Gordon Parker Presentation

Depression and Work:Can Employers Do Better?: 

Depression and Work: Can Employers Do Better? Gordon Parker, Executive Director, Black Dog Institute, and Scientia Professor, School of Psychiatry, University of NSW.

The Broadness of Mood Disorders: 

The Broadness of Mood Disorders In essence, there are few in Australia that are not affected by the impact of mood disorders: Sufferers Relatives and carers Friends Employers

Impact: 

Impact “I think it would be easier to come to terms with losing your husband to another woman, than to a Black Dog.” - Participant 2006 Black Dog Writing Competition

What’s in a name?: 

What’s in a name? Why ‘black dog’?

Our Logo: 

Our Logo

Organisational Model: 

Organisational Model

Community Support/Education: 

Community Support/Education In addition to more general activities (eg walk in centre, community meetings, web), we have taken up one narrow task – of addressing work force ‘crisis’ issues (eg high rates of suicide or depression) in certain organizations. Involved by invitation. Such work has identified some ‘sentinel’ issues.

The Impact of Mood Disorders: 

The Impact of Mood Disorders Distributed widely Deadly Disabling Discriminating Detection problems Dumbed down in a Dimensional model

Distributed Widely?: 

Distributed Widely? Lifetime chance of a mood disorder = 25% for women; 15% for men

Deadly?: 

Deadly? Lifetime chance of suicide = 15%. Of those who commit suicide, at least 80% are depressed.

Disabling: 

Disabling A study undertaken by the World Health Organization, Harvard University and World Bank established that depression was the most disabling – and Bipolar Disorder the 6th most disabling – of all medical and psychiatric conditions. Why? Young onset, repeated and often lengthy episodes. How? Not getting to work and difficulty in working if at work.

Discriminating?: 

Discriminating? Common ‘pull up your socks response’. Lack of appreciation by non-sufferers. General stigmatization. Reaction by some employers. Policies of insurance companies.

One Observer’ Comments….: 

One Observer’ Comments…. “The most difficult words I have ever had to speak are these: “I have depression”. In my eyes, these are the most powerful words in the English language. With these three words you can lose friends that you have had for a lifetime, make enemies with people you have never met, and lose opportunities that would have been laid out in front of you had you not had the courage to speak these words….”

Observer (cont).: 

Observer (cont). “….These three words can have you questioning your own sanity, have others question your sanity, and have many assume you are insane. Yes, these are the three most powerful words I know. “I have depression”. And for the first time in my life I am not ashamed to stand up and let the whole world know.” - Participant 2006 Black Dog Writing Competition

Detection Problems: 

Detection Problems Depression commonly undetected. Bipolar Disorder – if diagnosed, average duration from onset to diagnosis in Australia = 15 – 20 years. Diagnostic confusion……

Dumbed Down by a Dimensional Model: 

Dumbed Down by a Dimensional Model While we argue that there are several distinct types of depressions, and that the differing ‘types’ respond quite differently to differing treatments, ours is not the dominant view. Instead, a ‘dimensional’ view and ‘single cause’ views dominate.

Dumbed down?: 

Dumbed down? Depression is an ‘it’. ‘It’ is operationalised diagnostically as ‘major depression’, which is then interpreted as sufficient to dictate treatment. Treatment is then shaped more by the practitioner’s discipline and training than by characteristics of the disorder (i.e. the patient is ‘fitted’ to the practitioner’s treatment model rather than the treatment being fitted to characteristics of the depressive condition).

Imagine if….: 

Imagine if…. We treated ‘major breathlessness’ according to a similar model…..

Thus, our Model…: 

Thus, our Model… There are differing meaningful conditions. The differing conditions benefit from differing therapeutic approaches. Thus, the need to identify those differing mood disorders. Management AT ALL LEVELS needs to respect a ‘horses for courses’ model.

‘Meaningful conditions?’: 

‘Meaningful conditions?’ The Bipolar Disorders: ups and downs, with melancholic depression in the ‘down’ phases. Mania Hypomania Melancholia

www.blackdoginstitute.org.au: 

www.blackdoginstitute.org.au

Slide23: 

Online Self-testing CREATIVITY DISINHIBITION MYSTICISM IRRITABILITY More confident See things in new light Creative ideas & plans Things vivid/crystal clear Spend more money Increased libido Say outrageous things Feel ‘high as a kite’ Laugh more Do outrageous things Lots of coincidences Feel at one with nature See special meaning in things Mystical experiences Talk over people Feel angry Thoughts race Feel irritated

Online Bipolar DisorderEducational Program: 

Online Bipolar Disorder Educational Program

Slide25: 

Depressive disorders – multiple ‘types’

Depressions: 

Depressions Some (e.g. psychotic depression, melancholic depression) are categorical ‘diseases’, others more environmental reflecting stressors alone, or in conjunction with certain personality styles.

