Although review recommends cognitive behavioural therapy for depression at work, contextualization process highlights challenges in offering treatment
At some point during their lifetime, nearly three million Canadians will experience depression—most during their prime working years. As a result, workplaces are increasingly asking for strategies and interventions to help workers manage depression and minimize the effects of the condition.
According to a new systematic review update by the Institute for Work & Health (IWH), workplaces should consider offering:
- cognitive behavioural therapy (CBT) or problem-solving therapy to help workers with depression stay at work; and/or
- CBT with a specific focus on addressing work issues, called “work-based CBT,” to help people with depression return to work.
But systematic review recommendations aren’t always easy to implement everywhere. For decision-makers, whether at a systems or workplace level, the question 'What works?' is often followed by 'Will it work here?'
That’s why the systematic review group at IWH, with colleagues at Memorial University, developed a method for working with stakeholders to tailor review recommendations for specific contexts (see cover story). To test the method, the team led by Emma Irvin, IWH director of research operations and head of the systematic review group, worked with stakeholders to highlight important contextual factors to consider for the province of Manitoba, funder of the project.
The process involved assembling a group of about 20 advisors from Manitoba. They included clinicians, occupational health and safety (OHS) professionals, disability managers and representatives of employee assistance programs (EAPs), employers, labour groups and decision-makers from SafeWork Manitoba.
The discussion, guided by a list of contextual factors to consider, addressed a range of topics. Some of these were:
Population and demographics: Seventy per cent of the population in Manitoba is urban, and nearly all of that population is concentrated in Winnipeg. Stakeholders talked about the need to consider many cultural sensitivities and a high proportion of temporary workers.
Access to services: Wait times can be 12 to 18 months long, partly due to the number of psychologists and psychiatrists leaving the province, and partly due to the fact that psychological and psychiatric services can only be accessed with a doctor’s prescription. EAPs in the province do not alleviate wait times, as there are delays and gaps in service within the EAP system as well. As for rural areas, stakeholders spoke not of delays or limited access, but about a total lack of services available.
Service organization and delivery: Potential challenges exist with delivery options meant to lessen the service gap, such as telephone counselling and peer support. In small communities, these options could result in a worker receiving the service from a neighbour or family member, raising concerns about privacy and stigma. In some communities, English is a second language for large proportions of workers, so services in different languages may be necessary.
Technology: Web, telephone and mobile app options may help cover the large geographical area, but concerns were raised about the effectiveness of these services when they originate in another province (e.g. EAP services located mostly in Ontario).
So, will the review recommendations work in Manitoba? Pulling together the themes and concerns raised around the table, the team zeroed in on access to care as a major barrier in the province.
Access was seen to be restricted primarily because of geography (remote areas, long distance to reach services), and because of a lack of psychologists and psychiatrists in the province. Currently, there are no specific provincial programs in Manitoba to address depression in the workplace, states the team’s report.
A strategy that includes improved access to early care delivered in a variety of ways (e.g. telephone, web-based and in-person, such as peer-to-peer) would be welcome. The evidence regarding various treatment delivery methods is still emerging, but appears promising.
The report adds, however, that in-person treatment by trained clinicians remains an important aspect of an effective strategy to manage depression in the workplace and, as such, investments still need to be made to improve infrastructure, programming, professional expertise and peer support in the province.
Despite their various perspectives, the advisors in the room had engaged and respectful conversations about the topic, says Bruce Cielen, manager of the Workers Compensation Board of Manitoba’s Research and Workplace Innovation Program.
The people who were approached and agreed to participate—their passion came through, Cielen says.
Like anything, if you give people an opportunity to participate in the creation of something, you are likely to get a better outcome and potentially have better usage of the material. And what this committee did was create champions to roll this out with as far a reach as possible.
To download the report contextualizing depression management interventions for Manitoba, go to: www.iwh.on.ca/systematic-reviews.
Source: At Work, Issue 89, Summer 2017: Institute for Work & Health, Toronto