 people in your own communities and acknowledging the hope and dreams of this whole trust that I'll and the people as well. I'm Lina Grady and I'm a facilitator for this evening and I've been doing a number of the facilitation of these webinars over the last couple of years and I really enjoy the opportunity it provides for us to get into some difficulties and often interesting topics and really be able to tease out what it might mean for us as practitioners. So I'm a psychologist. I work mostly at the Australian Psychological Society. I'm a national project manager for a couple of projects here, Kids Matter and the Forced Adoption Project. I also supervise some psychology interns and so the issue of bullying in the workplace is something that I guess as a psychologist and certainly as a supervisor it does come up in various ways. So I'm very aware of it but I'm certainly not don't have the expertise that the people on the panel do have tonight so that's why I'd be here which is fabulous. You would have seen the panelist bios so you would have already had a look at bios but we will go through individually and just introduce you so you get to get to see who we're going to have taking us through their presentations and answering some of the many questions that we have. We'll get to as many of those as we can. So I'd like to begin with introducing Dr Anne Weif and Anne is an Occupational Health and Safety Consultant. She's based in New South Wales in the Blue Mountain who is just telling us and I imagine it's very cold up there and I understand you've worked for more than 30 years as an Occupational Health Safety Management and Education Consultant and you're often called upon to be an expert witness for workplace bullying. What's involved in that? What does it mean to be a workplace expert witness? Well the court requires that you absolutely have the competence to answer the questions that you're asked to answer as an expert witness so you need to have expertise, knowledge and a deal of experience in the field. If a person gets to the point where they want to do their employer or attempt to do their employer at common law for example because they've been bullied in the workplace then the lawyers will generally call for an expert opinion on the evidence that it is. Okay, alright thank you. Sam's very important and challenging work and yeah our next panelist is Dr Neil Azani. Now I'm not even sure if I've got that name right Neil, you'll have to tell me if that's right or not. Neil's from Western Australia, we're on a different time zone to me here in Melbourne and Neil's an occupational physician and work cover approved medical specialist and you use a lot of onsite consulting so what does that involve? I love that. I go out to see the worker in the workplace, see what they do, the things I like best is seeing how they go up injured and then how to help them get better and use their workplace to help them get better. I particularly enjoy that. The workers, the colleagues, the managers, the work they do and it's the best way to get the best result I think. Correct way to say my name is Ozan and Ozan as in Ann that we just met and I mentioned I'm an occupational physician, I've been doing occupational medicine like wholly for 10 years and before and about 25 years of cradle to the great grave GP experience which is where most of my comments tonight will be coming from from the GP perspective. I can't hear the occupational physician input as well. Okay yeah that's great so sounds like very hands-on work in terms of getting getting a real picture of what's going on to people as well as your GP experience so that sounds really useful for tonight so thank you and apologies about the surnames, might have just confused me though if I'd been thinking too much. Let's move on to Dr Nigel Strauss and Nigel you're a Victorian based occupational psychiatrist and you have an interesting post-traumatic stress disorder and workplace stress. What are some of the common issues that cause workplace stress? There's just a little question to start the night. Yeah it's a good question to begin with well there's a number a number of factors I think everyone's aware but I think the main thing is that employers look after their employees and often when there's something wrong with the workplace environment that's usually the basis of the stress and a number of factors that can be responsible for that and I think it's a characteristic in dealing with employers and employees I just always try and make sure that relationships are good and once relationships are good then the chances of stress developing are limited and that's a tall order of course but if people are cooperative and organisations are cooperative you do get good results. Okay so that fits really nicely with our early intervention focus tonight as well so that's another great contribution that you'll be making and last but certainly not least Peter Cotton. Dr Peter Cotton you're a Victorian clinical organisational psychologist and you specialise in how the work environment can influence and sway mental health and you've been involved with CSIRO over the last three years to assist them implement recommendations from an independent review for bullying improvements. Interesting idea. Can you tell us a little bit more about that? Oh CSIRO has done a lot of really good work in this space however I've been working with them for five years but it's a bit difficult when in the last couple of years governments has broadsided with various cuts and changes CEO so that all trickles down and affects what we're doing but we work for that as best we can. Okay great thanks Peter and again you can see already that I guess the way that these MHPN webinars work is this multi-disciplinary approach so bringing together a whole lot of different backgrounds and experiences of people that then will work our way through this interesting case study tonight so you've already got a little taste of what we're going to be in for tonight from the panel. I'm not sure whether people who've got 570 people joining us now and I'm not sure whether people have participated in that these webinars before and know how it works so I'll just show a bit of a run down of how things are working and hopefully I can see people have been chatting and introducing themselves in the general chat box so you've obviously found that which is good and that is a chance for you to ask some questions, ask some comments, certainly introduce yourself say hello to each other if you see a name of someone you recognise talking about the weather is always interesting but be mindful that is a public space and so whilst this is a virtual environment I guess the way I like to think about this is that we're in a space together and it's a public space it's a professional development environment so just be mindful that your general chat is public and so just being aware of that and thinking about it as if we were in a face-to-face space room. Some people love the chat and really get into it and other people find it really annoying and distracting so find that it's very hard to keep up with all the information that's being talked about and the panellists are talking about and keeping up with the slides so and then the chat as well can be a bit distracting to people so you determine what's going to work for you and you can use the little arrow at the top of that panel that sticks in up there that you can actually reduce that and you can get rid of that all for a little while and bring it back on later if you want to so it's up to you for how you manage that. If you have any technical problems we have fantastic support and one of the things about doing these webinars is the level of professionalism behind the scenes and we have people who are going to be doing moderating and we'll be answering some of your questions and helping you with any of those questions around where things are or any sort of questions they're able to respond to. You've got technical support you can see the technical help box there that's flashing so that's where you ask if you're losing sound or there's something not quite right in there you ask for some technical help in there. So just using those cats as well as you can and know that there's