Healthy workplaces and environments for Frontline Workers
Navigating Workplace Challenges: Fostering Supportive Environments
The calls to eliminate restrictive practices (e.g., seclusion and physical restraint) from acute mental health care services have been gaining momentum over time and have been one of the many issues at the forefront of the Royal Commission into Victoria’s Mental Health System. Whilst it is known that restrictive practices are often harmful and traumatic for the mental health service user, there is a lack of evidence as to what factors are influencing restrictive practices’ ultimate reduction and elimination from the perspective of mental health service users and practitioners. The aim of this paper was to conduct a qualitative evidence synthesis of the literature regarding the perceptions and experiences of mental health service users and practitioners about restrictive practices in acute mental health care services. A systematic search and inclusion strategy identified 40 relevant articles for review. Inductive thematic synthesis resulted in five themes across the articles: (1) Balancing safety versus care, (2) Reconstructed meaning and emotional experiences of restrictive practices, (3) Alternatives to restrictive practices, (4) Re-traumatisation and dehumanisation, and (5) Professional competencies and varying experiences. Discussion of these themes highlighted the many layered and often uncomfortable nature of restrictive practices which can pervade acute mental health facilities across the world and impose as a great obstacle for frontline practitioners in their workplace.

Our employees work directly with young people in out-of-home care, the most vulnerable population in Australia. Our frontline workers can experience violence, aggression, and hard stories to hold. This creates the psychological risk of burnout, secondary or vicarious trauma, and compassion fatigue. In response to the increased risk faced by our frontline workers, we created a holistic organizational well-being strategy integrated into our practice framework, designed for bio-ecological well-being.

This innovative and collaborative approach to thrive-based resilience is based on social neurobiology and includes an internally embedded well-being team equipped to deliver psychological first aid, strengths-focused well-being plans, care discussions, suicide prevention training, narrative therapy, and evidence-based assessment and monitoring of psychosocial risk with partnered responses.

We will share our insights into how embedding neurobiological research and strategies, polyvagal theory, invitational post-incident supports, evidence-based quality-of-life measures, and integrating the PERMA model into our framework has contributed to the psychological support and safety of our frontline workers.

Background: Emergency service workers (ESW) are regularly exposed to traumatic events leading to an increased risk of a range of mental health conditions. There are a lack of specialised services available to meet this need. Digital health technologies have the potential to provide ESWs with effective tailored, psychological interventions to reduce symptoms of distress and improve overall mental health and wellbeing. Build Back Better is a smartphone app that incorporates evidence-based strategies designed for day-to-day use specifically tailored to the needs of ESWs.

Objective: The current study examines the efficacy of Build Back Better, in providing evidence-based strategies to reduce psychological distress, and related harms in ESWs.

Method: A randomised controlled trial is currently underway (n=879) to determine whether the Build Back Better app (which includes a range of psychoeducational, cognitive, behavioural, mindfulness, and grounding strategies) compared with an active mood monitoring control version of the app, is effective in reducing symptoms of psychological distress, depression, anxiety, PTS and improving overall wellbeing. After completing baseline measures, participants are asked to use the Build Back Better app for 30 days. Follow-up occurs at both 1-month and 3-month time points.

Results: Data collection is expected to wrap-up over the coming few months and results ready to be present prior to 2024. Participants randomly allocated to using the intervention version of the Build Back Better app are hypothesized to achieve significantly greater improvements in general psychological distress (primary outcome) and a range of secondary outcomes compared to those assigned to an active mood monitoring control condition.

Conclusions: Data collection and analysis will be completed and associated conclusions will be prepared in advance of the conference date.

Introduction: Serving military personnel and veterans are known to be at elevated risk of post-traumatic stress disorder (PTSD), and some veterans have been shown to respond poorly to current standard treatments. Evidence so far suggests that ICD-11 complex PTSD (CPTSD) may be of higher prevalence in the general population than PTSD.

