 Good evening everybody and welcome to this MHPN webinar on collaborating with the workplace to enable good work for your patient slash client. My name is Steve Trumble and I'll be your facilitator tonight. Before we start though, Mental Health Professional Network would like to acknowledge the traditional custodians of the land, seas and waterways across Australia upon which our webinar presenters and you as participants are located. We wish to pay our respects to the Elders past, present and future for the memories, the traditions, the culture and hopes of Aboriginal and Torres Strait Islander Australia. I'm on the land of the Warrantory people as part of the Kulin Nation here at Naan, Melbourne in Victoria. So I'm a GP by background, I'll introduce the panel in just a moment. Before I do though, I would like to let you all know that on this occasion MHPN is partnered with ComCare to produce this webinar. So ComCare, as many of you will know, is a government regulator, a workers' compensation insurer, a claims manager and scheme administrator. And ComCare states that they work with employees, employers, service providers and other stakeholders to minimise the impact of harm in the workplace, to improve recovery and return to work and to promote the health benefits of good work, which will be a major focus of our discussion tonight. And we have a great panel for the discussion tonight. You will have seen their biographies that came around with the webinar invitation. So we can cover as much content as possible. I'm just going to very quickly introduce the panellists one by one. First of all is Dr Kath Killeher who is doing double duty tonight as both a general practitioner and occupational physician based in Canberra. So welcome, Kath. Good to have you on. Thanks, Steve. Can you hear me? We can hear you. Indeed. Indeed. There's a time lag with Canberra isn't there? We're ahead, I think. Oh, really? Okay. Well, good to know. So welcome. So as an occupational physician and GP and having government roles as well, what do you see as being most important about this field of work that drew you to it? Thanks, Steve. Well, I'm going to cover some of it as part of the presentation tonight, but it's really about, you know, those health benefits of good work and the good that they give to the patient and the community more broadly. So, I mean, yeah, thanks. So being able to do something useful, that's great. Yeah, absolutely. Our next panelist is Dr Diel Philbin who's a psychiatrist who actually focuses of practice on occupational psychiatry. You're based here in Victoria like I am, Diel. Correct. No time lag. I must say that occupational psychiatry is not an area that I was familiar with before we caught up again after I knew you many years ago when you were a medical student. What led you into occupational psychiatry and what makes it an important subspeciality? I think to be honest, I just fell into it. Like I had no knowledge of it either, which I think is a problem in itself as a psychiatrist not having any training in how to help someone return to work and why I think it's so important and why I enjoy it so much is, I mean, we so often see patients follow such a negative trajectory in this space and I think we as clinicians can really make a difference with our expertise, support and the interventions we can help provide to lead to better outcome. So I love my work. Well, fantastic. That's great. Thank you very much. Next, we have Dr. Jackie Stanford. Now, Jackie, you're a psychologist and you're based here in the Northern suburbs of Melbourne. Yes, I'm also in Melbourne. We're a little bit, gee, you're a sponsor on the netball team and suddenly it's all about Victoria. Great to... Sorry. Great to have you, Jackie. So you're in an occupational practice out in the Northern suburbs? Yes. So our clinic does a lot of pain management and with that comes a lot of return to work discussions and looking at how function can work for people, whether it's a mental injury or a physical injury because work is just one of the many different domains that's really important for our recovery. Sure. Great. Well, obviously it's a really important part of psychology practice as well. So thanks for joining us. And finally, we have Kevin Figueroa. Kevin, now you're on our board as general manager, risk, safety and sustainability. I have stalked you on Google. So I know an awful lot about you. But I'll let you explain yourself a little bit more to us and I'll tell you if you get anything wrong. Thanks, Steven. Hello, everyone. Simply delighted to be here. I look after risk, safety and sustainability. It's for the super retailer group. Been there for two and a half years. I've been at Woolworths for nearly 18 years. And I guess in both those experiences, there's about... At the time, there were 250,000 people at Woolworths. We have 14,000 team members at Super Retail Group, which is Rebel, MacBook, BCF and Super Cheap Auto. And so having to lead the health and safety and well-being and put programs in place and see first-hand the impact it has on people is actually a passion of mine. And I'm here tonight to talk about those experiences and what works and what doesn't work. That's fabulous. And having passion for your work is really what it's all about. So that's great. And if you had bunnings in that portfolio still, Kevin, you would actually have my weekend pretty well wrapped up with those brand names. So it's great to have you looking forward to hearing from your side of the table. So that's excellent. So just a few more things for us to work through before we get into the meat of the webinar. Now, this is... We've got a new platform, which is all very exciting. So even if you normally make a cup of tea while we go through these instructions, please do listen, because there's a few different buttons. The first is that there are three dots at the lower right corner of your screen. You can use to access information. You'll see the graphic there, hopefully showing three dots. And that will give you links to the slides for tonight to other resources that the panelists have provided. There's the survey for the end of the presentation and also how to get technical support go to those three dots. You can access the chat at the top right. There's a speech bubble up there. And there's the very helpfully labeled now ask a question button, which is where you ask a question. So if you would like to do that, and please do, you click on that and you'll be able to post a question to the panelists. I'm going to be looking at those as we go through or put someone together. We usually get lots of questions and we won't be able to answer them all, but hopefully we'll cover off on the main topics that you want us to address, because that's what this is all about. A couple of ground rules, which I'm sure as health professionals, you will all observe anyway, which is to be respectful of the other participants and panelists. Remember that the chat box is communication as is all social media. And so please treat people in the way that you would expect to be treated anywhere. Delighted to see Sabu from Kyneton. That's where my dog was born in Kyneton, my wonderful labradoodle. So it's great to have people from all over Australia with us today. I'm fairly distractible, but I am going to focus on the case now, because we have to get onto that. Before we do, learning objectives. The next slide, we would not be able to do this without making sure that we own the learning objectives that we're committed to helping you achieve. So you'll see that the aim is to discuss how practitioners can collaborate with workplaces to enable recovery and return to work with a focus on providing good work is the summary of that. The learning outcomes there are discussing the benefits of participating in good work with patients or clients who are experiencing mental health conditions that may impair their ability to work, including the benefits of recovery and a timely return to work. We want you to be able to identify what good work looks like for patients and clients and how practitioners can encourage the workplace to provide good work that supports health and wellbeing. And a number of questions have already come in about how we can help workplaces provide the right sort of culture for good work to be delivered in. The third one there discussing how to constructively engage with the workplace and other stakeholders to help patients, clients optimise their health and work participation recovery outcomes. And finally, we do want to recommend ways to deal with barriers to recovery and return to work and assist patients and clients to realise the benefits of participating in good work. So that's our mission tonight. Let's see how we go about it. So let's jump in then to the case. Now I'm not going to go through the case. Those of you who attended the first com care webinar would be familiar with the case