Workplace Prevention in Practice Pt.1: Shifting Workplace from Reaction to Care
In this first episode, Professor Goodman Sibeko sits down with Professor Nadine Harker to unpack what it really means for a workplace to take prevention seriously. Together, they explore how organisations can move beyond awareness campaigns to build genuine, prevention-oriented cultures.
Professor Harker reflects on the shift from traditional workplace wellness models to a broader public health approach, one that views the workplace as part of a wider ecosystem and emphasises shared responsibility across leadership levels. She discusses how stigma continues to shape responses to mental health and substance use, and why visible, informed leadership is critical to changing that.
The discussion highlights how consistent policy, management engagement, and everyday practices can embed prevention into organisational life, making wellbeing a core part of how workplaces operate.
Featured Voices
Host – A/Prof. Goodman Sibeko
ISSUP Global Scientific Advisor.
Head of Addiction Psychiatry, University of Cape Town.
LinkedIn: goodmansibeko
Twitter/X: @profgsibeko
Guest – A/Prof. Nadine Harker
Specialist Scientist in the Alcohol, Tobacco and other Drug Research Unit of the South African Medical Research Council.
Time Stamps
A/Prof. Goodman Sibeko (00:00)
Thank you for joining us for the introductory session of meeting Dr. Harker So as a follow on in this particular episode with Dr. Harker, we're going to focus on strategies to foster organisational norms, policies and leadership that prioritises mental health and substance use prevention. Thanks again to Dr. Harker for joining us. Dr. Harker, what does a culture of prevention look like in practice?
A/Prof. Nadine Harker (00:24)
Dr. Goodman, I think what we need to do when we seek to answer that question around the culture is what has historically happened within workplaces? And I think what I want to emphasise is that there's been a paradigm shift in how companies now address substance use and mental health in the workplace, as opposed to how they've done that, let's say, 25, 30 years ago. There has really been a concerted effort to move towards a public health approach as it pertains to workers' health. I'm suggesting that any kind of prevention or health promotion that operates within an organisational setting needs to include not just the workplace and those that are employed within the workplace, but also workers, families and the communities within which they live. Simply because we know and understand now that the workplace mirrors what happens within a community. And people that live, work within an organisation live in a community. So the narrow shift of just looking at employers within your sphere of influence has sort of changed over the last couple of years. Very often in the past, there was just a focus on work-related health issues. So whether you can fly the aeroplane and you are visually able to do that, to now include other health determinants beyond that. And that has evolved over the last couple of years. Traditionally, there was also just a focus.
And perhaps the work setting was like that at the time. You have people that are employed permanently within your organisation, but the global world has evolved. So you have informal workers, you have contract workers that come in and out of the organisation. And that the idea of prevention, not just extend to those that you pay on a monthly basis, but also those that you contract in to do some work from time to time. And the other was that I've also seen change over time is for instance, things around employees responsibility, that in fact, that health responsibility does not just rely or lie with employers, but also with stakeholders.
And by stakeholders, I would mean that it's also now become the business of occupational health practitioners, the issue around substance use and mental health, but also trade unions, which are also often left behind out of the conversation. And that right now versus 25 years ago, health promotion prevention has become to a certain degree a non-negotiable.
It's enshrined in a duty to care approach, which the international labour organisations subscribe to. And the principle of moving from a traditional labour approach to a public health approach sort of rests on that duty to care principle.
A/Prof. Goodman Sibeko (03:36)
That's great Nadine. So what you're really suggesting is that one has to be mindful of where we're coming from and understand the limitations that that's placed on our concept of what workplace wellness looks like in general. And particularly as it applies to substance use disorder. Specifically, you know, I enjoyed that you framed the extension of the workplace as an extension of society, of community, of where we're coming from.
Keeping that in mind, how in your view can managers and human resource leaders model healthy behaviours and nurture a supportive, healthy workplace?
A/Prof. Nadine Harker (04:11)
With all organisations, and you're right, it starts with the top down. And one of the challenge has always been that mental health and substance use is very stigmatised. It is not as palatable to managers organisational leaders as for instance, diabetes or cancer is. One of the things that we have often said is that organisations need to develop a strategic prevention framework substance use and mental health in their organisation. But to do that, you first of all would presumably need a very bushy-tailed leader at the top who already has an around substance use and mental health issues and has already perhaps dealt with misconceptions around these things so that it filters down almost a leadership ripple effect as needed. We often say that organisations, you need to generally do your needs assessment and build capacity. And build capacity is exactly where the leadership comes in.
Because when you introduce substance use and mental health prevention programs, uppermost should always be universal application of these and workplace consultation. It cannot be done at the top in an office and just faulted down because this is an issue that affects people and employees need to have a hand in those.
