The recently published (June 2021) new global standard for psychological health and safety in the workplace aims to provide clear guidance to employers on managing mental health at work. Whilst it is a voluntary standard to implement it will help organisations to ensure that they are complying with legislation. This new standard “is intended to be used together with ISO 45001, which contains requirements and guidance on planning, implementing, reviewing, evaluating, and improving an OH&S management system (and) highlights that the organization is responsible for the OH&S of workers and… (this) includes promoting and protecting their physical and psychological health”.
There are ten sections within the standard, the first three of which are shorter, give context and define the scope, references, terms and definitions found within the standard. The statement in section 3.2 stands out as it states that “wellbeing at work can also contribute to the quality of life outside of work”. This is important as it confirms the importance of good work as a health outcome that if not well managed can have a personal and societal cost.
Sections four and five focuses on pre-planning and offers a detailed checklist to consider in order to gain a thorough understanding of the organisation prior to section six, the planning stage. The stand-out in section 5 refers to it being essential that there is worker “consultation and participation” in order to develop, plan, implement, maintain, evaluate, and continually improve by leading to an “increase (in) a worker’s motivation and commitment to contribute to psychologically healthy and safe workplaces”.
Section six, planning, is where things start to get meaty regarding the identification of potential psychosocial hazards and has familiar overlaps with the HSE Management Standards for Stress (see tables1-3 in the standard). Section seven covers support and lists competency, awareness, communication, documentation, and confidentiality as resources to achieve the objectives of the standard.
Section eight guides on operational planning and control and covers risk assessment and control measures. It includes guidance on eliminating hazards, reducing OH&S risks and promoting well-being at work and usefully states signs/symptoms that a worker has been exposed to psychosocial risk. This section continues to be far-reaching as it also guides organisations to include procurement, contracting and outsourcing, and emergency preparedness and response and rehabilitation and return to work.
The ninth section, as would be expected following the planning stage, covers evaluating performance via both quantitative and qualitative means plus inclusion of senior management to indicate continued buy-in from the top. It clearly states within this section that “appropriate documented information” should be retained as evidence.
The final section refers to continuous improvement and corrective actions in the case of an incident or non-conformance. It is pleasing to note that the standard states that organisations should, in relation to incident or non-compliance “encourage and support reporting to reduce fear of reprisals”.
A full copy of the standard can found at ISO 45003:2021(en), Occupational health and safety management — Psychological health and safety at work — Guidelines for managing psychosocial risks and at a cost of £118.00 can be downloaded in PDF format.
A useful overview via e-learning can also be accessed for free at ISO 45003:2021 Psychological health and safety at work FREE resources training pdf
Personal Protective Equipment (PPE) for Mental Health Series
The idea of a PPE equivalent for mental health and safety was inspired between 2017 and 2019 whilst delivering mental health training within the construction and manufacturing sectors. PPE is about prevention, prevention of illness or injury and preventing litigation. Its purpose is to reduce risk and keep people safe and, in line with the 1974 Health and Safety at Work Act, provision of PPE is a legal requirement. It’s primarily about minimising the risk of physical harm with a focus on being proactive; no point in putting that hard hat on once you’ve been hit on the head and are unconscious or providing gloves after someone has dermatitis or a burn or that high viz jacket once you’re lying on the ground and have been knocked over! To make the idea of control measures, as defined within any risk assessment for health and safety, more relatable, and to normalise attitudes to mental ill-health, Mindshift offers a variety of organisational support that is based on areas found within the list below.
What might the equivalents of PPE for mental health and safety look like?
- The high-viz jacket is saying SEE ME. The response is WE SEE YOU and YOU ARE SAFE. To be mentally safe requires a stigma-free culture that enables staff to be comfortable if they need to say, “see me” about their mental fitness and a workplace culture that acknowledges, understands, and supports mental difference.
- Matching the right type of hand protection to the job being done is acknowledging that exposure to some products or heat sources can cause harm to the skin. The mental health alternative is acknowledging and assessing the potential for work-related stress by performing organisation-wide or individual stress risk assessments and implementing control measures to reduce it.
- The availability of hand wash or emergency rinsing agents is ensuring that if an accident occurs despite control measures such as gloves or eye protection being used that swift action to prevent long-lasting damage can be taken. The mental health alternative involves providing support if work-related stress or mental distress occurs. This could be via access to an employee assistance programme, funded talking therapy or availability of colleagues who have knowledge and confidence to talk about mental distress.
