Addressing Mental Health Stigma in the Workplace video transcript

Natalie Bekis – Master of Ceremonies

Good morning and welcome to the Seventh Mental Health Community of Practice. My name is Natalie Bekis, and I'm the General Manager of Strategic Partnerships and Engagement here at Comcare. And I'll be your host for today's event. Before we begin on behalf of Comcare, I would like to acknowledge the lands on which we are all virtually meeting today and to acknowledge the traditional custodians of the lands on which we're all meeting, the elder’s past, present, and emerging.

The Mental Health Community of Practice event brings together workplace leaders, human resource, and work health and safety practitioners from across Comcare's jurisdiction in an effort to drive better practice in creating mentally healthy workplaces. For those of you who are attending for the first time today, thank you very much for joining us. And for those that are returning attendees, welcome back. It's great to have you here. We're very happy to have you all with us today. I would like to also acknowledge our Chief Executive Officer, Sue Weston, who will be speaking to you all shortly also.

Unfortunately, due to the COVID-19 pandemic, we're unable to host this event in person, which we had planned to do earlier this year. However, we are really delighted to be gathering virtually today to discuss the important topic of mental health stigma reduction. The topic was chosen based on your feedback, the feedback from the attendees who attended our last Mental Health Community of Practice. You told us that mental health stigma is a key issue that you're faced with within your workplaces. And so today we have designed this agenda with that in mind. However, given the last 11 months and the changes that we have all had to respond to both personally and professionally as we've all had to adjust to the new normal, and for some of us who have had the opportunity to return to the usual workplace, following the effects of the pandemic, we need now more than ever to support our colleagues and employees to care about their mental health and wellbeing during this transition. So it's important that we talk about stigma. We know that mental health stigma is the key reason why people don't seek help.

Today's event will be recorded, and the presentations will be uploaded to Comcare's website within the next few weeks. We will also share the links of the recordings of the community of practice with members that were unable to join us today. This is all part of Comcare's commitment in supporting organisations to act and address workplace mental health stigma.

Today, we have presentations from four experts and some time for questions throughout the event, so you will have opportunity to ask questions. We will be doing questions through via the chat function and you'll see the little icon on the screen here by clicking on the question mark menu icon on the top right-hand corner of your screen. If you want to direct your questions specifically to a speaker, please use their name first and then ask your question, and that will help us address the question appropriately. We will also be using the chat function to ask you questions. We want to hear from you. So we'll be doing some thumb polls and we'd like you all to participate. All of your answers are anonymous, and you can simply give us a thumbs up to the answer that's most relevant to you.

The first question is going into the chat now. We're all excited to have you here joining us from across Australia. So have you attended one of Comcare's Mental Health Community of Practice before? And that should be going into the chat shortly. So as I continue to talk, please feel free to respond. While this event is designed to be informative and helpful, we know that discussions around mental health and illness can sometimes be difficult and may raise concerns for some attendees. We'd like to remind you of all of the support services that are up on the screen now. The team has also kindly published links in the chat function also. So you can access that throughout the entire event today.

First to speak to you today will be our Chief Executive Officer for Comcare, Sue Weston who'll provide you with an update on Comcare's current initiative. So thank you, Sue. Over to you.

Sue Weston:

Thanks, Natalie. And good morning, everyone. I too would like to start by acknowledging the traditional owners of all the lands we're meeting on and pay my respects to their elders past, present, emerging. And I extend that respect to all Aboriginal and Torres Strait Islander people who are here today. I'd also like to acknowledge that it's NAIDOC Week and what an opportunity to celebrate the history, culture, and achievements of Aboriginal and Torres Strait Islander people. And today, of course, is Remembrance Day marking the end of the First World War. We'll be observing a minute of silence at 11:00 AM in memory of those who've died and suffered in all wars.

Well, welcome everyone. This is our seventh Mental Health Community of Practice. We've been running these events now for four years and they continue to grow in importance and popularity amongst a diverse range of people in our scheme, APS agencies and self-insured licensees alike. We have more than 370 delegates registered to attend from Commonwealth agencies and licensees nationally. So it's clear that creating and maintaining mentally healthy workplaces continues to be a priority for our scheme. Exploring, fostering, and leveraging better practices to support mentally healthy workplaces is a significant and ongoing focus for Comcare. The Community of Practice is an important part of our mental health program and will continue to deliver these events to help minimise the risk of psychological health and create work environments that are mentally healthy. I'll outline some of the other mental health initiatives we're progressing in just a minute.

The theme for today is Addressing Mental Health Stigma in the Workplace. And as Natalie indicated, it's something that's taken on even greater significance as we deal with the mental health and wellbeing challenges from this pandemic. The importance of addressing stigma can't be underestimated. We know that one in five Australian workers have a mental health condition. Yet many don't seek help because of the stigma surrounding it. Stigma can have profoundly negative impacts in the workplace leading to discriminatory behaviour, including harassment, affecting people's attitudes and beliefs towards those with a mental health issue, including themselves, and preventing those experiencing a mental health issue from feeling safe to disclose and seek support from their employer and others around them.

While reducing stigma obviously improves health outcomes for individuals, it also has positive impacts for workplaces that increase productivity and workforce participation. Workplaces that foster and support the psychological health and wellbeing of workers address stigma early and encourage help-seeking behaviour. These workplaces are likely to experience less absenteeism, presenteeism, employee turnover, and psychological claims.

We're fortunate again to have a great cast of guest speakers today: Dr. Christopher Groot, Director of Mental Illness Stigma Lab at the University of Melbourne School of Psychological Sciences, Dr. Michelle Blanchard, the Deputy CEO of SANE Australia, Maria Katsonis, a volunteer speaker from Beyond Blue, and Colonel Neanne Bennett, Director of Mental Health Strategy and Research, Head of Corps Army Psychology at the Department of Defence. They'll cover topics, including what mental health stigma is and how it impacts workplaces and employees, what happens when stigma is reduced in workplaces, and the practical steps employers, workers, and leaders can take to reduce stigma and make their workplaces more mentally healthy.

I want to briefly outline some of Comcare's current efforts to make workplaces in our scheme more mentally healthy. We're championing a preventative approach to workplace mental health through targeted initiatives that have become even more important as we support workers during the pandemic. Following a successful trial, Comcare has partnered with Beyond Blue to roll out a two year expanded pilot of the New Access workplaces program to support agencies with staff mental health challenges.

Another initiative I want to highlight is better practice employee assistance programs or EAP. Comcare is leading and collaborating on the development of guardians and resources to support better practice provision of EAP services for APS agencies. Comcare's also working with members of the heads of workplace safety authorities from across Australia to create the People at Work digital tool. It's an evidence-based and free resource to help workplaces in all industries identify, measure, and control risks to the psychological health and wellbeing of workers. And this is a sample of the work we're doing to support mental health and wellbeing in the workplaces in our scheme. We'll continue to take an evidence-based and integrated approach to identifying opportunities to address the spectrum of mental health.

Thank you for coming along to support the Mental Health Community of Practice. It's essential that we work together to prevent psychological injury, and forums like this are an important way for us to learn from each other.

Natalie Bekis:

Thank you, Sue. And now before we kick off with the speakers, let's just have a look at our first thumb poll. So we've got around about half and half. So we've got around about just over more people who have attended for the first time. So welcome to all those new attendees. Thank you so much for joining us today. And welcome back to the other half of people who have already been here and met with us before we have [inaudible 00:10:57] previously.

So moving on now to our first speaker, Dr. Chris Groot. Chris is the Director of Mental Health Stigma Lab at the University of Melbourne and the lead research on the National Stigma Report Card project, which has been conducted in partnership with SANE Australia and the Melbourne School of Psychological Sciences. Chris is going to unpack the complex topic of mental health stigma, sharing insights he has gained from both his research and his background in large scale mental health service delivery. He will then touch on some of the initial steps undertaken to develop the National Stigma Report Card project before the project lead, Dr. Michelle Blanchard outlines some of its key findings. After Chris and Michelle have presented, they will answer some of your questions together. Please remember to post your questions using the chat function. And if you would want to pose a specific question to a particular presenter, please include their name at the beginning. So thank you very much, Chris. Over to you.

Dr Chris Groot:

There we go. Okay. Hello. Thank you, Natalie. We can hear me okay now. All right. So we're up and running. It's wonderful to see such a turnout and such interest in this very important topic. And indeed, Sue's already spoken about many of the reasons why addressing stigma in the workplace is just so critical for Australia. And as Natalie said, it's a very complex issue. This is very true.

And one of the things that I therefore would like to do for us today is to unpack this very complex construct of stigma and put a little bit of a system to the way in which we could think about what stigma is and how we experience it both as people who might stigmatise issues and people who are stigmatised by others. It's actually an evolutionary mechanism. This has been maintained through natural selection over eons. We are hardwired to stigmatise things that pose a threat that could be harmful to us in the modern world. However, those things are very few and far between. And what we see is applications of stigma towards things that pose us no threat. And today, of course, mental health issues are exactly one of those topics.

