1. Teaching of psychosocial issues in occupational medicine and case management FROM THE NORWEGIAN PERSPECTIVE EASOM Summer school 2015 Lake Bled Kristin Buhaug, senior physician Dep of occupational medicine Haukeland university hospital, Bergen, Norway

2. Introduction In this presentaion I will focus on the aspect of workplace bullying and harassment: A short presentation of Jobbfast Teaching on workplace bullying and health effects including case management –Patients –Students –Occupational health personnel

4. Jobbfast Examine, treat and rehabilitate patients with reduced health secondary to psychosocial strain at work; with a special attention to bullying and harassment –Two end points; health outcomes and work participation among the patients Develop research based knowledge –effect of patient treatment –spread this knowledge throughout health care and work life

5. Jobbfast This is the only clinic dealing with these issues in Norway Since the start in 2011, there has been a steady increase in number of referred patients At present, 100 patients have been through the 3-day programme

6. Flow chart Jobbfast Day 1 «The Story» Questionnaires M.I.N.I 5.0.0 Day 2 Occupational history Narrative Work consultant Day 3 Physiotherapy examination Teaching Interdisciplinary meeting* Various outcomes: Back to same job Change workplace Individual therapy Psychomotor therapy Group therapy Follow up by social insurance *participation from Bergen Bullying Research group, University of Bergen Day 4 Telephone meeting 4 weekes later

7. Teaching of patients Individual teaching of the patients by physician /psychologist Estimated time frame 90 minutes Organized as a “slide show” which is meant to spur a dialogue between physician and patient Hand outs with main points

8. Conflict as a process CONFLICT Psychological strain Integrity and dignity affected Bullying and harassment Negative behaviour

9. Defining bullying The term «bullying» refers to a situation in which a person repeatedly and over time is subjected to negative behaviours by one or several others in the workplace, and in which the person concerned does not manage to defend him/ herself against these behaviours Nielsen et al Tidsskr Nor Legeforen nr. 12 – 13, 2014; 134

10. Teaching of patients Laws and regulation – investigation –According to the Working environment act in Norway, bullying is against the law We talk about the difference between subjective bullying and bullying in the legal sense. –Employers have a legal obligation to ensure both the physical and psychological wellbeing of their employees –If there is a question of bullying the employer is obliged to make an investigation where all parties involved should get an impartial hearing and fair treatment

12. Teaching of patients Consequences of workplace bullying –Individual Health; mental and physical Work participation –Society Family life Companies Economic implications

13. Teaching of patients Experiences from Germany –Klinik AHG Berus, Saarland 6-8 weeks in-patient treatment Individual and group therapy Jobbfast March 2015

14. Overview of the bullying therapy Schwickerath & Zapf, in Einarsen et al. 2011

15. Behaviour analysis at the micro level Schwickerath & Zapf, in Einarsen et al. 2011

16. DANGER!! Amygdala Smoke detector Sets off the autonomous nervous system Frontal lobes Inhibited in order to ensure instinctive response Jobbfast March 2015 Alarm response

17. Teaching of OHS personnel Weekly meetings 60-90 mins at our Department on different issues concerning occupational medicine (OM) Teaching in course for MDs specializing in OM every other year –2 day-course on psychosocial work factors; bullying and harassment 2 hours Conferences for OHS personnel –Regional –National

18. Teaching of students Faculty of psychology: –PTSD –Bullying taught by colleagues in research group Faculty of medicine: –1 week teaching in total on the subject Occupational Medicine during the study for MD in Bergen; psychosocial issues 1 hour –At present the 4 universities with medical education differ; Bergen has been the principal institution –First professor in OM in Norway was Bente Moen

19. The assessment program also relevant for other patient groups? Interdisciplinary assessment Close cooperation with GP / OHS Evaluation of programme 12 months after