of Lisa. Lisa is a person who we've all met and is quite a common type at this phase of the current pandemic. And so we're going to keep on discussing the case of Lisa and how she's going. So if you haven't managed to read the case study before we meet, have a look at it now. You can access it by those buttons down the bottom there. So let's find out what people are going to do with Lisa now. I think we're going to start with Kath. You're going to have your GP hat on here. If we can go to your first slide. So much, Steve. And hi, everybody. It's really great to be here today. Thanks for having me. So as Steve mentioned, our case today is Lisa. She's got multiple stressors, a high-powered job, three young children and a husband who works long hours and is often absent. And as Steve mentioned, like many of us, she's experienced increased work stressors over the last few years and has presented this time with work-related mental health symptoms. Now Lisa's not alone. And we all know that mental health conditions are common. The 2021 National Study of Mental Health and Well-Being reflected what we've seen previously, and that's that more than two in five Australians aged 16 to 85, working age, have had a mental health disorder in their working, maybe not 85, that's a bit old. One in five have had these symptoms in the last 12 months. And more women are affected than men. And anxiety disorders are the most common, followed by effective disorders and substance use disorders. So evidence has also shown that job stress and work-related psychosocial hazards are the leading contributors to the burden of occupational disease and injury. And work-related mental health conditions are so common and so costly that the Australian Work and Health and Safety 2021-22 initiative strategy identified that work-related mental health disorders were a national priority. So these are challenging to manage, and they're challenging for Lisa, for her providers, for her family and also for her workplace. And if we could move to the next slide, please, thank you. So there are often delays in presentation of these work-related psychological injuries, and this relates in a delay in treatment. So 82% of workers who are diagnosed with mental illness don't inform their workplace or managers about their condition. And the common reasons for this are fearing the negative impact on their career, being embarrassed, and even fear of losing their job. So this adds further difficulty to managing a return to work, because obviously it can be difficult to return people to work when work is part of the problem, but when conditions are issued are entrenched because of delays, this can add difficulty to an issue. So Lisa already describes that sense of dread associated with a return to work, and she had an aggravation of symptoms on her return after a break. She feels hopeless and wants to quit. So she's actually at really high risk of being unable to return successfully to this workplace at the very least. And we all know that return to work to good work is important. There's strong evidence that recovery at work and early return to good work can help recovery and prevent those secondary complications associated with time away from work. And unemployment is bad for you. You're associated with depression, anxiety, reduced physical function, cardiovascular disease, increased mortality. And in young men who are out of work more than six months, there's a 40 times increased risk of suicide. And in the long term unemployment, the suicide rate increases by six times. So unemployment doesn't just affect those who are unemployed. It also affects families. So children in families where neither parent has worked in the previous six months has a higher likelihood of chronic illness, psychosomatic symptoms and lower well-being. Children in those households where parents aren't working are more likely in the future to be out of work themselves either for periods of time or their entire life. And children whose parents face financial stress may experience psychological distress resulting in withdrawal, anxiety, depression, aggression or substance abuse. And in the long term, unemployment doesn't just affect society. It prevents intergenerational issues. So early support is very important as well because the longer a person is away from work, the harder it is for them to return. In fact, after four weeks of absence, one in five people will not return to work. After being off work for six months, only one in five will return to work. So early active intervention is essential and the role of the GP to support return to work is critical. And in addition to the standard clinical management, it's really important to consider how we can successfully support Lisa to return to work. And some important tasks in supporting Lisa return to work include ensuring she understands the importance of returning to good work and the options available to support return. So let's frame that idea from the beginning. We need to gain an understanding of the strengths and vulnerabilities of this situation for Lisa, for her supports, for her workplace, for her work, and this understanding will help inform the supports and the workplace modifications required to help her successfully return to work. We also should consider using a shared decision making approach to develop formal written management plans that have been shown to work and also very important to engage early and regularly with the workplace because helping their understanding of what's the best management will help facilitate a successful return. As we've said, these cases are often very challenging, but there are some great resources becoming available to assist us in their management. And for GPs there's a newly released by the collaborative partnership principles on the role of the GP in supporting work participation and the clinical guidelines which were produced by Monash a couple of years ago on the diagnosis and management of work-related mental health conditions in general practice. And actually there's some great resources emerging for the workplace as well. The National Mental Health Commission produced mentally healthy workplaces in COVID, which is a great resource. And the mentally healthy workplace alliance produced heads up and the National Workplace Initiative has a rate of resources which they'll make available after the presentation. So thanks so much and back to Steve. Thank you so much indeed, Kath. That sounds like being out of work is absolutely horrible, although I've only ever heard that sense of dread referred to when people have been stung by your agangies up in the tropical areas. It just sounds equally awful. So we're going to be finding out in the discussion how we can help people get past that sense of dread when there's that awful, the risks you talked about, the consequences of being out of work. So thank you for your presentation. That was great. So Lisa's likely to find a way from GP to psychiatrist. So going from Kath to D.L., let's hear what you would see as the psychiatric perspective on Lisa's case. Thanks, D.L. Thanks, Steve. Thanks, Kath. Nice to see everyone. So Kath's very clearly spoken about the risks of Lisa not being at work, but I think it's important for us to just take a moment and think about the risks for Lisa if she continues at work as is and doesn't put her hands up, doesn't speak out like 80-something percent of people and as well as an increase in symptoms, increasing dread, increasing anxiety, what I often see in my role as an in-house psychiatrist is that people sometimes go down the wrong pathway. They go down a performance management pathway instead of an illness pathway and that comes with its whole other set of problems including increased anxiety, loss of confidence, self-esteem, shame which is already feeling, increasing negative feelings towards the workplace and it can result in just as negative if not more negative outcome. So we don't want Lisa to persevere as is. Next slide, please. So what is the way forward for Lisa? In my mind it's about really clear messaging from the beginning. So it's about validating her and reassuring her that the current work situation is just not psychologically safe and that we'll support her with a certificate that she's unfit for her full substantive position but at the same time the messaging has to be as Kath says that being away from the workplace is not the answer and sometimes that can make things worse. Oftentimes especially that sense of dread is not going to go away at the thought of returning. Lisa's very clearly said if I could afford it I would stop working now and I think one of the messages we need to share is maybe let's not make long-term decisions on potentially temporary situations and that the workplace actually has a legal obligation to make the workplace safe for Lisa. Next slide, please. So how do we approach it on the cold face? For me