So, we have a look at the next slide, Natalie. I'm going to tell you a little bit more about how we've gone about conducting a very large scale study across the country. So as Natalie said, SANE Australia, a leader in the country in supporting people with complex mental health issues and the Melbourne School of Psychological Sciences have got together with the generous support of the Paul Ramsay Foundation to run the National Stigma Report Card. And it looked at how people living with complex mental health issues, such as schizophrenia and bipolar disorder and so forth, experienced stigma and discrimination across their lives. So not just in the mental health system but in all areas of life. And today we're going to talk about employment and the data that we had forthcoming from employment.

Stigma is very complex. It plays out very differently in each one of these areas and differently for different types of people and in relation to different types of mental health issues. I've seen some questions in the chat already around gender and age, and whether stigma varies as a function of these things. And yes, absolutely it does. So it's really important if we're going to address stigma to have very detailed data and very nuanced understanding of this very complex issue and how it plays out if we're going to intervene and improve outcomes for people living with complex mental health issues.

We could go to the next slide here, Natalie. So there have been numerous taxonomies of stigma classification systems proposed. This particular one provided by Pryor and Reeder in some work in 2011 and 13 as well is very much a variation on the theme, or it's the fundamental way to think about stigma. We can think about stigma at the level of society. We can think about it playing out in interpersonal relationships. And we can think about how stigma affects a person through internalisation of stigma and through the direct negative effects of stigma.

So, Pryor and Reeder put forward this four-factor model. They said that stigma can be structural or institutional. So this would manifest in terms of prescribed laws and ideologies that restrict opportunities essentially for people with particular characteristics, such as mental health problems. Public stigma is thought to be the driving force behind all aspects of stigma, these cultural attitudes and beliefs and emotions and behaviours around issues like mental health. This is thought to additionally influence self-stigma.

How we feel about ourselves if we are having mental health issues is very much a mirror of what culture tells us we are to feel if we are having an experience of a mental health problem and whether that's okay in a workplace? Is it okay to be experiencing anxiety or depression or schizophrenia or an eating disorder? Is it okay to ask for help in a workplace? And that's really a challenge for us I think. We've come a long way in culturally sanctioning the experience of anxiety and depression, thanks to the wonderful work of Beyond Blue in recent decades. But we've still got a long way to go with making the message heard or translating that message that it's okay to have any mental health experience in a workplace. We really have got some way to go there. And carers and family and friends also experienced stigma by association, stigma as a fact, as a vicarious factor given their association with somebody who is experiencing a mental health problem. So there's public stigma, and this is a really big issue.

We could switch over to the next slide please, Natalie. And when we talk about public stigma, there's three bits that we think about. And we think about a causal pathway here where stereotyped attitudes influence our emotional responses to an issue, and they influence our discriminatory behaviours. So if we stigmatise something, if we have negative stereotype beliefs, that's going to affect the way we feel, we respond to somebody emotionally and it's going to affect what we do. The way in which this process plays out varies considerably across contexts. So let's have a look at the next slide, please, Natalie.

Actually, I'm going to pose your question, firstly. So if I say to you schizophrenia, if I use that label, that diagnostic term, a term of convenience, that from a clinical perspective ultimately describes a cluster of signs and symptoms of a particular mental health experience, when you hear the word schizophrenia, what do you think? What sorts of thoughts come to mind? For the general public, there's commonly thoughts of dangerousness, of unpredictability. And this is very much because this is what we have been conditioned to believe for the average person that whose knowledge about schizophrenia is influenced by large scale news reporting or by creative works that have created a misled and demonising picture of what schizophrenia might actually be.

Let's go into the next slide, please, Natalie, and have a look at just one example of how complex this issue actually is if we just consider the idea of stereotyped attitudes. So in our personal life, if we hear that somebody has got schizophrenia, as I just said, and we've got a lot of experimental evidence that points out that many people will interpret this through the lens of someone that's unpredictable. In our personal life, this unpredictability might play out in terms of perceived dangerousness. This is very common. This dangerousness leads to a fear response. And in turn, we socially distance ourselves from somebody living with schizophrenia. Social distance in this case, not referring to standing 1.5 meters apart, but in the psychological sense, limiting the degree to which we're willing to have somebody with schizophrenia in our lives as a friend, an employee, a colleague, an intimate partner and so forth.

In professional life in the workplace, that stereotype type of unpredictability plays out differently. It commonly plays out in terms of attributions of unreliability. This person's not going to be reliable in their job. They're probably going to be incompetent in their job. The types of emotions that ensue around frustration, irritability, negative emotion, anger, and so forth towards people living with schizophrenia commonly, and that leads to exclusionary and discriminatory behaviour in the workplace. So, whereas in personal life, discriminatory behaviour plays out in terms of social processes, that can certainly occur in the workplace as well, but it can also extend to limited opportunities and a range of other discriminatory behaviours, which we'll touch on in just a second.

So, what I'm trying to do here is just give you a flavour of the very complex nature of stigma, particularly around complex mental health issues. And taking schizophrenia as an example, we know that people's responses to schizophrenia in terms of stereotypes and emotions and behaviour vary as a function of the specific types of symptoms that somebody is hearing. So, whether they might be hearing a voice when there's no one there, an auditory hallucination, this can elicit a certain attribution, emotion and behavioural response. Or if somebody is having a false belief, a delusion, this can elicit a different one. And it varies as a function of gender and of age.

And that's why given this very complex nature of this task, it's been so wonderful to work with an organisation that is one of the few that are actually that have the capacity to work in an authentic and very nuanced way around stigma and complex mental health issues, and that SANE Australia in creating the National Stigma Report Card to try and find the footprints of this stigma in the lived experience of complex mental health issues across life and in employment. Let's have a look at the next slide, please, Natalie.

This slide here shows the summary report and the full report that you can access at nationalstigmareportcard.com.au. We've just launched these last month. And these are the findings from our National Stigma Report Card, as I said, a large national study. I'm going to now tell you about how we set it up and how we gathered the information about the lived experience of stigma and discrimination in the workplace for Australians living with complex mental health issues. But if you would like to learn more about our data and explore the employment data and all of the other data from the other 13 areas of life that we measured, please go along to www.nationalstigmareportcard.com.au or visit SANE Australia www.sane.org

So, we can go onto the next slide now. And just like the framework that I've just started to introduce you to, to help shape our thoughts around stigma, we of course created a taxonomy-driven and a theory-driven and an evidence-based approach to creating the survey that collected the data for the National Stigma Report Card. That survey was called Our Turn to Speak. And that was named accordingly by members of the National Stigma Report Card team who are experts by experience, our SANE Australia lived experience ambassadors, and indeed people with lived experience was central and are central to the National Stigma Report Card development, implementation, and reporting, and just throughout the whole process. And that's just so important.

Our focus was on the experience of the stigmatised. So rather than looking at public attitudes, we wanted to look at the flip side. We want to look at what is it actually like for people with lived experience of complex mental health issues to be in the workplace, live with schizophrenia, and how does stigma and discrimination affect them? How does it affect them in terms of perceived and experienced discrimination? How does it affect them in terms of their expectations to be discriminated against because of complex mental health issues? Does it affect their sustained engagement with employment? And what other areas of life of their personal characteristics might also come into play? We've talked about age and gender, sexuality, physical health, a range of religious affiliation and spiritual practices, ethnicity, and so forth. We looked at all of these things. We also looked at positive experiences around complex mental health issues as well. So a very complicated survey.

Let's go to the next slide please, Natalie. It was a very ambitious survey. As I mentioned, we were looking at 14 areas of life. Now, the way in which we were able to do this and also gather very in-depth information from participants without asking them to sit for 24 hours and complete a very long survey was to take them through essentially a filtering process where participants self-selected the areas of life that were most important to them or in which they had been most impacted by stigma and discrimination in the past 12 months. This is an illustration of the survey flow, and it shows that we first screened socio-demographic information and clinical information. Participants told us of those 14 areas of life where they'd experienced stigma, how frequently they've experienced that, in which areas they were most profoundly impacted.

And for example, here I've given healthcare employment and housing as an example of somebody's selection. And within each of those domains, you can see, we looked at experiences, the anticipation and expectation of stigma, withdrawal from opportunity and other issues around stigma.

And let's have a look in a little bit more detail now at the employment section of the survey on the next slide. These are actual items from the survey. And so there was always an anchor that said because of stigma about mental health issues and in the perceived experiences of discrimination section of the survey, there were questions like this. 'I have been unfairly denied job promotion opportunities.' So this is one area in which stigma and discrimination about mental health issues can play out. And then around anticipation of discrimination, we can see that the language has been changed to the expectation of, 'So I expect to be treated unfairly in terms of job promotion opportunities.' And then we've got that last layer of withdrawal from opportunity.

