1. Mental Health in the 21 st Century Workplace Hazards & Defences Dr Adrian Massey Islington Headteachers’ Network Summer Conference 2014

2. Overview Concepts Disease, illness, sickness Neurosis, psychosis, personality The medicalization of life Practicalities Workplace risks to mental health Healthy work

3. Health Warning “Psychology – The study of people who do not need to be studied, by people who do.” Variously attributed

4. Disease, Illness & Sickness DiseaseDisorder of structure or function Illness Experience of symptoms SicknessSocial recognition and support

6. Disease, Illness & Sickness DiseaseDisorder of structure or function Illness Experience of symptoms SicknessSocial recognition and support The medical model is not a very satisfactory explanation for human behaviour, particularly for mental health problems!

9. Disease, Illness & Sickness “It is more important to know what sort of a patient has a disease than what sort of a disease a patient has.” Sir William Osler

10. Neurosis, psychosis, personality NeurosisDisorder of feeling Psychosis Disorder of thought/perception PersonalityIndividual, distinctive characteristics

11. Neurosis, psychosis, personality NeurosisDisorder of feeling Psychosis Disorder of thought/perception PersonalityIndividual, distinctive characteristics Are neurosis and psychosis predominantly accidents of nature and personality disorders predominantly accidents of nurture?

12. The medicalization of life Expectation of material, social and sexual success Aspects of normal life reframed as pathological Grief, disappointment, frustration, inability to cope ‘Stress’ is the epitome

16. The medicalization of life Expectation of material, social and sexual success Aspects of normal life reframed as pathological Grief, disappointment, frustration, inability to cope ‘Stress’ is the epitome Within many organisational and legal processes perverse incentives exist for employees, managers and clinicians to medicalize non-medical problems

21. Costs – Individual Clinicians can make things worse! Distress protracted for the employee Risk of more serious ill-health Serious mental health problems are demeaned

24. Costs – Organisational Wasted medical and managerial time and resource Organisational inefficiency/injustice Disempowerment of managers and employers Compassion fatigue

25. Costs – Organisational

27. Workplace risks to mental health in the 21 st Century Obvious – Recessionary job insecurity Rapid change facilitated by IT Aging workforce Greater scope for job mismatch and strain

28. Workplace risks to mental health in the 21 st Century Insidious – Stifled communication esp. with ‘sick’ employees Ambiguity re. role of employer, job options Loss of autonomy Unrealistic expectations of employment Perceived injustice by stoic employees (fairness) Compassion fatigue of managers to genuinely ill

29. Healthy work

30. Recognition that policies can incentivise acopia Clarity re. management role/employment options Managerial ownership of management problems Timely resolution of employment issues Human (cf. medical) care and compassion Access to medical advice when needed

31. Then… Now!

32. “One of the first duties of the physician is to educate the masses not to take medicine.” Sir William Osler