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Early intervention and understanding psychological injuries

Presenter Chris Foley continues the Workers' Compensation Regulator's early intervention series with 'Early intervention for managing psychological injuries'.

Would you like to better understand mental health, psychological influences and reasons why early invention plays an important role in getting an injured worker back to work? This webinar discusses ways of reducing the barriers encountered by both injured workers and employers during return to work, and the importance of doing so.

Chris Foley, Managing Director of Strive Occupational Rehabilitation, has over 25 years' experience in the industry, working with injured workers and employers to overcome barriers in returning to the workplace.

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Early Intervention for Managing Psychological Claims

Getting Back to Work Series - Webinar

by Chris Foley

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Steven Campbell:
Good afternoon and welcome to today's webinar on Early Intervention for Managing Psychological Injuries. My name is Steven Campbell and I will be your Facilitator for today.
Before I introduce you to Chris Foley, our presenter for today, we have some tips on making the most of your webinar experience. Firstly, the presentation will go for approximately 40 minutes. At the end of the presentation there will be an opportunity to answer your questions.

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You can ask questions at any time using the box on the right of your screen and we will collate and answer as many as we can towards the end. Also to encourage you to interact throughout the presentation we will ask poll questions. Again, a simple prompt will pop up on the right side of your screen and you will have a brief moment to respond. A copy of this webinar will also be emailed through to you shortly and available on the website.

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If you are having some audio issues please use the chat box on the right hand side of the screen and we will have our IT expert assist you.

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Our presenter today Chris Foley is your expert presenter. Chris is Managing Director of Strive Occupational Rehabilitation. Chris holds qualifications in occupational therapy, family therapy, working in ethnic communities, Scott Works International Negotiation, mediation, conflict coaching, organisational behaviour and an MBA in organisational dynamics and leadership. With an extensive background spanning over 25 years in the field Chris feels that the experience of working with injured workers and employers to overcome barriers to work and find solutions to injury disability and engagement in useful and meaningful work has been a continuous passion. Keeping people engaged as workers meant that their sense of self worth has remained in tact and employers who want to know how to accommodate injuries and disability had a way of finding solutions for people. The benefit of this being high social engagement and workplace morale leading to better productivity. Chris will be able to provide a guidance on how to better understand mental health and psychological factors as well as why early intervention plays an important role in getting the injured worker back to work.
The injured worker and the employer may be faced with barriers during the return to work process and Chris will be able to explain the connection of its consequences. Thank you Chris.

Slide 7
Chris Foley:
Thanks Steve. I appreciate that intro. I feel like I've never actually had a chance to work. It seems to be that I've studied a lot. Certainly in terms of what we're going to cover today, I'm hoping that we'll be able to find ways of identifying an employee's mental health problems. Really have a bit of a think about whether it's our barrier or that person's barrier and making some connections about the consequences of the actions that we do and in particular looking at the first five minutes.
There's a business case for early intervention.

Slide 8
Okay, so essentially in the United States and certainly it's been proved here in Australia, that reporting an injury within two weeks or claims reported within two weeks of injury were 18% more expensive than those that were reported in the first week and 29% after three weeks, 31% after four weeks and 45% after that. And certainly the research would show that people who are out of work for 80 days or more, basically you're looking at extreme difficulties in getting them back to work.
Certainly the other – page down sorry.

