Minister of Health's address at the HRMATT Breakfast seminar on mental health in the workplace

Minister of Health, Dr the Honourable Fuad Khan

June 15, 2012:

Good morning.

It is indeed a pleasure to have been invited to address you at this breakfast seminar themed “Plan/Prevent/Protect: What Employers must know and do about mental health in the Workplace”. The theme indicates that you are aware that conversations on mental health must be initiated in the Workplace.

Conversations such as these are vitally important because employees represent half the world’s population, and are major contributors to economic and social development. However, an employee’s health is determined not only by workplace hazards, but also by social and individual factors. All of these factors can inadvertently impact upon mental health.

Concerns about mental health issues in the workplace are increasing worldwide since this impacts productivity, and carry human and financial costs associated with disabilities that extend to the individual, family, organization and society.
This situation combined with the fact that there is still stigma attached to mental illness further compounds the issue. Mental illness is still taboo. It is not even spoken about among family members, let alone co-workers and employers.

This is because mental illness is misunderstood, that these challenges exist. If someone has a broken arm, this is something we can see and relate to. If a family member has diabetes, which is better understood, we can give advice about diet or
medication. However, when the problem is psychiatric, people don’t know how to react because they cannot see anything that is physically wrong, and their knowledge about mental health is poor.

How many of you here can pass a basic mental health literacy quiz? Do employers and employees really know what mental illnesses are? Do you know that Depression is not just when you have a down or sad day? Do you know that eating
disorders, panic attacks, phobias and substance abuse are all classified as mental disorders?

A random survey was conducted among the staff of two companies in Trinidad. One company is state owned and the other is within the private sector. The results of the combined data revealed that just 27% of those sampled had only a fair knowledge of what the signs and symptoms of mental disorders are. However, employers can only plan, prevent and protect their staff if they have an understanding of what mental health is.

The World Health Organization has defined mental health as, “a state of wellbeing in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” In today’s globally competitive environment, organizations are under tremendous
pressure to:
• Maximize productivity
• Minimize costs
• Increase customer satisfaction, and
• Improve overall performance.

What does this translate into for the worker? It means that the employee is now required to do more, with less, and for less. There is then a domino effect. Increased job stress leads to a decreased number of satisfied employees. This in turn results in increased job dissatisfaction and increased worker depression. As a consequence, mental illness is a major issue for management.

At the Sixtieth World Health Assembly in 2007 member countries agreed there was a need for a global plan of action on workers’ health. At that Assembly it was stressed that the health of workers is an essential prerequisite for productivity and economic development. When employers fail to plan for the impact of increased job stress, the result can be devastating to their business. This is because it is well documented that the health and well being of an employee can impact on the survival and success of any organization.

The Ministry of Health is guided by this global plan of action on workers’ health as outlined by the World Health Assembly. It is for this, as well as other reasons, that
the Ministry of Health launched its Workplace Mental Health Policy for Internal Staff. This initiative serves as a primary measure in treating with mental health in the workplace, that is, it requires the Ministry to educate staff about mental health.
And, as discussed before, education is critical to eliminating the stigma and discrimination that is associated with mental health issues, and which can lead to a refusal to get treatment for affected persons. Every effort should be made to maximize treatment and prevent discrimination.

Mental Illness

Mental illness is usually characterized by the impairment of an individual's normal cognitive, emotional, or behavioral functioning. Anyone can become mentally ill at work; it affects both men and women. It can happen to top-level
management, or junior staff. Mental illness does not discriminate.
Early signs of trouble can be seen in increased absenteeism, reduced performance and increased accidents on the job. Underlying causes can be broken relationships, the death of a loved one, a financial difficulty, a major physical disorder, or even interpersonal conflicts. Each one of these situations can result in an employee who can no longer cope with the normal stresses of life. Employers need to adequately identify and initiate appropriate management of an employee who can no longer cope. Allowing the employee to access treatment can save the employer 5,000 to 10,000 U.S. dollars per employee annually.

The impact is serious:

Globally, 57% of graduating students indicated that they rank maintaining a balance between work and personal life as key in choosing their first employer;

It was reported that in the United Kingdom, approximately 80 million days are lost each year from work because of mental illness, with a cost to employers of 1 to 2 billion pounds each year;

In the United States of America, days loss from work due to depression alone incurs a cost of 30 to 40 billion U.S. dollars annually; and

Research has indicated that by 2020, depression will rank second only to heart disease, as the leading cause of disability worldwide.

