In the final article of her three-part series, Catherine D’Arcy-Jones examines some tools and resources OH practitioners can use to promote resilience within the workplace, and discusses why Covid-19 is making it even more important for organisations and individuals to build their resilience.
This is the last in a series of three articles that have been looking into different aspects of resilience. The first article explored the theoretical and psychological theories behind resilience, including the use of resilience scales. The second brought in organisational and individual factors to consider.
But what about practical recommendations occupational health practitioners can guide employees to? In my experience, there are many activities that can easily be introduced or revisited with employees who have stopped applying tried and tested research-based choices when their resilience becomes low. The result of this can be a downward spiral, exacerbating symptoms of low resilience and leading to further unhelpful choices of actions and behaviour.
About the author
Catherine D’Arcy-Jones, SCPHN, RGN, BSc Psychology, MSc Health Psychology, BSc Occ Health is director of occupational health company OPA Health
The role of occupational health can be seen as a guide to direct people back to those healthier lifestyle choices that individuals can easily apply and resonates with their outlook in life. It is not the case of advising in a “one size fits all” scenario and not necessarily the case of suggesting that individuals make huge lifestyle changes they are unlikely to adhere to. As OH practitioners, it is about conveying a tailored practical transference of health education and advice to individually suit each employee.
The role of nutrition
We know that well-nourished individuals are healthier, can work harder, are more efficient and have greater physical reserves, making them more capable of withstanding adverse events and shocks (Dufour et al 2014).
There is plenty of evidence linking the relationship between dietary habits and psychosocial conditions, but less so relating diet directly to psychological resilience. However, Bonaccio et al (2018) applied the 25-item Connor-Davidson Psychological Resilience Scale (discussed in the first of this series of articles, published in the September edition) and found that, in a general adult population, a Mediterranean type diet was more positively associated with higher psychological resilience than a Western-type diet.
Typical Western diets encompass levels of high fat and sugar (often hidden), refined foods, processed meats, junk food, high carbohydrates and stimulants. This creates a rollercoaster of peaks and troughs putting the body under greater nutritional stress leading to increased feelings of tiredness, hunger and stress.
Research has demonstrated links between stabilising blood sugar levels and improved mood levels (Knüppel et al 2017), poor nutritional choices and depression (Jacka et al 2017), between eating breakfast and improved mental performance with a reduction in anxiety and weight fluctuation (Reeves et al 2015), and between incorporating higher levels of omega-3 to improve mood levels (Blackdog Institute) and of incorporating pro-biotics to improve cognitive performance during periods of stress (Papalini et al 2018). The role of occupational health is to guide their clients with health education, to assist recognition of unhealthy eating habits and to promote positive dietary changes.
The role of sleep
The importance of maintain good sleep routines and engaging in behaviours that promote sleep was first proposed by Kleitman in 1939 but popularised in the 1970s by Peter Hauri (1977), who introduced the concept of sleep medicine.
From this time there has been extensive research into this field with some main themes emerging that can be easily incorporated into an individual’s lifestyle.
Documented influences on sleep are multifactorial. The positive association between stress resilience and sleep disturbance has been demonstrated by Xiaohua et al (2016) using the Connor-Davidson Resilience Scale.
Research has demonstrated that exposure to blue-white light suppresses the production of melatonin and disrupts the natural circadian sleep cycle (Lewy et al 1981).
The Sleep Council details good resources that are easy to read and apply relating to sleep routines. These include tips for promoting sleep, a variety of tools that can be used to induce sleepiness and practical environmental measures that will assist sleep.
Recent use of a cognitive behaviour therapy tool introduced by the company Sleepio to aid a return to a healthy sleep pattern for those with sleep disturbance has also seen positive results. A study by Bostock et al (2016) has shown that using digital cognitive behavioural therapy (CBT) techniques improves insomnia and increases work productivity.