Slide 9
The other thing that's worth noting is that your average claims cost for psychological injury across most jurisdictions in Australia is around $30,000 and that's something that impacts upon your premium for a number of years out and there is no need necessarily for you to actually expend on that level.
The Australian Bureau of Statistics talked to the incidence of illness and injury around mental health and these are statistics from 2007. As yet, these haven't been updated but every seven years the Bureau does survey people with mental health issues. In that survey, they've found one in five Australians will experience depression in their adult life. Fourteen percent of Australians at that time, were experiencing a diagnosable mental health disorder and what we mean by a mental health disorder is where the person's psychological wellbeing has been affected so much that they're unable to do normal things in life. So there are still a group of people that this doesn't capture of people with mild depression where they have not been picked up but are still being impacted upon by their illness.
Forty-five percent of the population experience a mental health issue some time in their life. That's nearly half. And I was listening to ABC Radio about five weeks ago and the President of the AMA was indicating that one in three doctors' appointments these days, end with the prescription of an antipsychotic drug or an anti – not an antipsychotic drug, an antidepressive drug or an antianxiety drug. The incidence tells us that depression most often occurs in women between the ages of 18 and 24 and in men between the ages of 35 and 44. People often ask me about why that is and statistics don't lend themselves to explaining that. But certainly my experience would say that part of it is about how we think about or how people grow up in this country.
So women in particular are brought up to talk about how they feel, about how they are experiencing life and talk with their friends about it and so are more likely to go to a doctor earlier on and say "I'm not coping." Whereas men on the other hand tend to wait until much later to attend. Partially, I think it's got to do with men at an early age, so as youngsters and things like that are often taught not to sook, not to cry, to be men and grow up. And as I'm presenting this I want you to think about the implications of this for people because it's my experience that men often feel alienated about talking about themselves whereas women don't.
But there are two very distinct dynamics that impact. One is that women will talk about what's going on but they operate in an environment that actually says "If you don't cope then you're not a worthy person." I'll talk a bit what that means a bit later, but not being able to cope - the woman cleans the house, gets the kids off to school, does their lunches, gets them cleaned, does the bed, organises the household, heads off to work, comes back, has to prepare meals and all those sorts of things. So for them often any implication that they're not coping ends up in depression and what have you.
For men on the other hand, they get diagnosed around the ages of 35 to 44 more often than not because they've attended for some other reason. So they talk to the doctor about their inability to digest or they're feeling unwell. Some tests are done. It comes back they've got a fatty liver and the doc starts talking about do they drink very much? The answer to that is "Yes, they do" and then asks why they do. And sure enough the facts of the person being unable to deal with things in life starts to come forward. So I think that's why there's a difference in age and certainly we're seeing no change in that in the last seven years.

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Out of that same survey 21% of employees report they've taken time off because they're feeling mentally unwell. The World Health Organisation estimates that by 2020 which is just four years' time it will be the second leading health burden worldwide.
Pretty much as I said before males have substance abuse disorders and women tend to present with anxiety disorders and affective disorders. Anxiety disorders are those ones where anxiety is predominantly the factor that's presenting and often that's about avoidance.  Avoiding coming to work, avoiding interaction, avoiding approaching things that they are fearful of. Whereas, affective disorders are those things like depression or elevated mood.

Slide 11
I want to talk a little bit more about human resources. You'll see the dark line on the screen before you. That's the trajectory of people's working life. At the beginning, we have to recruit them and we have to induct them. We need then to understand the performance levels that they're travelling through and then ultimately, if we're lucky, they work with us for lengthy periods of time and then at some stage they will decide to either retire or move on to another job. Now the blue line in the background is what happens when people put in a workers' compensation claim.
Now the reason I put this up is that you can see that there's interruption to productivity within the workplace but the Human Resource Institute has identified that the life of a person's employment actually has a cost to a business. So to replace someone it costs three times their salary in order to replace them. So if you've got people who you are turning over in a short space of time it's costing your business three times that person's annual salary and time and productivity. So there's good reasons to be thinking about people long before a claim is actually placed on your desk.