it's about putting Lisa's health and well-being first and making sure she's aware that her health and well-being is first from a clinician the treatment provider's perspective. So I want to reassure her that if we can address the stress that her symptoms might settle I want to answer be responsive to her questions. She's asked questions about a sleeping tablet and antidepressant. My preference would maybe be to refer her some psychological therapy to develop some strategies and avoid some of those addictive benzodiazepines. I think it's important while she is off work because it might take a little bit of time to negotiate a return to work plan. We need to make sure she's using the time for good and not evil. So not taking to bed with the covers over her head avoiding everything, napping during the day, being up at night, self medicating with alcohol but actually keeping busy rallying positive supports exercising attending to sleep weight cycle and also addressing some of the issues at home with the boundaries and maybe getting a partner to step up or getting some support elsewhere. Next slide please. So how do we plan a return to work? How do we optimise her return to work situation? In my experience patients, clients, they know exactly what the biggest issues for them are at work and more importantly they have a really good understanding usually as to what needs to change and what the workplace can reasonably accommodate. So for me it's an open discussion, a collaboration with my patient and thinking about what needs to change and what can change. Thinking about her symptoms and the functional impacts and then brainstorming a return to work plan. So for Lisa who's just exhausted and will be about reducing her hours in the short term, we need to take away some of the job responsibilities. She's managing 30 staff, can we reduce that for a little while, can we remove some of the extraneous work or maybe she just needs to do some alternate work if they have it available for a period of time. If you don't know what to suggest or your patient or client doesn't, I think that's a time when we go and ask the workplace what they can support. Next slide please. So how do we engage with the workplace? My preference is always to choose a medium that enables that bi-directional flow of information. So I don't want to just write a report. I want to speak to someone on the workplace. I want to understand their perspective of their attendance issues and their performance issues because that's going to impact on my assessment of capacity and I also want to know what can reasonably be accommodated and what can't be. I don't want to set it up for fail and make a recommendation they can't accommodate and then be stuck with her off work. Just as an aside, workplaces will often pay for your time so don't be afraid to ask. Next slide please. So my strategies for helping someone at least succeed in the return to work plan. For me it's about starting low, going slow. It's about developing a plan that she can well and surely achieve and that she feels she can achieve. I think it's absolutely imperative that she has buy-in to the plan. I think she's probably feeling quite out of control and we need to put her in the driver's seat and feeling control again. I want to reassure her that she's likely to feel anxious when she goes back. The longer she's off work is not necessarily going to reduce that anxiety and prepare for it and develop strategies for it and reassure her that that should settle if the return to work plan is a safe one to good work. When I have a patient or client who's reluctant to go back fearful of going back worried about failing or worrying about income supports dropping off, I like to frame it as their work capacity is untested and we're going to have a return to work trial and we can dial it up, dial it down as we need and it gives them that reassurance that things can change when they're in bed in stone and finally when they go back to work that's the time I see them more regularly, not Peter off the engagement because you want to identify and address issues as they arise. That's the end for me. Thank you. Thank you. I must say you caught me a little bit on the performance management issue. I've been involved in university management long enough to still remember being told that if you performance manage somebody they're likely to leave and that being seen as a good thing. We've moved away from that. Yes, we have. We've tried to identify what's going on first, I think. Absolutely. Thanks for that. Excellent. You did mention about having a psychology review and I think Lisa's going to find a way now to Jackie Stanford. Jackie, let's hear what you would do to approach Lisa's case. I think it's really important that we're finding what the barriers are. Most of the time as clinicians we know that work is important. She knows herself that work is important but at the moment doesn't feel ready. So we want to find what the barriers are and curiosity is really important. What I find the biggest barriers aren't the first ones that are mentioned. Often it's the second, third and fourth. So being out ask, what else? What else? Because otherwise we're going to bump into them when they return to work planning. So the more we can have that information it's a lot easier to set things up for success. And when we're drawing out the options for Lisa, what she think might be possible it's really important at this point it's brainstorming rather than problem solving. What we don't want to accidentally do is create a very fixed idea of what it needs to look like and then give it to the employer and say this must be accommodated. Good work has to be good for her as well as that's what we're working towards. Because if we can find good work that fits everyone's needs it's going to be a lot more sustainable which is going to be really beneficial for her mental health. By drawing out those barriers we've got a starting point for discussion. As DL said it's a discussion, it's a two-way flow of information. It's not simply written. And I know as a psychologist and for psychologists that are out there we often can fall into the habit of just sending a letter. We assume the other person can have time. It allows us to tick it off and send it but it doesn't allow the rich discussion and help us collaborate. Often what we want to do in finding the solutions will be things that can either decrease the demand or increase the support. Sometimes we just can get into the habit of just decreasing demand. Sometimes we can then make it work so meaningless it's no longer good work. We want meaningful good work with the right supports to help her recover. Next slide. So to effectively collaborate it needs to be that conversation. And one of the most useful tools that I find is finding points of agreement. When we say to Lisa we understand work is important to you. You need the finances. You previously enjoyed it. At the moment it's too stressful. You don't feel supported. As we find those points of agreement we're getting on the same page. Similarly if I was speaking to the employer we understand Lisa's been a key part of the team. Your workplace has been working for the past few years. There's some challenges for you and you want to make sure whatever solution we come up with is sustainable. As we find those points of agreement it's a lot easier to take steps forward. Always being aware of using the word and not but. So Lisa we know work is important for you but it's too stressful at the moment. It's going to be way less successful than Lisa we know work has been stressful and we know it's good for you. We want to create additional barriers. Helping with that flexibility not they should have done this. They have to do this. They need to do this. We want them to. It would be good. I'd like I choose as we shift that language with more flexible language. It's a lot easier to move forward and this may take a number of conversations. It's not about rushing to the end point. At first she might be so overwhelmed. If we look at in the case study she went back to work for a few days and had rest. None of her concerns had actually been addressed. Her manager was supportive verbally but with no change. Which can often lead to more disappointment and so we need to address the barriers. That may be anger and injustice. They don't care about me. They just want more out of me. It could be grief and loss. This job was great and it's not anymore and I miss feeling good. I miss my old self. It could be anxiety and uncertainty around what's the future going on. We need to be looking at whether it's us or someone else in the team is helping address these barriers and remembering that motivation there is both feeling motivated and being motivated. The feeling motivated is lovely. It's the drive and the energy. But most of us do many things every day that we don't feel like doing. We do them because