And what this allows us to do is to examine a theoretical pathway of how stigma affects somebody within employment. So if we've had negative experiences before, we're more than likely going to anticipate they're going to happen again. And we might withdraw from opportunity, and indeed our first inferential forays into the data now showing that this pathway absolutely holds up. It's a legitimate thing for the people in our sample.

If we go through to the next slide, Natalie, we can see the domains of employment and workplace practice that we looked at across withdrawal, anticipation, and perceived experiences of discrimination, so general treatment, but a whole range of areas of workplace experience. We tried to capture the spectrum as much as possible. And this is important. As I've said, there's so much evidence that demonstrates that stigma is incredibly complex, incredibly nuanced, and plays out differently for different people. So to some degree, a blanket intervention will be effective in decreasing stigma, but we also need to know the precise details about how things play out in all different areas. And now SANE Australia is sitting with a mountain of data that can inform very targeted interventions to ensure the biggest improvements we hope in due course. So let's go into the next slide. Just about to wind up, I'm not going to tell you what we've found. I'm going to leave that for my colleague, Dr. Michelle Blanchard. But who participated? These were the areas of mental health that we looked at. Again, we know that so much has been done already around anxiety and depression. These areas of mental health are far less addressed and are certainly more poorly understood and are certainly stigmatised for a range of different reasons, more than anxiety and depression. And so it's really important that we look at this if we are to support the spectrum of mental health issues in the Australian workforce. We can go to the next slide.

This is where our participants came from. They came from all across the country. They participated via our online survey, via telephone interview, and via face-to-face interview as we got out around the country. And on the next slide, this is a slide showing some demographics regarding employment status. From the overall sample, in the dark blue bars, and the light blue bars are the people from the overall sample, so the overall sample had 1,912 people living with complex mental health issues and all of those, 822, no small amount at all, 822 said that employment was one of the areas in which they had been most profoundly impacted by stigma and they then responded to this aspect of a survey. So clearly, a massive problem for people living with complex mental health issues.

Maybe I have one more slide. I'm not sure. Oh, there we go. That's it for me. So really what I wanted to do here was I supposed just create a bit of context, put a little bit of system to our thinking about stigma and also set the scene for Michelle to talk about the findings from the National Stigma Report Card. So, thank you very much.

Natalie Bekis:

Thanks so much, Chris. That was fascinating. There will be time at the end for questions for both Chris and Michelle together. So now we are moving on to Dr. Michelle Blanchard, who is the deputy CEO of SANE Australia and the founding director of SANE's Anne Deveson Research Centre. Michelle conceived all then developed the National Stigma Report Card project given her experience in senior roles at SANE, the Butterfly Foundation for eating disorders and the Young and Well Cooperative Research Centre, where she has heard firsthand from people living with mental health conditions and their carers about the impact that stigma and discrimination has had on their lives. I now invite Michelle to speak with you all. Thank you, Michelle.

Dr Michelle Blanchard:

Thanks so much, Natalie. And thanks to the team at Comcare for the opportunity to be a part of today's conversation. I'm coming to you from the lands of the Burren people and would also like to pay my respects to their elders, past, present and emerging. So Chris has given you a really great introduction to the National Stigma Report Card project. And what I wanted to do today was to actually draw out some of the findings from the survey, with a particular focus on the experiences of people who are living with complex mental health issues and engaging with or trying to engage with Australian workplaces. I think we always knew that stigma in the employment was going to be a really significant issue that came up in completing the National Stigma Report Card. But when you see some of these statistics that we're going to present, but also hear some of the stories of people who told us about their experiences of stigma and discrimination in the workplace, I think it really creates a real sense of urgency for us to try and address some of these challenges.

So, if we moved through to the first slide, and probably the second one, actually. The way that the survey worked is that we asked people to identify the areas of their lives in which they were most affected by stigma and discrimination, and those in which they most frequently experienced stigma and discrimination. As Chris said earlier, we asked people about their experiences across 14 different life domains. And we ask people to really reflect particularly on the last 12-month period. The area in which people said that they were most effected by and most frequently subject to stigma and discrimination was in people's interpersonal relationships, but the area that came up next in terms of the impact that stigma and discrimination had on people's lives was their experience in employment.

And I think when we think about our lives and the proportion of time that we spend in the workplace, the importance of meaningful work for our mental health and wellbeing, but also for our economic security, it makes a lot of sense that when people are subject to these kinds of experiences in the workplace, that they do have a really significant effect on their lives. In terms of frequency, it wasn't quite as frequent as some of the other areas of stigma, whether that be in mass media or social media. But certainly in terms of that impact on people's lives, it was really, really high up there.

If we move through to the next slide, just to give you a sense of overall some of the key themes that emerged from the data was that we heard very, very strongly from people with lived experience of complex mental health issues that what they thought was needed was education, understanding and acceptance of their experience. So while we've had a lot of workplace education to help people develop a sense of literacy, when it comes to things like depression, anxiety, stress, very few workplace mental health programs actually delve into experiences, like schizophrenia or eating disorders or personality disorder. And so people were really looking for there to be better community understanding and acceptance of these experiences.

People wanted to be communicated to and about respectfully, but also to have visibility. So again, so much of the public conversation that we have about mental health and wellbeing does focus on addressing common mental health problems, like depression and anxiety. And oftentimes, the experiences of those with more complex conditions are really outside of that public narrative. And so people were really keen to see that change. And people also felt that it was incredibly important that there were accessible services, that people were treated fairly, whether that be in employment, in education, or in the community, and had access to the support that they needed to be able to experience good mental health and wellbeing.

If we go through to the next slide, just to give you a little bit of a taste of these in the participant's own words, participants believed there should be more education and awareness. So there's a quote there from one of our participants in New South Wales. Also, highlighting that theme that Chris spoke to earlier around there's often this belief that people might be dangerous or unpredictable, but there is a more empathic way to understand those experiences. People are often frightened by what might be going on to them.

If we move to the next slide, which focuses on communication and visibility. And that actually some of this lack of visibility extends to these conversations that we're having in the mental health sector and in workplaces and in the community about mental health problems when we ignore more complex conditions, when we see them as being too hard, or we say things like, 'Well, there's very few people, or there's no people with those experiences in our workplaces.' That means that people become even less visible and feel even less safe to share their experiences.

And if we go to the next slide, just thinking about accessible supports. From a workplace perspective, it's worth being aware that these are the kinds of experiences that people are often having when they're going to seek help and support in the community. They are often told that they're not sick enough to be able to receive the kind of care and support that they really want and need, or alternatively, that their experiences are too complex, that they might be too sick for any help to be of benefit. And so I think just being aware that that might be what's going on for people. It's not as straightforward. It's taking a bit of time off work, recover and come back, but there's a lot more complexity to these experiences for people.

So if we move through to the next slide, I wanted to take you through some of the employment findings in a little bit more depth, just to share with you just the proportion of respondents who answered the questions about the employment domain. So thinking back to Chris's presentation, we had 1,912 individuals who completed the survey overall, and then a proportion of those responded to questions specifically about employment, and that was because they ranked employment one of the three areas in which they were most effected by stigma and discrimination in their lives.

So, if we move forward to the next slide, we asked people about the frequency with which they experienced stigma and discrimination. And this is the frequency of stigma and discrimination in employment amongst those who selected it as one of the three, in which they have been most effected by stigma and discrimination. So up the top, you'll see the frequencies reported by those who answered questions in the employment domain compared to the overall sample. And so it gives you a really strong sense that people are experiencing these forms of stigma and discrimination in employment very frequently and quite frequently. These aren't one-off occasions. These are things that are often happening repeatedly for people.

If we moved through to the next slide, we also asked people about their perceived experiences. So, these are people's reports of experiences of stigmatising attitudes or discriminatory behaviour. In particular, we asked people whether they had been treated unfairly at their workplace and whether they had been treated unfairly by employers, supervisors, or managers, so by people more senior than themselves or people who hold the power in these relationships. And as you can see there, it's just under 80% of the 822 people who completed these particular set of questions who reported that they had been treated unfairly at their workplace. And about the same number had also been treated unfairly by employers, supervisors, or managers. So that's a really significant number of individuals who feel that they have actually been treated in a way that is stigmatising, or in many cases, discriminatory. And that was something that I think came through really strongly in some of the qualitative data that underpins this survey.

In addition to people's responses to the questions in each of the domains, we gave people the opportunity to share with us their experiences. And some of the stories that people shared with us were actually examples of behaviour, which was illegal or discriminatory. So people being terminated from a position in an organisation because they had disclosed that they had to go and see a psychiatrist. Not that they're disclosed they had a mental health problem, but they simply needed to go and see a psychiatrist because of all of the assumptions that come along with that kind of disclosure. And so there is a real need, I think, for us to address some of these challenges in a very real way.

