All right, I think we'll get started. Good morning, everybody. I appreciate you coming in here so early, but I think we have an interesting talk which is going to touch everybody in some capacity because it certainly has touched all three of us on the platform. This whole idea of COVID, as I said yesterday, is making us very, very fatigued, but it's also causing a lot of emotional health issues. So we've tried to put together a presentation that addresses some of those emotional health issues and how best to manage them. I want to thank the college for the opportunity of speaking today and yesterday as well. And I want to say that the presentation today is on behalf of the International Corporate Health Leadership Council, of which I serve as the executive director. Philippe Gilbert is the co-chairman for Europe, and Richard Van Root is one of the members of the council. In his real job, Dr. Gilbert is a global medical director with International SOS and brings almost 30 years of experience in the international space, including but not limited to management of emotional health issues. And of course, Dr. Van Root is the medical director, global medical director for Freeport McMorrin and has been very engaging in the energy, mine, and infrastructure space all over the world. For those of you who aren't familiar with the International Corporate Health Leadership Council, on behalf of whom we are speaking today, this statement is our mission. In essence, what it is is it's a group of doctors from around the world representing some of the biggest corporations in every industry sector. We get together, we use Chatham House rule, and we talk about what keeps us up at night and what could potentially be best practices moving forward that we can share with the AHRQ Health community at large, and in fact, the world. You can see that the image on the bottom of your screen represents some of the companies that are either on the council today or have been members in the past. It's a huge privilege for us to have that council. It's a nonprofit. It's a 501c6, and we are incredibly excited to convene every year, and in fact, we just ended a meeting two days ago. We do a lot of publishing. You can see that we've written a number of white papers. We post them on our website, which is ichlc.org, which you're welcome to look at. We do trend reports. Dr. Druckmann, my colleague in the back, who's another co-chairman of the council, he's looking at getting another trend report because we're going through four years, and in that will be a lot of exciting information about what we've learned from COVID moving forward, and of course, we like to speak at different meetings, and you see we've been showcased at AOHC for the last five or six years. The way I want to set up today's talk is I want to leverage the expertise of my two colleagues, the two panelists, and I'm going to post a question, and I will ask them. I'll probably interrupt them because I know how to do that really well. I'll interrupt them, and we'll try and get some discussion going on each of these subjects, and the question will be posted at the top of every slide so that as the slide advances, there may be a new image, which will trigger a thought with them, hopefully, and you'll be reminded of what the question actually was. So let's get down to business. Let's talk about the first question from my panelists is COVID-19 has been particularly unforgiving to those in the workforce with any NCD, inclusive of mental illness. How are the NCDs linked to COVID-19? And before I ask either of you to answer that, I want just to talk a few moments, Philippe, about the NCDs and how mental illness fits into that. Thank you. Thank you, Rob. As we all know, this definition of noncommitable disease has been set quite a while ago and encompasses all these diseases that are not transmitted from human to human as infectious diseases are, and actually, when you think of what has happened during the pandemic, you know, you probably never lived as in any closer to your fridge or to your cellar or you didn't have any physical activity. All of this led to probably an increase of nonchronic or noncommitable diseases. And all of this is linked together because from pulmonary chronic diseases, pulmonary diseases as well, the fact that people who had cancer probably didn't get access to the right treatment at the right time. All of this participated to a surge of number of nonchronic diseases, particularly in countries where access to healthcare has been severely affected by the crisis. But most importantly, I guess, as you see, the pillar of this has become an evidence to all our specialists is that mental health, though part of the definition of nonchronic or noncommunicable diseases, has really becoming the sort of core of all these noncommunicable diseases because it truly is connected with each and every of this situation. When you think of someone that is affected by diabetes or cancer, the image this person, the emotional status this individual has with regards to this disease, the way this person interacts with others as well, in the healthcare industry as well, all of this has an impact on their emotional and mental stability. So when you think of all of this, COVID has probably led to an increase of this with unhealthy behaviours, addictions, sleep deprivation, and physical inactivity. So we do see the link, obviously, between COVID and noncommunicable diseases, and for those as corporate medical doctors in the room that have the responsibility to drive this agenda, recognising the importance of mental health as the pillar of all the strategy that will address these noncommunicable diseases is, I guess, extremely important. Thank you. So it's a cause and effect, and I think that's why this graphic has mental illness as the trunk of the tree and the other traditional NCDs as branches. Rich, do you want to talk about taking this one step further, how the NCDs have impacted the prognosis of people who get COVID-19? You manage a workforce that's enormous all over the world. Many of your workforce are in emerging marketplaces, and I'm guessing that many of them suffer from NCDs. What are your thoughts on this graphic from the CDC, which we're all very familiar with in terms of, it's almost like radiation effect, it's additive with your comorbid situation? Thanks, Rob. I hope you all can understand me. I'm very much from the South, and so you may have trouble with my accent. There's no closed captioning, I don't think. So I did, I had a very good eye on, I would watch the news, I would read the news, whatever, and I would see all these trends, and I actually had a better picture than a lot of the real world. I really did see it, because we have operations in Asia, we have operations in South America, we have operations in the US, and in Europe, and prior to vaccination, our bad outcomes, I would always reach out to my providers at site, and I never really asked about mental health issues, which is ironic, I mean, that's what we're talking about now, but I would always ask about body habitus, I would always ask about risk factors of folks that were having bad outcomes, and