Workplace Prevention in Practice Pt.2: Early Identification and Support in the Workplace

In this third episode, Associate Professor Goodman Sibeko and Associate Professor Nadine Harker discuss how workplaces can identify early signs of substance use and mental health challenges among employees, and respond appropriately before issues escalate.

Prof. Harker explains the occupational factors that increase risk, the visible and behavioural cues supervisors should look out for, and the importance of distinguishing between informal and formal referrals. She outlines how supervisors can express concern, make soft referrals to employee wellness or HR, and when formal action becomes necessary.

The discussion also covers how consistent health promotion, supportive policies, and structured employee assistance programmes can help organisations address problems early, reduce stigma, and maintain both compassion and productivity.

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)
Welcome back to the second episode with Dr. Nadine Harker. Nadine, thank you for coming back and joining us for this session. This time we're really going to be looking at what it means to equip the workplace to recognise the early signs of substance use or mental health concerns and how to then respond effectively. So Nadine, what are some of the early signs of problematic substance use or distress that we should be mindful of in employees?

A/Prof. Nadine Harker (00:24)
Thanks, Goodman. So one of the things that I think I should perhaps raise at this point is occupational influences. So occupations are we particularly worried about? And at the top would be safety-sensitive occupations when it comes to looking out for. Safety-sensitive occupations are those that have a risk component to it.
For example, those that work in the police services, those that work in the ambulance, fire ambulance, emergency services, workplaces, those that work shifts or work at nights, they would be at risk. Those that travel away from home and work remotely, research has suggested that those occupations in telecommunications, believe it or not, specifically in regions such as Asia. They generate a lot of stress. Business executives, high stress environment. So there are certain jobs that one needs to consider and be particularly vigilant about those that work on harbours that deal with the crates coming off, or a simple example would be the person that navigates those massive containers of ships onto the ground in a harbour. Those are safety-sensitive type jobs. And an organisation would need to try and pick themselves into either of those categories. 
Because If you have that kind of position or you work night, we know that you are at risk of developing substance use or alcohol use problems. So what would manifest could be a variety of things. And it's normally put down to the person who isn't productive. Sometimes the person is just not productive. But in other instances, there are other factors that perhaps stem from occupational influences, but also perhaps stem from the individual, just the individual generally, their makeup, maybe there's a predisposition to substances. But what will be picked up at work is things like physical changes to the individual. That a supervisor that has direct contact with an employee would need to look out for, things like bloodshot eyes, runny nose.

Just a general difference in the person's appearance. Very often, behavioural changes are noted. So specifically around absenteeism or So absenteeism especially if you know your employees really well and you know their habits. Presenteeism has also been flagged and that is where you are at work, but you are not there because you are preoccupied with perhaps something that's happening at home. Maybe it's substance use, maybe it's mental health issues, maybe it's other family related concerns, secretive behaviour. Obviously the usual subject, suspects like misdeadlines, judgment areas, not packaging something as it should.

And then of course, there's smells, especially with alcohol, people pick up smells and that happens commonly. People smell of alcohol, mental health, obviously difficulty concentrating, sometimes forgetfulness and confusion and changes in mood, et cetera. And very often one jumps to the person doesn't want to work or so forth, but very often there could be these things that are sitting there, but it's also in the context of occupational, potential occupational influences.

A/Prof. Goodman Sibeko (04:06)
Nadine, a lot of the time how someone presents, as you've alluded to already, the workplace, can often be put down to external experience. So we don't want to ask too many personal questions. And it's not contextualised necessarily as something that can be addressed in the workplace. So it's this idea of separating role and context. So how do we go about training staff to respond appropriately without overstepping, without feeling like they're breaking that barrier, that separation?

A/Prof. Nadine Harker (04:39)
So, and this is probably going into full on training on how to address these issues in the workplace, but supervisors would be trained to not be counsellors. And I think one of the pitfalls very often is as a supervisor, you notice all of what I've said, you notice it as a supervisor, it's clear as daylight.

It's difficult for you as a supervisor to address it because it's not what you are supposed to do. The role of a supervisor is to manage work. But by engaging in an informal discussion with the employee, saying to an employee that I have noticed some of these things in your work, tardiness, deadlines that are being missed.

The spark plugs that you generated last week, they are not up to standard. I get the impression that there's something off with you, a concern. And if so, I would like to suggest that you reach out. And this is a second element that should be within a policy of an organisation and should be existing. I would like for you to go and speak to the employee wellness division or to HR in the event that you are having problems. And because I, as a supervisor, cannot help you, I'd like to refer you to an individual that is at the informal level. This is nowhere near a formal referral or disciplinary referral. This is acknowledging that this used to be a star employee. Clearly, something is amiss. What can I do to help?

