FIFO, FIFO, and off to work we woe

Contrary to the stereotype, remote mining and construction workers in Australia experience high levels of psychological distress

The usual stereotype of those who work in mining and construction in remote parts of Australia is a blokey male; easy-going, stoic, practical, denying any worries (“No problems, mate!”, “Too easy!”) and dismissing anxiety and depression as something for wusses. A Jimmy Barnes-style Working Class Man with blue denim in his veins, who ain’t worried about tomorrow and takes one day at a time. But the reality is different! Firstly, not all these workers are men. More importantly, as reported by Bowers and her co-authors in this issue of the MJA,1 remote workers have a markedly higher level of psychological distress than the general Australian population.

The Kessler Psychological Distress Scale questionnaire (K10) was the principal measure used by Bowers and colleagues to quantify psychological distress in these workers. Comparator group data were drawn from the Australian Bureau of Statistics (ABS) 2015 National Health Survey. The broad age range of the ABS sample risks finding a higher overall psychological distress score for the sampled group than if a subgroup, controlled for age, sex, and other potentially salient variables, had been selected. The authors found that 27.8% of their sample of remote workers had K10 scores in the “high” or “very high distress” categories, compared with 10.8% for the general population (although Table 7.3 in the published ABS data2 indicates a marginally higher rate of 11.7%). Despite this minor caveat, we can accept the authors’ general conclusion that levels of psychological distress were higher in their sample of remote workers than in the general population. The choice of other control groups (eg, other shift workers) might have clarified whether the participants differed in unique manner, or were distressed to a similar degree as other young adults facing financial and other stressors while performing demanding work and being dislocated from their families.

How can these findings be explained? Two broad and not necessarily mutually exclusive hypotheses3 are worth considering. Firstly, that the data reflect a “social drift” model, whereby those who have psychological problems experience a downward spiral in their occupational capacity, and consequently “migrate” to such positions out of need. Secondly, that they fit a “breeder model”, whereby environmental factors — work circumstances, lack of social cohesion, being geographically dislocated — generate psychological distress.

Box 3 in the article by Bowers and colleagues provides a rich set of family-, work- and lifestyle-related factors reported by participants, but Boxes 4 and 5 are more useful for identifying potential causal factors, as they examine the impact of those variables on psychological distress levels. Social drift variables with the greatest impact were being 25–34-years old, being separated from partners, the relationship with any partner being problematic, having two or more children, and having financial problems. Regrettably, no data on drug and alcohol use were sought.

“Breeder” variables with the greatest impact were being engaged in construction work rather than underground mining, being on a two weeks on/one week off roster, having difficulties with the immediate supervisor, and the remoteness of the work base.

The authors note that the workers who nominated the stigmatisation of mental health problems as stressful were at “the greatest risk of high/very high psychological distress.” Is the association tautological? Are those who evidence or disclose their distress stigmatised as a consequence? Do those who judge mental health problems as stigmatising fail to disclose their psychological distress and are therefore disposed to greater distress as they unable to discuss their problems with others? Or is the association a reflection of a higher order variable (eg, higher levels of neuroticism) leading to two independent outcomes (psychological distress and judging mental health sufferers as stigmatised), thus generating a spurious association?

How important are these findings? Firstly, while challenging the stereotype of the resilient frontier worker, the authors suggest that high rates of psychological distress have been quantified in other studies of FIFO (fly in-fly out) workers, so that the macro findings are not entirely new, albeit not widely recognised. Secondly, the authors seek to enrich their main finding with a more specific analysis of likely determinants. Their findings support the relevance of both social drift and breeder models, but the study design and analyses fail to determine the most salient or dominant model. This might have been clarified to some degree had the respondents completed a K10 assessment prior to their taking up remote work; high scores both pre- and post-employment would favour the drift model, while lower pre-employment scores would support the breeder model. Again, however, we might suspect that both models apply.

The study nevertheless provides a vignette of life in a remote work location. While most adults of similar age are enjoying a young family and family life, remote workers are instead more likely to have difficult relationships with their partners, be separated from their children, experience financial problems, and either seeking to “get away from it all” or needing to take such a job in order to financially maintain their home base. And on top of all this, whatever their reasons for working in a remote region, they also feel stressed by their job and their supervisors.

Bowers and her co-authors recommend that their findings should inform health and safety policy and practice, inviting the question as to how employers might best handle workers who have formal mental health problems or are clearly experiencing significant distress. Pre-employment screening of psychological distress is unlikely to be useful, as applicants would simply deny such problems. Post-employment facilities providing confidential, “outside in” professional support are clearly favoured. In addition, having designated senior workers supervise large men’s sheds would provide “inside out” and peer support (with the strong meta-communication that “we are all in this together”) for the Barnesian men (and women) who work so hard to make a living in remote Australia.