it was 99, first of all, it was 99.9% unvaccinated with regard to very bad outcomes, meaning death, but I also saw that almost everybody that had a bad outcome had a BMI over 30, and these are in some countries where the BMI of 30 is very unique. It's sort of a double, it's, you know, working for a large company where we are in very, very remote areas, we provide not only food and housing, but we also provide a paycheck, which allows a lot of our workforce, unfortunately, to live a Western life. So in Peru, where most people would normally go to the market to get their food and normal foods that they have eaten for generations, they now can go to the grocery store. So we do have an obesity issue in our workforce that also leads to, obviously, hypertension, diabetes in a population that normally doesn't have those issues. As we see this get worse outside of the Western world, we were seeing this in a real time with regard to COVID and bad outcomes, it was very apparent. So the NCDs have been here, they're here to stay, and we can't put them on the back burner because they obviously have a significant impact on those patients that acquire COVID. Let's do a deep dive into mental illness, which is what we're supposed to talk about today or emotional illness. And I'm going to ask you, Philippe, to talk about this publication, which is actually not recent, but it's very, very revealing in terms of looking at the global population and what is the risk of an individual developing clinically documented mental illness in the course of their lifetime. This is our baseline. So forget about COVID, forget about any other factor, cultural, age, gender, whatever. Do you want to just comment on that? No, definitely. I think we've built a crisis on a burning one, as you said, on the existing situation, a baseline of mental health issues. I think what is important is this varies from one place to another, one country to another. It may be more acute here in the United States, but in other places as well. We had a situation where people do suffer and may not report culturally their mental health disorders because it's not accepted socially-wise and culturally-wise. So this is very important to acknowledge that when it comes to putting in place a strategy to address this issue, recognizing the baseline, the situation your employees are confronted with, culturally speaking, the disorders they're experiencing is very important because a one-size-fits-all approach doesn't work. And we'll see that later on. Second of all, I'd like to mention that on the top of this, the World Health Organization that recently published some information that COVID has triggered a 25% increase of mental health disorders, anxiety and depression on the top of this baseline. So it's really recognizing that the situation wasn't that good initially, that COVID has really crystallized in some places, in some culture, in some organization, this severity of these issues. And recognizing this is extremely important, particularly when it comes to pushing this mental health agenda within our organization. It's not about starting from zero, COVID has led to, out of a sudden, a new explosive situation. Actually, we started from already a degradated situation with this situation. Good point. So that is actually a good segue into this slide and the next slide. This was a publication that came out in Lancet Psychiatry a little over a year ago. And the authors were from Oxford in the UK, but their cohort of patients that were analyzed, I think it was in excess of 70,000 from American hospitals, all of whom had been diagnosed with COVID. And what they found was, was it a cause or effect in that, and that's hence the word bi-directional, were people that had COVID more likely to get some sort of a mental illness or people with mental illness more likely to get COVID? And it was an interesting study and it only went and covered 14 to 90 days post-infection. What was the bottom line with this paper, Philippe? Actually, as you said, it's not a one direction situation. And every chronic condition or acute condition, is it regards to non-clinical diseases, but also COVID-wise, still each other. So people are already more vulnerable with a chronic condition that has been exacerbated with COVID. Even though the World Health Organization, again, just published a statement saying that people with mental health disorders do not appear to be more vulnerable for COVID. So I think that's important to understand, but definitely the fact that, as you mentioned by this publication, psychological disease has increased the risk of complication and severity of COVID. Indeed. This article came out much more recently in the BMJ and it took the population out to one year. And the little emoji at the bottom emphasizes stress, anxiety, and depression. I want to go back for a second to something you said, Richard, about one size doesn't fit all when you talk about mental health programs. And I want to ask Rich, who oversees a workforce in emerging marketplaces all over the world, would you agree with that fact and would you agree that you have to take into consideration if you are planning some of the development and the institution of a mental health program, that it has to be in the context of where you are and all of those variables? Absolutely. I mean, you know, you have to, culturally, mental health is treated differently, governmentally it's treated differently, and societally it's treated differently depending on where you are. And I had to learn this very quickly because, of course, years ago I worked for Medecins Sans Frontieres and I was an HIV doctor in the middle of a slum in Africa and we really did not focus, everybody had HIV, everybody had TB and HIV, everybody had drug-resistant TB. And we really, we treated nobody with anything for any psychiatric issues. We only treated the baseline infectious disease. I come back to the United States and, of course, working, I'm an emergency room physician and I saw mental health everywhere and, of course, you all are as well and everybody has a diagnosis and everybody's on one pill or two pills and young people on all these medications. And I started thinking, well, it was really a Western issue, psychiatry. And I never, and so when I took this position, I started thinking, you know, it was sort of the same thing. It had been treated the same way. Our international sites, they did not really focus on mental health as much as they did on our Western properties or facilities. And so you really have to remind yourself that there are mental health, first of all, you have to make sure you're aware that, yes, there are mental health issues worldwide. Just because they're more diagnosed and more treated potentially in Western and wealthy countries, doesn't mean it doesn't have an issue in these other places. And therefore, we have had to ensure that we do have, you know, access to mental health treatment, mental health awareness as well within the workforce in places that didn't previously do that. It is not a one size fits all. We don't have one program that blankets our whole company. But we do make sure that we have these resources