If we move through to the next slide, one of the effects of people having experienced being treated unfairly or being treated in a discriminatory way is that people then fear or anticipate that they will be stigmatised in the future. So we asked people about their experiences of that. We asked them whether they expected to be unfairly denied employment opportunities. And we also asked them whether they expected to be treated unfairly in their workplace. And as you can see there, an extraordinary number of people saying that they expected that they would be unfairly denied employment opportunities. So if they were to put their hand up, they felt that they wouldn't be given that opportunity. And similarly, people expected that they would be treated unfairly in their workplace because of their experience of a complex mental health issue.

All of these responses are reflective of stigma and discrimination associated with complex mental health issues. We did also ask people about other forms of stigma and discrimination, so whether that was on the basis of gender, sexuality, other abilities, physical health, and other characteristics, race, being from an Aboriginal or Torres Strait Islander background. And certainly, those things did play in and amplified the effects, but these questions are people responding specifically about being unfairly denied opportunities or they fear that they would be unfairly denied opportunities because of their mental health issues specifically. So you add those other layers and certainly they have a huge impact as well.

If we go through to the next slide, one of the other effects of stigma and discrimination in the workplace is that eventually people stop putting themselves forward for opportunity, and we talk about this in terms of withdrawal from opportunity. So two of the highlights here around people stopping themselves from discussing their mental health needs and experiences at work and people stopping themselves applying for employment opportunities. You can say just over 80% of people stopped themselves from discussing their mental health needs and experiences at work. And when we think about creating workplaces that support people who are living with mental health issues, it's really important that people have an environment where they can talk about what they need to be able to flourish in the workplace.

As employers, we need to be able to create environments where we're flexible and where we provide people with the kinds of adjustments that mean that they're able to maintain meaningful work. And so being able to share what's going on and what your needs are is incredibly important. The other aspect of this was about people just not applying for employment opportunities because they just felt like they would be treated differently. And so when we think about the fact that people with complex mental health issues or severe mental illness are underemployed in Australia, Australia has one of the worst employment rates for people with mental illness and physical disabilities right across the OACD, it's really important that we create workplaces where people do feel that they're going to be treated fairly and they will have the opportunity to be able to flourish in a workplace.

So, if we move forward to the next slide, one of the reasons for doing this research was not just to understand people's lived experience of stigma and discrimination, but to make some really concrete recommendations for action. So in our recommendations for action document, which is on the National Stigma Report Card website, you can actually read a whole series of recommendations that we've made around reducing and eliminating stigma and discrimination in each of the 14 life domains that we examined. But I just wanted to share with you today the three recommendations in relation to the employment domain.

The first of those is to ensure that the National Workplace Initiative, which is a federal government funded initiative being led by the National Mental Health Commission with a coalition of partners, as well as other approaches to improving mental health in the workplace are inclusive of complex mental health issues, that these types of initiatives promote the making of reasonable adjustments, flexibility, the safe disclosure of mental health problems so that people can access the support that they need, as well as training around unconscious biases relating to mental health issues and mental health first aid. It's really important that the conversation about workplace mental health goes beyond depression, anxiety, and stress, and really starts to also examine and include the experiences of people with these more complex conditions.

Secondly, we recommended increased visibility, representation and valuing of lived experience perspectives through inclusion in training, decision-making, but also the role of peer supporters across the workplace. Each of these policy recommendations were created in partnership with people with lived experience, as well as our coalition of advocates who are a group of about 30 mental health and community-based organisations who also share this perspective, that by including lived experience, we create a far stronger programs and services.

And then finally, there is a need for increased funding for targeted programs that support people affected by complex mental health issues to identify strengths and employment goals, and also support them to enter and most importantly, remain in the workforce. So one of the things that we came up against across this data set was just people sharing the experiences that they often had support to enter the workplace or re-enter the workplace after psychological injury, but that when things didn't go so well, when they experienced stigma, when they came across an example of discrimination, that often meant that they withdrew from that workplace, that they left that position of employment. And what we really need to do is ensure that people are supported to retain meaningful employment because that's such an important part of recovery. So we want to be able to create workplaces that are inclusive of, accepting of, and actually promote and value that the role that people affected by complex mental health issues might play.

So, if we go to the next slide, just to bring us to a conclusion, there is so much more data to this National Stigma Report Card than what Chris and I have shared today. And so I really encourage you to head along to the National Stigma Report Card website. It's NationalStigmaReportCard.com.au. You can access our online data explorer. You can read people's stories in a more in depth way, which probably brings them to life in a way that just not possible by us talking to some of the headline findings. I encourage you to use these findings in your own work to really think about how we can create workplaces that are more inclusive and supportive of people living with a small complex mental health conditions.

So that brings us to the end of my presentation for today. Just to acknowledge, this is an enormous team efforts by the team across SANE Australia and the Melbourne School of Psychological Sciences, but also to acknowledge our funders, the Paul Ramsay Foundation, and our partners at the University of Melbourne. So, thanks again.

Natalie Bekis:

Thanks, Michelle. We are running a little behind on time, but there are a lot of questions for both of you. So I'm going to try and address some of these offline. If I don't get to each and every one of you, we will come back offline and answer your questions. The first question for Chris and Michelle, 'As the parent of a child with schizophrenia, I understand how difficult it is to accept and understand the illness. Even I have been guilty of stigmatising the condition, largely through frustration from being scared of losing my child to suicide. How can we reduce stigma in employment when even those close to people with mental illness struggle to come to terms with and understand what is happening?' So I don't know who wants to tackle that big question first.

Dr Michelle Blanchard:

Yeah, I can take that one, Natalie. And it is really, really challenging, I think, for families who are supporting a loved one who lives with a complex mental health issue. And we mentioned very briefly that the area in which people did say that they experienced stigma and discrimination the most was in their interpersonal relationships, so their relationships with those most close to them. We really feel that one of the missing pieces here is around support for families and carers. So much of the support that we provide in the mental health system is for the individual who is experiencing their mental health issue and very rarely do we engage families who often are doing the very best they can, but under really challenging and really trying circumstances.

There are definitely some great places where families can go. SANE has an online forum for carers and family and friends, where people can go and engage with others who've also walked this path and supported a loved one. But we absolutely believe that there needs to be a significant investment in evidence-based programs for carers and family, so that they are even better supported to care for their loved one.

Natalie Bekis:

Thanks so much, Michelle. And maybe this question then for you, Chris. How do we distinguish between interpersonal difficulties, personality clashes, genuine performance issues and stigma relating to symptoms of disclosure of mental health conditions?

Dr Chris Groot:

That's a really good question. So certainly, in some mental health conditions, some of the signs and symptoms of these experiences could play out in terms of relationship difficulties and interpersonal difficulties. If this is occurring that's in the context of today's discussion, in the context of a workplace, then I think the fundamental aim would be to open up a safe and open and honest discussion about what is going on for a person and to inquire around what sorts of supports they might need, honestly reflecting observations, and of course, concern.

I think inevitably if we were observing that somebody was having a difficult time interpersonally, we might want to, from a workplace perspective, create a space where we could have that discussion in a non-threatening way, and also maybe create a space where that person is able to have those discussions with another party, like a counselling service or something like that, but I think it's all about inquiry and so much of mental health. I think offering community-based mental health is about noticing something different, something's off and then opening up a discussion that portrays our concern, not our judgment, but our concern. Are R U OK? Day, for example, is founded on this premise that we can check in with each other, and through opening up a discussion lead to a positive outcome. And I think that's probably one of the fundamental strategies that one could apply here is to take that nonjudgmental open discussion from a point of concern.

Natalie Bekis:

We will now move to our next speaker. I'd like to welcome Maria Katsonis. Maria is a public policy fellow at the University of Melbourne, but today is joining us in her capacity as a volunteer speaker with Beyond Blue. In 2008, while working as a senior leader in the Victorian Public Service, Maria experiences severe episode of clinical depression that required hospitalisation. Since then, Maria has become a dedicated advocate for those living with mental health conditions and has even written a book about her own experience named The Good Greek Girl.

I'm very grateful for Maria for joining us today to share her experiences and insights into the impact of stigma in the workplace and how it can best be addressed. If any questions arise during Maria's presentations, please remember to post them in the chat function and we'll come to those at the end of the presentation. Thank you, Maria.

Maria Katsonis:

I'm still waiting for the red, if that still will happen.

Natalie Bekis:

You're on. Yes.

Maria Katsonis:

I'm on? Oh, sorry.

Natalie Bekis:

You're on.