Aims: The aim of the study was to investigate the prevalence of CPTSD compared to PTSD in serving and ex-serving military populations.
Method: A systematic review was conducted with the search criteria set to peer-reviewed English language journal articles, focusing on serving military or veteran populations, reporting on the prevalence of CPTSD, not restricted by year. Four comprehensive databases (Psycinfo, Pubmed, CINAHL and Embase) were searched.

Results: Of the 297 identified articles, 16 primary studies were eligible for inclusion. The review was registered in the PROSPERO database and results reported based on PRISMA guidelines. Of the 16 studies, 13 demonstrated higher prevalence of CPTSD than PTSD. Studies were predominantly veteran focussed. Prevalence of CPTSD ranged from 5% to 80.63%, while prevalence of PTSD ranged from 3.8% to 42.37%. There was high heterogeneity in study populations, preventing meta-analysis.
Conclusion: This is the first systematic review to assess the prevalence of CPTSD in serving military and veteran populations, with the findings demonstrating a higher rate of CPTSD compared to PTSD. It is hoped that the review will assist clinicians and military and veteran health services with appropriate assessment, diagnosis and intervention for those affected by CPTSD, as well as PTSD.

The world is grappling with an unprecedented mental health challenge, exacerbated by the COVID-19 pandemic, natural disasters, and conflicts. These crises have left an indelible mark on the global psyche, increasing stress, anxiety, depression, and trauma. Resolute Ready acknowledges the urgency of accessible and effective mental health support.

The Global Virtual Hub aims to connect individuals worldwide with mental health services, leveraging technology and collaboration to alleviate the burden on government agencies and understaffed institutions. This approach ensures timely access to vital mental health services, regardless of geographic location.

Crucially, Resolute Ready champions collaboration over competition in its approach to mental health support. It actively partners with service organizations, networks, businesses, and educational institutions, acknowledging the collective effort required to combat the mental health crisis. By sharing resources and expertise, Resolute Ready unites efforts, amplifying its impact and reach.

The initiative identifies and addresses complex challenges within communities, among military personnel, first responders, and families.

The virtual hub acts as an online resource library, providing immediate access to service providers, resources, crisis hotlines, and global crisis numbers. Resolute Ready launch was in April 2023 in May it received over 7,000 website hits in 7 different countries.

Through collaboration, stigma reduction, and improved access to mental health services, the initiative partners with government agencies, educational institutions, businesses, and organizations. Its mission is to generate employment opportunities, facilitate resource sharing, and bridge the gap between services and those in need.

In conclusion, Resolute Ready offers hope and progress in the face of the global mental health crisis. It embodies collective action for a brighter future, supporting communities, military personnel, first responders, and families to ensure that no one is left behind. Let us prioritize mental health, erase stigma, and provide the support that can transform lives and build a more compassionate world.

When considering the most effective ways to support the mental health of first responders, identifying facilitators to wellbeing as well as barriers to accessing support are crucial. There is broad evidence that social connectedness is one of the most significant factors contributing to mental health and wellbeing. Research on first responders in Australia has demonstrated that social connectedness (social support, belongingness, team cohesion, work/life balance, and access to social engagement) moderates various aspects of psychological health (wellbeing and resilience) and exerts a protective influence on the harmful effects of trauma exposure (psychological distress, PTSD and suicide). A key barrier to first responders’ engagement in mental health services has been identified in the literature as self-stigma, compounded by poor mental health literacy and delayed help-seeking. These issues create the potential for mental health challenges to develop into larger, more debilitating problems that adversely affect workplace functioning and quality of life.
To ensure first responders don’t ‘slip through the gaps’ when it comes to accessing support, it is important to tailor support options that address the nuances in the first responder experience to increase likelihood of engagement and optimise overall benefit to wellbeing. We present a model of care that champions social connection as a powerful lever of wellbeing for not just first responders but also their families. Low-threat, low-stigma, social connection focused wellbeing activities have the potential to engage first responders who may otherwise be unaware of the need for, or actively avoid, overt attempts to address mental health concerns. The wellbeing program can also serve as a “soft entry” into clinical services, allowing first responders to engage in evidence-based treatment. This innovative program that is evolving through ongoing review of effectiveness, paves the way for re-conceptualising how to best serve first responders and their mental health and wellbeing.

