Category: violence

Mental support research

In SafetyAtWorkBlog in 2008 there have been several posts concerning suicide.  There is a growing research base on the matter and The Lancet adds to this through an article published in December 2008.

Researchers have found that the type of mental health services provided to the community can affect the rate of suicide.  This is important research even though SafetyAtWorkBlog regularly questions the applicability of research undertaken in Scandinavian countries to the rest of the world.  Bearing the cultural differences in mind, the research will stir debate and, hopefully, localised research along the same lines.

Below is the text of the press release about the research:

WELL-DEVELOPED COMMUNITY MENTAL-HEALTH SERVICES ARE ASSOCIATED WITH LOWER SUICIDE RATES

Well-developed community mental-health services are associated with lower suicide rates than are services oriented towards inpatient treatment provision in hospitals. Thus population mental health can be improved by the use of multi-faceted, community-based, specialised mental-health services. These are the conclusions of authors of an Article published Online first and in an upcoming edition of The Lancet, written by Dr Sami Pirkola, Department of Psychiatry, Helsinki University, Finland, and colleagues.

Worldwide, the organisation of mental-health services varies considerably, only partly because of available resources. In most developed countries, mental-health services have been transformed from hospital-centred to integrated community-based services. However, there is no decisive evidence either way to support or challenge this change.

The authors did a nationwide comprehensive survey of Finnish adult mental-health service units between September 2004 and March 2005. From health-care or social-care officers of 428 regions, information was obtained about adult mental-health services, and for each of the regions the authors measured age-adjusted and sex-adjusted suicide risk, pooled between 2000 and 2004 – and then adjusted for socioeconomic factors.

They found that, in Finland, the widest variety of outpatient services and the highest outpatient to inpatient service ratio were associated with a significantly reduced risk of death by suicide compared to the national average. Emergency services operating 24 hours were associated with a risk reduction of 16%. After adjustment for socioeconomic factors, the prominence of outpatient mental-health services was still associated with a generally lower suicide rate.

The authors conclude: “We have shown that different types of mental-health services are associated with variation in population mental health, even when adjusting for local socioeconomic and demographic factors. We propose that the provision of multifaceted community-based services is important to develop modern, effective mental-health services.”

In an accompanying Comment, Dr Keith Hawton and Dr Kate Saunders, University of Oxford Department of Psychiatry, UK, say: “The message to take from these findings must be that while well thought out and carefully planned new developments that increase access to secondary care services for mental-health patients are to be encouraged, measured progress towards flexible community care, not rapid ongoing change, should be the order of the day.”

 

Management failures and a rape of a five-month-old baby

Earlier this year, SafetyAtWorkBlog reported on the attack on a nurse in the Torres Strait Islands north of Australia, the investigation of the issue by Queensland Health and the mechanisms introduced to get the working conditions and accommodation up to a safe level.  In this case there was a clear link between occupational health and safety and the security of a worker.

OHS law in Australia obliges workers and those in control of a workplace to ensure the safety of people on their premises.  Last week the Northern Territory government received a report (081128vol1-f9c6d46d-75d5-4a5e-95e7-7c040ae6600c1) into the security measures at the Royal Darwin Hospital.  This hospital has undertaken fantastic medical work in the past, most noticeably, on a large scale following the bombings in Bali in October 2002.

However it failed to prevent the rape of a five month old female infant on 30th March 2006, while the indigenous baby was an inpatient.

Carolyn Richards, the Health & Community Services Complaints Commissioner, said in her report

As a result of a complaint reported to the Health & Community Services Complaints Commission an investigation was undertaken by the Director of Investigations, Mrs Julie Carlsen, who is employed as the Director of Investigations (DI) Health &  Community Services Complaints Commission.

This report highlights that the Department of Health & Community Services (DHCS) needs to implement effective risk control mechanisms to minimise the risk of an assault on a vulnerable inpatient in the Royal Darwin Hospital (RDH). The investigation has led to the conclusion that DHCS (DHF) and RDH have not complied with the applicable Australian Standard. It has also revealed that crucial information has been withheld from an expert engaged by RDH to review security arrangements and from the DHCS (DHF) Security Manager based at RDH. This report also details inadequacies and failings by those responsible for managing RDH who have failed for over two years to implement and maintain better security for patients in the Paediatric Ward. It is published with the hope that it will cause DHCS (DHF) and RDH to give higher priority to improving its risk management and security procedures.

