is the primary focus of most organisational Occupational Health and Safety
programs. Scan the OH&S section of an employee manual or company intranet
and you will see reference to hazardous materials, equipment handling, r
epetitive strain injury, noise, heat stress, fatigue and falls. Peruse the literature
published by any of the State-based WorkCover bodies and you will find a firm
commitment to reducing fatalities and employee incapacitation through serious
physical injury.
This preoccupation with the physical welfare of Australian workers is warranted.
To lose a loved one to their work is tragic and workers' compensation claims for
physical injury do account for 93 per cent of total claims made. But what of
psychological wellbeing at work? What are the effects that work is having on
the emotional state of individuals? Who is vulnerable and what can be done to
reduce the risk of psychological injury? Finally, as psychologists, how can we
aid in the maintenance of psychological wellbeing at both the organisational
and individual levels?
The Centre for Corporate Health (CFCH) is heavily involved in the
assessment of psychological injury claims (commonly known as 'stress' claims)
which account for the remaining seven per cent of WorkCover claims.
Employed as independent specialists by workers' compensation insurance
bodies in New South Wales and the Australian Capital Territory, CFCH's
psychologists travel throughout NSW, ACT and northern Victoria to
undertake clinical interviews with individuals who have lodged claims for
psychological injury. These psychologists gather stories of workplace
difficulties from often emotionally fragile people and ascertain their
symptoms of distress.
The focus then shifts from the individual to the employer.
The psychologist attends the workplace and interviews managers,
supervisors and colleagues to gain a fuller understanding of the situation
that has led the individual to lodge a claim. The views of treating
practitioners such as general gractitioners, clinical psychologists and
psychiatrists are sought and the full account is written up with
recommendations as to the degree of psychological injury (if any,) its
work-relatedness and possibilities for treatment and return to work.
This is known as a Pre-Liability Assessment and is reported to the insuring
body. It is on the basis of this report that a determination of the liability of
claims is made.
Data from the front line
In this article we highlight themes emerging from a review of approximately
400 of these Pre-Liability Assessments undertaken by the Centre For
Corporate Health in 2004. Our aim in undertaking this review has been to
establish whether work is the primary cause of the distress or psychological
injury cited, or whether there are other factors at play. If work is the cause,
what is occurring in the workplace that makes individuals vulnerable to such
distress? And if work is not the cause, what is it that is leading these individuals
to lodge a claim for psychological injury?
The work-relatedness of psychological injury claims
In approximately 70 per cent of the 400 claims reviewed the distress cited
by the individual was deemed to be legitimately caused by work-related factors.
It appears that work is having an impact on the wellbeing of many individuals.
For those organisations specialising in the provision of human services, in which
exposure to traumatic incidents or threatening acts involving clients was more
likely, 90 per cent of claims were deemed to be substantially work related.
Such claims were related not only to the exposure of critical incidents but were
also related to the subsequent management of support issues following the
incident. Other work factors leading to claims for psychological injury included
being the subject of performance investigations or complaints, performance
management, exposure to aggressive clients, conflict with colleagues, high
workload, poor management skills of supervisors, transfers, and poor
person-job fit.
For those organisations in which exposure to critical incidents was less likely,
the likelihood that work was the cause of the injury was lower. The issues
raised were deemed to be substantially and legitimately work-related in only
60 per cent of these cases. In the remaining 40 per cent, non-work factors
were deemed to have led to the individual's distress. The most prominent of
these non-work factors were pre-existing personality styles that led a person
to be particularly vulnerable to ordinary workplace stressors. Also prominent
were high levels of vocational discontent expressed by the individual prior to
the individual submitting a claim for psychological injury. Other non-work
related factors included personal issues such as health, family or financial
issues and pre-existing psychological issues such as psychological disorders
that had not fully remitted at the time of the claim.
The degree of distress
The overwhelming trend in all claims submitted for psychological injury
and assessed in this review was the existence of clinical levels of distress.
In approximately 85 per cent of all claims reviewed, evidence was found to
suggest that, whether the issues were deemed work-related or not, the
claimants were suffering from clinical levels of distress and could be
assigned a diagnosis as defined by the Diagnostic and Statistical Manual of
Mental Disorders-Fourth Edition. It appears that those lodging WorkCover
claims for psychological injury are doing so only once their distress has
become significant.
In the majority of cases the individual's symptoms of distress met the
criteria for an Adjustment Disorder and to a lesser extent, Major
Depressive Episode and Post Traumatic Stress Disorder. The fact that
most claimants were assessed as meeting the criteria for an Adjustment
Disorder is a favourable prognostic sign for rehabilitation, given that the
symptoms are treatable and tend to resolve within a relatively brief
period with the appropriate psychotherapeutic and medical assistance.
Who is vulnerable and what can be done?
It appears that those most vulnerable to psychological injury are individuals
working in organisations in which they are more likely to be exposed to
critical incidents. Access to psychological counselling through Employee
Assistance Programs (EAPs) is often available to these individuals, and
this assists with the management of distress and the expedience of an
effective return to work and to full emotional health.