Introduction: Serving military personnel and veterans are known to be at elevated risk of post-traumatic stress disorder (PTSD), and some veterans have been shown to respond poorly to current standard treatments. Evidence so far suggests that ICD-11 complex PTSD (CPTSD) may be of higher prevalence in the general population than PTSD.

Aims: The aim of the study was to investigate the prevalence of CPTSD compared to PTSD in serving and ex-serving military populations.
Method: A systematic review was conducted with the search criteria set to peer-reviewed English language journal articles, focusing on serving military or veteran populations, reporting on the prevalence of CPTSD, not restricted by year. Four comprehensive databases (Psycinfo, Pubmed, CINAHL and Embase) were searched.

Results: Of the 297 identified articles, 16 primary studies were eligible for inclusion. The review was registered in the PROSPERO database and results reported based on PRISMA guidelines. Of the 16 studies, 13 demonstrated higher prevalence of CPTSD than PTSD. Studies were predominantly veteran focussed. Prevalence of CPTSD ranged from 5% to 80.63%, while prevalence of PTSD ranged from 3.8% to 42.37%. There was high heterogeneity in study populations, preventing meta-analysis.
Conclusion: This is the first systematic review to assess the prevalence of CPTSD in serving military and veteran populations, with the findings demonstrating a higher rate of CPTSD compared to PTSD. It is hoped that the review will assist clinicians and military and veteran health services with appropriate assessment, diagnosis and intervention for those affected by CPTSD, as well as PTSD.

Introduction: In the military setting, the most commonly recognised trauma is combat exposure. However, it is increasingly recognised that military sexual trauma (MST) can independently cause PTSD, as well as exacerbate the expression of PTSD when the veteran is also exposed to combat. Similarly, there is interest in how a history of childhood adversity could impact on the expression of PTSD.

Aims: The study had two aims:
1. To investigate whether veterans with a history of childhood abuse would be more likely to subsequently experience military sexual abuse.
2. To examine whether those veterans with a history of childhood abuse or military sexual trauma would exhibit greater incidence and severity of post-trauma sequelae compared to veterans without this history.

Method: A retrospective analysis was performed on baseline data collected from clinical case records of a cohort of Australian veterans with PTSD who had attended a Military Service Trauma Recovery Day Program as outpatients at Toowong Private Hospital between October 2020 and May 2022.

Results: There was a high rate of veterans reporting a history of abuse in childhood (sexual or physical) or in the military (sexual), with 48.5% of the 134 participants endorsing this. Of the 65 individuals that reported experiencing abuse, 50.8% experienced at least one form of sexual trauma (childhood or military, n=33), 47.8% reported a history of childhood physical abuse (n=31).

The relationship between those who experienced childhood abuse and those who experienced military sexual abuse was insignificant.
No significant statistical differences were observed between those who experienced abuse (childhood abuse or military sexual abuse) and those who reported no history of abuse on intake scores of psychopathology.
Conclusion: This is the first Australian paper to investigate how childhood abuse and military sexual trauma impacts on the expression of PTSD and associated psychopathology.

Introduction: Serving military personnel and veterans are known to be at elevated risk of post-traumatic stress disorder (PTSD), and some veterans have been shown to respond poorly to current standard treatments. Evidence so far suggests that ICD-11 complex PTSD (CPTSD) may be of higher prevalence in the general population than PTSD.

Aims: The aim of the study was to investigate the prevalence of CPTSD compared to PTSD in serving and ex-serving military populations.
Method: A systematic review was conducted with the search criteria set to peer-reviewed English language journal articles, focusing on serving military or veteran populations, reporting on the prevalence of CPTSD, not restricted by year. Four comprehensive databases (Psycinfo, Pubmed, CINAHL and Embase) were searched.

