PREVENTION

Resilience is the ability of a person or organization to successfully adapt and recover after stress, adversity, or trauma. Resiliency is important for both an individual and an organization as it helps to maintain balance during a stressful time or event, and in some cases, can help protect from the development of mental health issues such as post-traumatic stress disorder.

Additionally, resiliency in both an individual and an organization may have other desired outcomes such as improved performance, lower rates of absenteeism and presenteeism, a reduction in substance abuse, increased involvement in work, community, or familial activities, and increased physical and mental health.

Achieving resiliency requires commitment from senior leadership of your organization and should build upon the organization’s existing values and culture. Moreover, a commitment to continuous improvement is essential in achieving and maintaining organizational resiliency. This may be done through the inclusion of, and program evaluation by, the Health and Safety Committee or Representative.

Resiliency Training

As part of your organization’s commitment to PTSD Prevention and Recovery, you should incorporate resiliency training for all levels of the organization. Resiliency training should include an overview of what resiliency is and why it matters, information for reducing arousal symptoms, techniques for managing distressing emotions, and preparing for a crisis. Additionally, understanding the risk factors, such as severity of exposure, should be included in training so that first responders are able to understand how resiliency is related to prevention of PTSD.

Risk Management is an important component of a PTSD Prevention Program. This involves:

• Identifying exposures to potentially traumatic events
• Assessing the impact of the exposure of those events on individual staff
• Monitoring or screening staff on a routine and continual basis (immediate, 1 month, 6 months, ongoing) for signs and symptoms of PTSD
• Implementing PTSD intervention strategies which include provision of psychological support in line with emerging best practices that are known to be effective, this could include use of a psychologist or psychiatrist trained in addressing PTSD, peer support programs, substance abuse and suicide risk support, family and community supports, etc.
• Evaluating the effectiveness of the programs
• Learning from the organizations experiences and adapt the program for continuous improvement.

Risk Management and Mitigation Strategies

Research has identified mechanisms which organizations can use to support risk management and mitigation. These mechanisms include:
• Implementing duty rotation so that there is an opportunity for staff to restore a normal pattern of behaviors and reduce psychophysiological arousal
• Training supervisors to detect and anticipate adverse outcomes of exposures to traumatic events. When staff behaviors indicate possible signs of PTSD, the supervisor should recommend a health assessment
• Implementing a routine screening protocol for all those exposed immediately after exposure, at 1 month and again at 6 months. At any time individuals who are exhibiting signs of stress injury they should be immediately referred. Research indicates that screening is more likely to be successful if it leads to the provision of support and treatment. Screening should be supported by preventative health messages and organizational support/peer support and not just a voluntary option.

Learn more about treatment and support options.

It is important that your workplace promotes awareness of mental health and PTSD and helps to counter the stigma and discrimination that can be associated with these illnesses. A campaign is a series of activities, initiatives and policies developed to support education, awareness and improvement related to a defined topic. Implementing a campaign that reduces stigma and promotes a healthy workplace can have many benefits for a workplace including:

• Improved productive, moral and employee satisfaction
• Improved staff retention and co-operation
• Reduced medical leave and staff turnover
• Reduced absenteeism and presentism
• Improved engagement and loyalty to the organization

People who are being stigmatized because of PTSD may be subject to disrespect, exclusion, ridicule and excessive scrutiny, which can negatively impact both work and home life. Attitudes and actions that promote stigmatization include:

• Promotion of stereotypes of people with mental health/PTSD
• Trivializing or belittling someone who is suffering from PTSD
• Using insulting language with someone who is suffering from PTSD (i.e. describing them as crazy, lazy, faker, etc.)
• Patronizing someone suffering from PTSD by treating them as though they are not as good as other people
• Excluding them from opportunities for alternative work or promotion

Stigma is real and defined as “the negative and prejudicial ways in which people living with mental illness are labeled. Stigma is an internal attitude and belief held by individuals, often about a minority group.” (Workwell, Canadian Mental Health Association Ontario, & The Dalla Lama School of Public Health)(Mental Health Commission of Canada, 2013) Self-stigma, which is just as common, is defined as being embarrassed about having a mental illness and can often result in someone not seeking help because of feelings of shame, guilt or inferiority and a wish for concealment. Some of the resulting outcomes of being stigmatized include:

• Delay in getting access to treatment, which can impede recovery
• Weakened social support which impacts ability to interact with other people
• Reduction in quality of life/quality of work-life
• Lower self-esteem

Below are some steps that you can take to develop and implement an Anti-Stigma Campaign within your organization.

