Identifying and addressing psychological injury

<h3By Dr Peter Cotton FAPS

Typically, psychological injury does not arise overnight or in response to one discrete incident (unless that incident is very extreme and life threatening – which occurs rarely) but has at least a six month gestation period. Thus psychological injury is generally associated with a trajectory of gradual withdrawal, declining morale, increasing sensitivity to perceptions of workplace support and re-evaluating work experiences more negatively.

Over this time, various indicators of possible mental health issues and potential psychological injury tend to become discernable in the workplace. These may include increased use of unplanned leave, displaying excessive emotional reactions to minor day-to-day issues, showing obvious signs of distress, disengagement and withdrawal, more conflict, or becoming overly involved with parts of a job while neglecting other parts. At some point along the way a decline in work performance will also likely emerge.

The key challenge is not so much recognising these possible indicators but what to do in response. Most managers I speak with say, in retrospect, that they did recognise changes in the employee’s behaviour but weren’t sure how to respond and hence avoided doing anything: “I thought I would wait for them to approach me”; “mental health is a personal issue”; “I didn’t want to open Pandora’s box”…

Best practice in this space involves, in the first instance, managers proactively initiating supportive conversations with at-risk staff – as a people manager and not becoming an amateur psychologist. The role of the manager is primarily facilitative and the outcome will often be that the employee agrees to see their preferred heath care provider or access other relevant support services, much earlier than otherwise might have happened. Note that many individuals developing mental health related difficulties initially try to cope by ignoring their problems and ‘forging on regardless’. Hence it often takes engagement from a manager or peer, and supportive but forthright conversation, to trigger the person accessing relevant support and treatment services – even if it takes more than one attempt to engage the employee in conversation.

In such conversations, focusing on behaviours that are observable in the workplace is always appropriate. It is also appropriate to enquire whether work and/or personal factors are affecting the employee, and then gently exploring the latter if this is reported. This is not breaching privacy. Individuals may well invoke privacy in terms of issues outside of the workplace or their mental health diagnostic status – as is their right – but the manager is always on safe ground by maintaining a focus on behaviours and whether any work factors may be aggravating their concerns.

Interpersonal conflict or disagreement over performance appraisals can add a further layer of complexity, particularly when this progresses down a path where individuals’ involved start to frame their concerns as ‘bullying’. Further, it must be said that some managers generate (preventable) problems here because they have avoided providing appropriate feedback or engaging with a challenging employee in a more timely manner. Irrespective, the principle of early intervention, sometimes utilising someone other than the immediate manager, still obtains. Some cases of bullying end up with very poor health and return to work outcomes, but these are invariably where the alleged bullying has proceeded over an extended period of time and no early intervention has occurred. Early access to conflict resolution initiatives and related interventions significantly reduce the risk for bullying-related psychological injury claims.

Workplace-based early intervention has been shown to be highly cost effective. The longer an individual is symptomatic, or the more interpersonal conflict persists, and where the employee enters a workers compensation scheme – correspondingly then, the interventions will be more protracted and costly, and the outcome more uncertain.

More broadly, one additional factor that needs to be considered here is the underpinning ‘workplace climate’, i.e., the extent to which employees experience supportive leadership, clear job priorities, involvement in decision-making, frequent quality informal as well as formal performance feedback, opportunities to work collaboratively with peers and take ownership, and professional growth in their day-to-day work. In high quality climates, employees are more resilient and more likely to address any experienced difficulties earlier. By contrast, poor quality climates are associated with more work health and safety risks, lower levels of resilience and delayed help-seeking. In good quality climates, managers have their ‘finger on the team pulse’, have good working relationships with their direct reports, and do identify difficulties early.

Climate is the missing variable that is often not considered by organisations when implementing training programs and wellbeing initiatives. It is the underlying climate that largely determines the traction that will be gained from such initiatives. This is why the impact of many workplace programs can be so patchy.

Based on their experience of the local workplace climate, employees make judgments about the extent to which they believe their manager and the organisation value and are supportive of wellbeing. This does influence their behaviour and willingness to access support services. Local leaders have a key role to play in determining the quality of climate as it is local leaders that establish, implement and maintain organisational policies, practices and procedures. Ideally, leaders should also foster a ‘climate for wellbeing’. In terms of specific leader behaviours, this includes:

  • Validating the importance of wellbeing through appropriate messaging in team meetings;
  • Actively encouraging early reporting;
  • Role modelling;
  • Promotion of organisational values and behaviours;
  • Reminding staff occasionally about available organisational support resources; and
  • Proactively initiating supportive conversations with at-risk employees.

Developing core people leadership capability yields the most return on organisational investment and enhances the impact of a wide range of training and wellbeing initiatives.

About Dr Peter Cotton FAPS

Peter is a Clinical and Organisational Psychologist specialising in occupational mental health and how organisational environments influence employee behavioural and wellbeing outcomes. He has published a number of book chapters and peer reviewed research papers, and works as an advisor to government and the corporate sector.

Peter served three terms as a Director on the Board of Directors of the Australian Psychological Society and was appointed a Fellow of the Society in 2002.

Peter currently holds the positions of: Director of Psychology Services with Medibank Health Solutions; and Senior Mental Health Clinician, WorkSafe and Transport Accident Commission, Victoria. Peter also holds the following current professional appointments: (a) Mental Health Advisor with SuperFriend (a mental health foundation funded by the industry superannuation funds with 6 million members); (b) Member, Advisory Group, Comcare Centre for Excellence in Mental Health and Wellbeing at Work; and (c) Member, Expert Advisory Group, Mental Health at Work, Beyond Blue.


References

1 The Queensland State government Resolve at Work program uses a panel of health and rehabilitation service providers to deliver a range of assessment, case management, conflict resolution and other workplace-based early intervention services. A recent evaluation showed that this program resulted in savings of over $9 million in potential workers compensation costs and had a cost benefit ratio of 8:1. This is also consistent with the recently released Konekt Market Report that showed much higher costs and poorer return to work outcomes associated with downstream referrals (i.e., once an employee has ceased work and/or entered a workers compensation system). Earlier referrals were associated with much better health and return to work outcomes.