we are motivated to have them done or for something else. We do house work for many of us because we want to have them do it intrinsically. Tapping into that being motivated is really important to help Lisa feel like she's in the driver's seat. Next slide. It needs to be realistic for all. Looking at that language and realising unfortunately there may not be an ideal situation. I'll often talk to clients about it's either a crappier at this point. From what we heard right at the start being off work completely is the crappiest. What good work can look like hopefully with the same employer where that is possible because that leads to better outcomes. But at times it won't be there. If it is not safe and it's not good work we want to look at a strategy and an option. Sometimes I speak to psychologists and say maybe in a year's time this workplace will be okay. That's too long of being off work. We want to find work that is good for her recovery. So we need to meet Lisa who is using strategies like motivational interviewing. I often think about a few different frameworks. One is great exposure. For some clients who have been really traumatised by work, just mentioning the word work is the first step. That causes enough distress. But others it will be setting a return to work date. Working out where they're at and taking the steps forward. It's much easier to help someone cross a river by helping her. We need to work with her to take each step as she can one at a time. It's much easier to steer a moving ship. A ship in port is not going to move anywhere. But as we get the ship moving as we can help her start taking steps forward. As DL said we can tweak we can adjust we can modify. But while we're not moving it's very hard. We want her in the driver seat so she gets the empowerment because as she owns it she will get more benefits from work and more affordable. And I'll pass back to you. Thanks so much Jackie. Your passion is all out there to see. It's great. You also talked a bit about doing things step by step. And there's been a bit of chat in the chat room about graduated return to work. Everybody in this panel is too young to remember the original Poseidon adventure movie. But there's a fabulous scene there of one of the characters climbing a ladder as all the water washes that to explain to people. You got to take it one step at a time. What's your zone of proximal development if you like to mix disciplines. But the other thing I love is that buts are for goats. That thing that great way to start an argument with somebody is to use the word but to put things in opposition. And is a much nicer word or even perfect the art of the verbal semicolon. So work is really stressful. You know that work is good for you. How are you dealing with all this dissonance type thing? I just think that's brilliant. Thank you so much for that. That was really, really helpful. Let's cross the floor now and go and hear from the employer side of the table really. Although Kevin's obviously not only here to represent the employer's perspective. But Kevin, how would you approach the case of Lisa from your side? Yeah, just listening to the conversation so far. What came to mind is there's three types of problems. One is the way we organizations work stolen from or borrowed from Dr. Atul Gawande's checklist manifesto. There are simple problems. There's complicated problems and there's complex problems. And just being able to look at it in three different lenses, you know, you get a sense of how well how would I solve what's the approach I used to solve a problem as opposed to saying everything is complex. What we try to do with businesses is that there is in retail, for example, very high team turnover. So there's new people coming and new people going. So you're trying to simplify the message constantly. We see a problem like Lisa's or challenge as a complex problem. And for complex problems, we realize it's sometimes impossible to proceduralize everything. So in order to create a psychological safe workplace, an environment where people feel okay, we use this belief that it's okay not to feel okay. And that it's absolutely okay to ask for help. People can remember that. And we use that line just one simple belief, one simple action. And so if I go to the next slide please, there's a program that we implement called the I'm Here program, three little words that make a difference. Just being there sometimes is okay, particularly from males we find it's difficult to walk and therefore when you walk together sometimes that's also okay. And so one of the things, you know, our UK is a great program. People often forget this four steps to the our UK program. And we go, why do they forget that? Well, it's very difficult to remember lots of steps and flow charts and processes. And so what we train our teams to do is to go there's three steps after you understand the belief. It's okay to be able to understand the belief. And so what we feel is really important because we signal the temporary nature, the changing nature, some days are good, some days are bad. And that's okay too. And the three steps and he'll tell from three steps and three words in each step I keep everything pretty simple is step one, show you care in your own way. Step two, ask the question. You know, it's hard sometimes to ask the question how a relationship of the conversation, it could take days and so on as you build trust as you build relationships. We even equip people to ask the question. If you are thinking of hurting yourself, have you thought about suicide? So it, you know, that's not easy on day one. But as we get people to build the skills, courage and confidence we hope over a period of time we're able to ask those questions. And the third step is call for help. And that's where we need help from folks like you, because we're not doctors, I don't actually know how to help to the extent that a professional has and we help sign post the person to help. We don't try to solve the problem. So three little steps, show you care, ask the question, call for help. Next slide, please. So in terms of, I guess, you know, what are some of the things that I found that work over a period of time is getting this belief that people get better quicker when they're back at work. And what we often find having large sample sizes predominantly in workers' compensation data is that three days is critical. In fact, the first three seconds is the most important. We find how we respond and react to someone actually saying, I need help. I'm not feeling okay. That first inflection point. But if I extend that, the first three days are critical. I don't know about the health kind of sector, but in our in our business, three days feels like that's plenty of time, but it's not. Sometimes we respond five days later, eight days later, it's three weeks later. But for that person, that's a lifetime. We often think about the person like Lisa. I also think about Lisa's manager. It's not easy for Lisa. It's also not easy for Lisa's manager. It's also not easy for the support network. You know, we go to sell product. We go to provide service. We're not equipped to deal with some of these things. So you can acknowledge that it's difficult for everyone, but also bringing a sense of urgency that the first three days are important. We do our best to put people first than the process. They're both important. Should it make a semicolon there, Steve? And words matter. Words absolutely matter. And the words that we use will actually dictate or will almost forecast what's actually going to happen. And so I love, I love the pause of the word and using the word and because that word really, really matters. And so what we often say to people is if you look after the person that claimed the process looks after itself, we're not saying it's not important. The process is absolutely important. The person is more important. Next slide, please. And so in thinking about that, what we kind of look for and encourage people to do and work with doctors and health professionals is to focus on the capacity, not just the restrictions. And I think there's been some really good work in the health profession where that is actually really coming to life and doctors are helping us with in the last at least three to five years this person has capacity to do this. Whereas in the past, you know, we used to go they can't do this and organizations are not very equipped to actually understand that. So that's important. ATP is a technology we use. It's a very powerful technology. I'm licensed to use this in Australia. It's from Walgreens. I'm giving it to you as a gift today. ATP stands for ask the person. And the mistake we make often in organizations is we ask one person and then we assume everybody would want the same answer. So the trick is ask each person and don't make assumptions. And we say instead of asking a doctor for example, what's the