Work-related factors such as performance investigations or complaints,
performance management, exposure to aggressive clients, conflict with
colleagues, high workload, the poor management skills of supervisors,
transfers and poor person-job fit are also relevant, however. Several of
these (performance management, performance investigations, transfers,
promotions, demotions, employment contract terminations and grievance
management) are discounted by the NSW Workers' Compensation Act as
legitimate causes of psychological injury for which an employer could be
held liable, as long as the employer has handled these matters in an
appropriate manner.
In our assessment it appears that the likelihood of such appropriate
handling varies depending on the size, structure and availability
within the organisation of internal human resources to assist line
managers in handling these matters. For those organisations in this
review with a highly centralised organisational structure and well
developed policies and procedures, managers were deemed to have
handled human resource issues effectively in approximately 95 per
cent of claims. However, in smaller organisations in which policies and
procedures tended to remain undeveloped and managers were largely
untrained in human resources issues, these issues were deemed to
have been managed effectively in only about 40 per cent of the claims
reviewed.
Strategies for reducing the risk of psychological injury
In terms of mitigating the risk of psychological injury caused by these and
other work and non-work factors, there are a range of individual and
organisational-level strategies that can be implemented. At the individual
level, strategies include management training in skills such as providing
performance feedback and managing underperformance, coaching and
mentoring staff, managing the impact of organisational change on others,
managing critical incidents, and conflict management and grievance handling.
Career coaching to manage issues such as vocational discontent and the early
warning signs of distress associated with this can also be helpful, as can
occupational stress resilience programs aimed at enhancing emotional r
esilience in the workplace and the prevention of burnout.
Improving the quality of workplace relationships is also important in
mitigating the risk of psychological injury and in helping individuals to
recover from emotional distress and return to work. Relevant
interventions for improving workplace relationships include training
employees in improving individual communication, understanding and
resolving differences, assertiveness and teamwork.
At the organisational level, strategies such as well-developed recruitment
and selection processes incorporating psychometric assessment can ensure
better job-person fit. This can be particularly effective in reducing the risk
of psychological injury resulting from non-work factors such as personality
styles that increase the likelihood of individuals becoming vulnerable to
distress under certain circumstances.
Our data review suggests that the personality styles more often associated
with a claim for psychological injury include a highly personalised and
sensitive reaction to ordinary workplace events (high levels of emotionality),
perfectionist traits, a paranoid and distrustful thinking style, a somewhat
rigid and inflexible thinking style, and high levels of self focus (that is, a
strong sense of entitlement and tendency to view oneself in a highly positive
manner despite contradictory information from supervisors.) Such
personality styles are not in and of themselves problematic at work, but a
poor match between the individual's personality style and the requirements
of their role or the culture of the organisation can lead to dysfunction,
distress and a psychological injury claim.
Other organisational-level interventions include climate and culture surveys,
which can be used to assess the state of workplace relationships, perceptions
of supervisory skills, organisational morale and vocational discontent.
The development of robust, meaningful and effective policies and procedures
pertaining to the employment and management of people, and training in
these for anyone in a supervisory or management position, can also be
effective and worth the required expenditure. Finally, the prevalence of
access to Employee Assistance Programs amongst the organisations
whose psychological injury claims were reviewed may explain the lesser
incidence of claims resulting from personal factors such as health, family
or financial issues, and suggests that these programs continue to be
effective in maintaining wellbeing in the workplace.
A final, interesting theme to emerge from our case review which may
indicate a vulnerability factor in relation to WorkCover claims for
psychological injury was the average age of claimants.
Amongst the cases reviewed the average age of claimants was 41-45 years,
followed by 50 years and older. This suggests that the effective management
of individuals in the second half of their careers may be imperative in the
quest to minimise psychological injury.
Our review suggests that individuals aged over 40 are at greater risk of
experiencing distress as a result of burnout and vocational discontent,
much of which appears associated with organisational change.
Interventions that may reduce the likelihood of such distress include
training to develop enhanced awareness of generational and individual
differences, particularly for younger managers required to supervise
those who have been in their roles for some time, as well as training to
develop improved understanding of the implications and effective
management of workplace change. Monitoring of the impact of these
changes and ongoing job satisfaction amongst those aged over 40 also
appears important.
As psychologists we have an important role to play in not only the
assessment and treatment of psychological injury and work-related
distress but also in the education of individuals, organisations and the
community about the aspects of work that are having an impact on
psychological wellbeing, and the implementation of proactive strategies
to reduce the risk of psychological injury and maintain emotional
wellbeing. Given that the average cost of a psychological injury claim
has escalated in recent years to $27,798 per claim compared with $
18,913 for a physical injury claim and the average time off work has
increased to a high of 21 weeks compared with 8 weeks for a physical
injury claim (WorkCover NSW Statistical Bulletin 2003/04), public
and private sector bodies have an even greater incentive to engage
our assistance and to ensure that the profile of psychological wellbeing
in the workplace is raised and takes its place in the Occupational Health
and Safety strategies of organisations, Australia-wide.
Written By:
Ellen Jackson MAPS, consultant psychologist, Potential Psychology Services
and author, and Rachel Clements MAPS, Manager, Centre for Corporate
Health Pty Ltd
The authors can be contacted by email on:
ellenjackson@potential.com.au or rachel@cfch.com.au.
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