The Commissioner’s conclusions are worth including here so that OHS professionals and security officers can establish appropriate procedures for their workplaces.pages-from-081128vol1-f9c6d46d-75d5-4a5e-95e7-7c040ae6600c1

1. On 30th March 2006:

  • There were no arrangements in place on the Paediatric Ward to ensure the safety and inviolability of vulnerable patients.
  • No risk assessment had been conducted.
  • The arrangements in place did not comply in any aspect with the Australian Standard which sets the benchmark for proper security.
  • There was no control on access to the Ward or to the patients.
  • The staff had not received adequate training, and possibly none at all, about the risks arising from lack of security arrangements.
  • In 2002 RDH had commissioned and received an expert consultant’s assessment and report on security arrangements at RDH. The Terms of Reference did not require 5B to be assessed. By 30 March 2006 the recommendations in the report had not been implemented in Ward 5B. This failure can only be described as shameful.
  • Following the rape of the infant police were not notified for about 2 hours.

2. Action taken by RDH after the rape to improve security was: (a) slow (b) inadequate, and (c) has not been adequately evaluated or reviewed to determine its effectiveness

3. RDH has a Security Manager on site as well as an NT Police member stationed at the hospital. Neither has been asked to evaluate the security on the Paediatric Ward either before or after the rape of the infant.

4. Staff working on the Paediatric Ward have not been trained at their induction on the elements of security arrangements to reduce the risk to vulnerable patients nor has there been adequate ongoing training of staff before or after the 30th March 2006 incident.

5. In 2007 the same expert safety and security consultant, as in 2002, was engaged to assess security arrangements at RDH. He was not informed of the rape of the infant in March 2006 nor was he asked to report specifically on arrangements in the Paediatric Ward.

6. On 21 November 2007 two investigation officers from the Health and Community Services Complaints Commission visited the Paediatric Ward by prior arrangement. They were able to enter the Ward and wander around, have entry to every part of it and stand at the nurse’s station, for about 25 minutes without anyone asking who they were and why they were there.

7. Management’s lack of commitment to the proactive identification of risks and to taking appropriate action has not created a culture where each member of staff takes responsibility for identifying and reporting risks and developing safe practices.

8. A security review of RDH was carried out by an expert hospital safety and security consultant who issued a report in 2007. The Security Manager of DHCS (DHF) was not given a copy even though he requested it. HCSCC enquired of RDH management why he was not given a copy and RDH have offered no explanation. On 31 October after this report was published to RDH and DHF the CEO of DHF advised this Commission that he had finally been given a copy and that he had seen a draft copy.

9. RDH Maternal and Child Health Clinical Risk Management Committee considered security in the Paediatric Ward following the incident. The Committee met on 16th May 2006, 2.5 months after the rape of the infant. It met a further 4 times. It submitted an action plan to the General Manager of RDH in July 2006. At its last recorded meeting on 5 September 2006 there had been no response from the General Manager on the recommendations, particularly with respect to installing CCTV cameras with recording facilities on the Paediatric Ward. There were still no recording cameras on the Paediatric Ward as at June 2008 although a CCTV system had been installed in the kitchen area to deter the pilfering of food. Dr David Ashbridge on 31 October 2008 advised, when responding to a draft of this report, that CCTV cameras were installed in Paediatrics on 25 August 2008.

10. The surveyors from the Australian Council of Health Standards which accredits RDH probably did not receive all relevant information about the incident of 30 March 2006 and what action RDH were taking. Those surveyors on 13 October 2006 were informed by RDH that the patient information pamphlet and admission interview are being reworded to reflect the changes to ward access. There was no verification throughout the investigation that any action had been taken by RDH to implement the recommendations of the review. Neither the report of ACHS nor records of information given to ACHS have been provided to the HCSCC. DHCS (DHF) was invited to provide me with those relevant documents in response to this draft. No response was received on this issue from DHF or RDH. According to the published information of ACHS the accreditation survey commences with a self assessment by the hospital concerned. This Commission specifically requested details and copies of the information provided to the ACHS surveyors but no response was received from either the CEO of the Department or the General Manager of RDH.

11. The governance arrangements at RDH do not promote adequate transparent accountability of the General Manager and the Department of Health and Families for the operation of the hospital. Control of all aspects of the day to day management of RDH rests in the hands of three individuals. This includes staff recruiting, training, security, nursing and medical services, procurement, record keeping, financial accountability and risk management. Such specialist management groups as exist are subordinate to the General Manager’s authority. The General Manager reports to the Director of Acute Services who reports to the CEO of the Department. I have been unable to find out what role the Royal Darwin Hospital Board has since its last annual report to 30 June 2006. 