diagnosis? What's the prognosis? I don't know why we do that as human beings because we don't really know what that means. What we try to train our people to do is to simply ask one question. What can I do to help? Just that one question. How can I help? How can you help? How can we help Lisa? And we do that by being clear as leaders and we integrate the clear framework in almost all the training we do, like it's peppered through with every module, which is about showing compassion, listening, being empathetic, acceptance, so no judgment. It's really not up to us to judge whether Lisa has a mental illness or not or whether she's... We tell ourselves stories about is she really making this up? Is she serious? I was trying to performance manager and now she said she's got a mental health illness. What we try to do is get people to refrain from judgment, show acceptance and be real and authentic. Not having all the answers actually in the I Am Here program is awesome because it brings vulnerability and authenticity to the conversation and signals to both parties. We ask our leaders to just go and say look, I know this is hard for you. It's hard for me too. I'm not really sure what I need to do but together we'll work it out and that's all we're really asking. It's an open journey of collaboration to try to help people out. Sometimes it works, sometimes it doesn't work and that's okay too. It's about progress, not perfection. Next slide please. Some really practical tips. We say you have to make time and there is no transaction here, create the space, align on a goal. I find personally that a daily two-minute check is helpful. Sometimes it's even just a little thumbs up that's helpful. A smile, a check in a care. You miss the daily two-minute check-in you start actually losing track of the situation. It sounds like a simple thing but it's really refined practically. I don't have a researcher to back this up but actually I think totally know it works and then we say every week a 15-minute coffee, tea just sit down and a more formal check-in to work out what's working, what's not working, what can we do better and involve psychologists, the psychiatrists or the doctor in that conversation when you need help. I think that's my last slide from memory. I think I will remember that. Thanks so much Kevin, great to hear that perspective and I did notice Jackie's head nodding furiously when you were talking about the two-minute daily check-in. I guess that the sort of showing that you care, that you're interested and then Jackie also mentioned that you have more intense contact than you might otherwise do that's important to be in touch. We kind of transcend care really to be kind. It's a better word I find and most people, not all but most people are kind, most people we have this kind of saying about assumed generosity of assumption. It's positive intent lost in translation. Probably unwisely you've stumbled into another one of my particular soapbox issues and I do remember writing the number 19 tram up to the Melbourne Uni some years ago and hearing applicants to our medical course or talking about whatever they ask you in the interview just say empathy. It's the answer to everything and I couldn't help myself but lent in and said sorry guys, if you want to get into med school compassion is the word. I noticed that you had empathy and compassion there. What do you see as the difference between those two human qualities? One is feeling for and the other is feeling with and actually does keep you safe. A while ago I thought I only knew the word empathy and didn't realize the impact of vicarious trauma. I signaled once in the I'm here program that I am here call me that week I spoke to a hundred people and heard a hundred stories fleece every week. Of course, if you ask me because I'm not trained like the folks on this call I've gone, yeah, I've got this. I know what I'm doing until someone explained what vicarious trauma was and I find personally that compassion helps keep you safe safe for that empathy. But also the thing with compassion of course is doing something to help and I think you did say that what can I do to help is the important thing. It's one thing to know about the person's problem is another thing to actually do something to help. There are people on this call who are far more qualified than I am to talk about this stuff but I gather that's what this is all about is it not is actually this is what good works all about and I think it's important to people. I understand what's going on for you and the good news is there's something we can do to help you move from there. Any thoughts about that from the group? This is what my medical students do. They just sort of look blankly back at me. Let's get on to something a bit more productive then which is the conversation about the questions that have been coming in and lots of really important questions have come in. I thought it might be good just to start and this is a question that's come from Noel Ryan who's asked a very straightforward question about what used to be the quadrant of approach to somebody returning to work going back to the same job in the same place or different job in the same place or the same job in a different place or a different job in a different place. Is that something which is quite a useful frame of thinking about those 2x2 squares? Jackie do you have any thoughts about that? I think the broad framework is just to open up the possibility but not to stop at that point. Within each of those quadrants there's actually a lot of subtleties. There still might be same job but with extra support is needed as well or same job reduced hours at this point. So it's making sure that we don't just see it very simplistically as a swap and a change and a moving on but rather finding out the barriers and addressing the little ones as well. Thanks for that. There's also a question that is something that we've been talking about good work or anything we talked about it back in May but does anybody have a really tight definition for what we're meaning when we talk about good work? Hi Steve, I don't think there is one answer in the end what good work is because good work is different for everybody and one way of gauging that is to say do you feel valued at work? Do you feel safe at work? Do you feel respected at work? Do you enjoy your work? And that's a way of assessing how that person is in their workplace and what their work means to them. I'm sure the other panellists have other opinions but I don't think there's one definition or one answer. Well done Kath, you've dodged around that one but you're entirely right. I mean we'd normally give it a Greek name wouldn't we call it you, Laboria or something. Although that's mixing Greek and Latin that never goes well but anyway. So yeah look it is a complex concept isn't it and I think Comcare has a number of resources that help to explain it. I'm going to actually put some of the questions together. There have been a number of questions asking about what about when the workplace is not a good environment where there are problems there and what is really our role or your role as health professionals in helping somebody return to a workplace where really a lot of the issue is with the workplace itself. Does anybody have any thoughts about that, what we can do? Yeah I might jump in there seeing them from workplace so to speak we're all in workplaces indeed. I often find Steve that the question is actually instructive there's no such thing really as a workplace there's no such thing as a word words or as a super retail group there are people there and when you have an organization you start saying you know XYZ company that workplace it actually doesn't afford the solution you've got to find the person the face of that place the leader of that place and so often yes workplaces are the problem because they're made of people and you know in our case we've got 700 locations and when I was at Woolworths there were 300 locations sometimes you get it right sometimes you get it wrong some are more equipped some are less equipped but all especially in large organizations there's usually someone around and is trying to find who that leader is who that person is and they can go to that can help support large organizations have an infrastructure it's just understanding where to go is usually the hurdle but I often go back to that simple notion of when the workplace is the problem go back to the three steps which is show you care ask the question call the help quite often we find it difficult to get team members to get help and so people come to me and say listen I follow the three step process and they just won't get help what do I do now I've done one two three bang I'm done and we go this is a journey and what we say to people is go back to step one which is show you care you can't force people to things but if you go back to step one and repeat