people there that can support you and of course this webinar will be recorded and available later on so you'll be able to get it later if for some reason you have to finish early. There will be a survey exit survey at the end which we really like you to fill out it gives us really good feedback so that we continue to learn and develop and also see that in terms of the content. There's a little folder down the bottom right corner which does have some resources so it has the slide, it has the presentation, it has the case studies if you haven't had a chance to look at that and it also has a little arrow flashing showing you where that is and also it has some information there for you as well from resources that you might be talking about. Now the webinar has been made possible to funding provided by SafeWorks Australia and there's the website there for access more information as well. Just in terms of self-care I think it's really important when we're doing these webinars just to acknowledge that some of the people who are joining us tonight or looking at the webinar later on may have found themselves in a difficult work environment. Workplaces can be challenging and we're going to be talking a lot about that tonight and people may have had their own experiences for themselves or people close to them that they've supported who have experienced their own bullying. So we really wanted to be mindful of that and I guess again we're not able to deal with individual situations so the chat box isn't the sharing of personal information or particular cases tonight that's not the purpose but just I guess to alert people that there may be some things that are talked about that you know the nature of the topic might be a bit challenging or be a bit triggering for people. So be mindful of your own self-care what it is you need to do to be able to look at yourself in this kind of environment. So hopefully that's something you can be prepared for and ready for to do what will work for you. The learning outcomes and again this is information that's been distributed beforehand and the first learning outcome we've kind of thought a bit more about defining what bullying workplace bullying might mean so we're going to be spending that and we think that's going to be a bit of a learning outcome as well as thinking what is it that we're actually talking about so we'll be adding that to the list as well. So what does workplace bullying and harassment mean? What about the legal context that is including how to report where to notify how to access information? So we'll be adding that into that learning outcomes as well as the others which is around implementing best practices and strategies to improve successful early intervention to better support people experiencing bullying in the workplace and just stressing again that notion of early intervention so not waiting until people are really in great trouble but catching these issues as early as we can. Identifying challenges, tips and strategies and providing a collaborative response to supporting social and emotional well-being of people who are experiencing bullying in the workplace and we know that people really like strategies. They like things that they can take away from these sessions so I think that we will mix with that. They'll be mixed with some of the research and some of the things that we've learned and people on the panel have learned over time and are working on but I think there will be some really important ideas and strategies for people to take away as well. Before we watch into the presentations, I'm hoping people have seen the case study. We've had a chance to read it because it forms the basis of the discussion I guess. So the panellists have been asked to use the case study as the basis of their presentation. So I'll just do a brief recap before I hand it across to Anne to kick off the panel's discussion for tonight. So Mary is a person of fictional case study. Mary is a person we'll be talking about. She's 46 years old. She's a nurse unit manager and two ports to the supervisor Alice. And Mary has been in the hospital for 10 years and she's always been very confident. She's married, has four children and she plays netball. Mary has been well respected by her colleagues and since Alice has been appointed to the supervisor three months ago, Mary has been questioned and challenged by Alice about her decisions. So there's been a real shift since Alice's staff is. And some of the things that Alice has often questioned Mary in front of her staff directly contradicting her. Alice has been a single Mary out in meetings. And this is impacting on Mary and she's starting to second guess her ability and at home she's starting to drink alcohol to alleviate the stress that she's feeling. So it's starting to impact on her ability to cope. She's not confiding in with people. She's not sharing this with people at the moment. She's missed the netball game. She dreads the alarm going off in the morning, which I can understand especially these mornings, but for Mary it's great around wanting to go to work and see her about what's happening for her at work. She's avoiding Alice since she's starting to have some physical signs. She's feeling nauseous at work. And recently Alice's concerned Mary fears when the performance appraisals Alice had her poor rating implied she needed to lift her game or the position would be in jeopardy. So there's this real threat hanging over her now. So she's feeling low in mood and her sleep is starting to be affected. Her husband has noticed that despite her trying to hide this from him. He's noticed that and he's insisting that she go to the GP. And once you're at the GP's rooms she finally reveals what's happening. So that's setting the scene. Now let's hand across to you Anne and you can give us an occupational health and safety consultant perspective and you're going to begin with a bit of definitional information for us to help set the scene a bit further. Thanks Lynn. My first job is to briefly present the legal and definitional context of this discussion. Obviously there's only time to think about this in very general terms. The workplace bullying behaviour is accepted across Australia as a psychosocial hazard and by the term hazard we mean anything that has the potential to harm the health or safety of a person. Health in the work health and safety legal context refers to physiological and psychological health. The hazard in the case of workplace bullying is the abusive behaviour, not the person employing it. Although there are some differences between Australian jurisdictions in work health safety law, each jurisdiction assigns duties of care to all the players in the workplace setting. So this includes directors, managers, employees, contractors and others. The employer has a general duty of care to provide employees with safe working environments and safe systems of work. Several terms are sometimes used mistakenly and interchangeably in discussions about workplace bullying and they include the terms conflict harassment and bullying. They've got different meanings and they have different remedies. So let's just define these terms. Conflict at work denotes differences of opinion and disagreements. It happens constantly with and in between groups of people. It's not necessarily bad, it can often lead to creative solutions to problems if the conflictual opinions are harnessed properly. However, if it's not managed over time, unresolved conflict may lead or escalate into workplace bullying. Harassment denotes unwanted behaviour that intimidates offends or humiliates and can lead to less favourable treatment of the people or the people persons being targeted. It's relevant to some characteristic of the people targeted such as gender, sexual preference, marital status, age, status of the carer, race, disability and so on as listed in the anti-discrimination literature in each jurisdiction. Sorry, the anti-discrimination legislation not literature. Harassing behaviour unlike bullying does not have to be repeated. It can be a one-off episode. Safe Work Australia provides the following definition of workplace bullying. It's defined as repeated and unreasonable behaviour directed towards a worker or a group of workers