Unfortunately, there is very little comparative data available locally, therefore the Ministry of Health will soon undertake a similar study in Trinidad and Tobago through its Mental Health Programme. However what we do know from a local study, is that 20 to 25 percent of the population in Trinidad and Tobago have experienced a mental disorder or are currently inflicted by mental illness. In other words, if you look around this room it would mean that at least 1 in every 4 persons may have a diagnosis of mental illness.

In addition, at the St Ann’s Hospital, there were approximately 32,000 patient contacts in 2011, and, for at least two Regional Health Authorities, there were approximately 1,000 admissions for self-harm. So then what are some signs and symptoms which may present among your colleagues or employees? If someone you work with has any of the following symptoms, he or she may need to consult a medical or mental-health professional:
• Prolonged sadness or irritability
• Social withdrawal
• Extreme emotional highs and lows
• Excessive anger
• Violent behaviour
• Substance abuse
• Thoughts of and attempts at self-harm

These are just some of the signs and symptoms to look out for. This is imperative given the fact that it is well documented that early detection and treatment can be important to a successful recovery and reduce the likelihood of the disorder
becoming chronic.
However as employers you can prevent the occurrence of the disorders through simple but effective measures, such as creating a healthy work environment by:

Motivating your employees;

Establishing job security;

Proper job design and schedules;

Fair compensation;

Creating learning opportunities;

Utilising a comprehensive approach;

Embarking upon effective programmes to foster mental health in the workplace via:
 Primary measures which educate staff who are healthy;
 Secondary measures which focus on early detection, counselling and guidance so that the employee can be quickly brought back to their optimum level of functioning; and
 Tertiary approaches which establish an Employee Assistance

Programme where there is more in-depth treatment for employees who are more severely debilitated from their conditions.
Globally, mental disorders are a leading cause of disability. In some high income countries, 40% of disabilities can be attributed to mental disorders.

In most developing countries, 13.7% of disabilities are due to depression. There is also a 6.2% occurrence of alcohol related disorders. Schizophrenia and bipolar disorder have lower incidence rates but are long lasting disabilities.
Mental health problems have become one of the leading causes of absenteeism from work and of early retirement. Mental health in the workplace has serious effects, not only for the individual, but also for productivity and competitiveness for business and the economy…..in fact, society as a whole.

Mental health problems can affect work performance in terms of:

Increase in error rates

Poor decision making

Loss of motivation

Loss of commitment

Increase in tensions, leading to increased conflicts between colleagues.

Mental disorders affect individuals and their employment much beyond the economic issues. People with mental disorders face stigmatization, social exclusion, barriers in obtaining equal opportunities, and being bypassed for promotions. The stigma attached to the label “mental” is very challenging and people with mental health problems have two-fold mix of losing their jobs and are disproportionately out of work when compared to the working population.

Loss of jobs due to mental health problems can result in a further deterioration in conditions such as:

Loss of income

Loss of status

Loss of social status

This can lead to depression and a further exacerbation of the mental disorder.
Employees with mental problems pose more problems for employers. The diagnosis of mental disorders is usually much more difficult, and takes longer to establish. The symptoms are diffuse, and are not easy to distinguish from problems in and out of work. The problems are usually long lasting and the risk of relapse very high.

Mental problems show up as behavioural or relationship manifestations. Questions arise such as:

Is he / she capable?

Will they function normally?

Can they carry out specific instructions?

However, there is a taboo about asking these types of questions.
The methods of approach for focusing on mental health in the workplace aims to:

Educate based on evidence and dispel myths

Concentrate on common mental problems

Provide practical tools for managers

Keep mental health mainstream

Address stigma through multi-channel communications

Maintain business focus all the time

Promote mental well-being

Employee recognition of mental health and counseling

Ladies and gentlemen, I know that seminars such as this are long overdue and a lot more has to be done to educate our population about mental health and mental illnesses. But I assure you that the Ministry of health is committed to leading this initiative. I am happy to share that the Ministry will be embarking on a national mental health educational campaign by July of this year. I am pleased that we can come together today and plan the way forward for improved mental health in
Trinidad and Tobago. This collaboration between the public and private sectors in mental health care exemplifies the concept of the People’s Partnership.

Thank you