Maria Katsonis:

I'm on, but I haven't got any... So I haven't got any red around me. I was told to wait for the red flashing and there ain't no red flashing, so my apologies for that rather rough start. I will start formally also by acknowledging the traditional owners of the land on which we meet and pay my respects to elders, past and present, and also pay my respects to any First Nations people who are with us today. Thank you so much for making the time to talk about mental health. It's a subject that's very near and dear to my heart, and I'm delighted to be here on behalf of Beyond Blue, and it was even more delighting to hear in Sue's introduction that you had entered into a partnership with Beyond Blue to help mental health literacy and mental health support in the workplace. I became a volunteer speaker for Beyond Blue so I can share my story and increase understanding about mental health and even more so about how can we smash, and I use that word quite deliberately, how can we smash the stigma of mental health in the workplace? In talking to you about my experience, I want to share with you first my story of illness and also recovery, because I experienced stigma along each part of, if you like, of my mental health journey, and also subsequently in my... I always talk about being someone with a chronic mental health illness. I always talk about being in recovery. Why a story? Well, the writer Joan Didion wrote, 'We tell stories about ourselves in order to live.'

We all have a story. We have stories about our place in the world, about who we were, who we are, and who we want to be. I too had one of those stories. It wasn't a particularly unique story. It included university. It included a career which ultimately, for me, ended up being 20 years in the Victorian public service in the senior executive, and now teaching public policy and management at Melbourne Uni. Essentially, a life with purpose. I never thought that I would add mental illness to my story, let alone becoming a psychiatric patient. Let me tell you, if there is stigma in talking about mental illness, there is even more stigma attached to disclosing that you've been a patient in a psych hospital. But that's what happened to me. Sometimes our stories will take unexpected twists and turns.

I think in sharing my story about depression and recovery, I think it's important to know that everyone's experience of mental illness will be different. Mental illness, as you have heard from our previous speakers, includes everything from depression, anxiety, eating disorders to those more complex issues such as borderline personality disorder and schizophrenia. So, there is a spectrum, if you like, a wide spectrum of mental illness. And so too is there a wide spectrum of how people experience mental illness. For some it will be a one-off episode that will be treated, whether it be talk therapy, whether it be medication, and people will make full recovery.

For others like myself, it becomes a chronic illness that has to be managed just like any other chronic illness, whether it be diabetes, whether it be arthritis, whatever it might be, asthma, it has to be an on... It's a chronic illness that I need to manage. But ultimately in sharing my story with you, what I want you to take out of it, number one, it's a story of recovery, resilience and hope, but also get some pointers. I'm going to come explicitly to this about what can you do to reduce stigma in your individual workplaces?

The onset of my episode was very sudden and swift. It wasn't as if it was a gradual coming upon of mental health issues. One day, 12 years ago now, I was well. I was upright. I was fully functioning at the time. I was a senior executive, SES Band 2 in the Victorian public service equivalent of the Australian Public Service Commission. If I look back, there were no specific triggers or issues that were troubling me. It was as if one day I was well and that night when I went to bed, the depression absolutely took hold of me. That night in March 2008, I woke up in the middle of the night and I was bathed in sweat. My chest was constricted. I was gasping for breath. It was as if someone had thrown me into a pool of blackness and I was drowning.

My mind was almost... No rational thought was existent. My mind was turning inward and I was experiencing what I now know was a reality that was non-existent. I was upright, bolt upright afraid that this blackness was going to engulf me and I was disconnected from reality. I couldn't even pick up the phone and call someone to say, 'Hey, I'm in trouble. I need help.' All I could do was crawl in to the corner of my bedroom and huddle fearful for my life. That's where I woke up the next day, in that very same corner, but the world looked very different. The world was drained of colour. There was a heavy pallor that hung over me that made it very difficult for me to move. My movements were very sluggish. My thought processes were very slow. It was if someone had poured molasses in my brain. I couldn't quite comprehend what had happened to me and what I was experiencing at that particular point.

Again, it wasn't as if I was rational and coherent as I am now. I didn't think about picking up the phone. All I thought was maybe I had experienced some sort of episode of extreme stress, and that it would run its course, and maybe what I also needed to do was get my life back on track. I made those promises to myself that we all make. That I would eat better, that I would go to the gym, that I would start to look after myself, except none of that worked. There was no end to this profound blackness, feelings of helplessness. I started to socially isolate and withdraw. I stopped going out on weekends. I essentially stayed in bed all weekend. I know we all like to think of comforting doona dives, but I wasn't doing laundry so it wasn't a particularly comfortable doona dive.

I was incapable of the most simple of tasks. About eight weeks of living like this, it crossed my mind, 'Well, maybe this is depression.' See, I'd never thought of depression as a pervasive and disabling illness that affected mood, cognition, physical health. I thought of it as a extreme case of the blues or sadness. So, I actually went on Beyond Blue's website. Beyond Blue's website have got some excellent clinical questionnaires, and I stress that they are clinical questionnaires. They are not the kind of questionnaires that you are going to see in the Women's Day about, 'I'm an Aquarian. What's the other star sign should I marry?' These were robust clinical questionnaires. I completed the first questionnaire and a pop-up came up, because I basically scored 10 out of 10 on every part of this particular scale. High achiever that I am, I even managed to ace the Beyond Blue clinical depression test.

This pop-up came up and the pop-up came up, said, 'You are suffering from severe depression. Please seek immediate help.' It was something to that effect. My immediate response was to reject that. I rejected that advice because I thought people like me, your classic type A high-achievers, two degrees, successful executive career, do not get depression. That's when I started to experience this form of self-stigma, where I refused to seek any treatment, even though a robust evidence-based policy wonk, 'Let me just take another questionnaire just to be on the safe side.' There was another clinical questionnaire that I undertook that reaffirmed that diagnosis. But again, I didn't seek any help. I still went to work. I was very fortunate. Those were the days when we weren't an open plan and I had an office and I could close the office door behind me on the pretext of being in lots of conference calls at the time or reading reports.

I was managing a team of 15 people and just got by. The last shreds of, I guess, energy of any mental acuity I had I reserved for work, because there was a difference between what happened to work and what happened at home. But what happened at home began to intensify and it was like a pain that was associated with a depressive state, and it got to the point where I thought, if this was life as I knew us, if this was life, then it wasn't living. I had no past. I had no hope for the future, just this agonising pain of the present that I couldn't bear anymore. So, I decided to develop a suicide plan. Again, evidence-based policy wonk that I am, I developed what I thought was a particularly robust and effective suicide plan. That suicide plan stayed with me for at least four weeks until the day came when I couldn't bear it anymore, sat in my lounge room with everything I needed to take my life, fully convinced that I was going to take my life, and I didn't.

To this day, I'm still not quite sure why. I sat there thinking, 'I'm going to do this,' and all of a sudden, I think it was over a period of hours, 'I'm not doing this. I'm not doing this. I'm not doing this.' When I realised I wasn't going to do this, I thought, 'Well, what do the heck I do now?' I thought, 'Well, if I'm not going to end my life, I have to accept that I have depression and I have to seek help.' I was very fortunate to see, and this was the luck of the draw for me, a GP who I'd never seen before. To this day, I credit that GP with saving my life because she was empathetic, supported me and realised that what I needed was hospitalisation. I actually thought I was going to go there, medication, something like that.

But my depression was so severe, I was so dysfunctional and life-threatening that I was immediately hospitalised within 24 hours, and I began a process of recovery in hospital. It was a relief for me to be there. I knew I was safe. I knew I didn't have to pretend anymore, and I could give myself over to the care of others and begin my process of recovery. The GP, when I was admitted, said, 'You'll probably be there for a week.' It was after I had that conversation with GP and just before I was admitted that I rang my CEO. No one at that point knew that I was experiencing mental illness, neither family or friends. I did tell family and friends, and the next person I told was my CEO. I said, 'I'm going into a psych hospital. I've been experiencing severe depression. I think I'll be here for a week.'

Well, every week for five weeks, I had a call with my CEO. I said, 'Actually, it's going to be another way. It's going to be another week. It's going to be another week.' Took five weeks for me to fully recover, and then it took another four weeks of leave for me to be able to, I guess, assimilate back into day-to-day life, work out how to put one foot in front of the other. I got back to those simple things that had escaped me. So, I turned up to work. I had a conversation with my CEO and said, 'I'm coming back to work on this particular date.' She said, 'Fine. That's great.' I turned up to work and no one had prepared me and I hadn't prepared myself, in fact, about work. I thought, 'Oh, well, I'm better now. I'm just going to turn up and I'm going to do a full day.'

And of course, I couldn't do. After that sort of episode, I couldn't do a full day. Initially, I didn't have a return to work plan. My organisation wasn't prepared. They had never dealt with a mental health illness of this severity, so they they weren't prepared and they hadn't actually put the proper support in place. I suspect if I had turned up to work in half my body in plaster cast, the equivalent sort of physical injury, I suspect it would have been a very different proposition. For me, that comes to a couple of factors. It comes to the invisibility of mental illness. No one can assess what you're experiencing because there aren't those visible manifestations or symbols. And the organisation had not dealt.