- Occupational exposure limits and working time directives are about too much of something for too long being a risk to health and allowing workers to stop before harm is done. A working environment that supports the need to relax, reflect, and recharge is the MH alternative.
- Wearing a hard-hat, is acknowledging that we are not invincible, that we may be vulnerable if hit on the head. Provision of the hard hat is saying “things can go wrong, so, just in case, look after yourself and wear this”. The mental health alternative is an employee who implements self-help strategies and takes responsibility for his mental resilience as far as possible.
- Toolbox talks typically educate staff about PPE use and how to work safely. Regarding mental fitness this could include following national campaigns, holding regular health promotions on mental health and displaying relevant resources in the workplace or on the intranet.
- Access to Physical First Aiders in the workplace is a legal requirement as per the Health and Safety (First-Aid) Regulations 1981. The Act requires employers to “provide adequate and appropriate equipment, facilities and personnel to ensure their employees receive immediate attention if they are injured or taken ill at work”. In essence, trained staff aim to keep people safe and try to stop a problem getting worse until the professionals arrive, they don’t walk by and ignore the symptoms. Staff trained in mental health follow the same idea however their role is not to wait until a crisis occurs before stepping in. Many people have had no training in stress or mental health awareness, and many don’t know what to say or worry they could make a situation worse. Training related to stress and mental health increases knowledge, understanding and confidence and reduces stigma around this topic. Further this enables confidence to have a good quality conversation, to reduce the isolation and distress felt and, if necessary, to signpost to the professionals.
Parity of esteem
Parity of esteem is the principle by which mental health is given equal priority to physical health and was enshrined in law by the Health and Social Care Act 2012. The current lack of parity is evidenced in various research that demonstrates a life expectancy that is 15 – 25 years lower in those living with severe mental illness. My aim is to make the concept of minimising work-related risk of stress and mental distress easy to understand and to make it more relatable, especially within those sectors where physical health and safety and the usefulness of control measures and risk assessment is second nature.
The Health and Safety Executive is Britain’s national regulator for workplace health and safety and within its guidance documents aims to prevent work-related death, injury and ill health. This includes mental as well as physical health. Stress and mental health are one of the 3 health priorities that the HSE has been focussing on since 2016 as per their Health and Work Strategy. Many businesses continue to be reactive rather than proactive in their approach to managing work-related stress. With many employees feeling unable, to be honest with their employer about their mental health, this can lead to people becoming more unwell, being absent from work or attending work when not fit (presenteeism).
The PPE for Mental Health Series provided by Mindshift Consultancy offers a range of training and organisational support. Two brand new IOSH approved courses are now available for in-house delivery (virtual/face to face), entitled “Understanding and Supporting Stress & Mental Fitness in the Workplace” and “Performing an Individual Stress Risk Assessment: Why, When and How” under the licence of Mindshift Consultancy.
Mental self-care during the Corona Virus pandemic
For all of us, the fear of this unprecedented pandemic is very real, but somehow [to me] feels very unreal, despite my medical background. Personally, it resembles the horrific ‘War of the Worlds’ 3 legged, one eyed Martian, getting closer and closer, slowly advancing to attack us in our homes and communities. Whatever the image, conflicting and unclear advice, rapidly changing guidance and the influence of 24/7 social media can have a cumulative effect on our emotions, often detrimental, sometimes inflating and exacerbating our fears as illustrated by my own irrational visualisation of this situation.
Health fears, food security, cashflow, job security – indeed ability to work at all – futures…. each of us is affected to varying degrees depending on our circumstances and possibly our previous experiences. Simple self-care ways of maintaining our wellbeing can, at least help us to ‘keep on keeping on’.
Keep in touch with others – phone, email, Skype, local community Facebook groups.
strong>Keep up to date with the news, but limit your exposure as it can become upsetting if heard repeatedly – this includes social media [Facebook, Snap Chat etc that often contain utter rubbish] and stick to reliable, un-sensational sources such as BBC News. I avoid the 10 o’clock news just before I go to bed.
Keep active – we are currently allowed to go out for walks, walk our dogs [mindful of social distancing], get into the garden/onto the balcony and do some weeding or tidying, dig out that Davina DVD that has gathered dust for months! This can also help with sleep.