1. Understand how PTSD and mental illness is currently perceived in the workplace, what needs exist, what supports exist, what is the current experience, what are currently held myths within the workplace (I can’t work once I’m diagnosed, PTSD is a sign of weakness, etc.).
2. Identify key messages for staff, family and friends and the broader community and how you can engage families and friends of your employees and the broader community to help promote awareness and encourage conversations about PTSD and mental illness .
3. Identify existing staff communication channels and how they might be used to promote ongoing awareness and education about PTSD and mental illnesses.
4. Evaluate your campaign and identify what steps need to be taken to continue improvement in the organizations culture towards PTSD and mental illness.

Understanding how Mental Illness and PTSD is Perceived In the Workplace

Before you can run an anti-stigma campaign in the workplace you need to understand the current state. Information about how PTSD and other mental illnesses are perceived in the workplace can help to open conversations and build a strong foundation for a successful program. One tool you can use to assess the workplace mental health culture generally is the OHCOW Mental Injury Toolkit resources, another is the sample survey below. This survey has been adapted from MHCC Opening Minds Survey for Workplace Attitudes (Mental Health Commission of Canada, 2013) It can be used by your workplace to understand the current workplace attitudes towards PTSD which can then inform an Anti-Stigma campaign.

The survey should be administered anonymously. When it is complete you should review with the JHSC or HSR as well as the Sr. Leadership to determine how the information can be used to inform your organization wide Anti-Stigma campaign.

Identifying Key Messages for Staff

It is important for your workplace to identify some key messages for staff so that they understand what PTSD is and how they can support one another in the workplace. To be successful in your communication efforts you need to make sure that the information is heard and understood. Think about who in your workplace should help develop the key messages, what information is needed to development the messages and where you will go for information.

It is important that these key messages are actionable and resonate with employees. To develop these messages look at the results of your workplace survey and determine how as an organization you would like to shift or change attitudes and beliefs. Questions you can use to develop your key messages include:

1. Why does addressing PTSD matter to our workplace?
2. What specific items from the workplace survey would we like to address? Which is the priority? By when?
3. What does success look like? How will/should each of the items be addressed? How will we know if we have been successful – what are the indicators?
4. Why would staff care that these items are addressed? What are their motivations, needs, behaviours, challenges, pain points and goals and how does this impact how they receive the message?
5. What should be addressed next?

Identifying Key Messages for Families and Friends

Plan specific communications for family members and friends of your employees that help them understand PTSD signs and symptoms and the steps that the organization is taking to reduce stigma at work. Explain your organization’s PTSD Prevention Plan and share how they can specifically support the plan and the anti-stigma efforts. It is important that family members have the opportunity to understand the supports available to them and their loved ones from the organization. Promote open dialogue with family and friends as they play a key support in identification and support for employees who experience PTSD.

Sharing the Anti-Stigma Campaign

Once you have your key messages identified, you need to determine how you will share the message. It is important when you are selecting how to share the message that you take into consideration the audience who is receiving the message, where they need the information and when they will need it. You may need to tweak the message to meet the needs of various audiences and have it reviewed by an advisor knowledgeable about PTSD in advance (Peer-support leader/health professional). Some examples of methods of communication you could use include:

• Briefings
• Team meetings
• Newsletters
• Posters or other communications in the lunch room
• Letters to employees or family members
• Websites

Evaluating an Anti-Stigma Campaign

To evaluate your anti-stigma campaign, consider what you defined “success” to look like when you were building your campaign. Identify what the specific indicators are and how you will collect data or information to assess the impact of the key messages. Indicators to consider include:

• Has there been a shift in attitudes and opinions? (can be captured through re-administering the organizational assessment)
• What communication channels seemed to be the most effective? Can you count the times the channel was accessed/referenced/used?
• Were different communication channels more effective for different audiences?
• Are there specific case study examples, initiatives that came about as a result of the Anti-stigma campaign (integration into team meetings)
• Is there a sense in the workplace that there is more open dialogue about PTSD, how to access help, etc?