at each site acknowledging that it is an issue. We've talked about that World of Psychiatry paper, the baseline, Philippe, you said 50% of people at some point in their life will be diagnosed. We then talked about the article, the bi-directional one, and then the BMJ one. What about these three factors that are just going to be additive in contributing to the development of an emotional health issue on an already baseline that's above 50%? Do you want to comment on those three things? Yeah, I may comment as well back on the previous situation that reported, you know, this mental health disorder a one year long after the disease, and that's the only lag we have in terms of understanding the challenges. What would be the challenges 10 years from now? Nobody really knows. We know that the baseline wasn't that good to start with. What is the future looking like? Nobody knows, particularly because, first of all, the pandemic is not yet over, you know, it may feel like, but what's going on in the rest of the world, particularly in Asia these days, calls for a lot of, you know, let's be aware of the complexity of this evolution. So this is uncertain, and in many ways, people still carry the fear that they will be impacted in one way or another in their lives, in their work as well, with regards to the new development and the new evolution of COVID. We had this discussion before, you know, when will be the day that the World Health Organization would say the pandemic is over? Upon which criteria will they be able to say so? And I think until this day, you know, we all be living in a situation where in one way or another, some individuals may be less able to cope with this uncertainty, particularly in the context of this mass dissemination of false information. I mean, the word infodemic is, I think, extremely well coined to understand that we as healthcare professionals have a responsibility, have a duty to communicate on facts, on figures, recognize humbly that there are still many things we don't know, particularly with regards to the evolution of this disease and the mental health consequences. So we have to allege this is as professionals, you know, listening, understanding the challenges and supporting those that are more vulnerable. I think we'll see that later on. So it falls, the burden falls upon us as corporate medical directors to differentiate fact from fiction and at least reduce some of these three potentially additive contributors to more mental health within our, mental illness within our workforce. Duty of care has to be brought up here. And for those of you who don't have this concept in your mind, it's simply an organization has a responsibility to develop policies and procedures to mitigate against foreseeable risks. And you could argue that there's fiduciary, ethical, legal, commercial, depending on what part of the world you live in, but I think we all appreciate the fact there is a duty of care that organizations have to their workforce. In this particular case, we've just gone through three different peer reviewed papers that talk about the association between a COVID-19 infection and mental illness. So that means that mental illness is a foreseeable risk in that population of your workforce who gets COVID-19. So now it falls on your duty of care agenda. And in certain jurisdictions that can be very, very significant. So for example, if you have assets in Canada, in Canada, duty of care falls under the West Ray Bill, and that's under the criminal code. And it was all based on a mining accident back in the late 90s where somebody in the mine was trying to explain to the authorities that this is not safe, it's not safe, and then the mine did collapse and multiple deaths occurred. So that made its way to Parliament and Parliament made the decision that moving forward, any organization in any sector, if they don't meet their duty of care, in other words, develop policies and procedures to mitigate against foreseeable risks, they will be held criminally liable, which means they can go to jail, their brand would be ruined, they will have large fines. And in fact, that's happened. There's been several precedent cases to that effect. But that's not unique to Canada, it's a little different in the United States. What about in other jurisdictions, Philippe, for example, in the UK? You may mention the UK with the Corporate Manslaughter Act that puts the responsibility of an organization to address all duty-of-care issues in a responsible fashion. So a company, an organization, may be found guilty of corporate manslaughter if there's an obvious breach in duty-of-care. And now, with this definition, this sort of expanded definition of duty-of-care – remember, the trunk of these NCDs with mental health represents a foreseeable risk. So there's a body of evidence that demonstrates that COVID has impacted deeply the mental and emotional health of people and employees, and there's a breach in the way organizations are addressing this, at least recognizing the importance, and starting a journey to put in place measures, programs, plans to address this can be found responsible, if not so. Indeed. Number three, why should any corporation in any sector be concerned about workplace emotional wellness and not just the bottom line? If you think about it, and we talked about this yesterday, the corporate medical director has been thrust into the C-suite from previous years where he or she was relegated to a back room and managed issues that really never made it to the headlines. Today, the corporate medical director is providing strategy to the C-suite. The C-suite doesn't know what to do. All they care about at the end of the day is their numbers at the end of every quarter, but they know they can only get to those numbers if they have a healthy workforce, both physically and emotionally, and so they're turning to the corporate medical director, who needs to be, as Dr. Druckmann was saying yesterday, clairvoyant. They need to know what's happening down the road, and it's a tremendous responsibility that you all have to provide that kind of counsel. You're not always right. The science isn't always accurate, and we're basing our opinions on what we think is evidence-based medicine. Not always the case. So we walk a real fine line. So you talk about stress, anxiety, and depression. There's probably more of that in this room than I care to even think about. But if we go back to the economic standpoint of the value of an emotional illness program, Rich, do you want to talk about the direct and indirect costs? Because I'm sure you see this in your company. Absolutely. I mean, it's not just, I mean, mental health and chronic disease both have a huge impact on us, and I know you all, it's not rocket science. But we do see injuries increase with folks that have mental health complaints or have had recent access to REAP or other programs that we offer. And so at sites, they do indeed see that whether it was the stress of COVID, which we had multiple, I'm in the extractive industry, which is very, very polarized with regard to vaccinations. And so it's been very difficult. So we had people that were stressed