Psychological Injury

Stress at work is a world-wide problem. Its implications extend beyond health and safety in the workplace, and can seriously disrupt people’s lives. The International Labour Organisation (ILO) states that workers should leave time for rest and leisure, for service to society, and for self-fulfilment and personal development. It says these goals are unattainable if workers’ lives are dominated by occupational stress.

Common causes of work-related stress have been attributed to:

  • Communication difficulties between workers and managers – lack of formal or effective communication or consultation structures or procedures with workers feeling unable to voice concerns or problems or feeling insecure if they do.
  • Bullying, harassment or intimidation
  • Work overload and underload – unreasonable demands, impossible targets,
  • Inadequate time to complete jobs satisfactorily leading to a feeling of being overwhelmed or exhausted.
  • Job insecurity – fear of redundancy, lack of permanency, short-term or casual contracts, lack of career opportunities, lack of recognition or reward for a job well done, particularly where the pay is low.
  • Too much change – restructuring of workplace and the way work is organised.
  • Inadequate staff levels – staff leaving and not being replaced with the rest of staff expected to pick up the workload.
  • Inadequate resources – or equipment that is continually breaking down because it is poorly maintained or overdue for replacement.
  • Unresolved health and safety issues e.g. exposure to chemicals, noise, extremes of temperatures, exposure to potential violence whilst working alone.
  • Excessive performance monitoring and surveillance
  • Poor work organisation – lack of clear job descriptions, conflicting demands, too much or too little work, boring or repetitive work, no job satisfaction
  • Insufficient training
  • Dangerous hours – required to work overtime or through breaks. Shift rosters that are unpredictable or make it difficult to balance work and family life.
  • Difficulty dealing with clients/general public due to abuse and threats of violence.
  • Lack of control over how work is done – lots of responsibility but little authority or decision making, little or no say in how work is done.
  • Exposure to prejudice regarding age, gender, race, ethnicity, or religion
  • No opportunity to utilise personal talents or abilities effectively
  • Chances of a small error or momentary lapse of attention having serious or even disastrous consequences
  • Any combination of the above.

Stress is a natural reaction to excessive pressure. It’s the name we give to the physical or emotional reactions that we experience when we feel unable to cope with the pressures or demands upon us. It isn’t a disease, but if stress is excessive and goes on for some time, it can lead to mental and physical ill health.

Health and safety problems arise when we are continually exposed to stressors at work and feel that we cannot escape or avoid them. Human beings react to the external world through complex physical, biochemical and psychological systems which interact with and affect each other. What happens to the body affects how we feel and think and our mental state can directly affect the way our body functions.

When exposed to external physical or mental demands or threats – or stressors – the human body automatically undergoes a series of physical and biochemical responses. This is sometimes called the ‘fight or flight’ response. It is a survival mechanism which provides a means of preparing to confront or to run away from threats.

Adrenaline and other hormones, cholesterol and fatty acids, are released into the bloodstream, the heart beats faster and the nervous system ‘revs up’. We may perspire more, the muscles tense involuntarily and we breathe faster and more shallowly.

This stress response prepares the body for a short burst of physical activity, such as running. The body then quickly returns to a ‘non-stressed’ state. The stress response is not meant to be prolonged.

Chronic or prolonged stress results in the physical and biochemical changes being sustained over long periods. This affects our health, and can lead to an increase of cholesterol and fats in the arteries, a significant risk factor for cardiovascular disease. When faced with work related stress which we cannot overcome or run from a common reaction is to suppress our feelings and ‘soldier on’.

Some of the physical and psychological symptoms which can be experienced include:

  • Headaches
  • Backaches and other muscular aches and pains
  • Cramps in the neck, shoulders or arms
  • Poor memory, difficulty in concentrating
  • Feeling frustrated, irritable or angry
  • Feeling weepy or tearful
  • Loss of energy and motivation
  • Feeling anxious, helpless or afraid
  • Apathy and hopelessness
  • Changes in appetite and weight
  • Sleep difficulties
  • Generally feeling worn out or run down

 

Chronic stress can cause or worsen a range of ill health problems which severely affect quality of life. These include:

  • Asthma
  • Psoriasis
  • Peptic ulcers
  • Digestive disorders and irritable bowel syndrome
  • Sexual problems
  • Depression
  • Alcohol and drug use.

