Achieving reform in social housing: a case study of policy into practice

Public Sector leaders with a passion for social justice need to use every opportunity to influence policy change across a broad and, at times, populist agenda. It calls for awareness of the whole of government agenda, trusted networks and formal processes underpinned by personal and organisational credibility

  • Consider the risks of seizing the opportunity
  • Understand the importance of building and maintaining credibility
  • View the policy process through an implementation lens

Read the inside story here turning  Policy into Practice

Performance measurement – so much stuff

In 2009, I was pondering about how we measure the effectiveness of policy development in the public sector.  This resulted in a conference paper where I had the temerity to liken some of our efforts in performance measurement to doing the ironing – a lot of effort for little more than appearance sake.

Here is a copy of that paper.  If you think we have made progress I would be interested to hear about it.

Performance measurement – so much stuff

 

Wellbeing in the workplace: taking action

Lesley van Schoubroeck: Speaking notes for Pacific Institute Health and Wellbeing Forum

Perth 22 November 2017

Acknowledgements

Can I start by acknowledging the traditional owners of this land, and pay my respects to Elders past, present and emerging?

Thank you also to the Pacific Institute, in particular Brian Cook and Gary Hodge, for the invitation to be here this morning.

Context

I’m really pleased to have been asked to focus on the bigger conversation about mental health and wellbeing in the workplace. It’s a topic much discussed, and I think one which means many different things to different people.

In 2010 I found myself at the keyboard developing the background paper for the establishment of the Western Australian Mental Health Commission.

I thought at the time that I had a reasonable handle on what we meant by mental health and enjoyed the interesting debate about whether it should be ‘mental health’, or ‘mental health and wellbeing’.

After the public announcement, it was clear that there were many different ideas of what this term meant, and importantly, what was required TO MAKE THINGS BETTER.

Expectations of ‘doing something’ about mental health were very different in the community, in workplaces and among professional staff in the health system, in schools and in the justice system to name a few.

What different groups thought was a reasonable expectation differed enormously but this morning we are focusing on staff rather than on service delivery so the scope is somewhat contained.

A recent media article (Slide 2) suggests that Australian workplaces are failing employees with superficial mental health policies.(1)

Yet there are organisations like Aurecon (Slide 3) that have workplace mental health programs embedded in the fabric of how they do business.  They were awarded the Australian Human Resources Institute Diversity Award in 2016 for its Mind Matters program

And there is Mates in Construction (Slide 4) that has only recently got to this side of Australia.  This program is widely regarded and evaluations point to a direct link since its inception and reductions in suicide rates on construction sites.

But there is I believe some truth in the observation that in many workplaces, there is a lot of talk, ad hoc initiatives but no structured program that responds to the issues and culture in that industry or that workplace.  No measures to show if things are moving in the right direction.

So, I would like to give you an overview of some of those concepts.  Because if your organisation is going to ‘do something’, and set realistic goals, it is important to decide where your focus will be. Otherwise it will be very very difficult to deliver on expectations.

What are we talking about?

Wellbeing is the broadest construct. For some, this is simply: Are you happy? Are you satisfied with life?

Martin Seligman’s sees wellbeing as much more, with five elements all contributing in different ways.(2)  These elements are: (Slide 5)

–          P: Positive emotion (of which happiness and life satisfaction are aspects)

–          E: Engagement

–          R: Relationships

–          M: Meaning and purpose

–          A: Accomplishment

 

Work is certainly a big contributor to meaning, purpose and accomplishment. I am not sure it is a reasonable expectation of a workplace to make us happy, but it should not make us unhappy.

A somewhat controversial book The Spirit Level but one I really like, shows strong relationships between income inequality and wellbeing(3). Australia looks pretty average (Slide 6).  Addressing income inequality at a society level is probably also beyond most workplaces.

Closer to home, the Queensland Mental Health Commission working with Aboriginal and Torres Strait Islander peoples discussed social and emotional wellbeing.  Their definition: Social and emotional wellbeing is being resilient, being and feeling culturally safe, having and realising aspirations and being satisfied with life.(4)

Mental health, or mental health and wellbeing, however is a narrower, and for workplaces, perhaps a more relevant concept. The World Health Organisation definition is widely accepted.  Mental health is defined by WHO as a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

Mental illness on the other hand is a diagnosable disorder that affects mood, thinking and behaviour. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviours.  They can be chronic or intermittent.  People can recover as they can from many illnesses.

The important point I want to make is that people with poor mental health do not necessarily have a mental illness.  As someone once pointed out to me, sometimes you just need to take time to get life in order – it may be that your knitting is falling off your needles.

Similarly, like many other people with a chronic illness, people with mental illness can have good mental health and work productively with the right support and the right treatment.  They can have positive emotions, be engaged, have relationships, meaning, purpose and accomplishment.

