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 work 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.

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 employee, but the health and safety ofothers as well.

The fatigue factors that influence risk include:

• mentally and physically demanding work (very high demands);

• long periods of time awake (e.g. long hours of work extended by long commuting times);

• inadequate amount or quality of sleep (e.g. when ‘on-call’);

• inadequate rest breaks (e.g. inadequate or poorly timed rest breaks or rest breaks where the environment is not conducive to rest);

• disruption of the body clock (e.g. working when we would normally be sleeping);

• environmental stresses (e.g. noisy or hot environments); and

• work requirements, work schedules or systems of reward (pay, recognition orpromotion) that provide incentives to work longer and harder than may be safe.

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.

Fatigued individuals in the workplace may complain of feeling drowsy or of headaches, and may show symptoms such as increased irritability, blurred vision, falling asleep at work, making mistakes or having near-misses, yawning, moving off track while driving vehicles or increased absenteeism.

Personal factors can contribute to work-related fatigue, for example, employeeswith multiple jobs or lack of sleep due to young babies. Not all the factors noted mean there is a risk of fatigue in the workplace, but where the work involves potential for fatigue, the employer must assess the risk to determine whether risk control measures are required. 

Employers 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 employer if they take another position so that health and safety issues can be considered.

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 Occupational Health and Safety Act 2000 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

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.  WorkCover has produced a range of documents to assist managers with the identification of the risk potential for bullying and harrassment and the response to bullying and harrassment.  It is important to develop a suitable policy and ensure staff are trained on the policy.

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”

Job stress causes, impact and interventions in the health and community services area, WorkCover NSW

Queensland Health HR Manual "Managing fatigue risk"