Keep eating healthily as you can – our brains need good fuel – five a day veggies don’t necessarily need to be fresh – frozen or tinned are good for us too – include foods that contain Omega 3 [oily fish, soya-based foods, eggs and avocados. Try to avoid [or reduce] processed or ready-made foods. Of course, this may change as food distribution alters as the crisis unfolds.
More advice here: https://www.mindcharity.co.uk/wellbeing-article/food-and-mood/
Keep well hydrated – water flavoured with slices of lemon or lime, tea and coffee are fine in moderation [think of the unhelpful jitters from too much caffeine] and reduce alcohol intake as it affects the kidneys and livers’ ability to process toxins.
Keep to your normal routine as far as you can – get up and go to bed at your usual time – stick to your normal bedtime rituals – or try having a warm bath and a hot milky drink before bed if you’re struggling with sleep at the moment. Mindfulness Apps can also help, or relaxing music. For example: https://www.headspace.com/
Keep yourself stimulated – if you’re in isolation get reading those books or articles you never have time for, write – jotting down thoughts and observations can be cathartic [and make interesting reading in the months to come!] Finish knitting that cardigan or craft project – or try something new! All distract us from our worries and use our time productively.
Keep setting small, achievable daily goals – whether to tackle your sock drawer, tidy out and clean the fridge or have a pleasurable long bath – little achievements can cumulatively build and improve our wellbeing.
Keep on keeping on!
The [US] Centre for Disease Control and Prevention has some good wellbeing tips
Facts on the virus for the trusted NHS source
AOHNP Response to MHF report on stress
This is a response to the report on stress, published by The Mental Health Foundation in 2018
Stress: are we coping? Summary and comment.
This well-referenced report (81 are listed) based on a sample-size of 4,619, commissioned by the Mental Health Foundation (MHF), and undertaken by YouGov, provides yet more evidence that the workplace is a cause of stress and that more needs to be done by employers. Whilst the report explores several life situations that can be linked with stress, their comments regarding the workplace is of relevance here and will come as no surprise. With reference to evidence from the HSE, NHS Digital, Stevenson and Farmer and MHF research they conclude that “tackling stress at work should be a major priority, as should be creating a supportive workplace culture that promotes mental health and enables people to seek help safely, without risking adverse consequences”. Their reference to a 2017 Unison study highlights the challenges of balancing home and work where 92% of staff said they had been under too much pressure at work and 67% “considered excessive work demands as the source of their stress at work”. Long hours, staff cuts, taking on more work, difficulties with managers and working an average of “7.7 hours a week of unpaid overtime” can all lead to excessive demands that employees feel helpless to control. Work-related stress in 2016/17 accounted for an average of 23.9 work days lost for every person affected.
Stress-related figures for NHS sector workers are particularly alarming where 15 million working days were lost because of stress, anxiety or depression (49). Public sector workers, including those working in local government, showed an increase of two thirds in the reporting of mental health problems between 2015 and 2016.
The report offers a valuable description of how stress affects people, explaining that repeated activation of our stress-response, or periods of high stress and no recovery time can lead to “physiological effects (of) cumulative wear and tear on the body … and can cause us to feel permanently in a state of ‘fight or flight’. This prevents us from pushing through and causes pressure that “can make us feel overwhelmed or unable to cope”.
The report provides a top ten “individual actions” list to manage, reduce and prevent stress but it also makes it very clear that the wider community and society must play a part in-order to “mitigate and reduce long-term stress”. Their third (out of seven) “top-line” recommendation of where stress can be addressed states that “Government and the Health and Safety Executive must ensure that employers treat physical and psychological hazards in the workplace equally and help employers recognise and address psychological hazards in the workplace under existing legislation”. Further they recommend that “Governments across the UK should introduce a minimum of two ‘mental health days’ for every public- sector worker” and hope that this would be adopted in the private and third sector. The report concludes for “stronger action by government and relevant agencies including HSE to help employers recognise and address psychological hazards”.
Also launched during this 2018 MH Awareness week is a new six-week campaign called Where’s Your Head At? The aim is to change health and safety law, so it protects mental health in the same way as physical health. Mental Health First Aid (MHFA) England have teamed up with Bauer Media and Natasha Devon MBE, mental health campaigner and Youth MHFA instructor, to launch a petition asking the government to change the law. The petition is backed by Leader of the Opposition, Jeremy Corbyn MP and former Minister for Health and Social Care, Norman Lamb MP.