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If you're thinking about your workplace and the sort of work in there, this is a graph that is often used to talk about peak performance in organisations. On the left hand side is healthy performance and across the bottom is the amount of stimulation that a person derives from their workplace. So we've all been in workplaces perhaps where on the right hand side there's overload and typically that sort of workplace is where you come in on a Monday morning and your in-tray's full. And by the time you leave at the end of the day, you've made no dent on that and the next day you've got two in-trays and the third day you've got three in-trays. And often for people, that continuous avalanche of work coming in becomes one of them feeling depressed about not being able to achieve, feeling unable to actually do the work and unable to feel valued within the workplace just from their own views of the world.
On the left hand side you've got people who actually don't have enough to do and interestingly, one of the things that happens there is you get exactly the same psychological injury from people who are underloaded as you do overloaded.
The cause of that are slightly different but the belief system that the person has is much the same. Where a person is underloaded and feeling undervalued, you often get workplaces there where people are sitting around talking to each other. You'll have them more likely to be angry with the workplace because they've got time to sit around and talk with each other and on the right hand side you've got people who don't have time to do that but the sort of talking that goes on is about "Nobody cares about us." All of these impacts are on early intervention because if we are aware that this is going on in the workplace you will have people who are succumbing to that.
The best example I can give you of that is some years ago I was asked to come and interview and see if we could assist a man who had quite an unusual job. He flew around the world. He was a high flying performer within his company. He had a narrow set of skills that weren't actually found in many places and he'd been working over in Africa for nine months and come back to Brisbane. He had a glorious office overlooking the river but he was awaiting for the company to sign up a contract that was happening in South America and this kept getting delayed, delayed, delayed.
His Manager worked in Singapore and so as time went on, he had less and less to do. Now he had a salary that was fairly extraordinary but sitting in his office thinking about things he kept ringing his boss up and saying "Hey, I can go and do some things. I'm even happy to go and work in the IT Department and answer questions and things like that" but the boss said "No, no. Just stay there. You work hard enough as it is." As time went on, he started to think about – because this was around the time of the Global Financial Crisis – he started to think about maybe this contract wasn't going to get signed. Maybe the high mortgage that he had wasn't going to get paid, maybe that his children were going to have to leave private school and he started to think that perhaps he wasn't good enough. And because he had a lot of time to think about this thing that gradually wound him down and down and down - until one day, he sat in his office thinking about taking his own life. Fortunately, he managed to talk to the HR people who said "No, let's get someone involved."

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Talk about stress and anger again. So some of the things that are identified as possibilities. Dana in 2001 identified that in performance problems in workplaces 65% of them are actually as a result of strained relationships with employees and not from the deficits of their abilities or their skills or motivation. That's a fairly startling fact. So often we go down the path of performance management and suddenly get a WorkCover claim or a stress certificate from the person and often that's because we haven't stopped and thought about what's actually going on.

Slide 14
Let's have a think for a minute about this clip. You're right.

That's all right. That's okay. Anyway, it's a picture of Barack Obama and Heath walking across… Yep, that's right. That's okay. I'll send you the actual clip itself but it's a picture of Barack Obama and Heath walking across the road at 10 Downing Street. Barack Obama leans across and shakes the hand of a Constable that's standing at the front door and then Heath walks along, puts his hand out and Barack goes through the door and he takes his hand away and walks away and you can just see the Bobby standing there with this sort of stunned look on his face. Okay.
I think it's working now.
Chris Foley:
Got it?
Chris Foley:
Yep, that's it.

Woops. So you can see even in that little vignette there's a strong message that gets transmitted in workplaces that we often don't think about.

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So let's talk about communication and this is where it's really important in terms of thinking about problems that are in the workplace that people think about communication. There's a lot of research that shows that the spoken words and the written words are only 7% of what it is that we receive when we communicate with people, 38% is the tone in which we speak and 55% of communication is actually in the non-verbals. So you would understand people misinterpreting directions or instructions that are sent via email because more often than not they are just 7%.
Equally, when a person puts in a claim and the workplace makes an appeal against it the person will then up reading that appeal and make all sorts of interpretations about it. So it's certainly important when we're thinking about this about how we communicate with people generally.