step one that's helpful so in the same way we ask people at our teams to do that or encourage them to do so I think if you're on the other side and you find an employer or a manager or leader resistant show them the care model the behavior you expect to see in them we often find telling people what to do doesn't work and I think Jackie and Dale kind of cover that off it's actually asking them questions of if you can help who can is there someone else so the questions the asking bit the second step is more powerful than saying you must do this and then people get a resistance so it's difficult question to answer because every place is different every leaders different but hopefully the construct of the principles of approach is very helpful but in general terms from the clinician side of the table if we write a certificate that has words in it and this is a question that's come in from Karen Connell this is reinforced when a certificate it's signed to say they are unfit to undertake their current duties but the workplace is adamant that they won't alter the current duties which as Karen points out is something of an impasse we've got butting going on there so what do we do about that how do we I mean given us some ideas what about the clinicians are there any thoughts about how we can get around that apparent impasse between saying things have to change and the workplace saying things can't change yeah I think that there's a conversation there to be had not reports to and throw and maybe trying to unpack why they can't change what are the barriers from their end and how can we work around that so if the duties can't change can we change the expectations can we change the KPIs can they have longer hours to complete things what are what else do we need to do to help the workplace to be able to accommodate them I think that that's a useful starting points and then the other thing I find helpful is actually explaining the reason that we need these modifications and a time course so we might not be able to modify duties ongoing or we're worried that everyone else will want those modified duties but having a real clear medical indication and a time frame and a plan for getting back to full duties I think can often sway a workplace's ability or to support okay so it sounds like being a bit more specific but not prescriptive I guess is the thing and I think you use the word conversation so it does imply there's a dialogue going on it's not just you know handing down a plan or having a very regimented approach any any other thoughts yeah look I have a thought as well like they're unfit to undertake current duties as DL said that that's not very helpful for workplaces it makes it really hard for them so you need to say what they are capable of what they can do you need to be clear and then as DL said that conversation about what is available how can we modify what they currently do within the framework and the other thing is that they are actually required to provide suitable work for the person to return to it's actually legislated so it's a requirement so you don't want to go there first off and the conversation is important but it is good to understand that you do have that leverage at the end point there thank you and I think one of the challenges is when we're saying they're unfit to undertake their current duties we're focusing on the negatives and their stuckness and their hopelessness so when someone has had prolonged stress they're often feeling depressed a bit hopeless and then we say and you're not capable which is actually can accidentally perpetuate it whereas if we focus more like Kath said around what can they do, what are they capable of or what supports are needed we're starting to focus on a forward pathway and not accidentally making them more stuck. We obviously don't want to make things worse but the thumbs up from Kath Kila which is always a good sign. Thanks so much we might take a couple of other questions that have come in from the participants there's one here about the clash of personalities between worker and manager that's festered for a while Michael Hodgman's asked this one a key issue with stress claims is often the clash of personality between worker and managers festered for a while is this really something that we can work with engineer a way around if there are I mean the hardest thing about a workplace is that it's got people in it and people are difficult sometimes so that was probably an appropriate people have personalities that don't always get along what can we do when there's something there where there are people in their jobs and their personalities are unmixable. I think that's a really common issue and I see a lot of requests or certificates saying cannot work under the line of management needs a new manager and I think it's a lot easier said than being able to execute it a lot of the time in a workplace so some of the things I think about there are other avenues for addressing this so facilitated discussions for example it's a step down from a mediation where you will have an independent person come and try and smooth out the relationship and address any of the major issues and come with a way forward I think is often a good approach. This is the area where I spend a lot of time providing strategies and treatment around communication tools because when there's a clash it's often both ways of perpetuating it so what can my client do to change that dynamic and that relationship and also looking at the psychological contract we form of the expectations of they shouldn't speak to me like that they shouldn't do this which doesn't actually empower that person to make the changes as well and we know in relationships when one party changes there's often a change in the dynamic. I encourage my clients wherever it's reasonably safe to return to the same workplace the same manager to do so so that they can develop skills they may then choose to change work afterwards but if we're going to meet people that we don't get along with or click within any workplace simply removing ourselves from that is not necessarily fixing the problem the problem I think though as the question was asked is this is fested for a while so for any of us when we want to address these issues into personal dynamics as early as possible while it isn't toxic and while it is easier to use communication reframing and expectation strategies to make it genuinely workable. Thanks so much everybody I'm now going to get into a difficult area which is I guess industrial relations Claire has just tossed in a question about the role of the union or the legal system at these impasses it's interesting that there's been a fever to chat in the chat room about quiet quitting and acting your wage which I'm really sorry I didn't coin I think that's just a fabulous situation but really it goes back to the old work to rule doesn't it this is something that has been a sort of a workplace strategy for disaffected people and people being unfairly treated for some time but this situation we're seeing currently maybe it's a little bit of a topic but quiet quitting and acting your wage is that something that is a real phenomenon that we're seeing in workplaces at the moment? Steve I might jump in there and just say that I was listening to Simon Sinek talk about this last week on Bonnie Brown's podcast and one of the interesting things about quiet quitting in his mind was it's not a new thing it's always been around what's cool about it in his words is that because it sounds different like we've given it a new label it gets us to pause to think about this new thing rather than dismiss it like we have in the past but I think from a role of a union perspective or a legal perspective in my view personally and experience unions actually quite helpful lawyers can be actually quite helpful they're not we kind of get adversarial in organizations when someone raises an issue because what we do is protect the liability we're trying to break that cycle of the liability and go the first thing should be how can I help and if a union member can help or a delegate can help or a lawyer can help then they're part of the solution and I think quite often in liability land you think about plaintiff lawyers and look at them unfavorably until of course you need one then plaintiff lawyer is awesome being divisive sometimes even the language of manager and worker can be quite divisive and so we try very much to use the word team member both are team members both are actually workers and we find checking the language actually does help us we used to say an injured claimant we stopped doing that then we started to say an injured team member and we used to say yesterday it's a person with an injury there's still a team member today so labeling folks with injury you know this is an injured team member is actually not helpful very hard to do when you've got so many people but back to language