that creates a risk to health and safety and all three of those criteria must be met for the behaviour to be categorised as workplace bullying. Repeated behaviour refers to the persistent nature of the behaviour and can involve a range of behaviours over time. Unreasonable behaviour means behaviour that a reasonable person having considered the circumstances would see as unreasonable including behaviour that is victimising, humiliating, intimidating or threatening. Workplace bullying does not include reasonable managerial action carried out in a reasonable way. So for example the provision of fair feedback on a person's performance is not workplace bullying. Australian Work Health and Safety legislation embraces a risk management approach to hazards in the workplace and this includes the psychological hazard we're talking about. Risk is often expressed in terms of a combination of the likelihood and consequences of an event with the context being taken into account and I'll explain that a little later perhaps. Risk assessment refers to the overall process of estimating the magnitude of risk and on this basis the acceptability or unacceptable of risk is often decided upon. Risk control refers to the process of elimination or minimisation of risk. Safe Work Australia has developed guidance material in relation to workplace bullying based on a risk management approach. With the above in mind let's lead over to our case study. Mary has perceived certain negative changes at work. She alleges that Alice has repeatedly behaved unreasonably towards her. The situation is beginning to impact on her health. She can't sleep. She decides to consult her general practitioner and ask for sleeping tablets. Is this the way to go? I will now pass you over to our GP and occupational physician Dr Neil Ozan to his comment. Thanks Dan that's a really good opportunity I think for people to start thinking about the definitions and what it is we're talking about when we're talking about bullying and it's clear that there's some judgment in there I can see from the chat that people kind of do some examples of where that might be the judgment might not be quite right but we might come back to some of those. Let's move across to you now Neil and give us the GP occupational physician perspective. Thank you. Because Mary has gone to the GP a lot of my talk will be from the GP perspective but I can also talk a bit from the occupational position one. Because she's most come to me and my job as a GP is to look after my patients the best way that I can and what I want to work out is how is the best way to help Mary through this situation. But first of all I'm going to need to know what's important to Mary and I'm making the presumption that Mary being 46 she went into nursing on the basis that she wants to do a good job caring for patients looking after them making them feel comfortable helping them when they need things and and then go home and then come back the next day and look after patients again. She doesn't want to do what she now has to do which is look after budgets and money and performance reviews and and those sorts of things that didn't exist when she started. So I need to keep that perspective in mind when I'm looking at her. As an occupational physician I feel so wondering what's happening in the work and the workplace and I want to be aware of how this will affect other workers both both managers but more importantly other nurses in the hospital and they being affected as well as in if I'm the occupational physician there is Mary the tip of the iceberg or the presenting problem but there's a bigger problem underneath or is Mary the only one with the problem. So to work that out if I'm going to provide effective help I need to know what's going on I need a super good history and this takes a long time. It takes a long time to get a history of what's happened what the process is what were things like before when did they start to go bad what were things like before Alice came along and what are they like now has there been other changes in the workplace with the management system has the why has Alice come to that workplace because there are many there are many factors that could be in effect here has their budget changed many things affect that but more importantly for the topic of tonight is how am I going to be helping Mary that's to work out I need to know what's wrong with Mary to do that I need to know her background which is who GP I would have a reasonable idea but I would want to be sure that I know what's a medical background is there something in her medical history that could be affecting her ability to perform the work so I need to know who she is there really some substance to Alice's allegations that she's not working well and is there some substance to Mary's allegations that Alice is bullying her and so I need a bit of facts first I need to know is there something about Mary in the past that her medical or her mental health might put her at risk of poor performance and give so I need to look at that as a separate issue when I'm doing her examination I want to be sure that there's no physical aspect that's going to be affecting her fitness for work either because if there is a problem with Mary's fitness for work then it's a separate issue all together so I'm going to presume for the case here that Mary is actually doing okay as a nurse perhaps not as an administrator but she's doing a good job as a nurse still and there's a problem with Alice and Alice is being bullied now to move on effectively what I've just been saying is that I need to really define the problem so that I understand what's happening I can explain that to Mary along with the potential causes and then I need to look at it as in Mary's my patient what's wrong with her is the secondary mental health diagnosis appropriate such as have problem this has she become depressed and though she need treatment is she at risk to herself or self harm and suicide and more commonly is she going to be at harm of becoming worthless in the future and having the health problems to go with not working so my dilemma is how am I going to talk to Mary how am I going to write all of these subjects with her do I make communication with the workplace and if so who and how Mary's going to need some treatment and who's going to do that who am I going to refer for to help with the counseling and who's going to pay for it should I provide medication because she may have depression should I provide the sleeping tablets that she's asked for as a personal issue my answer is just a absolute no I hate the sleeping tablets I always have always will don't prescribe them ever but should I describe something else that's a question that will come later should I refer her and if so if we through I need to be aware of the work options for her I'm aware of the health benefits of work I'd explain that briefly to Mary but what options does she have does she have the option of restricted duties does she have the option of working separate from Alice and then the question is should I certify her and should I put her on to work as compensation or work cover and now it's time to move on to Dr Nigel Strauss thanks very much Neil that's a lot of things that DPs are thinking about so there's a lot of decisions in there a lot of information to be gathering and I guess lots of lots of things to be thinking through so it sounds like there's lots that we might pick up again later on so let's now move on to the psychiatrist so Nigel let's hear your perspective in terms of from the psychiatrist point of view what is it that you think is really important here to add to the other panelists well there's certainly a lot of questions that have been a lot of questions certainly a lot of questions that have been a lot of questions that have been asked by Neil and they need to be answered I think that the relevant point that I'd like to emphasise is this psychiatrist is it crucial the aim should be to get Mary back to work as soon as possible I've seen so many of these claims pulling the claims whereby people get caught in the system medical workers compensation system and the whole process becomes very protracted so the first point of contact for Mary is the general practitioner