So the universal application of it is almost paramount. Again, the focus has always been on the employee that uses, but never the executive that goes on business trips and drinks alcohol and is intoxicated the next day. It's almost more acceptable or considered acceptable.
in that way as opposed to the ordinary labourer that comes in the morning and may be intoxicated, the application of certain things is not the same. So one of the is obviously around universal application, workplace consultation and training. Training is underscored a lot of the time and this is from my experience working in that sector. When training comes or happens, it generally hits the lower level worker. That is the supervisor level and doesn't always extend to the manager or the executive management level. And in order to affect change, you would need all of those levels to be on the same path and to embrace the idea or the notion or the concept or the plan of becoming intentional about integrating prevention into the program. Things like visible leadership is underscored and highlighted always because if a consistently and leadership, I'm speaking the higher echelons of every organisation, constantly communicate the importance of mental health and substance use disorders, they are becoming wellness champions. That already is a quarter of the way into having a successful program running within your organisation.
A/Prof. Goodman Sibeko (07:34)
Thanks Nadine. You know your reflection about universal application and ensuring that capacity building and up-skilling is across the levels of leadership. So going all the way from the employee to the most senior manager really, I think has actually answered my next question, which was going to be about how do we deal with stigma? And when you talk about these interventions, you're also talking about really impactfully increasing accessibility. But really importantly is that
component of having a leader who has good knowledge of substance use and mental health considerations and the public health focus that the workplace should be oriented around. What are the implications for specific trainings? So does it mean everyone in the organisation should have the same training? Does it mean there needs to be differentiated training? What in your experience would be the advice there?
A/Prof. Nadine Harker (08:22)
So every organisation, and I must say the large corporates, would normally have a workplace or substance use policy in place. The smaller to medium enterprises, they perhaps struggle, and there's obviously a gap there. But the policies are a critical component of how this would manifest in the organisation.
Policies, I often when I used to do this training and even now when I lecture on it, on substance use in the workplace, I can't overemphasise the importance of having a policy for two specific reasons. So the policy naturally as policies would do, would address risk factors in the organisation. So it would look at what are the issues, is there exposure, is there substance use, et cetera, and map out a way to deal with that. But in another sense, if you look at the flip side of it, the policy will also have a protective factor element in it, in that if a policy indicates that all managers should at least have a one-hour session, on mental health and substance use and how to address it within the certain levels, that already starts acting as a protective factor for employees because managers would understand that there are so many factors that would drive things like tardiness, poor productivity, accidents, et cetera.
This policy would also look at, would also incorporate and address things like social influences. So for instance, a policy could be strongly rooted in encouraging things like teamwork, because we know teamwork group cohesion is a protective factor against substance use. So if a prevention framework, is centred and a policy centred around promoting these. Yes, the policy will say if you use substances at work, there will be sanctions. But equally, the policy will say, if you happen to be in that boat, this is how we can assist you. And that is a narrative that the leaders in the organisation would need to do and obviously be exposed to the training they're in.
It allows you to look at the workplace environment as well within the policy and how to address the risk factors and the protective factors. And that is in essence, think everything would ride on first, leadership, visible leadership, getting the messaging, having your proper policy in place that takes into consideration all of these finer nuances, including making accommodation for training at each tier of the organisation. What the executive gets trained on is not necessarily what the supervisor would get trained on. The supervisor would get trained on specifics, for instance, how to pick up if something is amiss with an employee, whereas an executive has the powers to make decisions as to whether there is a bar at the workplace that staff can access after work hours to have a quick drink. Executives, including other tiers, can have an influence on the culture of the organisation. So if there are functions that are big functions, we will not be selling or providing more than one glass of alcohol, for instance, or they may have a zero tolerance policy or what the case may be. But you can only get to that point in the policy once there's a mutual understanding of the harms and the potential negative impacts on employees. I'm not sure if that was clear.
A/Prof. Goodman Sibeko (12:14)
It was Nadine, thank you so much. So in this first session, you've really given us an idea of the importance of considering the workplaces and extension of the home space of society. You've given us a sense of the importance of differentiating training levels based on, you know, aligned with the roles of each executive within an organisation. And you've really spoken to us about universal application. Towards the end, you also mentioned some of the features that some managers might pick up that might allude to the fact that there might be some challenges with substance use. And that's actually going to be the topic for our next session. So Nadine, thank you so much for joining us for this episode. For our next episode where we are actually going to be diving much further into the considerations for early identification and support. Thanks, Nadine.
A/Prof. Nadine Harker (13:04)
Thank you.
A/Prof. Goodman Sibeko (13:23)
Thank you for spending this time with us. We hope you enjoy that as much as we do. Be sure to hop on over to our website, isop.net, where you'll find information on how to sign up for free membership. Take care and catch you on the next one.
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The ISSUP Exchange podcast series explores the evolution of responses to the challenges of substance use—from research and training to ethics, quality standards and evidence-based practice. We connect the dots so you can see the big picture.
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