Results: Of the 297 identified articles, 16 primary studies were eligible for inclusion. The review was registered in the PROSPERO database and results reported based on PRISMA guidelines. Of the 16 studies, 13 demonstrated higher prevalence of CPTSD than PTSD. Studies were predominantly veteran focussed. Prevalence of CPTSD ranged from 5% to 80.63%, while prevalence of PTSD ranged from 3.8% to 42.37%. There was high heterogeneity in study populations, preventing meta-analysis.
Conclusion: This is the first systematic review to assess the prevalence of CPTSD in serving military and veteran populations, with the findings demonstrating a higher rate of CPTSD compared to PTSD. It is hoped that the review will assist clinicians and military and veteran health services with appropriate assessment, diagnosis and intervention for those affected by CPTSD, as well as PTSD.

First responders are at heightened risk of work-related posttraumatic stress compared to all other occupations. Posttraumatic stress is complex and often associated with low success in resuming work.

IPAR worked with Monash University, Phoenix Australia – Centre for Posttraumatic Mental Health, and lived experience to develop 'Positivum after trauma', an evidence based biopsychosocial assessment and health coaching program for people exposed to trauma.

Positivum Trauma addresses a gap in post trauma care between clinical psychological treatment (focused on symptom management) and traditional occupational rehabilitation (focused on return to work). Centred around self-management and health literacy, health coaching builds functional capacity through goal setting and activity, empowering and motivating individuals to understand trauma reactions, re-set survival systems and improve their daily function as part of a trauma informed rehabilitation approach.

Methods:
Eligible participants were referred by their personal injury insurer or workplace. Analysis compared baseline and follow-up Positivum Trauma psychosocial assessment scores and changes to work capacity and work status.

Results:
51 individuals (predominantly male First Responders) completed an initial and final Positivum Trauma assessment and at least three health coaching modules.
On average, participants demonstrated significant improvement in 9 of 10 psychosocial factors, with the most significant improvements in Stress (PCL-5): 33% improvement; self-confidence (GSE-6): 26% improvement, and quality of life (QOLQ): 26% improvement.

At referral, 69% of the sample had PCL-5 scores above the clinical cut-off for PTSD. At follow-up, this had reduced to 33% of the sample.

Of those participants with reduced or no capacity for work at referral, 44% showed positive capacity changes and 42% positive work status changes. Compared to a group (n=9) receiving usual care, the participants who received the intervention were almost twice as likely to have a positive change in work status.

Our employees work directly with young people in out-of-home care, the most vulnerable population in Australia. Our frontline workers can experience violence, aggression, and hard stories to hold. This creates the psychological risk of burnout, secondary or vicarious trauma, and compassion fatigue. In response to the increased risk faced by our frontline workers, we created a holistic organizational well-being strategy integrated into our practice framework, designed for bio-ecological well-being.

This innovative and collaborative approach to thrive-based resilience is based on social neurobiology and includes an internally embedded well-being team equipped to deliver psychological first aid, strengths-focused well-being plans, care discussions, suicide prevention training, narrative therapy, and evidence-based assessment and monitoring of psychosocial risk with partnered responses.

We will share our insights into how embedding neurobiological research and strategies, polyvagal theory, invitational post-incident supports, evidence-based quality-of-life measures, and integrating the PERMA model into our framework has contributed to the psychological support and safety of our frontline workers.

Current policy discussions often position frontline rural healthcare workers as resources or units which can ideally be allocated to areas of shortage. This approach overlooks the experiential factors shaping frontline worker’s potential for long- term retention in a rural workplace, including the human impact of rural and remote practice. Greater understanding of the intersectional stressors shaping individual wellbeing and their interactions with other place-based social processes are essential to frontline workforce wellbeing and retention.

This presentation presents data from a qualitative collaborative auto-ethnographic study investigating factors affecting frontline rural health worker wellbeing and retention. Auto-ethnographic data was collected from experience and observation of the presenters as front-line medical officers working in rural primary and secondary care services in the Australian public hospital system from 2019 – 2023.

The outcome of this work is a proposed Wellbeing Centred Model of Health Workforce retention, conceptualising front-line rural health workforce wellbeing shaped by contextually dependent and intersecting factors across professional, organisational, and personal domains.

