Dealing with Workplace Bullying

In the first article we covered some of the basic concepts in understanding and preventing workplace bullying.  We outlined bullying definitions, legal considerations, the assessment process, and issues of potential bias in the assessment process.  We will now consider the effective management strategies required to support key stakeholders, particularly the injured worker.  We will be discussing this in context of the roles and perspectives of the various stakeholders involved in a claim.

Managing the claim

If a workers compensation psychological injury claim is to be managed well a thorough unbiased assessment needs to be undertaken combining the inputs and perspectives of the various stakeholders. This is essential because the information obtained will determine strategies that are incorporated to treat the injured worker, to address the issues contributing to the psychological claim, as well as to determine the time frames and priorities of the various interventions. The claim as discussed in the first article, will be investigated by an independent assessor, and the worker examined by an independent doctor.  An injury management plan is put together by the insurer outlining stakeholders (such as the GP, the employer, the worker, the insurer and the psychologist/psychiatrist of their obligations and roles in the management and support of the injured worker.

Some of the important information includes:

The workers current mental health and prognosis

There are a number of factors that influence how a worker will have responded to bullying, including the intensity of bullying, the frequency, the nature of the bullying and the time frames in which it took place. Sometimes trauma symptoms can result. Also to be considered is the culture of the organisation. Was bullying supported or were steps taken to prevent or minimise the employer’s behaviour.  The role of the worker in the bullying and subsequent reactions must also be considered when strategies are being planned to treat the workers resulting “psychological injuries” and in ensuring that the underlying issues are addressed that led to the claim. Consideration must be given to the general resilience of the worker and what strategies they were able to call upon to manage the past situations and to determine their reaction.  

It is important that the professionals assessing and /or supporting the bullied worker (i.e. that the “independent medical examination”) looks at these issues and gives feedback in their initial report, and the treating psychologist or psychiatrist who is involved considers these issues and gives appropriate feedback to the stakeholders, particularly the NTD. 

The psychologist or psychiatrist managing  the psychologically injured worker needs to take a thorough history of not only the bullying but of other aspects of the workers personality so that the approach and treatment priorities can be given that will be most effective for that individual.  Although there are specific evidence based treatments that should be applied, the way these are presented needs to be tailored to the individual.

The type of problems bullied injured workers may experience. 

Assuming the employee was not experiencing any significant other mental health issue over the time the bullying took place and that the employer was generally coping with life, it is probable that the psychological consequences of the bullying will lead changes in the three key areas of psychological functioning - thinking, feeling and motivation.

Stress responses are on a continuum ranging from arousal (we need a certain amount of stress / arousal to just get out of bed in the morning) to a full-blown panic attack (where there are marked physiological and psychological changes that make normal functioning impossible).  Physiological responses to stress include tense muscles, shallower breathing, an increase in heart rate, restlessness, dilated pupils and sweaty palms. It may include nausea vomiting, diarrhoea, loss of appetite and significant sleep disturbances.  Psychological cognitive responses include rapid thinking, poor concentration, difficulty in decision making, poor judgements when thinking, intrusive thoughts, “I can’t get the thoughts out of my mind”, catastrophic thinking and only seeing the worse possible scenarios, and cognitive rigidity where you can only see a very limited range of options.  The feeling (affective) responses may include agitation, irritability, a labile mood where the mood is all over the place, depression, fear and dread about returning to the place where the stress was induced.  Motivation and energy level changes also occur and a range of agitation and inability to relax as well as extreme fatigue, and exhaustion where everything is overwhelming.

Prolonged stress often precipitated by extended periods of bullying can and usually does eventually lead to clinical depression.  Many of the symptoms described may eventually become so severe that there is major impairment in everyday functioning and capacity to cope with the demands of life. Some of the key diagnostic criteria for major depressive disorder include:

• A quality of depressed mood
• Duration – the patient must have felt bad most of the day, most days, for at least two weeks
• It is accompanied by associated symptoms (meeting a specified number such as loss of interest ion people or things, changes in eating habits and weight, changes in sleep patterns, changes in psychomotor activity, fatigue, feelings of self-worthlessness, impaired concentration and preoccupation with thoughts of death)
• Has resulted in disability – severe enough to cause material distress in the patients work (or school performance, social life or some other area of functioning)

It is not unusual for health professionals to first see a once normally high functioning resourceful and normally resilient patient present to the consulting room after months with extreme depression of major depression after years of trying to manage the situation at work by themselves and only after years of dysfunctional relationships and dynamics do they finally “crack”

