Are we taking care of the carers?
Carers and support workers in disability and aged care are crucial but survey research suggest their working conditions are taking a mental toll
A new survey analysis of the psychological working environment in Australia’s health sector points to a sharp divide between the poorer conditions faced by disability and aged care support workers, and the largely professional healthcare workforce of doctors and nurses.
It finds that carers and support workers are more likely to be exposed to a higher number of potential job stressors – like high demands, lack of control, job insecurity and perceived unfairness of pay. At the same time carers and support workers are more vulnerable to these stressors, which are associated with a deterioration in their mental health.
In addition to those employed in the disability and aged care sector, other workers in this group include social workers and health and welfare support workers.
Lead author of the study, Associate Professor Allison Milner from the Melbourne School of Global and Population Health at the University of Melbourne, says the results are a wake-up call for policy makers, particularly given the continued roll out of the National Disability Insurance Scheme and Australia’s ageing population.
In the ten years to 2016, the number of people working as carers, aides and support workers increased by 34 per cent, according to Census data, and the workforce is overwhelmingly female. Some 500,000 women were employed in the sector compared to less than 100,000 men.
“Carers and support workers are an increasingly important workforce, and we know that these workers have disproportionately lower levels of education and income, are more likely to be female and are exposed to poorer working conditions,” says Associate Professor Milner. “Our study suggests that these poorer conditions are associated with declines in mental health.”
“This is seriously problematic going forward because we know people who are stressed or are mentally unwell, are more likely to leave their job, be absent sick, or be unfocused at work. In addition to the negative effects on an individual worker, clients may not be getting the care they should be getting.”
Indeed, previous research has found that poor wellbeing among healthcare workers was significantly associated with poorer patient safety.
The study with co-researchers Dr Tania King and Professor Anne Kavanagh, is based on data from the Household and Labour Dynamics in Australia (HILDA) Survey that tracks the lives of some 17,000 Australians annually, and is carried out by the Melbourne Institute at the University of Melbourne. HILDA includes a mental health survey – the Mental Health Inventory (MHI-5) – that provides an indication of depressive and anxiety symptoms.
Published in the journal Preventive Medicine Reports, the study found that among carers and support workers, nearly 9 per cent reported three or more potential stressors, but among healthcare workers the proportion was just 5.2 per cent.
There was a drop of over 4 points on the MHI-5 among carers and support workers when they were exposed to three or more potential stressors. This is significant because a 4-point drop is indicative of clinical symptoms of anxiety or depression.
In comparison, the reporting of three or more potential stressors among healthcare workers was associated with a 3.5 point decline.
Associate Professor Milner acknowledges that the relationship between job stressors and mental health is also a significant problem in healthcare workers, as highlighted in previous studies. However, she argues, there has been less attention on the disability and aged care workforce.
“Our results suggest that carers and support workers as a group are particularly vulnerable, possibly because of a range of factors. They may not have the resources that can buffer their mental health that say a doctor might have in terms of higher education, higher income and a greater degree of control over their lives,” says Associate Professor Milner.
In particular, she says the data suggests that concern over the continuity of work maybe a significant stressor for carers and support workers. In the HILDA data, some 26 per cent of people who identified as carers or support workers were employed as casuals, compared with just 11.5 of healthcare workers.
Associate Professor Milner says the survey analysis highlights the importance of considering and monitoring how the continued rollout of the NDIS may influence working conditions going forward. The NDIS is a government initiative that provides funding for people living with a permanent or significant disability to finance support from their choice of provider.
“One of the many good things about the NDIS is that it will give people with disabilities more choice and control over their lives, but in doing that we need to be careful that this flexibility doesn’t have unintended and negative effects on the workforce around people with disabilities,” says Associate Professor Milner.
“If we can improve working conditions for this important and growing workforce and by doing so protect their mental health, then it could have far reaching consequences, not only in terms of improving their own health, but in ensuring the high-quality care we want for the people that need it.”
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