Access to this is free, dependent on location, but has recently been made available to all NHS employees in the current Covid situation.
The role of exercise
Aerobic exercise is beneficial in countering stress by boosting the body’s natural endorphins, channelling the stress hormone cortisol, protecting brain cells and lowering blood pressure.
Acute exercise has been shown not only to improve the body’s immune system (Nieman et al 2019) but also to act as a protective factor against mild to moderate depression (Donaghy 2009) and to protect against the negative emotional consequences of stress (Childs and De Wit, 2014).
The benefits of exercise during the recent Covid crisis have been discussed on the SOM (Society of Occupational Medicine) website for both physical and mental health (https://www.som.org.uk/importance-exercise-during-lockdown), especially when individual resilience has the potential to be low within the restrictions of government advice being issued.
The role of hydration
The body is made up of approximately 70% water and the brain itself is made up of 85% water.
Dehydration is linked to increases in the stress hormone cortisol, affecting our stress response to situations (Popkin et al 2010). Water can be lost from the physiological stress response itself in increased perspiration, respiration and frequency of micturition.
Most people use thirst as a sign of dehydration but, at this stage, around 1-2% of the body’s water content has already been lost and can begin to affect cognitive processes.
Using water bottles with timing markers can be a good reminder to regulate a constant fluid intake throughout the day rather than loading the body with water in the evenings. However, this is also likely to cause nocturia and so may have a knock-on effect of disturbed sleep on cognitive function.
Including food with a high water content in meals or as snacks can assist, such as melon, grapes, cucumber and carrots.
The role of volunteering
Being part of a social group and forming a meaningful connection with others gives a sense of purpose, meaning and support and is congruent with the 5 steps to mental wellbeing strategy proposed by the NHS and posted on the NHS website. Increasing a social network can improve confidence, engagement with others and reduce the likelihood of depressive symptoms (Lum 2010).
Social prescribing is a process of referring to local non-clinical services to improve health and wellbeing. It is aimed at promoting inclusion in those with physical or mental health conditions who are socially isolated (Drinkwater et al 2019). In England, social prescribers are now being funded via primary care networks under the NHS Long Term Plan.
Many of these positions can be found in GP surgeries. Social prescribing as a process is an easy concept for occupational health to discuss and signpost to. Practitioners are in an ideal position to promote this and to tailor signposting to different activities and opportunities based on the information gained during the occupational health assessment.
The role of mindfulness
Mindfulness is an area that has been used to calm thoughts and bring attention to the present moment for thousands of years through religion and alternative therapy approaches. It is an important cornerstone of cognitive behaviour therapy and is aimed at counteracting cyclical ruminating thoughts associated with anxiety.
Many studies have demonstrated the links between mindfulness-based therapies and stress reduction in altering cognitive and affective processes, decreasing anxiety and positively impacting on health (Hoffman et al 2010).
Resources are readily and easily available for use through websites such as www.anxietyuk.org, MIND, www.getselfhelp.co.uk and www.moodgym.com.au. Apps such as Headspace provide free access to mindfulness relaxation resources to those in education and the NHS.
These can act as an important bridge of support for those waiting for NHS input. NHS waiting lists have become longer with increased demand in recent years, with more pressure being put on the Samaritans for those in mental health crisis and an employee assistance programme (EAP) for those in work. Despite anonymity being assured by these schemes, employees remain wary about confidentiality, which can affect the uptake of services.
There is no doubt that maintaining mental health has become an increasing priority during the coronavirus period, especially with the impact of lockdown on individuals and businesses.
Many of these workers were ill-prepared to ‘flex’ to a different set-up of home working and have found the isolation, loneliness and lack of workplace structure difficult to adapt to.