There are some unfortunate workers who have experienced threats of violence against them or who have been physically assaulted.  In these situations or similar situations where they have been exposed to a critical incident of threatened harm or have witnessed injury or death, a trauma response is probable, and symptoms of a post-traumatic stress disorder (PTSD) may also follow.  The diagnostic criteria for PTSD includes:

• Intrusive distressing recollections, repeated distressing dreams, flashbacks, hallucinations or illusions, Marked mental distress in reaction to external or internal cues,
• Patient repeatedly avoids trauma related stimuli, and has numbing of general stimulus.
• Patient has symptoms of hyper-arousal that were not present before the event and will include two of the following:
• Insomnia, angry outbursts or irritability, excessive vigilance;
• The symptoms have lasted more than one month; the symptoms cause clinically significant distress or impair work, social or personal functioning.

Treating the Injured Worker  

A psychologist tends to provide precise and gentle feedback to the worker including an adequate explanation of the strategies and therapies they need to incorporate into their lives to get better. Communication and management is essential for commitment to therapy and in moving towards a graded plan for returning to work.

Strategies and treatments that are most effective include

• Breathing and relaxation - mindfulness
• Cognitive Behaviour Therapy
• Systematic desensitisation
• Homework and goal setting

The injured worker needs to be supported and treated for the psychological injury they   sustained as a result of the bullying experiences, as well as developing on reducing and managing their “symptoms”. Therapy should encompass strategies for minimising the chances for such reactions to occur again.  Some of the strategies may include:

• Improving communication skills - for example a worker may not have communicated with anyone that the actions were upsetting them or they may have unconsciously given signals that the behaviour of the bully was “Ok”
• Assertiveness training can be helpful when a response to a bully is particularly submissive or passive, or overly aggressive.
• Resilience training can help when it is clear that some of the comments were not meant offensively, however the person reacted disproportionately.

Dealing with what happened at Work?

The emphasis on management of bullying needs to be spread fairly - and will include looking at what happened at work and what can be done at work to support the injured worker in the future.  Consideration needs to be given to:

• Policy and procedures concerning bullying that the company has (or in some cases does not have)
• Whether these were taught to all staff (and understood)
• Whether staff involved understood what they were doing and the implications
• Analysis of options that need to be considered to deal with staff who contributed to the bullying
• Options to support the bullied staff member back to work

The injured worker will only be able to return to work when the treating doctor certifies him/her as fit to do so. In most bullying claims the injured worker will be getting treatment from a psychologist, and / or a psychiatrist and it will be essential that their input is gathered from the NTD. 

In some situations it is not appropriate for the bullied worker to go back to work site at all, and they may need to change employers or occupations.  This is most likely to occur when the bullying was severe, frequent and occurred over a prolonged period of time, when efforts were made by the worker to get support to stop the bullying resulting in them being ignored or dismissed by an employer, and in situations where physical assault actually occurred. In most of these cases the injured worker is likely to have a significant psychological injury where there is substantial loss of confidence, self-esteem, concentration and focus. Although the severity of the initial symptoms may have eased the injured worker may still not have the capacity to work at the same level and at the same pace (dealing with and processing information) the way they did before the injury.  In these situations a work trial is advisable after a vocational assessment is undertaken.  

The work trial is usually performed with fewer numbers of hours than pre-injury and with lower workload demands.  The hours and duties can be increased progressively according to tolerances and a person’s overall health standing. At some point a decision will need to be made as to whether the injured worker can and should return to the pre-injury work site and employer. The decision needs to be made using all the information and should include:

1. The workers psychological health and progress to date
2. The workers attitude and responsiveness to returning to the pre-injury workplace
3. The workplace issues such as workplace culture, the overall support they are likely to receive and the availability of appropriate work roles needs to be weighed up, are those involved still employed?

There are other situations where the worker can immediately return to their pre-injury work site, and may be able to return immediately to their old role. This may be appropriate if the bullying was not for a prolonged period, the worker’s injury is relatively mild, if the situation has changed at the work site in terms of the bully or bullies having been spoken to, and or if they are no longer working in the section of the workers pre-injury workplace.

Workplace mediation is sometimes an extremely helpful and a necessary strategy to help parties with conflicting views and issues to better understand each other and to develop strategies for managing their differences. There are a number of different mediation models, however the ones that are most effective allow the mediator to firstly speak privately to the various parties involved, to outline their needs, fears and to allow them to ventilate their concerns before they meet with the other parties.   A good outcome from mediation will include better understanding and acceptance of each party’s points of view, a diffusing of anger and fear, and a specific plan to implement to minimise or deal with potential conflict situations in the future.  

When things get more complex

If there are sound anti- bullying policies and these are practiced at the workplace and if the workplace bullying is acknowledged and dealt with quickly, then the risk of substantial psychological injury can be minimised.