It is well worth obtaining the complete report to understand how such an individual tragedy occurred.  As one media commentator has posited

“One wonders what the reaction would have been if a non-indigenous infant was raped.”

Sexual harassment and politicians

Bernard Keane, political columnist with Crikey.com, wrote on 20 November 2008 about the unacceptable conduct of Australian politicians.  He wrote:

We’re not talking here about ordinary poor behaviour. There are boors and fools and thugs in workplaces across the country. It’s the sense of entitlement that seems to motivate many MPs to treat other people — whether they are staff, or waiters, or anyone who happens to cross them — with contempt. It’s a sense of entitlement encouraged by the job — one with a large salary, expenses, vehicles, travel and public profile. Most MPs manage to prevent it from going to their heads. But a lot don’t, and they make other people’s lives hell. Particularly because MPs aren’t under the same workplace laws as everyone else. 

SafetyAtWorkBlog believes that, as the sexual harassment is occurring in workplaces, predominantly, that MP’s ARE “under the same workplace laws as everyone else”.

Keane refers to one case where a Minister who was sexually harassing a staff member was relocated to another ministry.  The case recalls the Catholic Church’s risk control measure with paedophile priests.

Workplace safety regulators have been trying to emphasise for years that unacceptable behaviour in workplaces is more serious than a “bad day” or a “bad mood” and that this can be symptomatic of a sick workplace culture.

It is hoped that Crikey readers get to realise that inappropriate conduct at work can be criminal, a breach of OHS legislation or, even, a contravention of our Human Rights obligations.  That the Australian political parties tolerate such behaviour is shameful

Construction industry bullies

Workplace bullying is a possibility in all workplaces but more so in the blue collar construction industry than elsewhere, it seems. 

The front page report in The Australian confirms the blue-collar bully stereotype that the former conservative government tried to gain political mileage from, most noticeably in political advertising, but also in political rhetoric over the years.

The article reports threatening language and physical imposition towards inspectors from the Australian Building and Construction Commission (ABCC).  There was verbal abuse and insults to both the male and female inspectors.  John Lloyd, head of the ABCC, is quoted as writing in a letter to the building company Brookfield Multiplex, that his inspectors:

“”feared for their safety and believed they would be assaulted if they had left the vehicle”.

The article also says that John Lloyd believes the incident, being investigated by the police, to be

“the worst abuse encountered by his inspectors in 1400 building site visits.”

The ABCC has draconian powers and there is, obviously, tension between the ABCC and construction workers however there is no excuse for workers breaching their OHS obligations to visitors to their worksite, regardless of the organisation the visitors represent.

The industry and unions have tried to eradicate it for safety and political reasons but on some sites it persists.  The Construction, Forestry, Mining & Energy Union says that no CFMEU employee or officer was involved in the incident.  That is good news but it was very likely that many of the participants were CFMEU members.  The union should remind its members that the ABCC inspectors have the right to carry on their work tasks in a safe and healthy manner even if their presence is objectionable.

The construction workers involved in this incident are doing their case against the ABCC no good at all by their threatening behaviour.  Indeed it allows the Labor government the chance to use similar rhetoric to that used by the Liberal Party – construction industry bullies and union thugs.  Let’s hear the CFMEU discipline their members on their OHS obligations to others.

Countering Customer Aggression

Other than drunken pub patrons, customer anger seems to be common in social security offices.  In Australia, until recently, there were few screens or barriers between staff and customers, perhaps an indication of Australia’s egalitarian culture, or perhaps, naiveté of current reality.  

Centrelink, Australia’s social security agency, responded to the workplace hazard by banning those customers from face-to-face contact.  Several people complained about this restriction and the complaints were investigated by the Commonwealth Ombudsman, whose report was released today, 25 August 2008.  The Ombudsman found

“that in most instances the decisions to withdraw face-to-face contact were not unreasonable, but highlighted the need for national procedural guidelines to be developed to assist staff when managing customers who exhibit abusive or threatening behaviour.”

This justifies the removal of face-to-face contact, or in OHS terms, the risk has been eliminated.

However, the safety of staff may have been guaranteed but the anger of the client might still remain.  It is in this context that the Ombudsman has recommended further changes to processes for the benefit of staff and clients.

Centrelink should be 

• reviewing letter templates to ensure customers are properly notified of their review rights and the review process

• implementing strategies to ensure relevant staff are aware of the review processes required by the guidelines, and providing further training where appropriate

• introducing an appropriate internal monitoring/review mechanism to ensure quality and consistency in the application of alternative service arrangements

• encouraging decision makers to explore the most appropriate alternative servicing arrangement for future contact before deciding to withdraw face-to-face contact

• amending the guidelines to ensure staff record an appropriate level of detail to justify their actions and decisions following an instance of aggressive behaviour.