and I think the practitioner has two roles and I think that Neil's talked about those but predominantly the first role is to be a good listener to hear what Mary has to say because from that very brief outline of the case it appears that Mary hasn't been able to talk to anyone at work about what's happened and this is so common in these claims where people feel very isolated in the workplace and because of circumstances in the workplace there's no one they can fight keep they can confide in so they end up going to the general practitioner it's not the wrong of that obviously in general practitioners roles to listen and formulate what's going on it's important to emphasise that of course if you only have one side of the story you don't know the full facts if you're the GP but it's important to accept what Mary's saying in the her perception of circumstances accurate as far as she's concerned the next the second aspect to consider and this is that communication needs to be established between Mary and the treater and the workplace the workplace has to be informed as soon as possible about Mary's concerns now that doesn't guarantee that the workplace the employer is necessarily going to respond appropriately but hopefully the employer will and if they do there's good grounds for some sort of remedial action to get Mary back to work quickly into another role or to establish some form of mediation between Mary and the person who's concerning her is upsetting her the main thing is to get the wheels rolling in the workplace I repeat if that's not always possible but if it is then there's a good chance that we can get Mary back to work quickly so communication is important in setting up some sort of dialogue between Mary the other worker and the employer with the assistance of the general practitioner if the general practitioner doesn't feel that that's his or her role then certainly another treater such as a psychologist who's experienced in workplace circumstances can step in and act as a sort of advocate and help her for Mary and get this process rolling now Neil touched on the concept of illness and whether one makes a diagnosis I think initially it's important for a general practitioner to try and assume that Mary is simply upset and that if the situation of work can be resolved this upset can be managed appropriately on the other hand if Mary presents with severe symptoms and of course a diagnosis needs to be made but I'm always obviously that we don't want this to be medicalized we want this to be seen as a process of conflict of potential conflict of perceived conflict which can be resolved in the upset and the distress and be rectified of course a diagnosis maybe made if this doesn't occur if the thing becomes more impracticable and Mary's situation deteriorates and similarly does the general practitioner put in a workers compensation plan this is another big factor that can not always be necessarily helpful so that if claim is made or with compensation claims made this can sometimes slow the whole healing process down and provoke more conflicts a lot of employers are not happy with claims being made I'm not saying they should be avoided but again if this thing can be managed quickly and efficiently by communication and getting the worker back to work as quickly as possible and hopefully the workers compensation claim can be avoided because many times once a claim has been made the wheels start turning and the situation can just drag on and this will not be good for the area in the long term so quick quick action good communication and resolution as quickly as possible to avoid this thing going on too long and that I think is the important decision okay so we've got lots of various information there from range of perspectives and I guess seeing the chat there's lots of ideas and lots of questions being asked about this and people certainly picking up on the complexity of this and the notions of power and how this plays out and I guess for some people the challenges that they might be when they're not heard or asking is not taken so I guess trying to sort of stick with ideas that what it is we can do one of the suggestions that a number of people have made is taking it to HR or something that some of the the panelists talked about in terms of contacting the workplace so maybe a question that I could put to anyone who'd like to answer in the panel is what would that be like as an approach contacting the HR people as the workplace where Mary is and who would do that and what might you need to think about so anyone who'd like to jump in to get us talking about that is a possible option Well I think that human resources it depends on the size of the organisation in Mary's case it's obviously a de-organisation and human resources would be the aspect of the employment of the employer or the agency of the employer who should be contacted and hopefully the human resources department or officer will be of assistance in such a case that in a small organisation you might have to ring the employer but often human resources is the way or the place to go Well okay alright so it sounds like that's a good a good thing to have in mind particularly at this early intervention period as well when sort of there's conversations happening at the GP Alright thanks for that Nigel Tina let's move on to you and I guess you're going to be thinking a bit about and talking to us a bit about that workplace and some of the things that might be happening there and some of that bigger picture aspect as well so let's have a listen to what you might be thinking about from a psychologist's point of view Okay I'm in a fortunate position as coming last so just to endorse everything that's been said previously I suppose my sort of first point briefly was about not making assumptions there's a wide spectrum here there are dreadful things that do happen to some people in workplaces I'm involved at the moment in a couple of prosecutions as an advisor and but right up the other end of the spectrum there are also people who have what the literature calls high-trade emotionality and they are overly sensitive and they relabel what Anne referred to as reasonable management action as terrible actions undertaken against them so we've got to be careful not to make assumptions the other points are both Nigel and Neil made around not medicalizing low morale that's critical because we do see iatrogenic effects here where some people get worse as a result of the treatment they get the early re-engagement with employment is absolutely critical the longer people stay off work the worse they get people in a work once the claim's been made there are things about workers' compensation systems that are associated with worse outcomes same with surgery physical outcomes as with mental health outcome so we want to minimise people's involvement in the workers' compensation system we want to minimise medicalizing low morale so i think as Nigel said in communication engage with the workplace as early as possible if it happens to be an unreasonable workplace and you're not getting anywhere in Victoria which I'm most familiar with but other states have the same function we have work-state psychosocial inspectors who can go out and pay a visit if you're not getting anywhere with HR but certainly that should be the top of the list early re-engagement with the workplace but if things fall off the perch and you're not getting anywhere all of the state's workers' comp authorities and regulators have those sorts of functions where they can pay visits to the workplace another quick thing to slip in is around certification so I'm not quite done to my slides but what we find is that often GPs and physios who certify in some states now too is there's a mindset of either totaling capacity or total capacity but you can certify partial capacity and even put in place some restrictions and I think Nigel mentioned this and Neil as well that it may be a reporting restriction if it happens to involve a troubled relationship to the manager you can certify can't talk to that or can't report to that manager so those sorts of things are realistic but we must focus on re-engagement with employment the longer people stay off work and I think there's the next slide