matters absolutely what about the clinicians what are your thoughts about when things get into either the industrial relations or the legal area is this time for us to back out time for us to become more engaged Jackie's shaking her head which is an invitation to be called upon don't go to an auction Jackie I think we definitely need to be involved I think as clinicians we can sometimes get stuck in our little consulting room and not speak to anyone enough I've had clients who have told me that their lawyer says they don't have a capacity to return to work I didn't know that was now in the legal domain to determine that so we called the lawyer and the lawyer said no way I think they need to return to work they're not going to get much of a payout the age they're at their capacity and I could have easily gone with the assumption that what the message reported was what was actually said so first of all we need to speak to people to find out what's actually being said not what was heard and we then can find the points of agreement if we can find the points of agreement with the union rep the solicitor the team member the team member who's the leader who's been the kids all of those people if we find those points of agreement the pathway forward becomes so much smoother so the more people involved more conversations Fantastic great comment any other thoughts from the panel I've got a couple thoughts in the olden days when the insurers used to do a lot of surveillance I used to be really scared of the lawyers and when they got involved because I think they used to and I'm generalising I know but tell everyone to go home shut your curtain stay there for six months in case you get caught on surveillance and we all know what that did to our patients in terms of increasing illness disability phobic avoidance but I think that happens not so often now and anecdotally I think the lawyers often put the mental health first and I think the other thing to be aware of with the lawyers is to know what the agenda is because if they're going for a total impairment disabling claim that we want to know that we want to know what the motivations are we want to know the barriers as Jackie says and we need to address those the engagement with the lawyers is fabulous we certainly can't demonise the lawyers in this family it's all too easy to do from a clinician's perspective and they're basically doing their job and hopefully they're trying to get the best outcome for their client which could be an appropriate return to work without being further injured or traumatised in any way I fully agree with you I think I must confess my father was a clothing manufacturer over Jackie's side of town and he used to have people getting surveilled at weddings and things like that dancing with their injured shoulders up above their head well you do that when you're at a wedding you don't do that when you're at work if you've got an injury it's different it was just surveillance really was a horrible thing it still does happen but as you say not nearly as much so any other thoughts on that particular topic I have promised Melissa Erie in the chat room that we will address her question Melissa's an exercise physiologist who's three months into her first job as a rehab consultant so random applause for Melissa she's getting in there which is great and she's touched on something which I must say I've observed before that often we'll say I'll do some exercise it will do you good without recognising it as a disciplined part of the return to work that should be appropriately prescribed and monitored and thrown in as getting up or watch and do what it tells you what's the panelist's thoughts about exercise prescription as part of the return to work absolutely supportive especially in this mental health context getting people out and about and outside particularly it's trying to be good for mental health I'll let Dale jump in there that's her area of expertise but very supportive of prescribing exercise for people in physical conditions then obviously exercise physiologists are a key port of call fantastic Dale do you have any thoughts about exercise prescription I love exercise I think exercise is a great winner when it comes to mental health I shouldn't say this out loud but sometimes as good as an antidepressant for some people all about prescription all about exercise physiology big plug to that fantastic excellent thanks for that Steve can I add a link to that just quickly as long as you're not promoting rebel sports I was actually going to talk about the transformative power of sport at rebel but what I really wanted to say was it's the power of ant on that so quite often we find when someone's not feeling okay depressed someone goes well just walk it off run it off and yes it's helpful I agree with everyone on the panel and you still need help go see the doctor go see the psychologist psychiatrist because that's not the only thing you do quite often we find lay people who listen to that go well I've been exercising I don't know why this thing won't go away well there could be other issues as we all know so I just wanted to build on that all right great thanks for that what running off won't do is deal with a bully now Ronnie Tobens just popped a question in about the genuine business or bully in the workplace where actual discriminations occurring and what is our role there in advocating or identifying I guess this issue that we've talked a bit about workplaces that aren't quite right but if there is or where personalities are an issue but where there is actually a bad agent in place what can we do about that is and we might go with the clinicians first because I'll be interested in hearing the employer's side of it as well do clinicians have any thoughts about dealing with narcissists in the workplace well that adds a degree of complexity doesn't it to the return to work because generally when you have a bully in the workplace you have to consider that their workplace may not be safe for them to go back to and it may be one of those occasions where interventions mediation facilitated discussions need to occur particularly if they presented to you with mental health symptoms because of that situation in the workplace that does become a much more complex situation because you do need to consider their safety and I'm sure Jackie and Dale have comments on that as well safety Jackie and Dale any thoughts I think absolutely this is where from my perspective it becomes the choices and consequences I was involved with someone recently where this was the exact issue the employer even knew the bullying was going on they didn't even question the claim or anything and it's been going on for months and years and inadequately addressed so it's then having that conversation how likely do you think this is going to change based on all the steps and strategies that you've taken not likely so let's now look at a choice that can actually get you work that is safe so if someone hasn't taken any action, if the employer hasn't had an opportunity to understand and make changes, let's look at that because we also want to make this workplace safe for the future employees there as well we don't want to just run away and leave this bully potentially to other people and then employers need to then look at how they performance manage or manage those behaviours as well but in terms of my client it's always looking at what is the best choice you've got with the genuine options that are in front of you not the fantasy options I might just add to that as well I think most employers want to know about the bully amongst their staff and so calling it out and seeing what interventions they can provide I think a bit of caution though often a workplace will go and do an investigation I think it can be quite triggering for our patients, our clients and then the thing that really worries me is when their recovery becomes contingent on a positive outcome from that investigation which often doesn't happen we can see really bad outcomes for our patients, clients so disentangling their recovery journey is really important Is that true Kevin? Is that something that an employer wants to hear about or does it just make your job difficult? I think this is one of those questions that's complex to answer Employers from my experience want to know about the bully when they're relatively junior Employers that have a bully or a narcissist that is senior level usually don't want to know about it and so why usually delivering huge results they kind of go well because narcissists are very clever by nature they've got all kinds of unresolved issues that I won't even go into from my reading but they're very clever in terms, especially the most senior they are you might want to hear this this is only a personal kind of view on this is if you encounter with a senior narcissist that the organization doesn't take action on and the