Whilst reports such as this are welcome, there is already an abundance of evidence that tells us stress is real, damaging and has a cost to the individual, their families, to business and society. The workplace may be an environment that causes stress but is also an ideal place, with a captive audience who spend more time at work than at home, in which to educate people, to smash the myths linked to mental ill-health and to create a culture (and a society) where the first response to someone in mental distress is “how can we help you?”.
There is an abundance of resources available to engage your clients with a positive culture around mental fitness. Check out Time to Change and their Employer pledge or suggest they sign up to the Mindful Employer Charter. Mindshift Consultancy provides a range of workshops ranging from 90 minutes to 2 days, tailored to fit the business need and all levels of staff.
A brief review of Adrian Massey’s book entitled Sick Note Britain
Written in 5 sections that address Sickness, Certification, Medicalisation, Workplace and the Law and Solutions with wonderfully entertaining sub-headings within each, this book is a must-read. Whilst of particular interest to those working in Occupational Health, this book will stimulate and enlighten any reader. As I progressed through each section, I felt it raised more questions than (easy) answers; this was however enjoyable and offered a mental feast to digest!
“Measuring the Indescribable” provides an opportunity for the reader to consider how on earth can one objectively measure how a person feels and their ability to work. It asks if someone is deemed fit but could be harmed through working, should they work anyway? The author describes the extent of sickness absence, the costs and the challenge of knowing for sure that a person’s inability to work is genuine. Certainty is easier in those cases where an obvious impairment exists, but what about the many cases where the symptoms are more subjective such as “feeling tired, pained (or) anxious”? There is scope for exaggeration in these instances and the option of taking advantage of the recompense provided by the State or the Employer.
The scene is now set to dig a little deeper in the section entitled “Trench Warfare”. Here we are taken on a social journey from the times of “hunter-gatherer” and the very close community ties where everyone knew each other well and had no doubt about their neighbours need for support, and in the vein of reciprocity would do their bit to enable the whole community to thrive. Then through industrialisation, automation and globalisation the responsibility for providing welfare in the event of sickness became the responsibility of either the State or the Employer, and so required some way of checking and authorising the process. Trust is no longer possible as the relationship between the unwell and the (financial) saviour is largely an anonymised one. To satisfy the wider population, who are no longer close enough to be satisfied that a colleague is deserving, we now have to be reassured by a process run by “bureaucratic instruments” to govern the welfare state. Doctors have become central to this process, possibly (as the Author suggests) in an attempt for employers, employees and the State to shirk responsibility. Pages 47-48 provide an entertaining description of how ludicrous is the suggestion that a Doctor is the best person to determine an employee’s fitness to work! You will enjoy this section entitled “Doctor Priests”!
The book continues to offer a useful history of welfare support over the decades, the moral hazards for Doctors being relied upon to provide sick notes, peoples increased sense of entitlement, the pressures on the time of the GP, the fact that in most cases an underlying cause of illness is rarely found, the over-reliance by the legal system on medical assessment tools, the influence of our peers on how we ourselves feel and modern societies unhappiness.
This is an important book that prompts serious consideration of the many and varied angles it reaches. Employers, Politicians, Employees, GP’s, Occupational Health Advisors and probably Joe Public would do well to read this!
MSc, OHA, RGN
Owner, Mindshift Consultancy
Mental health: tackling it in the workplace!
Research by the mental health charity MIND indicates that a culture of fear and silence around mental health is costly to employers. With more than one in five working adults experiencing difficulties caused by their mental health in any given year every organization is likely to be affected.
The 2011 Department of Health mental health outcome strategy “No Health Without Mental Health” stated that “mental ill health is the single largest cause of disability in the UK, contributing up to 22.8% of the total burden, compared to 15.9% for cancer and 16.2% for cardiovascular disease”.
Despite a more positive attitude towards mental ill-health in recent years, stigma around the topic remains. 48% of people say they would not feel comfortable talking to their employer about mental health problems (National Attitudes to Mental Illness Survey 2014). As a cause of sickness absence, mental health has overtaken musculo-skeletal disorders and is estimated to cost business £1032 per employee per year (Organisation for Economic Co-operation and Development). According to the 2015 CIPD survey on sickness absence, those who meet their sickness absence targets were actively supporting the health and well-being of their workforce.