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So talk about the causes of stress. Usually it's around change, lack of control or high or low workload. We talked about high or low workload. Workplace stress more often comes out when people – the intrinsic factors of a person's job impacts upon them or their role. I can give you an example that I worked with a young lady at one stage who was a high performing person and the workplace actually organised for her to work to two managers. Those two managers didn't get on and the workplace hadn't identified, hadn't described her role properly nor did they actually describe in that role as to how she was going to split her time between the two managers. So between the waring parties it became so complex for her that she began to experience symptoms of depression and anxiety.
You can also see this happening in organisations where people – where departments might be there. So the classic one that I might see in a broad organisational context is maybe where the accounts department is having a war with the IT department because the software and the hardware doesn't quite work, where the parties are waring saying "Well if you had different software then our equipment would work" or "Our equipment is fine. It's your software." But at the bottom of that is the person who's trying to pay accounts at the end of this and who's on the end of being yelled at across the phone because the accounts are not being paid. So you can see that organisational factors and design can create stress.
In today's workplaces because we don't get much say as to who we're going to sit next to, we get stress arises from even people's working styles. So people can be distressed if they are an extrovert and used to talking and babbling out in the workplace, sitting next to someone who's an introvert who actually likes quiet and needs to think about things. And so the sort of conflict that starts to arise in that is that the extrovert thinks the introvert is hiding something from them and the introvert starts thinking the extrovert is just noisy and loud and vacuous when in fact it's just a style of working that people start to war with each other and again stress raises up.
There can be career development. Certainly a lot of times where people feel stuck in their career, feel that they're going nowhere, again this raises levels of stress. We have the organisational culture and climate. So there are copious quantities or copious examples of where organisations in recent times have gone through massive changes, different directions and things like that and the impact upon staff and what have you has become enormous and again that impacts upon people in different ways.
Then of course is the age old home-work interface. I have a wry smile when I walk into workplaces and people say "Yes, I leave my home stuff at home and my work at work." I defy anyone on this webinar or anywhere really to have a significant row with their significant other and not think about it during the day at work and of course these things impact upon people equally and I'm sure we've all experienced the situation of having a terrible day at work, going home and talking to our partners about it and our partner listens intently and then says "Yeah, I'm a bit tired of this. Move on." So all of these things are dynamics around what causes stress.

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Some of the things that you'd be aware of that certainly I look at when I'm talking with people are the sort of things people report themselves. When we are stressed and stress is not necessarily a bad thing, but when we are stressed our mouth goes dry, our breathing speeds up, our liver releases sugar for quick bursts of energy, our muscles contract to bowel and bladder and our immune response decreases. So we're more likely to get ill.
There's good reason for this because 30,000 years ago when we were on the plains and someone said "There's a sabre-toothed tiger" there was two important things that needed to happen. We either needed to run away or we needed to fight and all of these things that are happening that I'm talking about here are critical to fighting or running away. Our muscles become tense and ready for action. Blood is diverted from other parts of our body into the muscles getting ready to fight a flight, our sweat increases to cool us down, our heart rate increases, our blood pressure rises, blood clotting ability increases and we become more and more aware of the danger that's around us. This is critical in understanding people's responses to stress because when we perceive these things this sort of reaction occurs. When we see these things this occurs and there is nothing we can do to stop it.
Thirty-thousand years ago when our boss gave us a hard time all of this happened. The only difference was we'd pull out our knife, stab him and get on with our work. In this day and age, you can't do that. Or you can but that causes other stresses in your life. It is a fight/flight response and it is something that actually saves us, but you can see if you're on a deadline and constantly under stress and not dealing with that stress, then essentially this also leads to other issues, health issues that may arise. The consequences of having sugar in your system that's not being used up for long periods of time can result in Type II Diabetes and there's a strong correlation between stress and Type II Diabetes. Often doctors will diagnose anxiety and depression because a person will attend the doctor and say "My digestion doesn't seem to be right. I have indigestion. I need to go to the toilet a lot." You can see it in workplaces where people are often heading off to the loo on regular trips. Again, signs of stress.
Equally the incidence of people taking sick leave, as that goes up it's a signal to say there is something going on in the workplace that is causing stress to people in their fight/flight mode. There are lots of other things that happens around stress that is of interest but these are the things you can readily see. Just as an example there was some research done recently where they identified what happens in people's bodies when they perceive threat and something like 1,400 different chemical reactions occur. Someone said "I wonder what that is compared to when something good happens to people?" So for a joke they actually wired someone up who was talking about having been in love and something strange happened.
They found that the person who was in love had exactly the same number of reactions as the person who felt under threat and that started consideration about "Well is it about what we are thinking about is happening to us that actually depicts whether something is good or bad?" because if we're having the same reactions to a thing that's apparently good and a thing that's apparently bad – and I'll let you choose which one is which – clearly there is something that we can do about that.

