Temperature Noise Biological Infectious agents Pollutants Aeroallergens Psychosocial Imbalanced job design Occupational uncertainty Lack of value & respect (Woo & Postolache, 2008) (Harvey et al., 2017) Workplace Risk Factors
  11. 11. Unifying model of psychosocial workplace risk factors (Harvey et al., 2017) Psychosocial Risk factors
  12. 12. AT RISK OCCUPATIONS Emergency & Rescue services • Police officers • Military personnel • Firefighters • Disaster response personnel Transport control • Pilots • Taxi drivers • Public transport drivers Human service • HCWs • Teachers • Social workers • Sales & customer service • Public relations (Woo & Postolache, 2008) (Stansfeld et al., 2013) (Jansson & Gunnarsson, 2018)
  13. 13. CLASSIFICATION OF WMHP
  14. 14. Classification of WMHP Psychological distress Sleep problems Irritability Mental disorders Common mental disorders (CMDs) Anxiety Mood disorders Substance abuse Severe mental illness Schizophrenia Bipolar disorders Major depression (Nicholson, 2018) Most MHPs in the workforce is due to CMDs (Harvey et al., 2017)
  15. 15. MAGNITUDE OF THE PROBLEM
  16. 16. PREVALENCE AMONG GENERAL WORKING POPULATION Prevalence in the general working population within the past 12 months (Steel, 2014) CMD 1:5 (17.6%) Anxiety disorders 1:15 (6.7%) Mood disorders 1:20 (5.4%) Substance abuse 1:25 (3.8%)
  17. 17. PREVALENCE AMONG HIGH RISK GROUPS Commercial pilots MDD: 12.6% Suicidal ideation: 4.1% (Wu et al., 2016) Firefighters PTSD: 12.7% MDD: 11.3% (Harvey et al., 2016) HCWs MDD: 22.0% Burnout: 27.0% Suicidal ideation: 13.0% (Talih et al., 2016) Police Officers PTSD: 15% for men & 18% for women (Hartley et al., 2013)
  18. 18. ECONOMIC BURDEN OF WMHP The cost of MH leave is, on average, double the cost of a leave for a physical illness. (Moll et al., 2015)
  19. 19. The global cost of CMD (World Economic Forum) $2.5 trillion $6 trillion (Hassard et al., 2014)
  20. 20. “HIDDEN COST” OF WMHP (Goetzel et al., 2018) Hiring costs related to recruitment ↑ Absenteeism ↑ Presenteeism ↑ Accidents ↓ Performance Overtime & overstaffing
  21. 21. SITUATION IN EGYPT
  22. 22. MHPs (18–64 years) in the previous 12 months: 24.7% Mood disorders: The most prevalent Depressive disorders: 43.0% Drug abuse: 30.1% National Mental Health Survey– Egypt - 2017
  23. 23. Higher prevalenceOld age Low socioeconomic status +ve family history Lack of social activities Rural areas “El-Menia” Unskilled workers
  24. 24. SOME EGYPTIAN STUDIES ON WMH
  25. 25. HCWs at Tanta University Emergency Hospital: Violence: Physical 30.6%-Verbal 76.5%- Sexual 4.7%- >1 type 28.8%. Nearly 25% of cases with physical & sexual violence needed a vacation after the assault (Kabbash & El-Sallamy, 2019) Industrial workers 5 factories in 10th of Ramadan city: Substance abuse:18.3%. “Tramadol (66.2%), cannabis (55.4%)” (Bassiony et al., 2019) Teachers: Depression: 23.2% Anxiety: 67.5%. (Desouky & Allam, 2017) PHC Physicians : high burnout: 66.7% of the GPs, 26.7% of specialists (Farahat et al., 2016)
  26. 26. Temporary Hired Cleaners in Governmental Hospitals: CMDs (59.1%), Substance abuse: tramadol (39.7%), cannabis (Bango) (35.9%) (Abbas et al.,2013) Aluminum industry: Depression: 43.0% Anxiety: 70.0% (Moussa et al., 2013) Emergency medical responders (EMR) in the main ambulance service: PTSD “13.6%” (Khashaba et al., 2011) Pesticides formulators & applicators: Psychiatric disorders 50% among formulators & 30.7% among applicators (Amr et al.,1997)
  27. 27. PREVENTION
  28. 28. Strategy1: Designing work to minimize harm Strategy 2: Building organizational resilience Strategy 3: Enhancing personal resilience LEVELS & STRATEGIES OF PREVENTION 1ry prevention To prevent disease or injury by reducing exposures to hazards.
  29. 29. 2ry prevention Selective: high risk occupations ---- Indicated: early signs of WMHP. Strategy 3: Enhancing personal resilience Strategy 4: Promoting early help seeking LEVELS & STRATEGIES OF PREVENTION
  30. 30. Strategy 5: Supporting recovery & return to work 3ry prevention To treat & reduce the impact of an ongoing illness or injury. LEVELS & STRATEGIES OF PREVENTION
  31. 31. THE INTEGRATED APPROACH TO WMH Mental health interventions should be delivered as part of an integrated health strategy that covers prevention, early identification, support and rehabilitation (WHO, 2019).