Over the long term. prolonged exposure to stress has been linked to serious illnesses, including

  • Diabetes
  • Heart disease
  • Suppression of the immune system cells involved in fighting cancer.

Impairment

Observablae impairment may be due to a number of factors such as fatigue, alcohol or drug use, personal lifestyle factors or family or mental health issues. Where this impairment can impact on worker or client safety action is needed. A sample policy and impairment checklist are available.

Fatigue

Fatigue is an acute or chronic state of tiredness which affects employee performance, safety and health and requires rest or sleep for recovery. Fatigue may affect physical and mental capacities and increase the risk of workplace incidents. It can also contribute to workplace conflict and absenteeism. Through a build-up of sleep debt, fatigue can result in errors of judgement that may lead to injury or death, affecting not only the worker, but the health and safety of others as well.

According to the Safe Work Australia Guide for Managing the Risk of Fatigue at Work, fatigue can occur as a result of various factors that may be work-related, non-work related or a combination of both. The major factors contributing and increasing the risk of fatigue involve:

  • work schedules - shift work, night work, hours of work, breaks
  • job demands
  • sleep - length of sleep time, quality of sleep, time since sleep
  • environmental conditions
  • non-work related factors such as lifestyle, family commitments, health, other work commitments, travel time between work and home.
  • A risk management approach is recommended with the Guide providing a number of recommendations for control of the above factors and also tips for how to identify if a problem exists.
  • Shift work

 

Research shows there are significant issues associated with fatigue from shift work. Many aspects of human performance are at their lowest levels during the night, particularly between 2:00am and 6:00am. Disruption to the body clock by working during these hours can affect behaviour, alertness, reaction time and mental capacity.

Prolonged night shifts can result in sleep debt, as sleep cycles are usually about two hours shorter when sleeping during the day after working a night shift. Day sleep and sleep during ‘on-call’ periods at night are usually of a lesser quality thannight sleep.

Individuals adjust to shift work in different ways, so it is essential to consult your workers when putting together staffing arrangements and work schedules.

Prolonged fatigue can have detrimental effects on physical and mental health, for example, sleep disorders, mood disturbances, gastrointestinal complaints, headaches, depression, cardiovascular disease and irregular menstrual cycles.

A person can display the following signs which could mean they are fatigued:

  • headaches and/or dizziness
  • wandering or disconnected thoughts, daydreaming, lack of concentration
  • blurred vision or difficulty keeping eyes open
  • constant yawning, a drowsy relaxed feeling or falling asleep at work
  • moodiness, such as irritability
  • short term memory problems
  • low motivation
  • hallucinations
  • impaired decision-making and judgment
  • slowed reflexes and responses
  • reduced immune system function
  • increased errors
  • extended sleep during days off work
  • falling asleep for less than a second to a few seconds, and being unaware they have done so (otherwise known as micro-sleeps), and
  • drifting in and out of traffic lanes or missing gear changes and turn offs when driving.


Managers should ask applicants if they have another job and what it involves. They should also have a provision in the employment contract requiring employees to advise the PCBU if they take another position so that health and safety issues can be considered.

A recent US study found that sleep deprivation is the most significant cause of muscular and mental fatigue. They found that even a signle night of mild to moderate sleep deprivation reduces workers' physical and mental performance, which takes days to stabilise. Contributors to fatigue identified include:

  • mental exertion
  • muscle exertion
  • heavy workloads including tiem on task, cognitive and physical demands, repetition and scheduled breaks
  • overtime and low work hours
  • at work environmental factors such as noise, poor lighting, extreme temperatures
  • the social environment such as harrassment or conflict
  • an individual's emotional disposition

Remember fatigue decreases ability to process and react to new information and respond to hazards.  It can also cause mood change and subsequent depression, physical and cognitive degradation, reduce attention span and reaction time,and make works prone to error, injuries and illnesses.