To get a better understanding of what a great and productive life someone with chronic mental illness can lead, read the memoir by Elyn Saks, The Centre Cannot Hold(5).  She is a professor of Law, Psychology, and Psychiatry and the Behavioral Sciences at the University of Southern California Gould Law School.  Her story is about her life living with schizophrenia.  Or you can google her and listen to the TED talk. (SLIDE 7)

The language around mental health and mental illness is often used interchangeably.  Governments have a habit of talking about mental health when they actually mean mental illness.  All States in Australia for instance have a Mental Health Act that focuses largely on the treatment of people with mental illness.

The recently released fifth national mental health plan has been criticised by some for its focus on mental illness rather than mental health and wellbeing.  To quote directly: Ultimately the Fifth Plan aims to improve the lives of people living with a mental illness and the lives of their families, carers and communities.(6)  Of its 32 Actions, none relate to broader mental health and wellbeing although there is a proposal to measure connectedness and meaning in life of the general populations.

So probably not a lot of specificity in here for those of you focusing on mental health in the workplace.

But remember that some of your staff will be living with a mental illness.

They may or may not have told you.  A recent UK report found that while one in five people have said they take days off work with stress a similar proportion felt they couldn’t speak to their managers about stress(7).  While there are laws against discrimination, challenging perceived discrimination is not a step that most people choose to take. A bit like being pregnant in the 1980s.

People with mental health conditions are also much more likely to drop out of the workforce than people with physical health problems.(8)

Suicide prevention, and reducing its impact on affected communities, falls conceptually within mental health and wellbeing but is now pretty well established as an important and specialised area of focus.  There are 7 to 8 suicide each day in Australia, with three quarters of those men. Women however are much more likely to attempt suicide. Fewer than half the people who die by suicide will have seen a health care provider in the previous month but most but not all people who die by suicide will have some form of mental illness.

Many will have been to work in the previous month or even the previous day.  Some suicides occur in the workplace.

The nature of the workplace will influence what can be done in that workplace to prevent suicide.  For instance, our rail entities have major infrastructure to prevent suicide by train.  Hospitals can reduce access to drugs and so on.  We can all do something.

The aftermath of a suicide has a ripple effect throughout workplaces, be it a colleague, or their family or a client.  It is likely that in your workplace, someone will be impacted by suicide and that impact will be felt in the workplace.

Addiction to alcohol and other drugs also falls in the broader concept of mental health and wellbeing. You may be aware that the Alcohol and Drug Authority here in Western Australia has now been rolled into the Mental Health Commission after some debate.

While many people with a substance use problem also have mental health issues, and many people with mental health issues self-medicate with alcohol and other drugs, one does not necessarily cause the other.  But from a workplace perspective, harmful use of alcohol and other drugs is a signal that a person may have mental health issues and should seek help.

So, I guess the message here is, if you are developing an approach to mental health and wellbeing in the workplace, be clear about its scope.  Staff will have different views and expectations often related to their personal circumstances.  Does your plan need to consider the full gambit and include?

–          Mental health and wellbeing

–          Support for staff who have a mental illness

–          Suicide prevention and its ripple effect

–          Addiction

The imperative

Doing nothing is no longer an option.

The economic case is well argued. Return on investment is at least 2.3. Any number of reports will tell you this. If you haven’t done the rationale for it yet, I can recommend the Canadian website Guarding Minds @Work(9) for an approach to the legal case, the business case and the health case.

To quote a recent article in the Lancet, a workplace can be both a source of stress and a formidable support system. Importantly, the first step might simply be to ask, “What can we do to help?(10). This article provides an overview of the recent independent review of mental health in UK workplaces (the Stevenson/Farmer Review) which argues that there are many green shoots but we need to do better(10).

Around Australia we do see lots of green shoots.  We are not ‘doing nothing’.  There are initiatives in place that support staff with mental illness and also seek to improve the mental health and wellbeing of the whole work place. Take for example:

–          Australia’s new one stop shop mental health portal Health to Health has links to many organisations including beyondblue, Lifeline, Butterfly Foundation and so on (Slide 8)

–          Access to Employee Assistance programs

–          Psychological health is part of risk management – Western Australia’s Department of Commerce has a Psychologically Safe and Healthy Workplaces toolkit(11).

–          Mental health week and RUOK day are widely acknowledged

–          Mental Health First Aid training

–          Anti-bullying policies

–          Staff climate surveys

–          Inductions, mentoring and work life balance

–          Enjoyable but fun activities like Wheel of Wellbeing(12) (SLIDE 9)

–          Increased green space(13)– yes there is evidence that green rather than lean office space increases work satisfaction and productivity

–          The list goes on

Moving forward

Superfriend is national mental health foundation that partners with superannuation funds and group life insurers to create positive, healthy and safe working environments. Their goal is to reduce the high rate of suicide and harmful impact of mental illness on individuals and their workplaces.