Melancholic depression: 

Melancholic depression The real ‘black dog’

Treatment of Psychotic and Melancholic Depression and Bipolar Disorder Involves…: 

Treatment of Psychotic and Melancholic Depression and Bipolar Disorder Involves… A range of drugs prescribed by a medical practitioner – PRINCIPAL STRATEGY. Stay-well plans. Other self-management strategies: exercise, involving family in consultations, often negotiating with employers.

By Contrast….: 

By Contrast…. A range of non-melancholic disorders reflecting the impact of certain stressors on certain personality styles.

An ICONnoclastic ‘neuronal’ line-up relevant to the non-melancholicdepressive disorders: 

An ICONnoclastic ‘neuronal’ line-up relevant to the non-melancholic depressive disorders

Patterns of Non-melancholic Depression: 

Patterns of Non-melancholic Depression Acute and chronic stress-related. ‘Emotional dysregulation’ related Anxious worrying, Anxious irritability, Self-critical, Sensitive to rejection Shyness related Socially avoidant, and Personally reserved Perfectionism-related Explosive, impulsive related

Clinical Management: 

Clinical Management Medication may help some non-melancholic disorders (totally or as contributor) Benefit from counselling/problem solving/empathic support Benefit from attention to predisposing personality contributions (eg psychological therapies).

Impact on Work: 

Impact on Work Melancholia………

Impact on Work: 

Impact on Work Bipolar Disorder……

‘Meaningful conditions?’: 

‘Meaningful conditions?’ The Bipolar Disorders: ups and downs, with melancholic depression in the ‘down’ phases. Mania Hypomania Melancholia

Impact on Work.: 

Impact on Work. Non-melancholic disorders.

Impact on Work.: 

Impact on Work. Non-melancholic disorder examples: High anxiety group – internalising anxious worriers and externalising irritability. Shyness (and unassertiveness) Rejection sensitivity ‘Perfectionists’

Importance of Work for Those with Mood Disorders: 

Importance of Work for Those with Mood Disorders Ranges from beneficial (eg distraction, support from others – for those with non-melancholic disorders) to ‘toxic’ (eg for those with unipolar melancholic or non-melancholic depression, extremely ‘stressful’ work can sometimes be counter-productive in precipitating them into new episodes).

Managing a Worker with Depression: 

Managing a Worker with Depression Scenario A: Escalating downhill trajectory where the depression accentuates harassment and bullying (most often observed in organizations that are downsizing, offering VRs, or are very hierarchical).

Managing a Worker with Depression: 

Managing a Worker with Depression Scenario B: Line boss (not HR) takes responsibility, offers support and flexibility.

How to Intervene: 

How to Intervene Intervene: yes vs no. (ie can still support without issue being discussed openly). Who to intervene? How to intervene? Intervention options? Controlling the boundaries (ie limiting who knows, documentation, preventing secondary discrimination).

Impact of Premier Gallop’s Resignation: 

Impact of Premier Gallop’s Resignation Consistent with public and media empathy increasingly evident in Australia. Did raise the issue that ‘depression’ could cause people to need to give up their position. Right or wrong message? Another message – can depression, like any other crisis, encourage people to review their priorities and trajectories?

Organizations that “get it” – Two Case Studies: 

Organizations that “get it” – Two Case Studies ‘Core values’ ongoing model: Organization has customs (more than procedures) in place to handle depression akin to any other acute and/or chronic problem. Problem-based model: Organization responds to particular situation rapidly, responsively and confidentially.

Final Message - I: 

Final Message - I Mood disorders can be managed and are treatable. Most people can be given a good prognosis and expect their episodes to cease or brought under good control. No single condition ‘depression’. As we do in clinical management at Black Dog Institute – work to a ‘horses for courses’ model.

Final Message - II: 

Final Message - II The way in which an organization deals with those with depressive disorders will define the true value of the organization.