about not being vaccinated. We had people that were stressed about having to potentially be vaccinated. And a lot of that led to a lot of stress that led to other issues at site. And it did lead to probably people staying out of work. It led to people sometimes being injured when they were thinking about other things. And so we saw that. Going back to the duty of care, what I have done, what's been great about the COVID, I've always said, there's always some good things that come out of these, and for me, especially professionally. And what it has done is it's integrated me so deeply into this company that now I do have sort of a platform to discuss the issues as we move to the next chapter. And I saw all these wellness issues that had to do with mental health. And so my folks now listen to me. I'm an office of one for a company that has 68,000 employees. I don't have anybody below me or above me. And so I was it with regard to the resource that they relied on to get their information or to reassure themselves with regard to information. And so going forward, we're in the process of developing almost a grassroots in-house wellness program to go along with our external, basically, my thought process is that we owe these folks more than a paycheck. And we're, of course, bringing in now and focusing on wellness going forward because we are seeing that to have a healthier workforce, whether it be mentally or from chronic disease standpoint, we're going to have a stronger workforce and there'll be better people, they'll be better to their families, they'll be better when they go home, and hopefully they'll be better when they work from day to day. So we very much realize wellness is going to affect the bottom line and it's the right thing to do. Do you want to add something, Philippe? Yeah, definitely. Two rich points. I think the challenge, as you mentioned, is to partner with professionals when it comes to human resources and it definitely is the combination of healthcare professionals and human resources professional within organizations that is changing the way mental health is addressed. And particularly when it comes to these indirect costs, it's pretty easy, I guess, to get an idea of the direct costs associated with mental health and emotional health disorders. But when it comes to indirect costs, assessing the weight of absenteeism, presenteeism, there's another word at this point called leaveism, where people are taking leave just to catch up with their backlog. How all of this is weighted within organizations is extremely challenging. So it's definitely the partnership established within an organization between HR, occupation health, and healthcare professionals to be able to address this and be able to put this agenda forward to the executives to say, yeah, this is how much it costs, hence plan of action. What about this particular concept? C-Suite likes to talk about return on investment all the time and this is an interesting report that came out recently with the NSC talking about a $4 return on every dollar that's invested and there's multiple publications to this effect. So clearly, clearly the implementation of an emotional wellness program has its benefits from a economic standpoint and sometimes those are the only metrics that the C-Suite wants to look at. So if in fact you're trying to sell that concept to your colleagues in the C-Suite, get some ROI literature and there's lots out there and this is just but one example of that. This particular example of ROI comes from Bell Canada and if I'm not mistaken, the CEO of Bell Canada 12 or 15 years ago was having issues with either his wife or his mother with mental illness. It was a chronic mental health condition and he found it challenging to get care. First of all, there was a limited number of therapists available in his jurisdiction and there was still a lot of stigma surrounding mental illness and we as corporate medical directors, we really have to get beyond that stigma. It's our job to set the tone. It's our job to look at mental illness just like it's another NCD, which Philippe tells me it is. So let's make no bones about it. So if we can talk openly about diabetes, why can't we talk openly about mental illness, particularly now, which in my opinion is the new pandemic. But what he decided to do with Bell was he decided to erect billboards from Newfoundland to British Columbia approximately every 10 miles and all they said was one word and it was let's talk. And that had such an impact on the Canadian mindset in every corporation, in every sector that the stigma that we still see even today in America and certainly in other jurisdictions around the world almost disappeared and it was just based on that very simple principle of let's talk, let's talk about it. And then if you want to look at metrics, look at what it did to short-term disability claims down 50%, down 20% since 2010 and the mental health relapse down 50%. When you translate that into days of lost work, it translates into millions and millions and hundreds of millions of dollars. So there's definitely examples out there that you can use to demonstrate the value of an emotional health program. All right, I'm going to shift gears a little bit here. And Rich, I'm going to start with you. You're in the mineral industry, the energy mine infrastructure industry, global assets. And when you deal with mental illness, as you said, one size doesn't fit all. Actually, Philippe said that, but you agreed. One size doesn't fit all. But in many of your jurisdictions, there is Western-derived workers and there are Aboriginal ones. In Canada, there's the First Nation. Here in America, we have our own Aboriginal populations. In Western Australia, huge populations, all of which are part of the workforce. Can you tell me a little bit about the approach that's used with a Western-derived individual to manage their mental health? And then the next slide will compare and contrast that to what you do to an Aboriginal person. In the U.S., even our sites in the U.S., what's provided is even unique to those sites because some of those sites have a different makeup of population. Some more Latino versus non-Latino. Some in states where you have different rules and governance over what can be provided with regard to telemedicine and telehealth. But we basically have allowed folks come from the outside to tell us what we should do. And we, over the years, have just said we've listened to whatever the best – you know, this is the best and what you need to do for your folks. And I think that that's not the way to go going forward, and we've allowed consultants and we've allowed insurance companies to kind of tell us how to do this and how best to do this. And what we're learning is that that's not always the best for how our folks want to do it. So for years, we've been doing this all externally. We've been getting our information externally, and now we're trying to come from the inside and sort of state, what is mental health to you, and what is wellness to you, and how do you want to best access the ability to take care of your mental wellness. It's a good segue into what I want to