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In identifying people these are some of the things that you or your supervisors or managers should be looking out for because these are signs of those early warnings and doing something about it now means a) you've got a worker that's there longer and b) someone who's less likely to put in a claim and c) someone who actually is grateful for your intervention, and that's good for the whole workplace. Lack of concentration – I can talk about this in terms of that fight/flight stress response. Lack of concentration is easy to understand. If you are being attacked by a sabre-toothed tiger all you need to do is to run away or to fight. You don't need to be thinking about that report I needed to do or that bolt that I needed to screw on over there.
People often worry or they're anxious about things that are going on around them. The person who was cool and calm who suddenly bursts out angrily across the floor. People who are high and low in terms of their mood or people's attendance starts to drop off. Again I think of this as being a person who doesn't turn up for work is in flight mode. The person who is emotionally outbursting around the place is basically in fight mode. People's humour drops off. People take work home and I would love a dollar for every time I've heard people take work home because that works something like this. The person feels under the pump, they fill their briefcase with their work, take it home, sit down with the significant other, have a glass of wine, finish the meal, have a second glass of wine. That usually tastes pretty good, so have a third glass of wine. Then you don't care much about your work and then in the morning you beat yourself up coming to work because you didn't do the work the night before and you've still got that in front of you.
People's poor decision making, low interest in work, people who no longer care, the poor quality of work again falls off because people don't have that attention to that. People cancelling annual leave, being over critical. There's tiredness and depression. Again tiredness is a symptom. Thirty-thousand years ago when we were on the plains there was no point in going to sleep if there's a sabre-toothed tiger around. So even myself five weeks ago I was going on leave and there was a lot of things I had to do before I went on leave and so I recognised it as becoming more and more stressed. So about three days to go before I jumped on a plane to go away and have a great time, I kept getting woken up by silly things like the dog rolling over in his kennel or chasing a possum in the back yard, something that wouldn't have affected me in normal events but because I was concerned that I hadn't done something or something wouldn't be finished my sleep patterns started to get over-ridden.
Depression - I'm not going to talk a great deal about depression but it's certainly one of the things as we said, one in five people will experience it and depression isn't just feeling sad. Often we use the word 'depression' badly. So if I go into the workplace and say "I'm really depressed. My dog died" what I should be saying is "I'm really upset. My dog died. I'm feeling pretty sad" because depression is something greater than that. It's not something you can just turn around and we need to remember that depression actually comes from another place.
Increased use of drugs is certainly another one. And in today's workplaces, one of the things that's becoming more and more clear is that the older population are turning to alcohol but some of the younger members of the workforces are using social drugs on the weekend because they're better or whatever. And I have a friend who's a Psychiatrist and who has an interest in pharmacology and one of the things he talks about is in the hospitals where people are admitted with organic brain syndromes and what have you after a big night out on the weekend, they just don't know what to do to counteract the drugs in that person's body because it's made up with all sorts of stuff that's actually impacting upon people.
The increase in minor accidents or incidents in the workplace is another sign to say "We've got to be doing something different." And the person who has low self-esteem,  a person with depression will often ruminate over how bad they are, how awful they are, how useless they are, how something or other – that's just clicked off… You're right.
It's the update still on.
Chris Foley:
Right, okay. A person will ruminate on how bad they are. They will often be saying to themselves "They're useless" "They're hopeless", "They're not worthy", "They are frauds" and what have you. So the sort of conversation they'll be having with you is about being sorry all the time, making mistakes, accepting what it is that you're saying as the truth.
So if you identify this and talk to people, it's really critical if someone comes to you and says "I've got a problem" it's the next five minutes that is most critical.