Mental health resources tailored to the pressures of the coronavirus for practitioners themselves and individuals are useful to consider. These include the NHS Every Mind Matters website www.nhs.uk/oneyou/every-mind-matters/your-mind-plan-quiz and the Mental Health Foundation www.mentalhealth.org.uk/publications/looking-after-your-mental-health-during-coronavirus-outbreak
Since the start of the coronavirus outbreak, SOM has provided expert advice with the changing profile of the current situation. Of particular relevance is its mental health resource designed to sustain work relevant mental health post Covid-19 (SOM 2020).
Occupational health practitioners are also now being asked to provide decisions regarding the fitness of workers to return to workplaces that have started to open again, including those workers who have previously been within the vulnerable category with regards to Covid-19.
The important role of OH has been highlighted during this crisis and has brought the specialty to the attention of many businesses and workers that were previously unaware of the work OH provides.
The role of talking therapies
As occupational health practitioners, we understand the value and importance of referring individuals to the appropriate form of talking therapy. This supports individuals in recognising past events and stressors and in developing strategies to assist with the management of symptoms of mental ill health, be this clinically diagnosed or due to perceived situational demands.
There are many different forms of counselling, and it is important the practitioner is signposting to the most appropriate related to the reported symptoms. Practitioners may consider referrals to a workplace EAP, CBT, Eye Movement Desensitisation and Reprocessing (EMDR), and specialist counselling services such as bereavement counselling, the Centre for Action on Rape and Abuse (CARA) and so on.
Even if referral onto a specific form of talking intervention is not undertaken, there is no doubt that encouraging clear channels of communication between employees and their managers is beneficial in increasing individuals’ resilience.
Improving communication channels and support within the workplace does foster increased coping and adaptation skills. It increases the professional connections within the workplace and may even lead to improve social connections and social support for individuals.
The role of mental health training
It is essential that organisations take a proactive stance with regards to the mental wellbeing of their workforces.
A key recommendation of the systematic review undertaken by Kinman, Teoh and Harriss (2020) on behalf of SOM into the mental health of nurses and midwives was that managers at all levels need a greater understanding of the impact of work and workplaces on mental health and wellbeing. This research was discussed in Occupational Health & Wellbeing in August (vol 72 no 8).
There is a training need for many managers in order to gain this greater awareness. I-act, for example, has developed mental health training packages and takes a very proactive stance.
This training has been adapted for either employees or managers and teaches recognition, implementation and support for those with mental health symptoms in the workplace. It has also recently received endorsement from the Royal College of Psychiatrists www.i-act.co.uk.
Effective managers and mental health champions are two parts of the proactive jigsaw, with mental health first aiders undertaking a more reactive role. The training programmes for mental health first aiders aim at increasing skills in recognising, listening and signposting for those with mental ill health or in mental health crisis.
Proactive employers are supportive of training employees to act as mental health first aiders and to be readily available when needed to assist those requiring mental health support.
The largest provider of this training is Mental Health First Aid England, which supports the delivery of half-day, one-day and two-day courses by qualified instructors to train mental health first aiders in the workplace. Once training is complete, the first aiders have access to a number of resources that they can adapt for their individual workplaces.
Promoting work-life balance
Work-life balance is an area that has recently enjoyed renewed attention with the introduction of home working across the country following the coronavirus outbreak.
As an OH practitioner, encouraging protected downtime and engaging in the areas outlined above can empower individuals to take more control of their activities as well as increase productivity and mental resilience.
Ensuring an individual has effective prioritisation skills within their system of work also enables a higher chance of engaging with and sustaining an effective work-life balance.
To conclude, in this series of three articles I have touched on the breadth of stress resilience, including the origins and influences from a health psychology perspective, organisational and individual considerations and practical resources for occupational health practitioners.
The true impact of the global coronavirus pandemic on mental health is yet to be realised and it is likely to continue to exert some degree of influence over the years to come.
In that context, the need for individual and organisational resilience, and the role that OH can play in fostering, embedding and sustaining resilience, is only likely to become more important. Therefore, I hope this advice and guidance will be useful for practitioners going forward.
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