If the workers compensation claim is assessed in a timely manner and support mechanisms put in place, the psychological damage that has occurred can be treated quickly and strategies put in place to ensure a quick return to work. Even if the injury is significant, a strong support team that includes insurer, worker, and employer and treatment and workplace rehabilitation providers working to together will promote the best opportunity for the worker to recover and return to some form of work.   

There are indeed situations where this does happen, and in most cases the best outcomes are achieved in these circumstances.  Unfortunately there numerous obstacles that can slow things down, the majority occurring unnecessarily that are the product of an adversarial workers compensations system that it is more concerned minimising liability for some stakeholders than it is with genuine support of bullying victims and putting prevention strategies in place.

What are the obstacles?

1. Slow Claims processing and declined claims

Although there are specific time frames insurers are supposed to adhere to when processing claims and organising assessments and investigations, these can be very lengthy for the bullied worker who is in desperate need of treatment.  There are situations where a claim may be legitimate, however sometimes the doctor may make a “technical error” such as not using all the words in a recognised and acceptable diagnosis resulting in the claim being temporarily refused under “reasonable excuse”.  This means that the injured worker not only has no access to treatment but also has no income while the decision is being appealed.  Although the situation can often be rectified relatively quickly with clarification a change of diagnosis, there are sometimes pressures put on the insurer by the employer to not accept the claim, or a range of administrative and work load issues can mean that it is more than a month before a decision is reached.   This can and usually does exacerbate the anxiety/stress the injured worker already has.

2.   No suitable duties

Injured workers, whether injured physically or psychologically should not continue to be certified as unfit by their doctor if they have a partial work capacity.  This is particularly important when the injury is psychological as there is often a strong fear component in returning to work, particularly to the place where the injury took place. Extended periods of time off work, although initially helpful in reducing the precipitating stressors, can lead to a fear/avoidance and dread of returning to the workplace.  The fear can generalise over time into other parts of a persons life where the traumatised persons has felt considerable discomfort outside of work, often when in environments, or places where conflicts could occur.  Although it is understandable that the injured worker does not want to experience the distress again under any circumstances, it is important that he/she learns skills to reprocess events, reactions and future behaviours in ways that increases resilience to further distress.

The employer has an essential part in this process. Whereas the psychologist, psychiatrist and doctors treat and manage the symptoms and help the person to develop new coping skills, the employer must provide the environment for these to be practiced.  This is likely to mean that initially hours will need to be less than preinjury and the responsibilities and duties at work less and different to pre-injury.  In some situations the injured worker may need to be transferred to a different work site.  The employer has a legal and ethical responsibility to provide suitable duties if at all possible. When suitable duties are not available the worker’s rehabilitation provider will need to find work, often initially in the form of a work trial with a different employer.  This may take some time and can delay the workers recovery and capacity to return to maximum functioning psychologically and with work capacity.

Good management and support of the psychologically injured worker will minimise the chances psychological relapse occurs. Relapse may occur if the worker is certified as fit for duties before they are ready - i.e. they still exhibit unmanaged symptoms and having limited coping skills, if they are asked to upgrade hours and duties prematurely, if they are exposed to work environments and situations that trigger strong emotional responses that are beyond there coping ability, and when another traumatising or bullying event occurs that is beyond there coping ability, or is contrary to the conditions they were led to believe would occur when they returned to work.

It is important to provide thorough risk assessments of potential situations (hazards) in a workplace that could precipitate relapse.  A competent rehabilitation provider will know what to look for, - i.e. support of management, other staff, and a positive organisational culture and will demonstrate excellent communication skills when liaising between stakeholders.  When an already injured worker experiences a relapse of symptoms, it can take more time to recover and it may be harder to convince them to attempt to try again. 

4.     Other issues contributing to cause by following The Psychological Injury

Toxic work places, traumatic events at work and bullying are not the only precipitants of people’s mental health or ill health. A person’s social environment, family support, family background, general health, are just the some of the factors that affect why and how we respond to the demands of life at any given time. With accepted work injury claims there is an assumption that the workers psychological injury was caused at work and it is the main factor why he/ she is now unwell.  Other factors however need to be understood by treating practitioners when planning   and supporting workers who have been psychologically injured as these factors can influence the nature and extent of symptoms.  For example stress and depression that is managed by large quantities of alcohol or other drugs is unlikely to respond as well if little or none of these substances were being consumed. Likewise, lifestyle habits such as diet and exercise, social activity are all “hygiene factors” which need to be understood and promoted when helping the injured worker to recover and maintain their recovery.

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