Source: Causes and consequences of Occupational Fatigue: Meta-Analysis and Systems Model. Ulises Techera, et al, US, Journal of Occupational and Environmental Medicine, August 2016.

  • Heads Up campaign

    The Heads Up campaign is a joint initiative by beyondblue and the Mentally Healthy Workplace Alliance, of which Safe Work Australia is a founding member. The Heads Up website has a suite of resources and a kit to assist business to create mentally healthy workplaces.

    Management of Work-related stress

    The majority of work related stress leading to psychological injury claims are not the result of a major traumatic event or critical incident. Most such claims develop over long periods, often in response to the interaction of a number of work related and other factors.

    Under the Work Health and Safety Act a manager has a duty of care to ensure the well-being of its workers. You should be aware that employees affected by stressors may be more likely to make mistakes that may result in other forms of injury.

    Action to reduce work related stress can be cost-effective. The effect of unmanaged workplace stressors on your organisation may show up as high staff turnover, an increase in unplanned absence, workplace conflict, reduced work performance, customer complaints, staff replacement costs, and costly workers’ compensation claims.

    Psychological injury claims can have a significant impact on your workers compensation premium as they can involve extended periods of time off work, and higher medical, legal and other claim payments compared to other types of claims.

    Adopt a risk management approach to work related stress. Identify sources of potential harm. This may be possible through employee opinion surveys or data relating to absenteeism or workers compensation claims. Assess the level of risk through systematically assessing the extent and causes of psychological injury and identify priority areas for action. In consultation with employees, middle and senior managers, develop and implement a plan to:

  • Address the workplace factors that are risks to psychological injury (primary intervention)
  • Minimise the impact of stress on employees by responding to warning signs and intervening early (secondary intervention)
  • Provide safe and effective rehabilitation and return to work for individuals once an injury has occurred (tertiary intervention)

 Most of the ‘things to do’ boil down to good management practices:

  • Show that you take your staff seriously when people admit to being under too much pressure
  • Ensure that your staff have the skills, training and resources they need, so that they know what to do, are confident that they can do it and receive credit for doing it well
  • If possible, provide some scope for varying working conditions and for people to influence the way their jobs are done. This will increase their interest in, and sense of ownership of, their work
  • Ensure that people are treated fairly and consistently in line with the policies and practices in your agency and that bullying and harassment aren’t tolerated at work, and
  • Ensure good two-way communication, especially at times of change.


See top ten tips for managing stress claims for further information.

PREVENTATIVE STRATEGIES

Following are a range of Risk factor or indicators and possible solutions

1. Change management - Provide effective leadership during periods of change, build the capacity of managers to support their employees through times, review how the organisation provides employees with information about proposed changes,  establish consultation and communication process to engage employees in change and provide access to relevant support during changes

2. Climate/culture - Focus on recruiting and developing supportive leaders with strong people management skills, use organisation development programs to improve the quality of leadership and people management practices (focusing on clarity around work expectations and objectives, strong employee engagement processes, good co-worker relations, goal congruence, provision of development-oriented feedback, and transparency and equity of organisational processes and         procedures), develop accountability for people-related outcomes at all levels of the organisation

3. Communications - Consider the systems in place for top-down communications (such as newsletter, briefings, regular meetings), consider systems to provide staff feedback and staff involvement in decision-making – such as team and group meetings, consider systems to improve cross functional communications – such as forums to discuss common problems and solutions, and shared leadership and governance models.

4. Co-worker relations - Identify the characteristics of teams that are working well within the organisation to help identify what can be done to improve workgroup interactions in areas with problems, establish clear job descriptions and task assignments, supportive supervisory styles, participative decision making and prior agreed mechanisms to reduce conflict,  don’t ignore signs of conflict, and use EAPs or external mediators if help is needed to resolve issues, use work team projects to improve interactions, eg. A work-based project with focussed coaching so that new behaviours are integrated into the core business of the team, consider short-term secondments to and between work units to improve understanding of the work.