or two talks to that the worse their outcome the less likely they are to get back to work so the mental health of unemployed Australians is actually up to four times worse than people engage in employment the OECD and the whole health benefits of work agenda which Neil mentioned indicates that engaging with employment is better for people's recovery and better for people's mental health and that's absolutely critical so the whole agenda nationally around re-engaging with employment it's not about nothing to do with cutting costs for insurers it is about people's long-term mental health and wellbeing outcome in terms of when psychologists get involved the challenge is that most of our psychologists in private practice are engaged in Medicare systems they have their set 10 sessions it doesn't matter what you do between beginning and end but in this jurisdiction you have to get very directive very strong and the first point to make is you must not reinforce avoidance behaviours avoidance behaviours we do see a lot of cases where people it's iatrogenic people are being made worse by the treatment they've had they get reinforced into victimhood blaming the employer blaming everyone else and particularly if they're up that high emotionality into the spectrum you've got to have a completely different approach you need to go in strongly so motivational interviewing to sort of work out if you don't re-engage with work this is the prospect in terms of worse outcome often in this population too lots of pre-existing things get stirred up but you still need to try and quarantine that's what the best clinicians do we do over 1200 secondary treatment reviews a year in WorkSafe on what we call the clinical panels and the best clinicians try and quarantine that and really focus on current function trying to get back to re-engaging with employment then you might concurrently, subsequently look at some of those underlying issues so the sort of generic supportive counseling where you're unwittingly reinforcing misattributions it's all you must be very active and the framework we use and this has been adopted nationally across all WorkSafe jurisdictions it's a thing called the clinical framework which you can access on New South Wales, Compaire, Vic Victoria etc etc website and it just details the principles of sort of active treatment that need to be employed in this space I did want to end on a positive note because I think I'm about running out of time I could talk a lot more about that but on the positive end there are a lot of good things happening I do see in Victoria we've just produced some psychosocial guidance materials for employers I do a lot of work in a space it's called Incivility which is low-level negative stuff in the workplace that if you don't check it it can morph into bullying downstream but a lot of employers are really seen on that notion and so establishing strong values and behavior piece in the workplace etc holding people accountable having people-related KPIs in managed performance there are a lot of good things actually happening out there probably the overriding big challenge and I think Neil alluded to this Mary's role is morphing over time there's a macro sort of thing about where change intersects with globalization whatever whatever so it's a real challenge as we move forward in terms of the safety nets we have the pace of change Comke put in the place last year a sort of psychosocial checklist reviewing organizational change because a lot of claims come as a consequence of change so these are all big things perhaps the final thing to note I was involved with Mary White who's an opposition and we did a review for Safeworth Australia and just to note that above and beyond treatment the support that people perceive from the workplace is an absolutely critical factor that either facilitate the rails or hinders their return to work so above and beyond clinical treatment the workplace has an absolutely critical role to play in this whole process it's the treaters the workplace working in partnership to try and progress and improve those return to work outcomes so yeah so there's a lot of good stuff happening in the prevention space as well but that's probably enough for me so thank you very much and I'll move on I think Lynn to questions whatever yeah thanks Peter and the passion just comes through doesn't it I know you could be here all night I thought I don't know how I'm going to stop him but I'm glad you did that so thank you look I think there's probably lots of questions I know we've got lots of questions coming through when people register we ask for the questions and we had lots of questions and just looking at the tab we can see people talking about how this is really happening a lot and how there's kind of a sense of helplessness I guess I was really pleased Peter you ended with that positive note and that notion of prevention but if we do go back to thinking about Mary in this case there's a part about supporting Mary and working out what we need to do to support her but there is the visual balance in the workplace so any of the panelists I guess the first question is any kind of reflections or thoughts given if you've been keeping an eye on the tab that sense of things not working or the management won't listen or people don't you know that don't want to Mary might not want to go to HR EAP might be limited in what they can do so any of the panelists wanting to kind of give us any any reflections on that and again with that kind of strategy hopefulness that that I think is really going to be most helpful for us tonight anyone like to start Neil's got a comment yeah my comment is to pick up on something that Peter mentioned which is to focus on the function and I think to focus on capacity what Mary can do and Mary's function what she is doing and maintaining that supporting that and helping her increase that is probably the most important thing here far more important than focusing on what's Mary feeling bad about what are her symptoms and what are her problems because if you focus on those symptoms and problems she'll focus on them then she'll think about them more and they'll become worse which is a self-fulfilling prophecy what we need more than anything is to help her focus on how she can make things better yeah so is that like an empowerment working towards empowering her is that that be how you describe that Neil in terms of you helping her think about what if she can do it would that be part of that focus yes that's part of it and a large part of that is going to be talking with the the workplace talking with people to help and maintain Mary's usefulness because if someone saying this this person is useless they're no good they're no good but then effectively all you're going to do is drive them away even more make the problem even worse and that's worse for the workplace as well as being worse for Mary so as a GP treating Mary that's going to be bad as a occupational physician that might be involved with the hospital that's going to be bad for that too so the thing I like about treating any of these things what's good for one party is also good for another party everybody benefits by doing the right thing so it sounds like that's the way in then if you wanted to get management or HR involved that's that's the angle then in terms of what it is that's going to work for them as well it's not just about Mary that's a whole system sounds like someone else wants to talk is that you Peter oh yeah look at two things if it becomes a claim in Victoria and other states that have parallel and a developing this direction we have a scheme called workplace support service which means that the claims are triage and where it looks like more an interpersonal barrier than a medical barrier to return to work a rehab provider with skills is appointed to liaise between the worker and the employer and try and resolve those interpersonal barriers so that brings in a third party who's experienced in this space and understands what the employer obligations are and pursues that in that direction the other thing in the very positive end of the spectrum is you know beyond blue is out there promoting the notion of mentally healthy workplaces some employers are actually embracing