Melissa Harries shares her insights into how the workplace impacts the mental health of aged care workers, and what leaders can do about it.
Australian workplaces have improved in leaps and bounds in the last 10 years with how well they manage mental health – and aged care facilities are no exception.
The evolving workplace health and safety legislation supports these improvements by encouraging employers to consider psychological safety of staff, not just physical health and safety.
The stigma surrounding mental illness is shifting and workers are speaking up more and more about their psychological health.
It’s easy to assume that an employee’s mental illness is caused by individual factors like family history, past trauma and personality. However, an unhealthy work environment or a critical incident at work can be a significant factor in causing, contributing to or maintaining a mental illness.
If an employee experiences a stressful event at work – like being threatened by a colleague, repeated clinical audits due to complaints or regularly feeling that one does not have sufficient time to adequately care for each resident – it takes a certain amount of coping resources to respond.
When staff face multiple stressful events, or the stress continues at a high level over a long time, coping resources run out unless the employee is able to effectively replenish them. That employee is then vulnerable to developing a mental illness the next time a stressful event occurs as they simply have no more resources to remain resilient.
How does an aged care facility even begin to assess how “psychological healthy” it is? The work health and safety framework for identifying hazards, assessing risks and implementing controls can be a useful starting point for understanding the unique factors of your workplace that may be impacting on employee mental health.
Identify the hazards
The mental health of staff at aged care facilities has been the focus of many researchers. While there are psychological threats that all employees, regardless of industry, are vulnerable to (such as poor role clarity, low levels of recognition or reward) aged care staff face numerous specific hazards.
Violence at work: A 2014 survey by Australian Catholic University of 269 nurses working in the aged care sector found that over a third of staff had experienced physical assault by a resident or family member in the last five shifts. Some 15 per cent of this violence was from residents, with the majority coming from family members or visitors. Such critical incidents or potentially traumatic events are a well-known cause of mental illness.
Role overload: Staff in aged care facilities frequently report high workloads that prevent them from engaging with residents one-on-one. Some staff report concerns that they are not providing an adequate level of care as they are rushing from one room to the next. Researchers have found that when staff perceive there are poor resources in their facility – such as insufficient time or staffing – rates of violence from family members is higher.
Lack of supervisory support: A factor related to role overload is perceptions of support by supervisors, managers and seniors. Staff can feel that “no one has your back” because leaders are too busy, lack the soft skills to support staff or there is a culture of persecution following errors. The impact is low levels of trust, poor team cohesion and hypervigilance, which paradoxically lead to more errors and stress.
Emotional strain: Aged care staff must be constantly vigilant to maintain the balance between providing compassionate care of the resident while not becoming too emotionally attached. Interactions with families make this task more difficult, particularly when the family is grieving. Staff regularly experience their own grief response when residents die and have varying abilities to cope with this.
Assess the risks
What is the likelihood that a staff member will be impacted by the hazards identified?
Violence at work is a reality for many aged care staff and a risk to mental health. A physical attack from a resident was cited as the cause in nearly 33 per cent of compensation claims and nearly 40 per cent of unreported injuries.
Unfortunately, some facilities have a culture of under-reporting and the true extent of the violence against staff members and its impact upon their mental health is still unknown. Reasons for not reporting the incidence of violence include:
- compassion, especially if the behaviour is caused by a disease like dementia
- an implied culture of acceptance towards violence that causes staff to believe the aggressive behaviour is normal or that they won’t be supported by management in a claim
- a fear of being blamed or having the situation diminished – for example, where the attacker/resident was extremely fragile.
Implement controls to minimise the risks
While the risks may be inevitable, aged care managers can implement control measures to reduce the incidence or minimise the impact.
First, implement training programs that teach staff how to identify and avoid triggers or to de-escalate aggressive behaviour with both family members and residents. It’s also important staff understand their rights to personal safety as this helps create a culture where violence is not accepted. The lack of knowledge of their rights can prevent many staff from reporting attacks, resulting in feelings of vulnerability and helplessness – both of which are barriers to good mental health.
Second, tackle poor resources, such as time and staff numbers, as this is a common factor in the major risks to psychological health. Balance staff wages against absenteeism, presenteesim and workers compensation claims due to mental illness. Are you really saving money with a lean staff roster?
Third, develop supportive management practices that engender trust so staff feel someone “has their back”. This might require additional training for leaders on how to identify and respond to employee mental health issues, and how to provide performance feedback so staff do not feel persecuted. Invest in training managers so they are proficient at the “soft skills” too.
Fourth, implement healthy worker initiatives that address the effects of stress. Exercise is the quickest and easiest way to treat the stress response as it undoes the physiological effects of stress. Every dollar a business spends on physical activity – for example, gym membership, onsite yoga classes, subsidised FitBits – leads to a $6 return on investment due to improvements to employee performance and reduction in time off work.
Fifth, enhance resilience through evidence-based training. There are a variety of individual skills, such as mindfulness, keeping perspective and tolerating distress that can be taught though group training that enhance an individual’s resilience to stress.
Finally, link employees in to your EAP counselling or coaching services. Employees may not actively seek out psychological support for stress however the recovery from a stress response can be dramatically improved with counselling. Nip these issues in the bud by addressing concerns with employees before they become emergencies.
The great news is that when aged care facilities address employee mental health issues they see a sound return on investment. PricewaterhouseCoopers found in 2014 that Australian businesses gain up to $16 return for every dollar spent on mental health at work. The key is to be strategic and consider those “upstream” hazards in order to address problems before they become emergencies.
Melissa Harries, a registered psychologist, is principal with Mindset Psychology.
This article first appeared in Australian Ageing Agenda magazine (July-August) and has been published online today in recognition of World Mental Health Day, which takes place annually on 10 October.
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