NICE indicate that in a company of 1000 employees, mental ill-health loses an organisation £835,000pa. A saving of £250,000 (30%) per year could be made if prevention or early identification of problems were tackled. Compared to savings on tackling obesity or smoking in the workplace where companies could save £126,000 and £128,000 respectively it is clear that tackling poor mental well-being needs to be regarded as equally if not more important to any business.
The most successful organisations will have/ be aiming to have a mental health and wellbeing strategy. The “process” adopted to implement such a strategy will make a huge difference to its success, with involvement of the wider workforce and communication being crucial. Use of the WHO’s healthy workplace model (Burton 2010) offers guidance on how to get started. The WHO recommends:
- leadership engagement based on core values
- involve workers and their representatives
- gap analysis
- learn from others
Tackling mental health in the workplace needs to be seen in the wider context of a wellbeing strategy. The following actions can support such a strategy and whilst some may offer a “quick-win” it should be made clear that as “stand-alone” actions they are likely to have less impact on the success of a business.
- Flexible working options to improve work/life balance
- Training for line managers to more effectively identify and manage stress
- Employee Assistance Programmes
- Easy access to talking therapy/CBT
- Early involvement of Occupational Health
- Risk assessments/stress audits/surveys
- A clear policy on and guidance relating to stress, mental health and well-being
- Changes in work organization, role adaption
- Reasonable adjustments
- Stress/resilience training available to the wider workforce
- Use of HSE’s management standards
- Access to activities such as Mindfulness, Headspace App or relevant fitness or relaxation classes
- Regular health promotions relevant to the whole workforce
- Does the organizations culture enable poor mental health to be acknowledged and responded to in a positive way?
- Where do employees go when they need privacy or time out?
- What barriers could prevent employees being open about mental health?
- How do employees know that they are valued?
- How much control do employees have over the design of their work?
- How well is change communicated?
- Is there an effective route for staff opinions to be heard?
- How do organisations know if staff are being bullied, harassed or discriminated against?
- What offerings are made that allow staff the time needed to access resources that could help prevent or support poor mental health?
- Could any environmental factors in the workplace have a negative impact on well-being?
- How does wellbeing fit into the organisation’s mission statement?
Mindshift Consultancy can support your business in dealing with mental health.
Time to talk day February 6 th 2020
The World Health Organization’s definition of health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
They assert that physical and mental well-being is a human right, enabling a life without limitation or restriction.
This is as good a place to start as any and for us to take a moment to reflect on our own current mental ‘health’ or ‘ill health’. How am I feeling? Am I feeling well or a little low? Am I having more good days than bad days or vice versa? Who can I speak with to express how I am feeling?
Time to Talk is an initiative led by the mental health charities MIND and Rethink Mental Illness recognising that ‘Mental health problems affect one in four of us, yet too many people are made to feel isolated, ashamed and worthless because of this. Time to Talk Day encourages everyone to be more open about mental health – to talk, to listen, to change lives.’’
Time and time again I speak with employees [during my occupational health consultations] who are initially reluctant to engage with any form of talking therapy, however having been able to express and explain their concerns and anxieties to me during our meeting, report that ‘it was good to talk’ and ‘I feel better having talked with you’.
Think about it. That old saying ‘a problem shared is a problem halved’ rings a little true doesn’t it?
Many employers provide an external confidential support service – usually known as an EAP [Employee Assistance Programme] who most often provide a 24/7 helpline for people to contact if feeling low, or sad or overwhelmed. Many also provide simple, focus based counselling, usually up to 6 sessions [if deemed appropriate]. Find out if your organisation offers this resource and if so, give it a go, there really is nothing to lose!
Some organisations have employees known as Mental Health First Aiders [MHFA] who have engaged with “training” much like a ‘physical’ first aider – who are able to listen non-judgementally, help you to find the support that you may be seeking, or just have a chat if you’re having a bad day and need some support.