show next, because the next slide is a graphic which was taken from a First Nation paper that we read. And the difference in this graphic from the previous one is that in this population, they want to manage their mental illness surrounded by their elders, by the members of the community, which is very different than the Western model which was originally established in Western Australia where a lot of this basic research has been done. But Philippe, I'm going to turn to you. We just talked about Aboriginal populations and non-Aboriginal. What about in other parts of the world? What about the thoughts on, let's suppose we're someplace in Sub-Saharan Africa, for example. What do we do about trying to implement successful mental health programs in places like that? I guess it's a very important point, because to your views, Rich, you need to understand the meaning of mental health in these communities, actually. When you think of some communities in West Africa have no words for depression. That doesn't mean anything to them. But I think that there's a spirit that takes over control of individuals and lead them to unstable conditions. If you take the example of a syndrome in Japan called Akikomori, which is about individuals that do not want to leave their room for months and even years, because they don't feel appropriate to the community. In Korea, that's exactly the same. It's something different, where individuals don't feel they deserve to be part of the society because of their perception. So if you don't get to understand the way mental health is culturally displayed within these communities of employees, you missed the point. Back again, this one-size-fits-all approach is probably good enough to initiate a strategy, but you have really to understand that there will be variations from one place to another to address these inner needs and make sure that your programs, your intervention will bring the desired outcome. And it is complicated with a company like mine, because sometimes 10% of my population, say in Papua, Indonesia, is expat. So they're Australians, New Zealanders, South Africans, Americans, and they are going to want their mental health access to programs different than my indigenous or my nationals, I would say, who also are from different cultures. Because Papua is a Melanesian island, a Melanesian Christian population, the rest of Indonesia is primarily Muslim and of Malay extraction. And there's a lot of cultural, so you really have to really know your site, whether it's in the U.S., where we also have the same issues. High Latino population, high Native American population, high non-Latino or non-Latin American, and all want it differently as to how, or all treat mental illness differently. And so not knowing or understanding your people and understanding your sites especially can get you in a lot of trouble as to how you go about it going forward. Exactly. I just wanted to change gears yet again and talk about the fact that this isn't new. This idea that we're talking about is not new. I think what COVID has done to all of us is it's brought to the forefront many, many issues. And one of the issues that have been brought to the forefront is health inequity. And we hear about that a lot. But there's historically been health inequity with respect to the provision of mental health services to underprivileged populations. And as far back as 1996, the Nations for Mental Health was a WHO initiative, which got a little bit of traction. But these kinds of initiatives or campaigns require a global effort to maintain and follow up. It wasn't until 2016 where all of a sudden the World Bank got involved with the WHO, which is a good step. We now have, I don't want to call the World Bank necessarily private sector, but at least it's not per se a governmental agency. And they began a campaign called Out of the Shadows, which was making mental health a global priority. But these are kind of hit and miss. I mean, they get a lot of attention at the time. The press even gets a hold of them. But where do they really go? And how do we get impacted by any of these? Which brings me to 2021, the pledge. Philippe, do you want to explain to us what the pledge is and why this means something to you? No, definitely. As you see, we are part of this pledge because we do believe there's a way to address these mental health issues within our organizations in an adjusted way. So the pledge is about not only establishing this culture of mental health, you know, breaking the stigma, as you said before, around having the right resources, the right action plans. It's about empowering people, you know, whomever they are. It could start with the C-suite, you know, for them to understand the reality of mental health and what is expected from them as leaders, but also down to managers as employees. But it's also about putting in place programs that could be monitored, out of which some performance indicators could be established, and out of which outcomes could be evidenced. And with a sort of a plan, do, check, act strategy that we are all familiar with, you can improve your program. You can adjust it. You can turn it into more bespoke in some nations, cultures, and make it a virtual cycle of your mental health within, across your organization. And this is really the first time where we might be seeing some traction, because what we've learned, all three of us, is that when there's a little, it's like a stalk on Wall Street, when there's a little whisper, the whisper gets bigger and bigger and bigger, and all of a sudden that stalk starts to rise. When more and more corporations in more and more different sectors start to sign up to the pledge, we may find we start the momentum of a commitment globally in every sector to the provision of mental health programs, and that it is part of your duty of care. So how about notable generic strategies that we want to avoid when we're thinking about a mental health program? A lot of us are busy and we think, well, you know, we've got so many things on our plate, don't have time for that right now, this employee's knocking on my door. What wouldn't you say, Rich, if somebody knocks on your door, and these comments ring true with you? Well, what I do know is that this, in the industry that I'm in, which is a very historically masculine business, a lot of these hold true. The supervisors do, indeed, probably have problems with this issue, where they kind of say this is, you know, leave your problems at home, and so one of the things that we've started to realize is that it is up to us to make sure that our supervisors, but also the leadership, voices to folks on the ground just how important it is to not live like we used to live and act like that, you know, A, that mental health is not an issue or not a medical problem, B, that it's not a problem for our people, or C, that it's not something that you deal with. Because I do think that a lot of times what we're finding is that our workforce, doesn't matter where they are, are not voicing their concerns, and we have had some bad issues that have occurred. And so what we're trying to do now is we're making folks, not only