that space they're doing more to hold managers accountable at different levels for behaviors managing behaviors etc etc so there are some positive things at that end as well right yeah thanks Peter so it does seem like whilst we're talking about this is being a very big problem it does sound like there's been the culprits that's starting to happen in tax time obviously anyone else like to comment on on any of those in terms of what's what can happen in terms of the roles that you might have or that health professionals who are in the audience tonight might be able to play in terms of engaging the the employer having their management talked with or HR contactors or mediation might be another another possibility that I've seen raised in the chat as well Nigel any thoughts well all those all those techniques are for point of communication important I don't want to be the prophet of doom but some of the workplaces are very resistant to any suggestions and as much as you know I'd like to be optimistic I think there are still a lot of recalcitrant employers who make it extremely difficult to get workers back to work and we can't deny that they do exist and it can be a real struggle so to try and bring about mediation communication human resources and in most cases I think it's very important to protect people like Mary from being battered and bruised continuing to be affected by this treatment and I think that we have to keep that in mind and even though we do make attempts to get it back to work quickly if that becomes quite quickly apparent that it's not going to happen and we have to do everything to protect you know and talk about other possibilities if in the going back to work he's only going to make it to work so maybe even encouraging you to look for work elsewhere I'm not saying that's necessarily the approach but it might be something we have to consider certainly we have to look after her and that's about the primary concern of the treater at least I think in cases like this so keeping Mary at the centre yes yeah yeah I can I can see people talking about the workplaces are quite different so for some people we're talking about family businesses or talking about very small businesses but it's not a HR it's not necessarily employment assistance program to go through so I guess that that means that that's even more challenging so any thoughts about that if we are talking with someone who's he's part of you know very small business and some of those structures aren't in place and I do use about that and maybe thinking about you know what is what are the options outside is that that employment place itself just just a quick comment there Peter here can you hear me just just a quick comment that certainly the data for small employers from a worker's comp spend expected is worth because if the alleged bully is the owner of the business and there's only three or four employees there's not much you can do in terms of alternative reporting etc also as has been mentioned they don't often have the capacity of a HR function so work safe small business associations blue beyond blue have developed various sort of guidance materials there but it is a bit of a gap often the option needs to be looked at as a return to alternative employment of course you know if we try and focus on moving upstream if we can get to these things earlier mediation as has been mentioned can be a very valuable tool but it does have a window of opportunity often supplied to late and it becomes ineffectual and a wasted space but yeah we've got to acknowledge there is a real ongoing challenge small business in the UK they've piloted programs around government funding to provide a sort of HR service to support small business so there's various initiatives around the try to address that issue but it is an ongoing challenge yep great okay thank you now Ann I can see that you're wanting to participate in this discussion but we've had a little bit of a hectic plan it's all gone past see you now well I think a lot of the things that I would have liked to have said the opportunity has gone past but there's a couple of things I'd like to reinforce that Peter spoke about and Nigel as well in some cases we have to face that the person needs to leave and that often happens in a small business for example if it's to say a smaller state agent and that the family run business and somebody goes in generally the person you report the problem to is also going to be the perpetrator and it's often the case that that decision may be the best for the person to make unfortunately that's very difficult for some people particularly if they're working in regional areas where there's no great opportunity for other employment and that sort of thing the other thing I just want to stress that mediation used too late can be as Peter said more harmful than useful and there's a number of reasons for that as Peter said more harmful than useful and there's a number of reasons for that obviously if something has gone into full blow and bling there's an absence of trust and you know mediation involves the voluntary it's a voluntary intervention and it does mean that people need to to enter the situation in good faith and if there's a fear that the other person isn't doing that then I've seen it cause a lot more harm than being helpful I just wanted to emphasise that mediation is great for conflict but once it's gone into full bling then it may in fact be another layer of bullying in itself if a person feels that they have to enter a mediation situation when they really don't want to so then it's going to help people and understanding the potential impact of that is really important yep okay great thank you now we've got lots and lots of possible questions we could go to but I'll go back to some of them that came through earlier on and one of them was around the role of the family and we've sort of identified with Mary that she was keeping this quite secret from home even though her husband was sort of onto something was not going quite right for her what would anyone like to comment on the impact on the family or the way that you might engage with the family and any any kind of aspects around the family considering the family and if when Mary might have different ideas that whether she wants to wants to engage with that or not but any examples of how that might be useful well it's Nigel I think that the family is a crucial factor in all of this and cannot be denied and inevitably in these types of situations the family's become involved and the secret can't be kept and I think it's important that the family be considered because if there is a good supportive family around the workhouse then that comes in much better that the worker will need support because as Freud said there's only two things that are important in life and that's love and work and this work's not going well we need as much love as we can get and we need a lot of support from the family and it would be good for the treasurer to talk to other family members particularly the spouse obviously and then discussions could be broadened and if there are discussions about say leaving the job then of course this is important and I think that if these things become protracted then one has to be careful or one must be aware as a treasurer that there often are strains on the marriage emotionally, financially and so forth and these have to be monitored and made and managed as well either by the general practitioner or by psychologists whoever's involved so of course with all these issues the family is imperative and needs to be involved and needs to be helpful and informed yeah great yeah really comprehensive answer thanks Nigel now I'm just looking at the time and I know that we're just really just warming up and we can keep going but we've got six minutes before we finish so I'd love to keep answering questions and I can see the discussions happening I can see people providing ideas to each other and lots of people agreeing with some of the things that the panelist has talked about and sharing ideas and other people raising some new concerns and it's obviously complex and there's lots to think about but we do need to wind up so I'm keen to give each of the panellists a couple of minutes