Arising from the Wellbeing-Centred model is an analysis of the role of secular dedicated pastoral care in supporting and retaining rural front-line health workers facing intersecting stressors across multiple domains. The proposed Wellbeing-Centred retention model can be used to identify stressors and potential wellbeing and support interventions across front-line clinical and non-clinical workplaces in both rural and urban settings.

In beautiful tropical Far North Queensland, Cairns has the added bonus of both a QPS and QAS co-Responder team, as well as a Mental Health Intervention Co-Ordinator to assist with liaison, co-ordination and educational needs.

There are 3 key learnings to be highlighted.

#1 – Improved Patient Experience
• More appropriate care in the home
• Referrals for ongoing care to relevant agencies
• Reduced stigma when calling for Emergency Services (EMS)
• Better understanding by QPS/QAS of a person’s vulnerable state when mentally compromised
• Reduction in fear of QPS/QAS due to positive experiences with CoResponders

#2 - Impact on Mental Health Services/Emergency Department (ED)
• Reduced Use of Emergency Examination Authorities
• Reduction of ED “ramping”
• Reduction in inappropriate ED presentations
• Improved relationships with QPS/QAS

#3 – Improvements in QAS/QPS partnerships with Health
•Relationship building and networking between Mental Health Services and QPS/QAS, both in the Cairns region and the outlying regional sites.
•Pathway for referral and liaison when general crews attend a mentally ill person.
•Sharing of responsibility, in managing the person with compassion, which helps to reduce the risk of a traumatic experience, for all, when EMS are called
•Support and acknowledgement of exposure to volatile situations such as extreme dysregulation and suicidal/violent behaviours.
•Improved understanding of conflicting systems/processes, and how to work within the challenges/limitations of this.
•Improving trust and confidence across services and having a designated pathway to discuss and /or escalate any issues or concerns.
•Operational Liaison Committee ( OLC) – shared experiences, complex presentations, shared problem solving and actions
•Use of Police and Ambulance Intervention Plans ( PAIP) as a tool to guide interactions and inform how the QPS/QAS can best engage in the safest way possible.

Aim: The aim of the study was to examine the relationship between stress, psychological symptoms and job satisfaction among frontline nursing staff at a military hospital in Saudi Arabia during the COVID-19 pandemic. Design: Descriptive cross-sectional study. Methods: Data were collected using an online survey. All Registered Nurses (N= 1,225) working at a military hospital between February to April 2021 were contacted, 625 responded (51%). Data were analysed using descriptive and multivariate analysis, Student's t-test for independent samples and one-way analysis of variance followed by Tukey's multiple comparison tests. Results: Stress was experienced more significantly than depression or anxiety. Approximately 29% of the change in scores for psychological symptoms was explained by age group, being a Saudi national and working in emergency departments (F[3,620]= 19.063, p< 0.0001). A 37% change in nursing stress scores was explained by nationality and work department. (F[5,618]= 19.754, p< 0.0001). A 29% change in job satisfaction scores was explained by

Te Whare Tapa Whā is a well recognised Māori model of health and wellbeing, created by Sir Mason Durie, and embraced within the health system in Aotearoa/New Zealand. It was the first indigenous Māori model of health to be recognised and utilised in mainstream services in the early 1980s. This model was created to give Māori a voice, helping non-Māori to understand Māori health, but also create a pathway for other models to be developed and thrive.

Mental health is complex, there can be more than one explanation for deteriorated or there are multiple factors that have contributed to the outcome. There is high population of Māori tangata whaiora which is disproportionate to the amount of Māori mental health nurses, but Māori concepts were being utilised within nursing cares. Reflecting on these thoughts, I wanted to conduct research around them which is how I came up with my research topic.

My research is the first to be conducted of its kind looking at mental health nurses, Māori and non-Māori, perceptions of Te Whare Tapa Whā. This created some barriers for my literature review, so a broader search was utilised. As the researcher, I was interested in seeing what nurses thought about the model, what they knew, if they implemented it and if they found it useful in nursing care. A mixed method approach was conducted but based around Māori centred research.

Important information was gathered from this research, reinforcing the need for more Māori mental health nurses, the different depths and knowledge between Māori and non-Māori, further education needing to be provided to staff and further research to investigate this topic.