So, there was an ignorance, not an ignorance, but I guess a lack of preparedness on the part of the organisation. The other thing that I had to do was, within a couple of days... Because remember no one in the organisation knew what was going on. They'd been told Maria would be away for a week, particularly in my team, and that one week stretched into nine. So, there's a lot of curiosity in the organisation about, 'Why was Maria away for so long.' I started to get some questions around that and I hadn't really thought about, 'Well, what am I going to do?' I made a decision very quickly within a couple of days after people were literally coming up and me and saying, 'Hey, Maria, you were away for nine weeks. Were you sick? Was something wrong with you? Are you okay now? Is there anything we can do?'

There was that basket of questions, and then there was my team, 15 people and an assistant director who had to step up, thinking for a week, and then ended up having to manage for nine weeks. And then the third factor that made me decide to be very open about my mental illness was the fact I had been to hell and back, and I didn't want to be held captive by my illness. I didn't want it to have any more power over me than it already had. So I made the decision within about two or three days of being back at work about disclosing, because then the next time someone came up to me and said, 'Hey Maria, are you okay? You've been away for nine weeks,' I'd simply say, 'Well, I had an experience of depression. I needed to go in the hospital. I'm on the road to recovery. Thank you very much for asking.' It wasn't just colleagues who I shared that information. I'm sure you're all on committees where you might see someone every nine weeks or something like that.

I had those kinds of conversations with people at deputy secretary level and in each of those cases, people, as soon as I told them about my experience, people disclosed their experiences with me about either their own experience of mental illness or their mother, father's, brother, sister. Because if you're not one of the one in five who's experienced a mental health condition, you will be someone who will either know. Mother, father, brother, sister, aunt, uncle, children. I was really struck by this overwhelming collection of stories that I began to collect, and so I decided, just decided, one of those things that you do, you wake up in the morning and you think, 'Well, I'm going to take all these stories and I'm going to write an op-ed about the stigma of mental illness in the workplace.'

This was now 2009, about four months after my illness. 'And I'm going to get it published in The Age.' I starting to float this idea with a number of colleagues, some senior executives, some not within the Victorian public service, and nearly all of them counselled me not to do it. The reason they shared was that this is going to affect your career. Do not publish something about mental illness. What people couldn't understand is that I'd had such a hideous experience, so what if a particular organisation didn't want to employ me again? I was well. I was alive. So it gave me this fearlessness, to a certain extent. So I did write the article. It was published and the response was extraordinarily positive within the Victorian public service because I disclosed where I was working, disclosed that I was a public servant, and you're very discoverable.

If you're in government, it's .vic.gov.au and my name. Within a couple of days, I had 200 emails from people within the VPS sharing, again, experiences with me. One of those was a carer and we met, and to cut a long story short because I know I'm running close to time, we co-founded a peer support network of Victorian public service employees caring for someone with mental illness or experiencing mental illness. At our peak we had over 1000 members, and I heard appalling, appalling stories from people about the stigma and discrimination they'd experienced. Just to share two now, very quickly. The first was from someone who was admitted into a psych inpatient unit for treatment. Within two days, someone from HR in their organisation had rung not to ask how they were, but to have access to their medical records to see if they were up for a work cover claim.

I always ask people in organisations, where does mental health reside within your organisation? Most times I hear it's in HR, sometimes in occupational health and safety. The worst area I've heard, from my perspective as someone with lived experience, is in risk management. Because for me that sends the signal, 'I am a risk to be managed, rather than a valuable contributing member to the organisation.' Because there are different issues about people with chronic mental health illness, and those with one-on episodes about how you return them back to work. I've got one more minute for organisers. I'm very close. From my perspective of lived experience, we have heard from Michelle and Chris and we'll also hear the case study, but I think there are two critical factors about reducing stigma in the workplace. The first is the role of leadership and culture, because policies and programs are simply not enough. They have to be championed and they have to be animated within an organisation.

If someone goes to a manager in an organisation and says, 'I think I'm experiencing mental health issues. I'm not quite sure what to do.' With all due respect to EAP programs, if that manager refers them to EAP and does nothing else, that for me is the lowest common denominator. The second is about including the voice of lived experience in the workplace, whether it be about developing the policies that you design and implement, whether it's about mental health training or any other mental health decision forums. We say, in the lived experience community, 'Nothing about us without us.' So I would ask you all to think about, how did you incorporate lived experience in mental health policies and programs?

In closing, as I said, I now live with depression. I also now live with anxiety as well. I developed that as a result of one of my relapses for 12 years and people ask me, 'Why do I do this? What do I share very intimate aspects of my life with complete strangers?' I speak to schools. I speak to workplaces, community organisations. If I were speaking to one of those organisations, I would say to them, 'Because I want one person from this event to do something differently.' In those contexts, I would say it's a personal. You could do something at a personal level. Reach out to someone who's doing it tough. You can improve your own mental health influencing.

But the people who are participating in this forum today can do more than do something personally. So, if you've asked me, 'Why do you do this?' Because I want one person from this forum today to do something differently. If you don't hold the levers to change within your organisation, depending on where your role is in mental health within your organisation, you can influence the person who holds those levers. I'm going to close with the question to you. If you experienced a mental health issue and needed to take a week off work, and you went to your manager to tell them, would you tell them you were taking a week off work for mental health issues, or would you say you're taking a week off work for physical health issues? Think about that question and think about your response.

Then I want you to think about that question from someone more junior in your organisation. Think about a graduate with three or four years work experience. If that staff member, if that junior APS person experienced an episode of mental illness, had to take a week off and went to their manager, is your organisation safe enough, is your organisation inclusive enough for that person to disclose to their manager or would that person resort to physical health issues? So, thank you very much for letting me share my story with you today. I've probably run out of time. I don't know if we have any time for questions, but I'm also very happy to take questions both online and offline, depending on our time availability.

Natalie Bekis:

Thank you so much, Maria. You are very, very kind to share. I don't know about all of you, but that was very insightful and really do, from the bottom of my heart, thank you so much for being so open and honest with all of us today online. So, I guess... And in closing, we are about to move to our next speaker, but Maria, you've got a lot of thank you's online when you get a second to have a little look at that.

Maria Katsonis:

Sure.

Natalie Bekis:

But also, I guess, for people on the line, you've encouraged us to take action and do one thing. Can you give people some ideas? What can people do? What is the one thing, some ideas that people can take back?

Maria Katsonis:

Well, you heard me talk about the lived experience and I asked, how can you include the lived experience? Do you have lived experience in your training? Doesn't necessarily need a speaker. You can do it by video. How are your policies developed? Do you draw on the lived experience within your organisations to develop those policies or are they just done by the HR area or a particular area of practice? If you haven't got lived experience, start thinking about how can you incorporate that? So, two very simple ideas.

Natalie Bekis:

Thank you so much, Maria. It has been a real honour to listen to you today and thank you for being so generous.

Maria Katsonis:

Thanks so much for having me.

Natalie Bekis:

No problem. For those, just a reminder in terms of health services, including Beyond Blue that Maria was talking about and the supports that are available there, if you scroll up to the beginning of the chat, all of the support services are listed there. All you got to do is hit a link a if you need to, or if you need to share that with a colleague or a loved one. So thank you, Maria. Moving on now to our next speaker. Our final presenter for today is Colonel Neanne Bennett. Colonel Bennett is the director of mental health strategy and research, head of Corps Army Psychology, Department of Defence. As a military psychologist, Neanne has provided clinical care and treatment to veterans and military personnel and has also been involved in the development of ADF's Critical Incident Mental Health Support Model, resilience initiatives, and also the Department of the Defence Mental Health and Wellbeing Strategy.

Neanne has been the commanding officer of the Australian Army's operational psychology unit and has extensive operational and disaster response experience, having supported humanitarian, peacekeeping, and combat operations. Once again, remember to post questions online and we'll come to them at the end. But over to you, Neanne.

Colonel Neanne Bennett:

Thank you, and good morning, everyone. Thank you for the opportunity to be here today and be part of the conversation about addressing stigma in the workplace. It is, without doubt, a very complex topic, and I think that has certainly been demonstrated in the presentations that have already occurred this morning. My presentation today reflects an ADF perspective on how we have tried to strengthen employee mental health and wellbeing in the ADF, and that incorporates stigma. I don't proclaim at all that we have all the answers. We don't always get it right, but we have certainly made some significant changes over the years. Mental health is something that defence takes seriously. We provide access to one of the most comprehensive mental health care services in Australia for our serving members. We invest in research, education, mental health awareness, and training.

