Speaker 1: You know, this idea kind of came out from some of the research that we've been doing. You know, I should acknowledge my colleagues from Washington University, Brad Evanoff and Annie Kinghorn, as well as some of the others who've participated in this. And our research is showing that people are worried about mental health. And so there's a need for resources and how to address it. And you know, I come from it from the lens of what's the relationship between work and mental health. You know, my role here at the College of Public Health, that's the focus that I think is important. And I'm going to take a few minutes here and try to tell you what my perspective is, so you understand where I'm thinking from it. So I just want to increase the awareness of that relationship between work and mental health. And then I want to think about how the organization impacts that. How do they play a role? And then, you know, I always hate just doing a talk where you say, well, here's the problem. Good luck. Go off and do it. I want to talk about some potential solutions. And your ultimate goal is to develop a model policy, provide guidelines and get these resources disseminated. But we also know that we need to learn a lot from other people. So this is why we invited you guys to attend today. So I want to start off with the definition of what good mental health is. And this comes from the World Health Organization. And mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. So I think that's a great definition, and it's kind of a goal all of us can strive for. And it's also something that we know can vary and change over time. So based on that, let's think about how that plays a role with the workplace. And we know work influences both health and well-being. And over two-thirds of Americans work. We often spend more time at work each week than we do with our families. Work impacts worker health and well-being both positively and negatively. And it gives us a sense of pride, identity, and personal achievement. And for many of us, we realize we get our social interactions at work. And I think recently we've kind of realized that we miss some of those social interactions. So not having that support has been hard for many of us. And we know that people who work are happier and healthier. Our physical and mental health is generally improved. We recover from sickness quicker. We're at less risk of long-term illness and incapacity. And then work, for many of us, provides our benefits. And so it's important to have those. That's the way our model for healthcare is set up here. But work also impacts kind of where we live and our commute time back when we were commuting. And it can take away time from other pursuits. So it may impact our ability to exercise, to eat healthy, to, you know, have a social life. And we also know that there are hazards in the workplace that can directly impact our health and safety. So it's complicated, but, you know, the more we understand it, and I think the workplace might be a good place to address these broader issues. You know, I'll kind of go back to another definition from the World Health Organization, and that's work affects a person's mental health, while in turn an employee's mental health affects the workplace. And that's really true. So there's been a review done by SAMHSA who looked at all of these articles looking at the impact of an unhealthy workplace on different outcomes. And this graph, which I stole from them, really shows some of those things. You know, an unhealthy workplace is associated with physical conditions, back pain, certain cancer. It's associated with increased injuries, also increased infections, substance abuse, and mental health issues there. So it's really important to understand that connection between work and well-being in order to help us to be more successful going forward. We look at the data, we also see some startling data that we're seeing here. Right now, although we don't have the most recent numbers, and I think this past year it may have changed, but suicide is the 10th leading cause of death in the United States. And if you look at this graph on the left, we see that over time that rate is increasing. And, you know, we're located in Iowa, many of you are from the Midwest, and we also see that we have higher rates of deaths by suicide than national averages, which is concerning. We need to do something about that. The data that we look at also shows that certain occupations are also at greater risk than others. And these are the top four occupations associated with higher rates of suicide. And we see that two of those industries that Vicky mentioned I work in, construction and agriculture, are particularly impacted. And so the question is, is what is it about those occupations that have these higher rates of suicide? And how can we address that by looking at the work organization? You know, we can also look at workplace overdose deaths. So between 2011 and 2016, there were 760 overdose deaths in the workplace. And so that also is increasing if we look here on the blue line. And we know that nearly half of these workplace overdose deaths occurred in three industries, transportation and warehousing, construction, and healthcare and social assistance. And again, this data is from 2016. What we'll see in the last year is hard for us to know. The other factor when we think about workplace overdose deaths is we want to think about prescription pain medication. And many of these industries are physically demanding work and associated with high musculoskeletal injuries. And at times, those are where you're prescribed prescription pain medication, which can lead to problems with addiction and subsequent substance use disorders. So when I am talking about mental health, I'm really talking about three different things. I'm talking about a diagnosed mental illness. I'm talking about substance use. And I'm also talking about workplace stressors. And these are things that overlap. We know that mental illness is common. One in five adults in the U.S. have a diagnosed mental health disorder. Substance use is common. One in 10 adults in the U.S. have a diagnosed substance use disorder. But we also know that treatment is low. And people are not seeking treatment. And one primary reason usually is associated with stigma because we don't want to talk about it. And so we need to change that conversation and start to talk about it in order to get people to treatment. Because the positive side here is that treatment works. So if we can get people there, we can help to address this problem. So many of you are employers or you're in a position where you've got to think about the bottom line. And there's a lot of, you know, benefits for addressing mental health in the workplace. We know that it will lead to increased productivity. If you're trying to watch the bottom