Superfriend’s recent report on thriving workplaces has four focus areas for attention (14):

–          Leadership – Supportive and committed leadership that endorses and prioritises initiatives that support a mentally healthy workplace

–          Connectedness – A work environment characterised by strong interpersonal and social support, trust and fairness, and inclusiveness.

–          Policies and practices – The existence and use of robust policies, strategies and processes that address mental health within an organisational framework. Clear processes driving policy development and implementation in the workplace

–          Culture and capability – The application of knowledge and skills within an organisation to support positive mental health and wellbeing, and to influence the culture through changing practices and improving the environment.

Not a bad place to start if developing organisational change frameworks is not your speciality and you don’t already have a framework.

Within those four areas there are 38 recommended actions. But it is not a recipe.  There can be no recipe because each organisation is different. For example:

  • How do managers in your workplace set a good example for a happy, healthy and productive workplace?
  • How will your organisation operate so that it feels like a community of people working together?
  • What workplace programs to improve physical health will suit your organisation and your staff?
  • How do you ensure the culture is such that people feel comfortable raising their mental health issues with managers?

Based on Superfriend’s 2017 survey of 5000 Australian workers, there is clearly a view that employers place more emphasis on and are more comfortable addressing physical health rather than mental health issues.

The good news is that things are moving in a positive direction (Slide 10).  On a scale of 1 to 100, the survey rated Australian workplaces as:

  • Leadership: 62/100
  • Connectedness: 61/100
  • Policies and Practices: 50/100
  • Capability and Culture: 47/100

Leadership must have the highest score, because without leadership none of the other actions will happen.

In summary

In summary, addressing mental health and wellbeing makes good sense.  It is an imperative for a successful organisation.  There are many surveys, there are many reports, there are many programs and activities.

We can’t imagine workplaces now without first aid kits and fire alarms, without ramps and even stand up desks.

We can’t imagine workplaces without workplace health and safety policies, recruitment and retention strategies, access and equity plans.

We have reached the stage where mental health and wellbeing must be an integral part of how we do business. It is no longer an optimal extra.

We need connected and inclusive organisations.

The challenge for each organisation is to take the decision to do something, allocate responsibility and develop a program that responds to your business, your staff, your environment.

A program rather than ad hoc initiatives will give you a measurable return on investment.  It will give you confidence that things are improving.

Thank you.  I look forward to hearing great things from Western Australia. (Slide 11)

REFERENCES

  1. Ried J. Australian workplaces failing workers with ‘superficial’ mental health policies. The New Daily [Internet]. 2017 27 October 2017. Available from: http://thenewdaily.com.au/money/work/2017/10/26/superficial-mental-health-at-work/.
  2. Seligman M. Flourish: A Visionary New Understanding of Happiness and Well-being. New York: Free Press; 2012.
  3. Wilkinson R, Pickett K. The Spirit Level: Why More Equal Societies Almost Always Do Better. New York: Bloomsbury Press; 2010.
  4. Queensland Mental Health Commission. Proud and Strong: Queensland Aborginal and Torres Strait Islander Social and Emotional Wellbeing Action Plan 2016-2018, . Brisbane2016.
  5. Saks E. The centre cannot hold: a memoir of my schizophrenia. Great Britain: Virago Press; 2007.
  6. COAG Health Council. The Fifth National Mental Health and Suicide Prevention Plan. Australia. 2017.
  7. Morgan E. Should you tell your boss about mental illness? Absolutely. The Guardian, Mental health Opinion [Internet]. 5 November 2017. Available from: https://www.theguardian.com/commentisfree/2015/jul/06/mental-illness-stigma-ruby-wax-work-employers.
  8. Farmer P, Stevenson D. Thriving at work. The Independent Review of Mental Health and Employers. United Kingdom2017.
  9. Canadian Centre for Occupational Health and Safety. Guarding Minds@Work [Available from: https://www.guardingmindsatwork.ca.
  10. The Lancet Editorial. Improving mental health in the workplace. The Lancet. 2017;390(10107):2015.
  11. Department of Commerce. Psychologically Safe and Healthy Workplaces: Risk Management Approach Toolkit Perth.
  12. South London and Maudsley NHS. Wheel of Wellbeing [Available from: https://www.wheelofwellbeing.org/.
  13. Nieuwenhuis M, Knight C, Postmes Y, Haslam S. The relative benefits of green versus lean office space: three field experiments. J Exp Psychol Appl. 2014;20(3):199-214.
  14. Superfriend. Indicators of a Thriving Workplace Survey – A Work in Progress. Melbourne2017.