The Ombudsman’s report is available for download HERE

Media reporting of workplace bullying

As a publisher my mailbox is constantly bombarded by media releases.  Some are irrelevant but most relate to safety in some way.

Over the years the amount of attention given to workplace bullying has grown phenomenally.  In my opinion the attention it garners is way beyond the level it deserves.

That is not to say that those subjected to workplace bullying are not seriously harmed, they are, but the big-picture issue is disproportionate.

This is partly because many people who talk about workplace bullying do not apply the definition of the hazard, and as a result other non-bullying matters get included.  A media release I received today, 14 August 2008, illustrates this point.

Workpro has undertaken a survey of

“2,146 employees applying for work through recruitment agencies across Australia, to gain an understanding of the experiences and beliefs about bullying and discrimination among Australian employees today”.

The survey found

“almost one in three (30%) employees claiming they have been bullied at work; one in four (24%) claiming they have been discriminated against, and 44 per cent stating they have witnessed their colleagues experience either of these”.

That data is pretty clear and you can expect the Australian media to run articles on the survey results tomorrow.  These surveys usually get a good hit rate.

The media release provides the impression that 30% of employees have been bullied at work.  This is not the case.  Thirty per cent of employees who are looking to change jobs say they have been bullied at work.  This does not represent 30% of the workforce but that is the impression we are given.

Another part of the release is annoying.

“27 per cent of respondents say they feel bullying or discrimination has happened to them within the past two years.”

Bullying and discrimination are very different interactions.  Discrimination can be a one-off event, bullying must be a repeated action.  To ask about these two disparate items within the one question is inappropriate or, if the results of two questions are combined, it provides a false impression.  Did 10% nominate bullying and 17% say discrimination or was it vice versa?

The media release says

“When asked about their peers, almost half (46%) of respondents say they have seen their colleagues bullied or discriminated against within the past two years; 31 per cent of this group say multiple times.”

The point about definition made above applies here but why ask about other people anyway?  The multiple times quote muddies the water because it is impossible to be bullied once, a single attack is just that an attack or in OHS parlance, “occupational violence”.

A spokesperson for WorkPro, Tania Evans, says

“It’s quite shocking to hear from employees that this sort of behaviour continues to happen in modern times, but organisations need to realise that bullying and unfair treatment of staff is occurring and could be impacting their own workplace culture or worse still, exposing them to the risk of liability, possible fines and even brand damage.”

Now we have something called “unfair treatment” in the mix.  (And I hate “impact” as a verb) The penalties could be liability, fines or brand damage, what about workers compensation claims for stress and bullying?  Not only is this a substantial business cost, the cause of the claim may result in the employee never being able to work again or lead a functional life?  I place these risks higher than brand damage.

Media releases are not the be-all and end-all of a survey.  Press statements are intended to generate contact in order to provide further information and hopefully generate business opportunities.  Alarmism is an effective tool and this media release is unhelpful.

You can imagine the articles in tomorrow’s papers where the journalists, if they can be bothered, will have asked the OHS regulators or unions for their response to the statistics, even though it may only be those statistics in the media release that they have seen.

I would have liked this survey to be reported in two parts, bullying and discrimination, to reflect their difference but also to report on the different control mechanisms for the harm that each of these hazards can generate.

But, I forgot, that’s my job.

Kevin Jones

Don’t rely on alarms

The Australian media has been following the investigation into the crash of a light aircraft that was travelling to Benalla on July 28, 2004.  There was a report on 5 August about a family who will be suing Queensland Rail over the serious bashing of a relative.  Different stories, different states, different modes of transport, but both stories of sadness.

Both stories illustrate an important reminder for the management of safety in workplaces and in public – alarms are there for a reason.

According to media, Barbara Lillicrap, the widow of bashing victim, Scott Lillicrap, said witnesses had pushed the emergency button at the station at least three times, but rail officers believed it to be a prank and ignored it.

A newspaper report says that air traffic controller Stuart Hodge said that an alert was sounded when the plane veered off course before approaching Benalla Airport.  Mr Hodge said false alarms were common and there was a culture among air traffic controllers to ignore them.

These two reports also need to remind safety professionals that alarms are simply audible signs to which people need to respond, or at least acknowledge.  An ignored sign is a useless control measure and if this is likely to occur, then a higher order of control measure needs to be implemented to control the hazard.

(Don’t get me started on signs at level crossings!)

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