line, you know, having a more productive workforce is helpful. We see decreased risk of injury and illness. Health care spending costs also go down. There's reduced turnover and more engagement. A lot of times what may make you aware that this is something as an employer you want to address is you might look at what's going on in your organization. You might see that people are leaving an organization, maybe due to burnout. These are even your high performers there. Or maybe managers aren't comfortable talking about mental health. You can look at your data, insurance claims, prescription drug claims there and see if you're seeing a lot of claims for behavioral health. If you have an employee assistance program or a member assistance program or people utilizing that, you know, or you may see a workplace suicide. And, you know, we want to get to the point where we don't see those. So we want to think early on for prevention. So I want to talk about solutions because that's where we need to go. I've laid out what the problem here. And in public health, we sometimes use the stream analogy, you know, which is the idea that a man and woman were fishing on a riverbank when they saw a woman struggling in the current. And so they jumped in and they rescued her and went back to fishing. Soon a little while later, they saw a man struggling. So they rescued him, too. And this continued all afternoon. So finally, this couple who were fishing said, what's going on? And why is everybody, you know, falling in? Where are they falling in? What's going on there? So they walked along the riverbank. And at the top, they discovered that there was a beautiful overlook along the river's edge, but there were no warning signs or any protective barriers. So they went to the community leaders. They explained the problem and the connections that, you know, there is no, you're at this beautiful overlook here and people are falling in. And the community leaders agreed that if they put up some warning signs and put up a guardrail, that would solve the problem. So when we think about solutions, we want to go upstream. We want to think about prevention. We also, you know, have solutions that, you know, not everybody's going to be caught with the prevention. So let's think about early intervention. And hopefully, we won't have to use them, but we also need to have those things for crisis response. So you might also know primary, tertiary, and secondary care follows that same model there. So very briefly, I want to talk about what would fit into each of these categories. So when we think about those upstream solutions that focus on prevention, the first thing you have to have is leadership support. If the leader and the management of a company is not buying into, we need to address mental health, it's not going to occur in the workplace. You probably all know that. So you need buy-in from the top to create a culture that supports mental health. But the other group I want to mention here are those frontline managers. Those are the ones that have, may have direct interactions and may need to know what to look for. They need to be aware that this could be an issue. They need to know what the signs are. So there's also a need for communication and education, and that can be part of the prevention there. And then let's look about how the work is organized. And with that, you know, one of my jobs here in the Department of Occupational and Environmental Health is to look at workplace hazards there. And there are many factors in the workplace that affect our physical and mental health. You know, we could start with physical stressors, you know, chemical agents, noise, heat, vibration. When we think about traditional occupational safety and health, those are often the things we think about. But these are other hazards here associated with the job design and organizational practice. These are as much a hazard as a chemical exposure or working with an awkward posture or doing heavy lifting there. Things like mandatory overtime, poor supervision, insecurity about your job. Maybe you don't know what the career path is or you're worried about losing your job because there's a downturn in the economy. The environment, if there's bullying and harassment, all of these factors are important when we think about workplace hazards. These non-traditional hazards need to be addressed just as much as the more traditional hazards. And then, you know, this past year, we've been dealing with a new hazard in the workplace, COVID, and that's changed how and where we work. And it's led to a lot of mental health issues there. I think there's a lot of concern about what we are going to see in the future as we go forward. And so hopefully we can start addressing these now and be prepared. The other thing I want to emphasize is that when we address mental health in the workplace, just like when we address any other hazard, we want to think about solutions that address the organizational level. So those of you who are familiar with the safety paradigm might recognize this as a modified hierarchy of controls. So the most effective solution to address a workplace hazard, to control your exposure, is to eliminate it or substitute a safer alternative. And that's the same thing when we think about mental health, is can we eliminate some of these hazards that I'm showing in the yellow boxes there? Solutions that target the individual level are good and they're necessary, but they're not as effective as policies or changing the culture, which are going to lead to eliminate that hazard. So I would encourage us when we think about solutions to think beyond handing out, you know, personal protective equipment and think more about organizational level solutions. So that's prevention. The next phase really is these midstream solutions here. And these are focused on building out a support system. So having qualified mental health services or peer specialists available to help people, things like screening programs, gatekeeper trainings. A lot of trainings are available right now that can be used to raise awareness and reduce stigma. But we can also think about accommodations that can be made in the job and creating recovery friendly workplaces, which can help you increase your workforce. So just to touch on a couple of those, let's talk about screening programs there. You know, as I mentioned, people may be reluctant to seek treatment and that's often due to the stigma associated with it. But if an employer provides a screening program, it can be the intervention that moves people from thinking I don't have a problem to maybe I do have a problem. And if you can get people to move from that and then also provide them with what resources are there, then it's a great tool to get them thinking that maybe I do need to reach out to someone. But the employer can also monitor this from an organizational