are we doing a lot of mental health assessments during our yet regular medical fitness exams, but also during our new hiring exams, we're including it substantially in these exams, but also making folks, making the workplace aware of it so that they notice when they see their colleagues or their friends that sometimes that they live with, some of our minds are indeed fly in, fly out, where you leave your family for three or four weeks and you live in a dormitory with other guys, you work 12 hours on, 12 hours off. Some of ours are just in very remote areas where there is not very much access to psychologists or psychiatrists. Everything would be primarily done virtually, and that's okay because folks don't want to be seen walking into a psychology office. And we have to be aware of just, again, be aware of how our folks want to access mental health, but more importantly, make sure that everybody is aware that it's their duty to kind of help us to police it and treat it and continue to allow others to have access and know when we have a problem on the ground, because I'm not there everywhere, and neither is anybody else a lot of times that's an expert in these issues. Philippe, this is a graphic taken from a paper that was actually published in the JOEM by Andrew Rundle, Epidemiology in Columbia. Just walk us through very briefly what the illustration on the right indicates for business travelers that are traveling for more than 14 days a month, and this would also obviously apply to the mining industry where they're on assignment for 14 days. Philippe? Simply put, as you can see, the incidence of depression, anxiety, and stress is really correlated to the number of days spent out of home, and there's quite a linear progression to this. So it tells a lot on the importance of the balance between life and work, I guess. It's not only, if you put it in a broader scale, as you remember, it's not only these mental health issues, but also these non-communicable diseases, the prevalence of obesity, of hypertension, sleep deprivation, diabetes as well, is increasing against the same pattern. I think it's about recognizing that the workplace can be detrimental to the health in a broader definition of employees, and it's our duty, I guess, as medical directors or advisors to our executives, to recognize the potential significant negative impacts on health and find a way that is appropriate for the business, but also for employees alike. Our company right now, ironically, two of our folks, A, we're working with folks that are experts on circadian rhythm because mines don't shut down, they work 24 hours, 365, and so we've got a lot of guys that drive trucks in the middle of the night, and for years, just like emergency room doctors, people just thought, oh, you're the night guy, you're the day guy, but we've started to use experts to understand how best we can help these folks, and really a lot of it is them doing things to help themselves because they really are living, it's our night folks that are having a lot more trouble with obesity or hypertension or diabetes, and then it's the same with sleep apnea. This month, we're focusing on sleep apnea, so we are, in our grassroots internal wellness program, we're focusing on identifying sleep apnea and making sure that folks get the proper care for sleep apnea, but also understand repercussions and how to potentially address it even personally prior to it becoming a problem. So this is sleep and travel and circadian rhythm, we all know, have an impact on the overall health of these individuals, and we never thought about it before. We, I'm sorry, we in the mining industry, that was a total on the side, and these guys and girls are a lot of times unhealthy in the first place because of what a, you know, growing up in a mining community which didn't always push for positive health, but also because of sitting in a truck for 12 hours is not an easy way to keep in shape. So to your point, Rich, even the fly in, fly out, which is a very, very important part of the mining industry, it falls upon us as corporate medical directors to develop those policies and procedures, again, in the spirit of our duty of care, and perhaps our FIFO practices need to be changed if you're in the mining industry. Are there any lessons from the mental health programs in the mineral industry, and the reason I keep turning back to the mineral industry is not just because Rich is here, but because they really have set the bar in every industry sector on best practices because I think they've been hit the hardest with behavioral health issues, and many of the programs they have in place are very, very effective. Obviously this comes from Australia, mate helping mate. It's nothing more than having your workers at the same level understand, be educated on helping each other because a worker is much more likely to go to a mate than they are to a manager. So this can be extrapolated from the mines to the office space. Similarly, mental health first aid, Philippe was just telling me the other day that he was with a client and they've developed a mental health first aid advocate within the office. Well, this was something that originated in the mining space of having somebody on site who could provide mental health support. Why can't we do that in a financial office? Why can't we do that in a clothing store? Why can't we do that in any jurisdiction in any sector? Time out, another concept from the mineral industry. It's nothing more than just taking a few moments of the day to get rid of all the distractions that you have. The reason why this was developed in the mining industry, and in fact I believe it was Exxon Mobil that started this principle, was that many of the workers are operating heavy machinery, and if they've got distractions, they've got a sick child at home, they've got marital problems, they've got an addiction problem, whatever the case might be, they're distracted. They're operating heavy machinery, this is a great way to get hurt. And so time out, time out, let's take five minutes out. But we can do that in any office. We can do that right here in this room where we just clear our heads of whatever might be bothering us. This graphic I'm sure you're all very, very familiar with, particularly the blue. We see this over and over and over again. Philippe, do you want to comment on the question mark down on the bottom left-hand corner? Yeah, I guess it really brings us to the point that health is becoming a strategy to organisation. It's not only about ensuring that the physical infrastructure, the organisation, the plans work. It's about people, eventually. And we found over the years that definitely being prepared to crises coming, starting with the pandemics, but also addressing these non-communicable diseases, and now understanding that within non-communicable diseases, mental health is so important that it needs to be addressed. There must be references within these plans, and not only these crisis management plans, by the way. Mental health can be a crisis if someone is experiencing a dire situation collectively. But I guess it's also reflecting to the business continuity, the