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Certainly, my experience over the time says that people who are experiencing stress and what have you, their first point of call will be to say to someone in the workplace "I am struggling." In those circumstances it's what the person says that will matter most. I'm sorry about my phone going off there. I'll have that turned off on the day.

Slide 20
So the first thing is about thinking about active versus passive listening. We need to be motivated. We need to actually want to believe in people in our workplace. If you don't like the person, that's going to come across to them, being motivated to actually find a solution is the first thing you have to be. Making sure that you make eye contact. Be interested in what they say. Avoid distracting actions. Have empathy for what's going on for them. Think about the whole picture and ask questions. It's critical at this stage that you don't actually offer solutions. People have a problem. They need to be heard and certainly my experience in workers' compensation over 30 years is that people in the latter stages of very long and complex claims, will often ruminate about the fact that "No one is listening to me", "No one is hearing what my issues are" and a lot of that dates back to the very early stages where they've actually made a complaint and someone barks at them and they either go into fight/flight mode. Flight mode is go home, see a doctor, "Keep me away from the place." Fight mode is go home, see a lawyer, "See you in court."

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The first five minutes. So some of the things not to do when the person's talking. Don't think about whether or not liability should be accepted. That's someone else's job. In the first instance it's about listening to the person. Don't discuss the difficulties, inconvenience, the annoyance or the doubts that you may be feeling. Again, I'd love a dollar for every time I've spoken to someone who said they went in and spoke to their supervisor and said "I'm having difficulties. I can't do this. I can't concentrate" and the supervisor turns around to say "I haven't got time for that at the moment. Go out and load the truck."
Don't take control away from the person describing the difficulty. What I mean by that, don't tell the person what to do. Don't try and minimise what it is that they're talking about.
Other things like that is where someone might say "Well give it to me. I'll do it." Again, that just falls into the "I'm hopeless, I'm useless" category. Not showing your negative thoughts. People pick those up in an instance and women particularly are good at picking up in the first half second people's – sorry about that – in the first half second people's negative thoughts. I've lost my track. People are very good at picking up negative thoughts and women in particular will pick up whether or not you like them in almost less than half a second. Men are a bit later than that but essentially they are particularly good at hearing tone and picking up facial queues.
So in doing that you need to be thinking about what do you believe about mental health. If you think that there is something wrong or negative about a person with mental health issues then you need to learn more about what those things are.
Last but not least, don't fall into the trap of becoming a counsellor. Many people I know actually do do this and in the short term that's not so bad but in the long term the problem comes when some critical decision needs to be made about the person's role and you go from being a counsellor to being the world's worst person.

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What is important for you to do is ask the person what they feel would be most helpful. Often people will say "I don't know" but helping them to actually explore what options might be there, whether it be for them to think about EAS or EAP, whether or not you get a provider involved or whether they take some time off or what it is that they do, getting them to think through the solution depending on what the issue is that they have.
Do think about what you can do to assist the worker towards wellness and resumption of productivity. Other people in the workplace will be watching. So where you actually assist that person, other people will feel relaxed that they too can receive help in situations. Try to empathise so that you can create positive rapport. And what I mean by that is understand the person, that it's not you that's happening, it's them that's happening. Try and understand from their perspective what that might be and good examples that I can think of around that – what's the time? How much time have we…
It's 38 minutes.
Chris Foley:
Okay, good. People will fall into the trap of being a counsellor – sorry. Try to empathise. Trying to understand where the person's coming from is critical. Often I'll have experience with people, certainly in my days in psychiatric hospitals one of the things that people remembered most of all were the people who listened. One of the things that people found most difficult were the people who tried to convince them that there was nothing wrong with them. Often the person themselves experiences negativity and what have you, and the task for them is to actually try and regain mastery in their own life.