  32. 32. The integrated approach to WMH (LaMontagne et al., 2018) 2ry prevention 1ry prevention 2ry&3ry prevention
  33. 33. WMH IN EGYPT
  34. 34. 1993 1997 1998 ‫صابر‬ ‫فرحات‬ ‫من‬ ‫االنتقام‬ ‫الفندق‬ ‫ادارة‬ ‫لفصله‬‫وابعاده‬ ‫عزف‬ ‫عن‬ ‫الموسيقى‬ ‫لرواد‬‫الفندق‬!!
  35. 35. 2007 UN Convention on the Rights of Persons with Disabilities (CRPD) ‫اإلعاقة‬ ‫ذوي‬ ‫األشخاص‬ ‫حقوق‬ ‫اتفاقية‬ Everyone with a disability has the right to work, should be treated equally and not be discriminated against, and should be provided with support in the workplace. 2009 Mental Health Act ‫النفسي‬ ‫المريض‬ ‫رعاية‬ ‫قانون‬ Establishment of a National Mental Health Council (NMHC) (Fawzy, 2017)(WHO, 2019) An Egyptian-Finnish Mental health reform programme (EGYMEN) “2002-7” (Jenkins et al., 2010)
  36. 36. The Egyptian MH strategy did not gain public or political acceptance (Loza, 2010). Lack of public awareness of MH Stigma of mental illness
  37. 37. https://www.skynewsarabia.com/images/v1/2017/12/15/1004904/1100/619/1-1004904.jpg
  38. 38. ‫الصحة‬ ‫خدمات‬ ‫فجوة‬ ‫سد‬ ‫مشروع‬ ‫األولية‬ ‫الرعاية‬ ‫بوحدات‬ ‫النفسية‬
  39. 39. •‫اجراء‬‫مسح‬‫للكشف‬‫المبكر‬‫عن‬‫األمراض‬‫النفسية‬‫للمواطنين‬‫المترددين‬‫علي‬‫الوحدات‬. •‫تقليل‬‫عناء‬‫الذهاب‬‫لمستشفي‬‫نفسي‬‫متخصص‬‫و‬‫تقليل‬‫الضغط‬‫علي‬‫مستشفيات‬‫الصحة‬‫النفسية‬ •‫تقليل‬‫وصمة‬‫المرض‬‫النفسي‬‫نظرا‬‫النه‬‫يتم‬‫عالجه‬‫في‬‫الوحدات‬‫الصحية‬‫كأي‬‫مرض‬‫عض‬‫وي‬. ‫الهدف‬ •‫طبيب‬‫األسرة‬:‫هو‬‫المسئول‬‫عن‬‫تشخيص‬‫حالة‬‫المريض‬‫وتحويله‬‫وكتابة‬‫الخطة‬‫العال‬‫جية‬ •‫فريق‬‫التمريض‬‫واألخصائيين‬‫االجتماعيين‬‫والنفسيين‬:‫أجراء‬‫المسح‬‫وتقديم‬‫ال‬‫دعم‬‫االجتماعي‬ ‫الخدمة‬ ‫مقدمي‬ •‫األمراض‬‫البسيطة‬‫والمتوسطة‬:‫عالجها‬‫في‬‫الوحدات‬«‫القلق‬‫واالكتئاب‬‫واألمراض‬‫النف‬‫سية‬ ‫الجسدية‬» •‫األمراض‬‫الشديدة‬‫والمتخصصة‬:‫يتم‬‫تحويلها‬‫للمستشفيات‬‫المتخصصة‬«‫األمراض‬‫الذهنية‬ ‫والفصام‬»‫لكتابة‬‫الخطة‬‫العالجية‬‫ثم‬‫يتم‬‫متابعتها‬‫في‬‫الوحدة‬‫شهريا‬‫والحصول‬‫ع‬‫لي‬‫األدوية‬‫كما‬ ‫سيتم‬‫متابعته‬‫بشكل‬‫ربع‬‫سنوي‬‫في‬‫المستشفي‬،‫المتخصصة‬‫للتأكد‬‫من‬‫صحة‬‫المتابعة‬. •‫األمراض‬‫النفسية‬‫الطارئة‬:‫يتم‬‫إجراء‬‫تدخل‬‫أولي‬‫في‬‫الوحدة‬‫ثم‬‫تحويلهم‬‫للمستشف‬‫يات‬‫النفسية‬. ‫الخدمات‬
  40. 40. CONCLUSION
  41. 41. Collaboration between academics, employers and policy makers is urgently needed to design an integrated intervention programs for WMH. Optimal WMH is best facilitated by implementation of a mixture of preventative strategies. Workplace needs to be a key location for initiatives for reducing the burden of MHPs.
  42. 42. RECOMMENDATIONS
  43. 43. Provision of awareness raising campaigns in all workplaces “Breaking The Silence”. Encouraging employers to celebrate the “World Mental Health Day” on 10th of October to raise employees’ awareness
  44. 44. Training of OHWs in the detection & management of WMHP. Research: to evaluate the current state of WMHP & to implement WMH programs.
  45. 45. Development of an integrated intervention program, including OHWs, psychologists, social workers, and physical therapists. Legislative & policy reform to address the insufficient WMH services that needed to be included in the country MH agenda. WMH should be a National priority
  46. 46. A National summit with experts from government, universities, business & media to explore the current state & designing a start point for moving forward

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