And as a supervisor and the organisation policy says, we have a duty to care. This is how I care without going into a counselling session about whatever your ailment is, because that begins to blur lines. Does that clear it up for you?

A/Prof. Goodman Sibeko (06:37)
It really does.

It's really for me, saying we need to make sure that staff and management who oversee specific staff are capacitated to provide safe informal discussion space for informal discussions and to be able to then provide that soft referral. So it then speaks to wanting to make sure that the organisation does have policies and referral pathways in place for those soft referrals.

A/Prof. Nadine Harker (07:05)
And that should rest within the policy that we initially spoke should be clear in what is available for that employee. And if in the event that a supervisor notices that three months down the line you've done the soft referral, nothing has really changed, you can then initiate a formal referral, which is the next step before a disciplinary hearing. But with substance use specifically, less so with mental health, what employers do is they immediately embark on a disciplinary process. And we have to acknowledge, Prof Goodman that as you and I sit, and as Kwadwo and all of us sit in this session right now, we are all employees, perhaps. We all have a life. We all have challenges.

We all have problems that may impact us from time to time and take 10 minutes away from our job. But that can be managed without going through harsh penalties, which has happened traditionally before the workplace setting has evolved over time.

A/Prof. Goodman Sibeko (08:13)
So Nadine, what are the most effective support models that are available for the workplace and how should these feed into a formal referral? We just spoke now about a soft referral. So the formal referral being the next step, how do these feed into this?

A/Prof. Nadine Harker (08:30)
If I could categorise it this way, first of all, if an organisation has health promotion activities, prevention activities that happen constantly, consistently that are not ad hoc, immediately what happens is it sensitises the workplace to substance use and mental health issues. People begin to understand that these services are available and they could reach out to it.

And that could even be before an informal referral by a supervisor. There's also another component that I'll speak to a little bit later when we touch on other strategies. But that would be the first would be these promotion, these health campaigns that sensitises, destigmatizes everybody. Once the informal referral happens, the policy that exists within the organisation should make recommendation for employee assistance or wellness programs that exist either within the space of organisation or externally. So that would be, as me as the supervisor, gently referring you to go and speak to someone because I'm noticing as a supervisor that something is off. If there is no change.
The supervisor does, because remember an organisation is about productivity. We cannot escape that reality. The supervisor can make a formal referral to the employee wellness program. And this is where you set the employee down and say, we recognise that you have, there's something amiss. It's not my business to understand what it is amiss unless it's work related.

I am now formally referring you to an employee wellness practitioner to help you deal with the issues and concerns that you have. Unfortunately, if there is no change, the next process, and this varies from country to country, but in South Africa, it would happen within a disciplinary, it would move into the disciplinary space. But the idea of SOFT is to show that we recognise people have challenges. We recognise that there are other play or that come into play. And let's address that before we move into the disciplinary space. And the policy would recognise that. The policy would clearly stipulate how that happens for persons either with a substance use or mental health issue.
And then disciplinary processes would run.

A/Prof. Goodman Sibeko (11:06)
Is disciplinary process the next step for an employee who declines help? What do we do with an employee who doesn't want to be helped?

A/Prof. Nadine Harker (11:13)
Unfortunately, if an employee does not want to be helped, the organisation would then take it and productivity continues to be a problem. The organisation would have to go through a disciplinary process. And sometimes within a disciplinary process, there's still recourse in that the employee can still be formally sanctioned as not that you are dismissed, but that you are being referred to a treatment facility, for example, for an alcohol problem. Because this is what has emerged out of a need or a direction from the EWP or the employee wellness section.

A/Prof. Goodman Sibeko (11:53)
Nadine, it sounds to me that what you're suggesting is that now we're talking about what are the internal policies of the organisation that would then govern how we manage individuals in this case. And that happens to be the topic for our next podcast. So Nadine, thank you so much for joining us for this particular episode and for sharing your expertise. Colleagues, please join us again for the next episode where, as we've alluded, we're going to be looking at policy, compliance, and ethical practice.

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.

About the ISSUP Exchange 

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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About ISSUP 

ISSUP is a global network that unites, connects, and shares knowledge across the substance use prevention, treatment, and recovery support workforce. Our mission is to make our members’ work as effective as possible—by providing access to training, resources, and a vibrant professional community.