We provide mental health services and we have a number of initiatives to ensure serving and ex-serving ADF members are able to access the right support at the right time. We've learned a lot, but it does continue to be a work in progress, and hopefully I will give you a bit of a understanding of that as we work through these. If we can go to the next slide, please. So, a career in the ADF undoubtedly means that at some point you will be put in harm’s way. The privilege of wearing a uniform comes with an obligation of service. We experience stress. We're pushed out of our comfort zones. We deal with hardships. We respond to trauma. Military service, and indeed combat, has an unchanging human element, and even if we consider the realities of modern warfare, the human impact is constant. We also know that good mental health is vital to the capability of a deployable force, so it's crucial that we consider it as part of our entire career continuum.

What's interesting, well, I think is interesting, is that an environment where we train and expect people to adapt and respond to situations that are dangerous and uncertain, that we, at times, have a group that hesitate in asking for help when we need it. We've tried to find out more about that. So, defence has done a lot of research, particularly in the last decade, and we're very fortunate to be well-informed by that. We've made significant ground in terms of understanding the mental health effects for ADF members. The first case study, and all of these are available online, they're public documents, so you can punch them into Google and pull up the reports if you would like to explore them in more detail, the ADF Mental Health Prevalence and Wellbeing Study. It was released approximately 10 years ago. It was the first comprehensive description of the mental health of the ADF population, so it established our baseline data.

The results of that study showed that one in five in the defence population experienced a mental health disorder within the last 12 months. More broadly, most of the rates were similar to the rest of the Australian community. A point of interest in that study. It showed that mental health problems were not just a concern for our deployed members. So, it reiterated that any member of the ADF is vulnerable, that mental health can impact on anyone, for any reason, at any time. The baseline data provided an important resource in terms of us understanding what our service delivery requirements needed to be. It allowed defence to develop targeted mental health and wellbeing programs, and like any research, it also prompted further questions. So, it allowed us to keep expanding what we were doing in that space.

A study that led on from that is our Laser Resilience study, which examined changes in mental health and resilience in ADF personnel. This was a longitudinal study. It collected data over five time points. So ab-initio training, so when people first come into the organisation. It tracked people across posting cycles, across deployments, and for some of them it worked right up until their point of transition or discharge from the service. A key finding from Laser is that it indicated the majority of ADF members, so over 80%, are resilient. It's linked to factors such as social support, leadership and individual coping styles. It also informed about some of those factors that make people less resilient in our organisation. So, poor sleep, negative social interactions, a tendency for self-blame, a tendency to avoid help-seeking. None of that is probably surprising to anybody who was listening to this today. The last study that I just want to touch on is the Transition and Wellbeing Research Program, and this is a joint project that was funded by defence and the Department of Veterans Affairs. It's the most comprehensive study ever undertaken in Australia in terms of the impact of military service on the mental, physical, and social health of serving and ex-serving ADF members and their families. If we go to the next slide please.

So, this slide just gives you a little bit of a snapshot about what we have learned as a result of that study. So it confirmed that most ADF members and their families are healthy and that they manage their transition from the military to civilian life very well, but we know that some people do experience problems. And the transition out of defence can be a particularly challenging time for some. You can see up there, one in five serving ADF members will experience a mental disorder, one in two will experience a disorder every 12 months in terms of leaving service. Approximately 50% will not seek help. And we know that we have an at-risk group for males aged between 18 to 24.

The study also gave us a better understanding about how people access our mental health support and services and that's on our next slide. So we know that over half of ADF members with mental health symptoms are likely to access the services that are available, but the majority who link in with this support have help in doing it. If we go to the next slide I'll talk you through that in a little bit more detail.

So, it's interesting that the majority of defence members who were concerned about their mental health had help from someone to access care. What we've identified is who are these people who are most likely to influence those decisions? So partners are most likely to suggest that individuals seek assistance, followed by friends, supervisors, and then the general practitioner or medical officer. We also then know that there is another group, so some people suggest that people access support. And then there's another group who actually help to facilitate access to that. And for us the most common person helping someone to access the care is a workplace supervisor, followed by a GP, and then friends and partners.

So, this is really important for us because it actually helps us identify where we need to target some of the interventions that we provide. I think it's also important because it highlights that whilst we have a really resilient population, with that comes a strong desire amongst defence members to manage themselves and solve their own problems without asking for help. We like to be self-sufficient, and so people will try to fix things and potentially delay on accessing care early in the belief that they will be able to work through it themselves.

Again, what this highlights is that our mental health professionals are unlikely to be the first point of contact when people ask or need help. So when it comes to managing stigma in the workplace, it's our non-mental health workforce that become our key players. It's our peers, it's our leaders, it's our supervisors, it's our managers. It's everybody that is part of the team around that individual. And it's our families. We have done a lot of work in terms of increasing the level of awareness about mental health and looking at the shared value in mental health and wellbeing across the organisation. The next slide please.

Thank you. There'll be lots of little bubbles that pop up on this one. So even though we're aware of some of the issues we still have challenges. It would be naive to think that we can solve such a complex problem when nobody else has been able to do that either. Certainly in terms of military research and practice we tend to think about stigma as being thought of and treated differently in the workplace.

We know that ADF members are concerned about injury or illness, whether that be physical or psychological, impacting on their career, about their deployment opportunities. And we also know that it impacts on reactions or perceived reactions from leadership and peers. We are very much a team organisation and there is certainly a strong element of not wanting to let the team down. I have spoken to numerous serving members who talk about not wanting to do all of the training only to miss the grand final.

There are significant events that occur within a military career that people desperately want to be part of, and we're very conscious of that. So we know that for most ADF members the stigma and the stigma related beliefs about accessing mental health support includes feeling embarrassed about having a problem, feeling disappointed or worse if they're unable to solve their problems. So that's the resilience and the self-stigma aspects, is being worried about being treated differently. And that may be that they're worried about missing out on one of those career milestones and feeling that people would have less confidence in them.

We also know that, and this is from our research, that even though those stigmas exist the majority of people with mental health concerns will engage in care. So there is a level of self-awareness in our population and people will take positive steps to do something about it. The majority of people will do this within 12 months of becoming concerned or noticing a change in their mental health. Some people do it earlier, there's a certain percentage that would do that within 30 days or a month of noticing a change. Again, the majority would do it within 12 months. And then we have another group in the minority who will wait up to three years before they start to engage in care.

The latter is problematic because we know that that delay can actually result in a disorder progressing, becoming more complex and therefore much more difficult to treat. Can we turn to the next slide please?

So, I've put this slide in here because a quick Google will show that stigma and defence is a topical issue. It attracts a lot of attention, but it's not just in Australia. It's not just the ADF who are trying to improve in this area. I think the majority of militaries certainly experience the same challenges. And whilst there's a strong interest in veterans mental health, and this is a very positive thing, it allows us to do more, to strive to do more, to ask more questions. What is often not reported is that defence has made significant changes and improvements in how we do things.

We have become a leader in many respects in terms of mental health reform. And part of that is realising that addressing mental health stigma has to be done holistically. We have to be clear about what our expectations and goals are. We've started conversations, we promote early intervention and help-seeking. And one of our key initiatives in trying to strengthen what we do in this space is the development and implementation of a mental health strategy. And that's on our next slide.

So, this version of the strategy, again it's available online so you can Google it and download it as a PDF. We first introduced a mental health strategy in the early 2000s. It's been revised and updated several times. And this current iteration is certainly our most comprehensive. It is also our most complicated in that we recognise that we have to incorporate the needs and differences across three services. So army, navy and air force, as well as our APS workforce.

So, this is not an ADF mental health strategy, it is a defence organisation mental health strategy. So it's quite broad and there are lots of moving parts in it. There are a number of central components though and I'll talk you through those briefly on the next slide.

So, what you see up here is our model, and our approach to strengthening mental health and wellbeing is underpinned by being fit to fight, fit to work and fit for life. So, the mental health and wellbeing model which is in the centre of that slide identifies that a person's mental health and wellbeing relies on a number of factors. There's strengths, there's risk, there's early intervention, there's treatment, recovery, support, as well as acknowledging that transitional separation from service aspect.

We have tried to incorporate this across the entire career of a serving member. So from the moment a person joins the organisation their training is designed to have them ready for service and it's designed to provide personnel with resilience that helps them not just in their career, but also translates to life. We also know that mental health and wellbeing is not determined just by the individual and their characteristics, there are several external influences that need to be considered. Family, support networks, the work environment. So there's a set context around this which involves shared responsibility.

Commanders, managers, the individual, their family and healthcare providers all have a key role to play in this. So quite multi-dimensional in that element. One of the key reasons I think we have been successful in promoting mental health has been those partnerships. One of the other aspects about the strategy and our model is about our objectives, and that's on the left of the slide there. So these are our action areas, things that we are trying to do to bolster the mental health and wellbeing of our people.