5. Critical incidents - Develop and implement an organisational policy on critical incident response, provide access to practical, emotional and social support, provide factual information, monitor employee reactions, provide access to early intervention for employees who report distress

6. Client-related - Develop and implement policy and procedures that deal with threatening or inappropriate client behaviour to ensure that employees feel secure during interactions with clients (also see violence below), provide professional role behaviour training to enhance an employee’s ability to separate personal emotions from the inherent demands of the job. ‘Role separation’ may be important to coping with the unique stressors of disability services wor, focus on control/autonomy and social support as these have been recognised as important in determining the impact of client-related factors.

7. Decision latitude/control - Develop supportive leaders who delegate and encourage participation and initiative, encourage leaders to provide support when things go wrong – discourage the development of a ‘blame culture’, use developmental programs and team projects to encourage initiative and involvement in decision making, ensure that regular team meetings are held that provide scope for employees to participate in decisions that concern their work, ensure that consultative mechanisms enable participation in broader organisational issues

8. Harassment/bullying - Promote a supportive leadership culture that will not accept bullying and which encourages and acts on reports of such behaviour, develop and implement an organisation policy on harassment/bullying, clearly define the complaints process, inform and train managers and employees on their rights and responsibilities, develop support during any investigation process

9. Performance capacity and career development - Review recruitment strategies to ensure that individuals are recruited, inducted and trained to have a clear understanding of work expectations, objectives and requirements, the skills and abilities to carry out their tasks competently, and appropriate support to enable them to do so, consider using probationary employment to assess suitability, consider using mobility, mentoring and career counselling programs to better match individuals to jobs, broaden the skill base and assist in developing career paths, use team based projects to broaden skills and develop responsibilities

10. Performance management - Implement effective performance management systems with clear expectations and procedures that are understood by managers and employees. Aim for a two-way process, covering positive feedback on performance, areas for improvement, future goals and objectives and training needs, train managers to provide effective development-oriented feedback, encourage a culture of continuous feedback, rather than restricting feedback to performance reviews

11. Role in organisation - Ensure roles and responsibilities are clearly specified, regularly reviewed and modified where necessary, in consultation with staff e.g. as part of the business planning process, where role conflicts emerge, review relevant roles and responsibilities. If current roles are appropriate, clarify these in consultation with staff. If not appropriate, establish revised roles in consultation with staff, avoid situations where an individual takes on dual roles where conflicts of interests might occur

12. Occupational Violence - Conduct a violence vulnerability audit, considering all the environments in which the organisation operates, develop a policy in relation to violence and aggression against employees, including a statement that violence is unacceptable and a commitment to prevention and support strategies, develop a control plan for any identified ‘at risk’ areas (e.g. clients do not have access to dangerous implements or objects that could be used as weapons or missiles, no ready access to cash/valuables/drugs on site, take into account how staff move between working areas, parking lots etc., consider using architectural and engineering designs as part of the control plan for ‘at risk’ areas (e.g. use of safety glass, good internal and external lighting, escape routes planned to prevent entrapment of employees, duress alarms, communication devices etc), ensure that risk controls cover employees exposed to violence (consider rations of staff to clients, training and experience, use of rotation to reduce exposure, procedures and back up for staff working alone or in areas of isolation, support and supervision), ensure that procedures are in place to manage critical incidents, emergencies and evacuation nd that drills are used to test their effectiveness, where risk controls include security devices, ensure periodic servicing, testing and maintenance is carried out, investigate and assess all reports and threats, including near misses, and regularly review the effectiveness of controls.