resiliency of our organisation. So making sure that at some point mental health, there's a strategy to recognise that mental health is so important. It needs to be addressed. It needs to be reported. Actions, as you said, which needs to be implemented, needs to be reported on, and need to be completely meshed with any other programme. To run a fitness programme, mental health needs to be part of it. Running a health check programme, mental health, education and awareness, all of this is intimately intricated with mental health. Definitely I think it's a call for us to make sure that eventually, within these plans, there is a space for mental health to be recognised as so important that it's part of these CMPs. And I think COVID really did put this on the forefront for a lot of people because it wasn't thought about in my industry or my company, which is a thoughtful company and it's a company that has always cared deeply about its workforce. But when you started to realise, and I started to listen to HR and health and safety, and we would start hearing these issues, I'm stressed because I've got to be at home. I don't like being at home. I'm scared that I'm going to lose my job. I'm scared I'm going to get COVID. I'm scared about the next variant. And we would hear these, and EAP use was doing this, and it was doing this because people weren't at the office every day. So finally it's at the forefront now. Everybody's talking about it. HR's talking about it. Health and safety's talking about it. Security's talking about it. The C-suite's talking about it. And that's an opportunity. Absolutely. Which is a great segue into this slide because the EAP programme, the traditional, that's a duplication, the EAPs are not adequate today. We need to be doing a lot more, and to your point, Rich, it needs to start from the top down, and all of these items that are checked on the screen in front of you are all additional efforts that could be made, of which you as corporate medical directors could take ownership and help implement those. Also consider a chief health officer. There's many organisations that don't have one, and if they don't, they should. And the reason they should is what I was talking about a few moments ago, which is the chief health officer, the chief medical officer, the corporate medical director, whatever you want to call him or her, their job is now to be strategic with the C-suite, to guide them towards productivity. And if you are in a company that doesn't have one, think about ways in which you can get one even if it's on a part-time basis. And certainly there are organisations out there, including corporate medical advisors, that have doctors that can be secured for hours at a time, 9, 12, 18, whatever you want, who can provide that guidance in those companies that don't know how to navigate through these new worlds. Without a mental health program, this is what we're looking at. I mean, this should come as no surprise to anybody. Again, it doesn't matter what sector you're in. It doesn't matter whether you're in the mineral industry or whether you're in the financial industry. Consequences of emotional illness, these all speak for themselves. These are all additive. Anybody who's emotionally ill has all of these issues around the clock that you can read on the slide in front of you. If you want to look at that from a company standpoint, Philippe had mentioned presenteeism and absenteeism. That has such an impact on the company because it means everybody else, particularly if you're in an operational platform, has to step up and fill in for those that are absent or present and not doing anything. But then to Philippe's other point, leaveism, which maybe we should put that on this slide as another box, that's impacting all of us as well. So as we're thinking about redeveloping the hybrid model of work, we've got to maintain productivity. We've got to keep people happy. We've got to remember the bottom line. There's so many issues that are coming across our desk as corporate medical directors that never before had been even on our radar. You've all seen this McKinsey quarterly report, the great attrition, the great attraction, the choice is yours. I think those corporate medical directors that are able to convince the C-suite that we need an emotional health program as an added benefit far beyond just an EAP are those corporations that are going to be able to retain their staff. Because everybody's just exiting. Many people are exiting without even having a plan anywhere to go. They've had enough. So those companies that are going to have retention are those companies that have benefits to offer for everybody. And so it's worth doing a deep dive and saying, what don't we have? What does our next-door neighbor do that we don't do? Why are they all exiting stage left? So think about what is your benefit package and re-advise your C-suite to that end. Philippe, do you want to tell us a little bit about ISO 4500 in the next minute? Yeah, no. I think to start with, the good news is that there's a norm, there's a reference, a standard that's been published last year that gives evidence on the way any organization, no matter what the size is of the organization, may address mental health as part of their responsibility. So from organization, resources, responsibility, purpose, but also actions, outcomes, performance, measurement, and improvement cycle, all of this is very clearly spelled out in this norm. So I would advise that if you are embarking into this journey, take advantage of this ISO norm that is extremely useful to address this issue, again, no matter what the size of your organization is. So it's an ISO standard. It's something you can use, as Philippe says, as a baseline from which to work, a benchmark, so to speak. Very quickly, these are three examples of three different companies that have used different strategies with respect to the ISO 45003. One of them is PHI, where they did a gap analysis based on what they were doing and what the ISO standards were, and then they just filled in the gaps and they executed. Here's another example of Mount MacDonald, who, in this case, created a one-stop solution through a digital wellness portal made available to all the workers, so a different strategy. And the third example is one you might be familiar with, this one more than I am, Philippe. SBM, yeah, definitely. I mean, a very complementary to the other strategies is about deploying professional health advisors and occupational psychologists where and where needed to support the communities in this space. You know, it's an offshore industry, making sure that people have access to support when and where needed, where they are. Right. So a third one. And there are many more, but these were just three classic examples that came to mind. We have a couple of minutes left, and I've done that deliberately. We have about four minutes if there are any questions. I want you all to ask yourselves, does your corporation have an incomplete benefits package? Think about the big exodus. Are we offering as many benefits as we can to retain our workforce? It's our duty of care. Yes, sir. Thank