We know that there are risks and stresses associated with military service. They're not all linked to deployment. We know that most people cope well and they're resilient. We know that everybody has a role to play in building and maintaining mental health and wellbeing. As I said family members, the community, the lived experiences of others is also something that we include in this. As an organisation we will provide treatment, no matter what the cause of a mental health problem. So we have comprehensive screening programs, resilience training programs, mental health awareness and promotion programs, including a peer support model which we refer to as KYMS, which is keep your mates safe.

And we are also committed to monitoring our progress. And we are about to implement an incredibly comprehensive and coordinated approach to evaluation and quality insurance that will form part of our continuous improvement framework. It's a mammoth project, there is nothing like it that has been conducted before. So, it will give us an inordinate amount of data that allows us to measure the success of our programs as well as the success of the overall mental health strategy. Next slide please.

One of the things that I just want to talk about is the role of leadership in this. Leaders set the conditions that allow the team to work optimally, so this is a key aspect of success for us. Leaders who are trusted and respected have more influence in this space than any mental health professional ever could. They relate to others, they set the conditions, they model the example that they're trying to establish. We know that they create cohesion in the workforce, in the workplace, which is important in terms of positive mental health.

They are able to recognise and accept limitations, including their own, which again feeds into that modelling and positive leadership behaviours. But they also ask for data and they're constantly looking for insights about what is happening in their workplace. And I think that would be something that I would encourage people to be able to do in your respective organisations, is to have a think about what is the information that you have access to and how can it inform what you do next. And finally, the point up there about managing career transition. The role of leadership in helping support people through that process cannot be underestimated. They will often be the first person to know if an individual is having a problem and they can facilitate or help navigate their way through that. Next slide please.

So, what have we learnt? We know that friends, family and colleagues are likely to be aware of concerns first. So we have to include them in the programs and education and the strategies that we provide. We have to know the services and resources that are available for people. As leaders and managers it is difficult to be able to facilitate that access to care if you're not completely sure about where to go yourself. We know that access to accurate information is critical. Google has thousands of searches available, not all information is equal so we do recommend a certain number of resources for people. And we point them in the right direction to be able to ensure that if they are using online services to get information they're at least looking in the right place.

We know that early identification and support is essential, and we are continuing to work on the messaging about seeking help early. And we do have some initial data to say that that is actually making a difference. Next slide, please.

I just want to share a few reflections, and this is just my own thoughts about how we've progressed as an organisation on this journey. Certainly in the time that I have been in the ADF I have seen a number of changes and the focus has shifted. So as a leader I have seen the focus shift so that it's less on mental health disorders and illness, and we talk now about wellbeing, performance and mental fitness. So it's a positive rather than a negative connotation about encouraging people to access support or educate themselves, because positive mental health outcomes will improve and impact on each of those areas.

We have started to look at resilient individuals as well as resilient organisations. We can't have one without the other. We certainly encourage self-reliance but we also promote courage to seek help early.

We look at our senior leaders to help them get involved in the messaging, and certainly we have a number of them who have stepped forward to be part of that lived experience and share their own experiences which other people then respond to. We have shifted from being a stepped care model into one that is much more integrated, and have this become a whole of organisation focus, not just about an individual. So we have workforce health, workforce capability, workforce enablers. We involve family in rehabilitation and recovery, they are a critical component to the success of anybody's treatment. And we know that the message of seeking help early, no matter the cause, is working. Our rates of engagement and our uptake of services currently exceed community and international standards in the veteran and military mental health space. Next slide.

So, lessons. I guess the takeaway points that I'd like to leave you with today focus on three areas, and it's about leadership, empowerment and responsiveness. I think as leaders we have to be aware and alert that mental health and wellbeing issues are just part of normal life. We have to develop workplaces and cultures that support positive attitudes and behaviour and we cannot underestimate the power of lived experiences in that space.

In terms of the empowerment, it's about being proactive, trying to figure out where you can make a difference and not waiting for a problem to occur before you start to do anything. So being on the front foot, the language that we use in that space I think is incredibly important. So this comes back to the positive messaging. The ADF is very much a fitness focused organisation, people want to train, they want to get stronger physically. We've used that a lot in terms of how we sell mental health, particularly around the mental fitness aspects.

And responsiveness. We need to make sure that people have trust and confidence in not only our programs but the services. And our policies and our programs and the systems have to be agile and adaptive enough to be able to meet the needs of the organisation as well as the individuals in it. Delays in access to care, those kind of barriers are not helpful. We have done a lot of work to be able to ensure that people who put up their hand and request support can access it almost immediately, which is a big step for us.

I am very aware that I have probably gone over time. I am on my last slide so we can finish there. And I'm happy to answer questions depending on how much time we have left.

Natalie Bekis:

Thank you so much. That was... I personally have so many questions, that was absolutely fantastic so thank you so much. We do have a number of questions that are coming in and I am also conscious of time. So I'm just going to go straight to them. Firstly, there was a question around the current strategy. Once your current strategy is fully implemented, what would you like defence to do next to reduce stigma?

Colonel Neanne Bennett:

Good question. I think we still have scope to improve what we're doing in our lived experience space. So we are definitely doing work in there but I think we have capacity to probably standardise that and make it more of a enduring framework. I think our next strategy will certainly be informed by the data that we collect as part of our continuous improvement, monitoring and evaluation. We have a number of programs, but being able to use the information that we collect from the [inaudible 01:58:36] to see whether or not they're actually doing what we think they do, or whether we're targeting the right areas, will be really important. So that for me will be a significant step in terms of what we do next to keep working in the stigma space.

Natalie Bekis:

Yeah, fantastic. And another question here around do you see any generational or gender differences in how stigma is viewed or perceived within defence?

Colonel Neanne Bennett:

It's an interesting question and it's a little bit hard to answer in the sense that defence is a very male-dominated organisation. And I think typically our response rates from research probably sit at around 13 to 15% for females. In terms of access to care I'm not sure that we see much difference there at all. Presenting problems we probably do, so I think our data would suggest that females present a little bit more with the anxiety-related conditions and are less likely to have alcohol or substance use concerns.

There are also differences across the services in those kind of presentations as well. From a generational perspective, yes, I think there has been a shift since the time that I joined the army. The way people talk about mental health has changed significantly. People's willingness to actually seek people out and ask questions. Our senior leaders have become very strong advocates for mental health. When I first joined people would make jokes about, 'Oh, I can't be seen talking to you as an army psychologist.' You don't know what people will say. Whereas now everybody wants psychologists to come to the table and be part of a conversation, whether that's in terms of preparing for training, operational planning. We are a constant request. So that I think is a fabulous step forward and certainly reflects how far we've come in this journey.

Natalie Bekis:

Thank you so much Colonel Bennett, it has been fascinating listening to you. We are out of time so unfortunately for all those other questions we will come back to you offline. And so I just want to say a big thank you to all of our presenters today. Dr. Chris Groot, Dr. Michelle Blanchard, Maria Katsonis, and obviously also Colonel Leeanne Bennett. Thank you all so much for sharing your insights, your useful strategies in addressing mental health stigma in the workplace.

I'd also like to thank each and every one of you who attended today's event. Thank you for taking the time out of your busy schedules to talk about and be part of this conversation around mental health stigma in the workplace. As I mentioned earlier, the mental health community of practice is usually an event in which we do come together as an opportunity not only to hear from the latest in research and great speakers like today, but also to provide an opportunity and avenue for you to build your networks and connections across the Australian Public Service and the Comcare jurisdiction more broadly in tackling mentally healthy workplaces.

We hope next year that we will be able to look at how we can create a forum where we can bring people together, including across all of our Australian offices, including Darwin and Launceston which are two new offices. And we are working on that in the background, we know that that's an important part of this forum for people to have time to connect and network.

And for now, though we're all adapting with the times and we're hoping that you've taken away some really practical tips in applying... In looking at new ways around workplace mental health and to create safe and inclusive and mentally healthy workplaces. If you've got any feedback on today's event there will be a survey sent out to you. We do listen to your feedback, it helps to craft and shape the next event. So please take the time to give us your feedback. We really do appreciate your comments.

If you'd like to learn more about what Comcare is doing around enabling healthy and safe workplaces we also have a new e-newsletter so you can subscribe to that. You can also follow us on social media as well. We're often posting new insights or research around what we're currently doing or what may be emerging. For links today, so there are a number of links in the chat function today that we have posted including some of the reports that Colonel Bennett was talking about.

And lastly, if you're not already a member on the mental community health mailing list and you want to be, please get in contact with us through the mental health research team and the email address and that will be posted.

So, thank you again all so much for all of your time. Thank you to our wonderful speakers. Have a wonderful rest of your week and stay mentally healthy.