Slide 23
So the sorts of styles that actually can help as opposed to not help is trying – the things that don't help is where people start to look for the causes. "Well what's happening?", "Why isn't this doing?", "What are you doing?", "What are we doing?", "We're not doing that" all of those sorts of things. Looking in the past doesn't help. Seeking the truth about what the problem is - "It's nothing to do with work. It's because you're wife's left you" all of those sorts of things impact upon people in very negative ways. Being interested in what maintains the problem is not helpful.
What is helpful and certainly I've found this from people is people who can sit and say "Well what sort of solution have you tried?", "What can you do?", "Have you thought of this?", "Have you thought of something else?" Look to the future – "What could we do from here on in?" Not "What caused it?" but "What can we do from here on in?" The person themselves will be able to articulate what they're finding difficult. Focusing on what works and what theories that you might have that actually help. When I say that I mean more about the "If you're at work rather than home it's going to be better for you." So talking those sorts of things through with people is useful. And then along the way being interested about what has changed from before and now. So typically when we're talking with managers about managing people in their workplace is to think about "Why is it different now?" So the conversation about someone who's not performing in the workplace might be "But you used to be able to make 100 widgets a year ago and now you're only doing 50. I don't understand what's going on."
Giving the person the opportunity to actually explain what's going on for them. It may be that they have an alcohol problem. It may be that they have problems at home but allowing them to actually provide you with the reason rather than putting it in their mouth is going to end with a better outcome.

Slide 24
Intervening as early as possible. So where workplace conflict occurs things like mediation or conflict coaching is critical. A number of times where I've seen people who undergo mediation early in the piece when they've fallen out and resolve those issues certainly is a better outcome than waiting two years and trying to then mediate at that time because more often than not the parties are still at war with each other.
Providing coaching to managers and supervisors about what's going on around mental health issues, what they can expect, that the person's thinking's going be impacted upon. Providing EAP for people and EAP is a particular model of interaction where the worker goes and develops up a plan to deal with their issues or their family's. Getting a rehab provider involved. Again, this will be slightly different in that the personal issues will remain confidential but the rehab provider will work with the workplace and managers around dealing with the specifics around a particular case. Or keeping connected with workers, treaters and significant stakeholders about what it is that you're doing in the workplace because often the person themselves will be minimising the things that you do. Again, talking to doctors along the way. They have five minutes to talk to the person.
If the person's giving themselves a message they're not worthy and the doctor says "What can you do at work?" the person themselves might turn around and say "Well nothing because I'm not worthy of anything and people don't like me" and the doctor will go "Okay, we'll give you time off" rather than engaging with the doctor about "We have this work" and "We can do this" and "We can actually provide support for the person."

Slide 25
The take home messages – identify at risk behaviours and act early and refer early. When I say "refer early" do something about it early. Deal with interpersonal conflict as it arises and often we think "Oh, it'll blow over." It never does. It should be dealt with at all times. Deal with harassment issues quickly. Support stressed staff. Maintain them with attachment to work. It's better to have people at work and still engaged than have them at home. Work to overcome barriers to return to work. Have them feel safe and supported at work and you can do that by having those conversations and identifying and helping that person or get that person involved with the return to work that they do. And seeking expert help, talking amongst your HR team, unions, EAP services or rehabilitation providers.
I hope that has covered a lot of the things that people have asked. I'm happy to take any questions.

Slide 26
Steven Campbell:
Thank you for your informative and enjoyable presentation Chris. We have a number of questions from our audience and would like to answer some of those now.

Okay. Well we are now at the end of the webinar. If your question was not answered today, please email us at and we will endeavour to provide a response to you.

Slide 27
A list of useful resources and references used throughout the presentation will be made available with the copy of the webinar. Again, thank you Chris for your time today and sharing your expert advice and tips.

I was listening. I was listening.
That was my take home message.
Steven Campbell:
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On behalf of the Workers' Compensation Regulator, I would like to thank you for participating in the webinar today. Your feedback is valuable for future webinars so be sure to take a couple of minutes to complete our survey.
Bye for now.
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