13. Boring, repetitive work - Redesign jobs to increase the variety of tasks, use job rotation to increase task variety where redesign is not possible

14. Shift work - Use best practice shift systems to minimise fatigue. Specifically, ensure that rosters permit adequate time between shifts for employees to arrive at work well rested. See fatigue factsheet for further information, Avoid mandatory night shifts for older employees

15. Workload - provide supportive leadership – regularly review workloads, prioritise tasks, define performance quality expectations, cut out unnecessary work, give warnings of urgent jobs, meet training needs, and encourage employees to raise and discuss problems so solutions can be developed, ensure that staff levels and performance capacities are adequate including to meet periods of peak demand, where practicable, give employees some control over the way they do their work, avoid unrealistic deadlines, where practicable, substitute heavy manual tasks with equipment to reduce physical workloads, avoid encouraging employees to regularly work long hours, put systems in place to respond to individual concerns. Consider where low morale, unsupportive leadership and poor work team climate are the real issues

16. Work pace - Set reasonable work rate standards, ensure adequate work breaks and, where practicable, allow some flexibility in timing of breaks to match employee’s needs, use job rotation to enable respite for employees working at fast pace.

Source: Comcare "Preventing and Managing Psychological Injuries in the Workplace" Managers Guide.

Bullying and Harrassment

A major cause of psychological injury arising out of the workplace is bullying and harrassment.

Bullying is a hazard because it may affect the emotional, mental and physical health of workers. The risk of bullying is minimised in workplaces where everyone treats each other with dignity and respect. Workplace bullying isrepeated, unreasonable behaviour directed towards a worker or a group of workers, that creates a risk to health and safety. It does not include reasonable management action taken in a resonable way.

‘Repeated behaviour’ refers to the persistent nature of the behaviour and can refer to a range of behaviours over time.

‘Unreasonable behaviour’ means behaviour that a reasonable person, having regard for the circumstances, would see as victimising, humiliating, undermining or threatening.

'Reasonable management action' inlcudes allocating work and giving feedback as long as it is undertaken in a reasonable way.

Safe Work Australia has produced a Guide for Preventing and Responding to Workplace Bullying.

Sources of information that can assist in identifying whether bullying is, or could be, a problem include:

  • regular consultation with workers and their reps if available
  • seeking feedback when workers leave the business
  • seeking feedback from managers, supervisors, or other internal or external parties
  • monitoring incident reports, workes compensation claims, patterns of absenteeism, sick leave, staff turnover and records of grievances
  • recognising changes in workplace relationships between workers, clients and managers.

The presence of bullying in the workplace can be the result of a workplace culture and environment that allows or encourages such behaviours to occur. It can also be the product of poor people management skills and lack of supportive leadership. The risk factors that make it more likely for bullying to occur involve:

  • presence of work stressors
  • negative leadership styles
  • inappropriate systems of work
  • poor workplace relationships, and
  • workforce characteristics.

The Guide has information on controlling the risk as well as responding to claims of workplace bullying.

See the following document on responding to bullying and harrassment.

It is important to develop a suitable policy and ensure staff are trained on the policy.

A key area of harrassment is sexual harrassment and it is important to also have a policy covering this area. The Human Rights Commission provides some guidance about what to include in such a policy.

The key approach is for Managers to develop and model a respectful workplace. The approach should be to set clear expectations of behaviour and to model these behaviours so that it becomes how your organisation does business. Behavioural expectations should be included in performance plans. Unacceptable behaviour such as displaying discourteour, unconstructive or abrasive behaviour should be addressed. A positive work environment is one where there is open and transparent communication, work is shared fairly and there are clear and reaslistic deadlines, Constructive and regular feedback should also be provided. Workloads and priorities should also be managed.

References:

Ellen Jackson and Rachel Clements: The Australian Psychological Society “Workplace stress: What’s causing it and what can be done?”

NSW Department of Premier and Cabinet “Leading Well: The role of leadership in improving and management of psychological injury”

Queensland Health HR Manual "Managing fatigue risk"

Safe Work Australia "Preventing Psychological Injury Under Work Health and Safety Laws": May 2014
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The Industry Development Fund is delivered by National Disability Services on behalf of Family & Community Services: Ageing, Disability & Home Care.