you. Michael Caldwell from Harry Medical College, Nashville, Tennessee. We're going to be launching Dry January USA. There's poster 542 in your swap card to look at that. I'm interested in your views of alcohol prevention as part of mental health. Has that been part of what you've been considering with the mental health of your workforce? I didn't understand the first one. Alcohol. Alcohol. Yeah. Alcohol. Absolutely. No, we, as a part of our, as I said, our yearly fitness, medical fitness exams, we discuss alcohol. It, again, going back, it is an industry that, you know, we see a lot of problems in the Australian mining sector where they are in sites where they've had a lot of issues with this. And so, yes, we, not only do we think about it, we address it and make sure that people are on a very regular base being assessed with regard to alcohol use and if they do indeed report, self-report to having issues or if we have a cause for testing secondary to an episode, we make sure that they have access to not only counselors, but also rehabilitation if need be. So, to your point, addiction, addiction is a big deal, I think, in any organization, but I think it's very significant in the mining industry, correct? It is. And you'll see that most of these mines, unfortunately, alcohol ends up being a very big part of folks when they're off that 12-hour shift. And that's why we're considering this a dry January, is perhaps a proactive campaign, just offer an educational tool to businesses. Thank you. And I think the oil and gas industry, it goes to the same thing, so, I mean, again, it comes with the territory. So, we very much think about it and we very much recognize it's a problem, a potential problem. Okay. Thank you. Thank you. Yes. Hi. Good morning and thanks for a great session. Lydia Campbell with IBM. I wanted to know, you talked a lot about a lot of concepts, which I totally agree with, but the one thing you didn't mention is about resiliency and the place or placement of resiliency and building a resilient workforce in this. So, I wonder if you could give us a quick point of view on where that might fit into this whole concept of mental health. I apologize. I didn't say, you said we didn't address something and I missed what the word was. Resiliency. Resiliency. Ah, okay. Which is... Go ahead. So, by resiliency, you mean the sort of the personal capacity to address and rebound to get your personal or your company-wide resiliency? So, I guess the answer is both, but right now, there's a big movement afoot, lots of vendors with solutions around building a resilient, more resilient workforce as a part of this whole concept of mental health well-being. That's a very good question because precisely resiliency in the US has not the same meaning that resiliency in the rest of the world, you know. So, that's my point. Now, when it comes to building individual resiliency, you know, it's really about, as you said, Rich, from induction to training to regular sessions and by coaching as well. Actually, the people not only, I think, recognize their own mental health condition, their emotional stability, the way they deal, they address issues themselves. So, I think it's about knowing oneself first before being able to address and support others as well. So, that's part of the training of some organizations where we mentioned this mental health first step, you know. In a way, it's about helping individuals recognize their own vulnerabilities without creating any stigma or breaking anything, but so that they recognize the way they address issues themselves as individuals so that they are able to help each other within the organization. I guess it's about building this individual resiliency but also strengthening the overall organization. And we've the same. I think really recognizing what is resiliency to your population because it is very different to different folks within my organization and so that's why our kind of grassroots in-house development of well-being is we're starting to learn what is it that is bothering you, what is it that allows you to keep coming to work or wanting to deal with issues the way you deal with them and that's why we're not going out and just letting a consultant tell us this is the best and this is what you got to have for your mental health or your resiliency or whatever. Because we're not Starbucks, we're not Chase Bank, we are very complicated and we are very complicated places and so we're letting them tell us what it is that they need in order to remain effective but also have happy and good lives. I got one more question and then we have to close. Yes, ma'am. Thank you. Yeah. Val Tifnan, I'm the Director of Population Health Strategy and Well-Being for a consulting company in Massachusetts and I see many companies investing a lot of resources and money with vendors to help with mental health because as you said, EAP has really failing us at this time and one thing that they are not often doing is changing their internal culture to also make sure employees are being well treated, that they have work-life balance and many other things in the culture that obviously influences mental health. So I wonder if what has been your experience on this and what some companies are doing to change that internal culture also to support mental health? Well, I think from our standpoint, we're now realizing that health is not all about just physical health and therefore but then mental health is not just about physical health or mental health and we're dealing with financial health, we're dealing with emotional health, we're dealing with educational health, we're dealing with cultural health, we're dealing with domestic health amongst families and a lot of – my company alone, we own three whole cities. We own a whole town where we own every church, we own every building, we have these old company towns that used to be where there are not very many of these left but we still have three of them. So we have to think about not only the employee but also the dependent which is a child or a female or a male, they've got other issues and so it really is realizing that there's a lot that goes into wellness and there's a lot that goes into mental health and it's not all about just what is in the brain. All right, I'm going to say thank you for that question. Going back to what you had said earlier, Rich, it starts from the top down to change the culture and I'm going to leave you with one last thought. You said work-life balance, maybe we should be looking at the other way, life-work balance and I think if we start focusing on people's lives and letting them tell us what's going to make them happy in their life and then we make work around that, we might have less attrition. Again, I thank the college for the opportunity to speak. I know there's some online questions and I apologize that we've run late. I would ask that the college forward those questions to us, we'll be happy to answer those offline. Thank you very much for your attention.

mental health

workplace

COVID-19

strategies

doctors

prognosis

cultural differences

emotional wellness programs

resiliency

ISO 45003 guidelines