level, not an individual level, to see where their workforce is on a broad level. You can use the information from these health risk assessments or climate surveys to understand what's going on at the organization and think about what changes can be made. Mental health parity. So as I mentioned, we get our benefits through our workplace there and mental health parity just means that insurance benefits for mental health and substance use need to be equal to coverage for other physical health conditions. So if your plan offers low co-pays or unlimited office visits for something like diabetes or other chronic condition, they need to offer that same for mental health and substance use treatment. And so that's really important to think about what are you offering people. And then workplace accommodations is really important. If somebody gets injured on the job or breaks their leg and comes in, you may make accommodations for them in the workplace. And you can make those same accommodations and apply the same sort of reasoning when we think about mental health issues. And accommodations, you know, just any change in the work environment that's reasonable. And I gave some examples here of some mental health issues and reasonable accommodations that can be put into place, you know. Maybe it's just allowing a flexible schedule for appointments or instead of having longer breaks, have multiple short breaks throughout the day. More frequent reminders of tasks, noise canceling headphones. These are reasonable accommodations that can be put into place. Now, not every situation can be accommodated, depending on the job, but it's important to think about mental health, just like we would think about physical health conditions. And then the last one are those downstream solutions or what I'm calling crisis response. And this is where our employee assistance programs come in or a member assistance program or policies that we might have in place if we're dealing with you know, an overdose that occurs in the workplace or a workplace incident there. And these are great resources that are there. They're designed for people who are in distress and who need help on a short term basis with the goal of helping them at this time point and, if needed, feeding them out to different resources there. And so they play an important role. So understanding who's utilizing your EAP program, what programs are they using and are they even aware of it, you know, and if we think about our smaller organizations, they may not have access to those. A policy is what kind of started us with this is, you know, let's draft a mental health model policy and that is one of our goals. But here's some of the things that you might think about and things that I've heard here. Communication was really important. And we don't have the word compassionate in that first bullet point, but I think that really comes up. And you can be compassionate if you understand. So there's knowing you should ask that question, but also maybe knowing why you should ask that question. So there is a definitely a need for education and raising awareness and I heard that a lot. You know, addressing the aspects of the workplace. I can't remember which group, maybe it was Liam's group who talked a lot about sitting down together. And using a participatory approach. So, you know, don't just have the manager sit up in the office and say, here's how we're going to fix things. Engage the people at all levels to do that. And that will lead to a more successful program. And that's a lot of where we're at is, you know, what are those things about work organization that can be changed. And we didn't talk about it. But one of the things we should have mentioned was things like flexible work arrangements or alternative work arrangements. When we've been looking at University of Iowa employees, we're seeing that that's really important. And that can be linked with reduced stress and increased well-being. So supervisor support and thinking about those alternative work arrangements, which may sound really scary. But now we've all realized we can work from home for many of us. And we've also realized that the second point is just gone. So we can work from home. Oh, it's just like, you know, those reasonable accommodations is that, you know, some of these flexible work arrangements don't have to be really complicated. Maybe letting people have flexibility on when they work and how they work and where they work. Stigma is a huge issue. You know, we had Matt share the importance of that. We certainly see that in the construction industry. I know David Brown from Iowa State's been working a lot with farmers. Another area with stigma, reasonable accommodations, and building that culture of safety there. But I also want to move beyond those things and think about higher level things. How can we set up our benefits plan? Do we offer mental health substance use treatment programs for employees and their family members? How is that covered? Is there access to care? You know, another benefit of COVID, maybe those words don't go together, really is the fact that telehealth has become more and more common. And so that may be an opportunity here. What can we do remotely, which we can access people in our rural areas? Employee assistance programs, how are they being utilized? Do people know? You know, the people who work in that really work hard and they have a lot of knowledge, but is it getting to the people at risk? And thinking about, you know, bringing in our pool of applicants by allowing some more flexibility in the workplace. So supporting somebody who's struggling with addiction. But all of this makes people concerned about privacy. What are you going to do with my information? Who's going to have access to it? So those are really important questions that also need to be addressed. So it's a big issue. But I think today we really started to address this. We're going to compile all of this information and the research that we've done into a white paper. We will share that out with everybody. We will create an issue brief, which will be a one page document. Vicki's been encouraging us to do that. And that will be something that you can use maybe in your workplace or as you talk to other people to make the case for why this is an important topic. And, you know, we want to develop some guidelines. That'll be kind of our next process. This was our first step really to kind of float the idea, get some information back, see, you know, when we go take our ideas out into the real world, what do we hear? So we really appreciate you all taking these two hours to work with us and share with us. I think that is it. I do want to recognize Vicki with the University of Iowa Institute of Public Health Research and Policy for kind of spearheading this and then we've been adapting it with our Healthier Workforce Center.