 

Leaving now

Final speech to Mental Health and Drug Advisory Council and staff 16 June 2017

It’s been a while.

1969 I started teaching, that makes almost 48 years working in the public sector, with a bit of time off to have children in the 1980s and another break in 2007 to go back to study.

So that is almost half a century spanning Queensland and Western Australia, spanning classroom teaching, research, policy advice to Governments of all flavours, across most of the human services agencies.

The common thread, and one that I hope is there for most public servants, is not the tussles with complex policy problems, not the fights for equality of opportunity, not even the highs of major system reforms that can come to fruition long after the initiators have moved on.

The common thread is knowing I have made an impact on the lives of individual people – it is the faces and names of individuals whose lives I have had the privilege of improving. All it takes is a belief that the public service is there for the public good and some need our help more than others.

In the public service, it is easy to think of our achievements in terms of policies written, of services funded, of performance indicators reported.

There are times when it seems that font shape and font size are the only things that matter.

So, it’s important to have names and faces to know our time was worthwhile.

The teenage girl with tears in her eyes and all you can do as her maths teacher is give her a safe place to spend the day before she goes home again to her mother’s boyfriend

The young lad who thought he was dumb until he topped the science test because I read the questions – he couldn’t read but he knew his science

The young man back at school from his time in detention, needing someone to believe in him

The young public servants who decided to go into teaching and children’s services because they wanted to help people more than they sought a job with a nice office

Bright aspiring leaders promoted early, only to be cut down by former mentors who suddenly became competitors

A coffee for experienced leaders dismissed without thanks and without reason, and ostracised by former colleagues.

These are the things that let people know that strangers care, and that help is available.  These are the things that help people through their dark moments.

None of these things are on our CVs.

And it is why I believe we need to retain a strong and proud, frank and fearless public service.

In my four years in the Mental Health Commission, many of our achievements have been quietly won

  • For the first time in over 15 years, data about suicide has been presented in a way that resonates with local health services – that has resulted in local ownership and local action and will save lives
  • The big things and the small things in the mental health act, will improve lives. We already have feedback of improved lives with legal representation before the Mental Health Review Tribunal
  • Wellbeing activities are springing up across the State
  • Alcohol and other drugs services are now back on the agenda with mental health services
  • Many government agencies have much stronger focus on the mental health and wellbeing of the people they work with as well as their staff
  • And as a final effort I have finally secured Queensland a place on the national group that advises on mental health issues in the NDIS – Ivan will represent MHCs from July

The conversation has changed, and we should take some credit for this.  Many Queenslanders now talk about the importance of including and respecting people with lived experience, and increasingly people understand this means lived experience of mental illness, of suicide or problematic use of alcohol and other drugs.

We have been through a very independent review – it determined that we have done a commendable job in challenging circumstances.

So, I am content to leave this role, knowing that the Government cannot retreat from its promise to provide redress to the women who were in Wolston Park; and perhaps its best to go with a credibility rating of 74% because it will be very hard to go higher if we keep a broad stakeholder base.

We have not met all the expectations of our stakeholders.  That would have been impossible. But we have had a good go at meeting a lot and I wish you all well as you move forward.

 

 

 

 

Wolston Park

Wolston Park survivors

This in one project I will follow beyond my time in the public sector.

In 2016, in my role as Queensland’s Mental Health Commissioner,  I learnt about the people who had been incarcerated in the Wolston Park adult psychiatric hospital from the 1960s up to the 1980s.  They were sent there as children when they were wards of the State.  Despite repeated attempts, and an apology from the State of Queensland in 2010, it was not until September 2016 that the Minister for Health responded to my request for action and agreed to establish a process of consultation and redress.

There are now fewer than 10 survivors.

On 5 June 2017, we arranged an event with Access Arts Qld to raise public awareness of the gross injustice and celebrate the spirit of the survivors. The Minister for Health reinforced the commitment of the government to reconciliation.  Read what he said here.

The process was underway but the surviving women remained impatient.  The Queensland Mental Health Commission website provided update on progress.  Anne Wallace, well known Australian artist has remember them in art.

On 27 July 2017, the Minister provided an update of the redress process which is not moving as fast has the women had hoped.  See page 13 of Hansard – this was also reported in the local press.

The report commissioned by Queensland Health is now in the public domain and in October 2017 redress offers were to the surviving women.  The local media details Rhonda’s story.

While their experiences are not included in the Royal Commission into Child Abuse case studies, some of them did attend private sessions.

The question this leaves for us:  why didn’t any of the public servants who had known about this appalling part of Queensland’s history for many years speak out?

PS: in November 2017 the Royal College of Australian and New Zealand Psychiatrists published a statement of regret on their website.  The challenge will be for the people to whom the apology is directed to know that it has been made.