Impact of Stressors on the Worker and Taking Care of Self Dr Sue Blair MBChB, MFOM Consultant in Occupational Medicine; NHS Fife

OHSAS NHS Fife’s OH service for 20 years Small Medium sized Enterprises (SME) Including various 3rd Sector Organisations See staff from all job types Pre-placement Management referrals Occupational Medicine for 20 years NHS based but experience in many industries; 1500 cases a year; 80% are stress-related / neurosis Context 1 in 3 families have a member suffering; 10% of UK adults will have symptoms in any given week Understand about what causes occupational stress (and non-occupational stress) Passionate about individual self care as the best resource available to combat the experience of stress

Stress Common Denominator in all Occupations Prevalent in Caring Professions Why? Self Selection? Empaths? Experiences?

Occupational Stress – a definition “the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker.” ‘Exposure to Stress; Occupational Hazards in Hospitals; CDC; NIOSH 2008’

We know it’s a stressful job

What’s the impact of stress (SAD)? In one organisation, in a year: 50,000 hours lost to sickness absence in a year 40% is ‘stress, depression, anxiety’ Mixture of work/non work-related =26 WTE staff off every day of the year across the whole service

w/r non -w/r? MIXED PICTURE

In a Fife Organisation 670 days lost in Fife between January ‘15 and December ’15 due to ‘SAD’ = 4 (wte) off work due to SAD every single day in 2015 Majority of the workers were in roles where exposure to Trauma (physical and mental) was a daily occurrence 18% of total sickness absence

Occupational Health figures for the same organisation January ’15 – December ’15 OHSAS received 89 referrals, 82 were seen 28 (34%) were coded as SAD Of those, 12/28 (42%) were perceived as ‘work-related’ (so most not work-related!)

What we see in the worker: PTSD Bereavement –type reactions Depression Anxiety Alcohol abuse

But also: Burnout / compassion fatigue Interpersonal relationships/ loss of camaraderie Anger / irritability / intolerance/ poor resilience Poor patient experience/ complaints Feelings of poor management support (perceptions)

Impact on: The organisation cost of absenteeism Colleagues...shift cover, annoyance/ tolerance, extra pressure Managers...extra work in absence mangt, shift cover Wife... Children... Friends / hobbies... Finances...

And of course: Clients/ Patients

We know it’s a stressful job…what are we doing about it? Downstream ‘aftercare’ Upstream ‘ prevention or self care’

Neuro-science has shown: Professor of Medicine at Pennsylvania University, Michael Baime and Neuroscientist, Sara Lazar's from Harvard University have done research using brain scans and they have visually amazing representations to show meditation can actually change the size of key regions of our brain, changing how our brain actually works, improving our memory and making us more empathetic, compassionate, and resilient under stress Her research showed a meditation group (as compared to a relaxation group) saw a significant increase in the density of grey matter in the hippocampus, important for learning and memory, an increase in the density of grey matter in the neural structures responsible for self awareness, compassion and introspection and a decrease in the density of the grey matter in the amygdala – the part of the brain associated for anxiety and stress. According to Harvard research mindfulness also Relieves / reduces stress, depression and anxiety Lowers blood pressure Improves chronic pain Improves sleep Improves resilience / capacity to deal with stressful situations Improves the ability to form deeper connections with others (camaraderie, support etc) http://evp.harvard.edu/mindfulness

Strong evidence from the UK Government support: Mindful Nation UK: cited >500 peer reviewed articles on mindfulness and its beneficial effects Mindfulness All Party Parliamentary Group; October 2015 recommends integration of Mindfulness across the Public Sector in Health/Education/ Workplaces/ Criminal Justice System NHS based staff mindfulness programmes; helping staff with rumination; sleep disturbance; attendance; supporting colleagues; and having a transformational impact Unique research project based in Ambulance Service staff in UK – one such pilot project showing sustainable positive benefits

Taking care of self Mind/ body connection

Self compassion Kirsten Neff self-compassion.org