As an employer you may wish to promote Time to Talk – free resources are available via the website below to promote this day and stimulate open conversations and help us to begin those often-awkward chats with our work mates or manager. Whilst one day has been chosen to promote this it is worthwhile considering ongoing ‘time to talk’ – take baby steps to help your employees feel valued as human beings and not ‘Julie in Accounts’ who needs to ‘complete the weekly figures by yesterday’…. Julie may be struggling with things at home, she could be looking after her Mum who has Alzheimers and is getting little sleep for example. Or ‘John in IT’ who seems to have been a little distracted lately – we didn’t know that he is a single parent, his teenage son is having troubling thoughts and has started harming himself…. Allow Time to Talk and enable staff to feel the ability to open up and share their concerns.
It is worth remembering at this point about Stress – the Health and Safety Executive [HSE] has huge resources to help managers to identify stressors at work and ways of mitigating this. Remember that your employees are human beings like yourself, who may need extra support at times. If you would like to explore how Mindshift can support you in meeting your legal requirement to complete an organisational stress risk assessment, or to train your managers on how to complete an individual stress risk assessment, then please drop us a line!
Finally – Time to Talk – give it a go, and help contribute to your employees and colleagues wellbeing.
Some Useful Websites
Useful management toolkit:
Does it have to be pink and fluffy? Men’s health week June 13th – 19th 2016.
High-vis jackets, hard-hats, corporate suits and mental fitness!
During a stress awareness workshop for managers at a company I will call “macho, engineering and plenty of ex-army types” (MEPET) I admit to being concerned about its success! I am at the clean end of the organisation and provide Occupational Health (OH) support to approximately 1000 staff. I am not directly affected by but am aware of customers changing the goal-posts, parts arriving late and slowing down productivity, dead-lines being brought forward, a sense that management don’t listen or reduced manpower leading to an excess of overtime. I am not directly affected by but am aware of the personal life of the employees; the strained personal relationships at home, the stress of an ageing parent needing extra care, the change in the status-quo brought on by a new baby, seriously ill child or living away from home all week. I am at the clean end, not directly affected by any of this or by the statistics that indicate one in four adults will experience unpleasant symptoms of poor mental fitness in any given year. Your business needs to be aware of all this and it is highly likely to have already been affected.
I have the pleasure of meeting those affected by any of the above in a calm, clean, confidential and non-judgemental space. My role is to support both the business and the employee. I doubt that MEPET is much different to other organisations. It lost almost one year’s worth of working days due to absence caused by poor mental fitness in 2015. Hence the reason for training managers in stress awareness. It’s too soon to see the impact this will make on attendance, but I do know that one department now has “stress” as an agenda point at their team meetings; I have been asked to run a similar themed workshop for their graduates and for other areas of the business. At the induction meetings I can say with confidence that the company recognises the existence of mental health challenges and that support is available via training, OH and the Employee Assistance Programme.
Any of you familiar with driving on the M1 will know that roadwork’s continue to delay our journey! Again, I am feeling similar to when I trained at MEPET, a similar demographic of staff, and this time it’s a Mental Health First Aid Lite course to raise awareness to the road-side workers and CCTV operatives. After a long day’s work, the chaps arrive in their high-vis clothes, hard-hats on the desk, arms folded, and legs stretched out; will the jaffa cakes and Haribo sweets be enough to keep their interest? Of the 9 delegates 2 had been directly affected by suicide, 1 was supporting his daughter with poor mental health and 1 disclosed a past experience of depression. The course was not about providing a therapeutic space and nobody had their arm twisted to force them to share. All went away with new knowledge about the impact vocabulary has on the stigma surrounding mental health, all had the myths around mental health conditions explained and all have access to a toolkit they can dip into to support friends, family and colleagues. What really struck me with this group was that without realising it, a team-building event had taken place. They know each other better, together they have heard the facts about mental fitness from a trained professional, they know how to recognise signs that someone may need support and they learned a formula to help guide someone to get support; in a safety-critical environment or for businesses aspiring to be as successful as possible I can only see the benefits to this.
Mental health, good or less good, affects everyone. Ignoring the facts that one in four adults are negatively affected by reduced mental fitness and that over 70% of suicides in 2014 were male will cost your business. Mental health is rarely black and white, but Mindshift Consultancy certainly won’t deliver pink and fluffy.
I hope that during this year’s men’s mental health week you might consider how well the culture of your organisation currently empowers all employees to speak up and to access appropriate guidance at the earliest possible stage.
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