to really just any summary, reflection take home message I guess so Anne let's start with you home message that I take from this and that I would like the audience to take from this is the idea the intervention the better everybody wins this means that encouragement of reporting needs to occur what happens once the reporting has occurred needs to be resourced and the situation where follow-up is required needs to be done very carefully I would still endorse that a person who feels that they're being bullied in the workplace sees their GP in the first instance but earlier the earlier the reporting the better okay great so early messaging is really important to be able to act and have more options would that be the main message there that's having more options the earlier we intervene the prognosis yeah and better outcome I've just had some messages from MHPN that I've got a little bit more time than I thought so we can take a little bit more time to do these messages so Anne if you've got anything else you want to add you could do that or I can come back to you well I'd just like to say that this whole reporting thing is very fraught it often reporting often falls on deaf ears and that we really need to educate people who are responsible for workplaces and for the health and safety of people in the workplaces that they must accept early reporting and resource what interventions need to happen from there these problems don't go away generally they get worse and so you know my plea is for everybody involved in this in this area to encourage and and see through the red flags that people raised by reporting and to encourage people to report there's also a whole lot of under reporting there may be over reporting but there's also under reporting the criminologists call that the dark figure and there are people who feel they just can't report for various reasons and we need to troubleshoot that and find out what are the constraints on people feeling they can report and have a look at how we can overcome those constraints so looking out for these signs early on and taking it seriously people raised and also here other people who might see someone in strife making some steps to assist yes right okay good thank you who'd like to go next in this sort of extended final comments or take home messages who'd like to go next Neil I'll go next if someone's dog wants to have something to say yeah the dog the dog will go first I'd agree exactly with what Anne said earlier at the better before things get too bad before things get worse before they have time to become entrenched the more people that get involved who are around the outside of it the worst things will get because all that will happen with that is that Mary will focus more and more on what bad things are happening how bad it is how bad it is how bad it is which will make her worse and everything will get worse we need to focus on getting Mary assessed get her function maintained what she has got we want it maintained we want her supported we want her lifted we also want to be able to help work become a better place to work and we want to help Alice probably needs some help too she'll need some education I would hope that because Alice is also a nurse that she's got hopefully some good qualities about her but she probably needs a bit of education on how to take on her role but she hasn't been trained for either so we've got two people who though trying to do one job both being asked to do another job neither of them really well one of them at least doesn't like it the other one probably doesn't like it either but it's just a bad situation that they're both in but it can be helped so we need to focus on how to help them rather than what problems there are yep okay so that that's thinking about the underlying causes of the bullying I guess is what you're saying there isn't it in terms of not just seeing the bullying is happening in isolation to nowhere or some nastiness it might be maybe happening as part of something that's happening to Alice as well yeah we don't know whether Alice is what pressure Alice is under that then being passed on to Mary and to finish with Mary and the family we can't really have to be sure that we don't go direct to the family we have to get Mary to go to the family or at least have her permission to go to the family but for Mary it's going to be hard for her because she's the nurse looking after other people and she's not patient usually so she has to be encouraged authorised that she can be the patient and that she can seek help and ask her husband because she's probably thinking that she's protecting him but he's probably feeling that he's been excluded and left out of it and he'd like to be able to help so we need to encourage and authorise allow Mary to be that person yep and he's being his partner struggling with something that's impacting him too I can thanks Neil I can see that there's a comment about peer-reviewed academic research and findings that the whole topic the area that perhaps isn't a lot of that so I'm wondering Peter or Nigel if that's something that you might want to just pick up on well we've got a moment that's come through in the comment so any comments around academia and research around this topic you'd want to pick up on or alert people to where they might find out some information cool I got you there I can give you some thinking time and come back yeah could I just make some final comments while Peter's talking about that I think that you know these bullet cases we mustn't generalise too much about bullying each case has to be seen on its own merits and it's very hard to summarise I think that bullying is a relative term and I think that some people can withstand behaviour at work that other people can't withstand so personality factors are relevant I think we have to look at the organisational structures the leadership of organisations that sometimes bullying unfortunately is very common in an organisation because people who are in charge manifest that behaviour we have to look at the structure of the organisation itself I think the way that misbehaviour in particular organisations dealt with is also important whether we like it or not the human resources function doesn't always work very well and there's a lot of discussion about whether the human resources department are working for the employer or working for the employees and that can vary too what so what I'm saying is one person might call bullying another person might not call bullying and as we all know there's been a lot of publicity about bullying in recent times and loads of good things that's been accepted and taken into consideration sometimes I think that people cry wolf too often so I think that bullying exists I have no doubt that it does and it can cause terrible harm and it can cause illness and so forth but the people who manage and treat it have to take each case as they come and try and get and the institutions is very important there's much information about each case as possible as it can be possible at a time because there are always two sides to the story and if we have those two sides it makes it easier to decide upon what's actually happening how we can manage the situation yep getting as much information as possible yes yep okay I can see and you've put a note in the chat about some key reviewed literature so you're talking there about mobbing it's called mobbing in the northern european literature people looking for that so people might be doing a literature search I've been putting in mobbing as well as bullying a lot of the northern european researchers some of whom I met recently in Auckland do still use the term mobbing which we tend to use in Australia as a term when we're saying it's a group of people mobbing either an individual or another group whereas in northern europe they think they tend to use the term mobbing too or so to mean bullying so it's just another term to put into your search if you're making one all right thank you okay now Peter yes you can talk about research if you've got some thoughts now I've given you this interesting one or you can do a paragraph yeah look I'd rather not talk much about research and talk to that most researchers in the school bullying space there are