organizations tend not to from my experience then I go back to Jackie's point to examine the choices you have as an individual don't feed that person would be the first one but ultimately and I say this with great sadness go find another job go find another manager because it is harder I think for the person to tackle that situation the most senior the leaders and as you pointed out narcissists eventually get all the way to the top next thing you know they're buying Twitter or in the president of a country or whatever so it is a massive problem with the way we reward outcomes for people and yes Susan has asked in the chat box what is the bully is the CEO well yes indeed not helpful response from me so it's time for us to wrap up there are so many more questions still coming in I seem to have managed to jammed my question viewing box somehow so we will be providing all the questions to com care as the sponsors and they may well be able to find some answers to communicate with people from the questions that remain unanswered because there have been some blinders coming in but I would just now like to whizz around the group and ask for just some final words from each of our panelists starting with Kath about whether the case of Lisa or just some final words on what we've been discussing tonight yeah thanks Steve and thanks everybody I think the important thing is to remember that as a clinical provider you're not alone there are a lot of supports out there these are challenging issues they're not simple for anybody and think about all the complexities of the issue so think about the worker who's affected think about the workplace think about the work they do and think about their family supports and that will help inform your approach going forward and remember there are a lot of supports for health providers as well thanks so what are some of those supports for health providers can I just ask quickly Kath well we mentioned some of the ones at my talk so the collaborative partnership has just produced a guideline and Monash has also produced a clinical guideline and those will be in the resource section as I said before there's some resources just being developed by the National Mental Health Commission that will be available for workplaces going forward there's quite a lot of work in that space fabulous and as you say they're in the resource box on the screen so thank you so much great Jackie what are your final thoughts for me the really important thing is the collaboration and problem solving we need action and this is a really fun process to work when you do it when you can see someone get their life back on track all of their recovery including good work the difference it makes and that means their mental health their life becomes their treatment we don't need to see them anymore because they're good work their connection with their kids not yelling good night sleep the exercise all those pieces of the puzzle are the best antidepressants that we can work at having for a lot of people but we need to collaborate to be effective we need to place antidepressants with those sorts of conversations and with a jog around the block with properly prescribed exercise so that's fantastic there is a role for medication there really is sometimes do you have any other pills of wisdom apart from the fact that the pharmaceutical industry actually has some role to play in all of this yes I do I have a few pills of wisdom I think if we're in the pro health efforts of work return to work space our message has to be health and well-being first and or semicolon and going back to some work is good for you and my second point is to echo everyone else collaboration collaboration collaboration with your patient with the other treatment providers and with the workplace and lean in and be proactive don't wait for them to come to you that's it thank you so much I do have a medical student tell me one was what you had after bowel cancer surgery but there's no classical grammar teaching anymore these days Kevin I think we're heading into the final words from you I'll say the thing we've learned with the I'm here program is that one of the greatest gifts another human being can give you is when they tell you how they feel the folks on this call receive those messages quite often and it's really a huge gift having received this gift what we've learned that you choose to help other people with compassion and empathy there's no such thing as true altruism by helping others you help yourself so I'll say that I'll finish off by saying thank you all for all the work that you do and help folks like me out and folks that need your help and know that there's no true altruism you're helping yourself I always finish our chats sometimes at work by saying leaders to be kind to your people but also be kind to yourself great I'm sorry Kevin unless you would beat boxing at the end there I think you broke up a little bit for us but basically I think you were saying that we need to be kind to ourselves by being kind to our people was that pretty much it? fabulous thanks and I mean what you were saying about the response to somebody telling you how they feel that empathic response to somebody revealing that really important information is just so important I did see a comment in the chat about that question and that really important question a nuancing of that to what do you need so not what can I do for you but what do you need and then part of my role is figuring out how I can help you find what you need not that it's all on me to provide I think that's a really nice nuancing of that really important topic so you've all been incredibly disciplined in keeping to time just run through the final part of the webinar now unless there's any is anybody going to lie awake or not tonight thinking I didn't say that thing because here's your opportunity and you're not using Tomazopam we know that we've all decided that's bad alright look fantastic now if we could ask our audience many hundred people to stay with us just while we go through the last part it's really important to get you to do a few things for us probably the most important of that being to complete the exit survey now that's changed as well so you'll find if you hover your mouse at the banner above the presentation there a little thing will pop up there so that you can fill out the questionnaire and there's even a QR code that you can scan or a survey monkey address so that you can get to that at the end of the webinar and provide us with the feedback because we really need to know there's been lots of conversations going on in the chat box there we want to see if there are areas that we haven't managed to address properly or that we've taken a wrong turn on and also just whether we've actually met your needs tonight so please do fill that out that survey now there's more information about ComCare on their website which is comcare.gov.au MHPN is finishing a webinar in fine style with a flurry of educational activities so don't slow down quite yet the next webinar is tomorrow there's Breaking the Silence the Black Rainbow Quirrobri series 3rd of November at 1 o'clock I did have a speaker from the Quirrobri group up in Darwin speaking to our students medical students last week it was absolutely brilliant so if you can attend that webinar tomorrow at 1pm please do for a webinar next week 7th of November it's never too late to diagnose ADHD a really important topic so that's on the 7th of November there's a QR code there for you to scan if you've got another device emerging minds supporting social and emotional well-being of children with higher weight which is really important on the 17th of November and then we even go into December there with the non-medical supports and programs for older Australians on the 6th of December now MHPM's networking program supports practices to meet and network with others from their local community and there are more than 350 networks across the country so please visit the website there which is the hot link you can click on to join your local network and if you're interested in starting one yourself then you can contact that email address there click on that or pop it in the questionnaire that you're all busily diligently filling out in hope of winning one of our grand prizes tonight which we haven't organised but anyway it's the joy of participation and the sense of a job well done so thank you very much for that before I close I would like to acknowledge and experience people and carers who've lived with mental illness in the past and those who can continue to live with mental illness in the present so thank you everybody for participating thank you to our wonderful panel it's been a lot of fun with this amount as always and thank you to all of you who have attended and been so active in the chat room and with your questions I wish you all the very best for the rest of the evening good night