Background
The Australian mining industry currently employs approximately 278,800 people (ABS, 2021). The workforce is largely comprised of middle-aged males (ABS, 2021). While some mining workers are based in major cities, a substantial number of mining workers are based on-site, in and around “mining boomtowns” in regional and rural areas of the country (ABS, 2000). These employees generally work on a fly-in-fly-out (FIFO) basis, working configurations such as 9 days on-site and 5 days at home, or 28 days on-site and 7 days at home, and variations in between. The Australian mining sector is a billion-dollar industry and despite the Covid-19 pandemic, it is an industry that has continued to grow (ABS, 2021). While it is a sector that generates significant employment and economic benefits, it is also an industry rife with mental illness.
Mental Health and FIFO Work
The Mates-In-Mining suicide prevention group revealed that suicide rates are 80% higher in the mining, construction and energy sectors than in the general Australian population, with 190 deaths by suicide reported each year. Research indicates that levels of psychological distress are three times higher among remote mining workers compared to the rest of the Australian population (Bowers et al., 2018; WA Mental Health Commission, 2018). Research also shows that over a third of FIFO workers have been found to experience depression, anxiety or stress above the clinical cutoff levels, with 10% experiencing a combination of depression, anxiety and stress (Vojnovic & Bahn, 2015).
The on-off rosters for FIFO workers appear to contribute to the high levels of psychological distress among the group. FIFO workers have reported that it is difficult to adjust to being on-site and it is also difficult to return home (Gardner et al., 2018). They report distress stemming from missing special events at home, relationship issues, shift rosters and social isolation (Bowers et al., 2018). FIFO workers report that the nature of their work leads to disruptions in social activities and family dynamics (Torkington et al., 2011). FIFO workers reported isolation to be a significant issue, manifesting in multiple forms including isolation from their peers, from their management, and from their families (Colquhoun et al., 2016).
The nature of FIFO work appears to lend itself to both employees and their family members engaging in unhealthy lifestyle choices and unhealthy coping strategies. FIFO workers have been found to be more likely to use drugs, smoke, drink at risky levels and be overweight than non-FIFO workers (Joyce et al., 2013; WA Mental Health Commission, 2018). FIFO workers and their partners also reported having poorer sleep quality, eating less nutritiously, and needing to take more physical health medication on workdays compared to non-work days (Rebar et al., 2018).
FIFO workers are less likely to report mental health problems compared with other workers (Joyce et al., 2013). This is likely due to the stigmatisation of mental health that exists in the industry (Bowers et al., 2018). Research indicates that FIFO workers experience issues with communication and trust (Colquhoun et al., 2016), and have reported a reluctance about accessing formal supports (Torkington et al., 2011). A recent inquiry into the 50,000 FIFO workers in the Pilbara region of Western Australia found that phrases such as “suck it up princess”, “harden up”, and “if you can’t hack it there are 300 people waiting to replace you” are commonly used.
It is evident that the nature of FIFO work is one that is not conducive to positive mental health and wellbeing. This is compounded by the demographics of the workforce and the location of the mines. 80% of mining workers are male, with a median age of 41 years. Data from the Australian Institute of Health and Welfare shows that suicide rates are consistently 3-4 times higher over time for males compared to females (AIHW, 2021). The data also reveals that people in the 30-44 age group are amongst the highest age brackets for dying from suicide (AIHW, 2021). The Australian Institute of Health and Wellbeing (2021) also report that regional, remote and rural areas of Australia have higher rates of mental illness and suicide compared to major cities. In fact, the age-standardised rates of suicide increase in line with increased remoteness, and have increased steadily over time for all areas except for major cities (AIHW, 2021).
Recommendations and Available Support
The findings from the research, the demographics of the workforce and the geography of mining communities indicate that mental health interventions are needed in the mining industry. The Lifeline Report into FIFO work in Western Australia has recommended that there needs to be increased help-seeking behaviour, targeted supports, pre-employment services that inform people what to expect from FIFO work, and post-employment services that address mental health and coping. The City of Karratha Inquiry recommended that support services be made available to FIFO workers and their families in the source and host communities, that telecommunications are improved, and that the “macho culture” is changed. The Parliamentary Report into FIFO work in regional Queensland made several recommendations including the implementation of roster standards, protection for workers experiencing mental health issues, better access to health services, and access to independent mental health services. The Western Australia Parliament Inquiry into FIFO work put forth a number of recommendations such as addressing the stigma with mental health, promoting a broad range of support services, providing reliable communication options, implementing initiatives that support FIFO partners, and implementing interventions to enable FIFO workers to thrive.
Despite the recommendations, resources are limited for FIFO workers and mining communities. The Lifeline Report into FIFO work in WA found that 1 in 5 workers didn’t have access to on-site mental health facilities, and 1 in 10 did not have access to an Employee Assistance Program. According to the Australian Institute of Health and Welfare’s data on mental health services in Australia, 8 in 10 psychologists, 9 in 10 psychiatrists, and 3-quarters of mental health nurses work solely in major cities, leaving a very small percentage of workers in those fields available to work in the regional and remote areas where the need is significantly greater.
There has been some traction in the provision of support to remote workers with programs such as FIFOFOCUS, Health-e-mines, Mates in Mining and Resource Minds. Resource Minds provides information on mental health and suicide prevention to mining workers, FIFOFOCUS offers online courses, counselling and coaching from mental health professionals, Health-e-mines provides self-help tools, fact sheets, and confidential intensive programs addressing substance use and mental health issues, and Mates in Mining provides General Awareness Training, suicide prevention training, and case management. Findings from the feasibility and accessibility evaluation of the Mates in Mining program reveal significant improvements in self-reported confidence in identifying workmates with mental ill-health, ways to get support, the ability to have a conversation with a workmate about mental health, and the perception of their workplace as being mentally healthy for the intervention group (Tynan et al., 2018). While there is some movement on the provision of counselling services and mental health training among FIFO workers, more work is needed to assist this population.
The Potential for TMS and tDCS
There is no doubt that increased telehealth services and on-site training will benefit FIFO workers and the mining industry. However further avenues for mental health treatment and support must be pursued. To our knowledge, there are currently no neurostimulation treatments available specifically for FIFO mining workers. Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are noninvasive neurostimulation treatments that stimulate pathways of the brain involved with mood regulation. Both TMS and tDCS have been found to be effective in treating depressive symptoms (Bennabi & Haffen, 2018; Bozzay et al., 2020). TMS and tDCS have also been found to be effective in increasing emotional awareness (Ando et al., 2021). Additionally, TMS can be effective in reducing suicidality (Bozzay et al., 2020; Godi et al., 2021).
Given the evidence base, TMS and tDCS have a role in treating mental illness among FIFO workers. Both modalities would provide treatment that is external to the industry, meeting the recommendation of the Queensland Parliamentary Report to provide independent mental health services for FIFO workers. The rosters of FIFO are conducive to the usage of both of these treatments, as TMS treatment needs to be administered in a clinic and tDCS can be used at home. Combining the TMS and tDCS treatments would provide FIFO workers with a treatment they could access both when on-site and when at home.
Conclusion
Clearly, more support and services need to be made accessible to FIFO workers and their families. The rostering, stigma, lack of support, and demographics are all factors equating to a workforce that is at a high risk of mental illness and suicide. While some training and programs exist, much more needs to be done. Increasing access to counselling services for both workers and family members is essential, as well as implementing novel therapies. Neurostimulation treatments such as TMS and tDCS are novel therapies that could provide an option for addressing mental health issues and suicidality among this workforce.
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References
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