studies in the workplace bullying space but it's a literature that's pretty disparate probably the two things I just wanted to quickly conclude on was number one and Anne will emphasize this as well that all jurisdictions are starting to emphasize psychological health and safety as distinct from physical health and safety that's becoming more and more prominent under the law they're equal but it's still working its way through Australian society and workplaces that the obligations are the same in Victoria we're just developing a whole of government approach utilizing what are called the Canadian standards around psychological health and safety safe work Australia some lot of work in this space so there are good things happening there the one thing I did want to conclude on because there's probably a lot of people on this webinar but psychologists in particular who get referred people that's fairly downstream so that the person's gone to the GP the GP's done certain things and probably provided maybe some sleeping pills if they didn't go to see Neil but etc etc and then let's refer to the psychologist so by the time they get to you they're fairly downstream I just want to say that the couple of things when I see people in that space I do what's called motivational interviewing on steroids like you've got to go in really strongly you're at high risk I will get family members allies whoever wants to come in relatives get them all in lay it all out about the risk you have we have to get you re-engaged with alternative employment we've got to get you active and functioning so you've got to be doing exercise every day if you prescribe mindfulness for example don't just give the person a CD they must rigorously do it every single day and be accountable for that you've got to get them very it's like a military training machine because the longer you go on like this the less likely you are to ever get back to work don't focus on the underlying stuff recognize and acknowledge it quarantine it do a bit of EMDR if you need to to sort of sideline it that's what a lot of experience clinicians do but you've got to focus on functioning and re-engagement as best as possible with alternative employment whatever all the Australian schemes have an equivalent of what we in Victoria call the new employer scheme if you're not going back to the same job the vocational rehab people help you to sort of identify skills and go to an alternative job but you must do that intensively and full-on because every day goes on the risk increases that you will never get back to employment and as we said earlier the mental health of unemployed Australians is on average up to four times worse than people engage in employment so don't just do the sort of empathy ventilation support you've got to be very directive very full-on and get them doing stuff really actively between every session thanks yep okay good I like the way you know that you keep going again I've got that sense so just one last question which is kind of a wrapping up question one of the one of the really interesting questions you had early on was if you could develop a five step quick reference guide for healthcare professionals assisting clients who've been subject to workplace bullying what would those five cornerstone steps be? So would anyone like to have a a wrap up final, final wrap up there of five cornerstone steps so it might be one each or it might be a couple that people want to throw in so what would be the cornerstone step? Who'd like to have a stab? Communication? Absolutely Well communication and empathy I think okay two communication, empathy any others? Cornerstone This is assessment holistic approach Holistic approach Neil It's a holistic approach you need to look at that may have turned out that's kind of like and everything and put it all together to then come up with the final answer Yeah Okay Great So communication, empathy holistic approach and any any one cornerstone points? I know that it sounds like empathy but I will also add the word caring so many people say to me and of course the people I meet are end stage their lives are ruined and they say if only the workplace cleared they never visited me they never wanted to know how I was they never followed me up blah blah blah and the word that I do here all the time is caring Okay thank you And Peter final words Oh look I'm just going to rip off Ann and say that again with the review I've been involved with the State of Lake Australia that the perception of workplace support is so important and some employers get it and are gradually getting it but where the perception of support is poor that really reinforces that trajectory onto long-term disability so employers need to be more accountable for that we're starting to hit in that direction with the emphasis on psychological health and safety so let's move on as quick as we can in that direction Okay Great thank you So it's been a big session I can see that the dogs that have joined us with all the people who have logged on as well are getting a bit upset with your dog Neil so we began before the second session we had a cat walking through the background one of our panellists so now we've had dogs barking and people telling us that that's then set their dogs off so we've had a bit of an interesting time and then of course I know what time it was so thank you for persevering with us and hopefully this has been a really useful some useful ideas certainly not pollution I think we obviously have a long way to go but it does sound from the comments in the chat and from the panellists as well that there's a lot of progressive action happening and long way to go but certainly some recognition and some actions that we probably didn't have 10 years ago or so so let's move to the last couple of things we need to talk about now so we have an exit survey when you do when the webinar does finish there'll be an exit survey that comes up that we would like you to take the bit of time to complete the certificates of attendance will come out the next couple of weeks it will receive those and you will also receive a link to online resources that come out after in about a week's time as well in terms of some MHPN webinars coming up there's a Department of Veteran Affairs series of six webinars that are focused on supporting the mental health of veterans and the first one of those is called understanding the military experience warrior to civilian and that's going to be held on Tuesday the 16th of August 2016 and the other work that MHPN are doing are with APS which is where I work and this is a webinar as part of a forced adoption project that we're working on and I'll be facilitating this one and that's forced adoption best practice principles and that will be on Wednesday the 24th of August 2016 so we'd love to see you join us for those and we would also like to encourage you to think about joining an MHPN network in your local area there's a link there for you to have a look at some of the MHPN networks so they're there already and an opportunity for you to join up there as well and also a reminder if you haven't already to have a look at the networks and the online activities on the MHPN website I'd certainly like to acknowledge the consumers and carers who've lived with mental illness in the past people who are living with experiences of bullying and suffering from those experiences and continuously live with mental illness at the moment so certainly when we're talking about this work it does really bring that home in terms of the work that we're doing and the importance of that work I'd like to really thank the panel for their participation their energy and their enthusiasm and it does feel like the time has gone incredibly quickly and that we've touched the surface but people will be able to access the resources that are there and have a look at those and I guess from their own sort of state and territory perspective have a look at what might be relevant and hopefully you did find this very useful and can go away with it with a couple of ideas and some hope that things might get better as we go by so thank you panel and thank you to all the participants and the behind the scenes people and we'll finish there so good evening everyone thank you