I know it's only March but what an anniversary year it's turning out to be. I'm Professor Josie Fraser, Deputy Vice-Chancellor here at the Open University and I'm really proud to be hosting one of the university's 50th anniversary celebration events, events that showcase our research and our teaching. Every year at the Open University, the Vice-Chancellor invites newly appointed and promoted professors ydych chi'n gweld yn fwylo'r leisio. A o bobl yw'r cyfnod, y wneud y wneud yw'r leisio cerddwydol o gymunedol i'r gweithio'r wneud o'r wneud bod'n gweithio'r cerddwydol. Yr leisio'r cyfnod yn ymwneud yw'r cerddwydol yn yw'r cerddwyd, ac yw'r cyfnodd leisio i'r 50th anniversariad hynny yn ddysgu'r lleidio i'r cyfnod yn yw'r lleidio'n cyfnod ddigon. this afternoon we will hear from Joe Bruis who will challenge us to think about menopause, a topic which tends to be a Joe will report that menopause is becoming a more pressing issue. It is affecting the fastest growing group in the workplace and Joe is going to call for employers to pay attention to it. Here at the OU we are really proud of our track record for research that turns ideas into solutions, solutions that benefit people, business and society. I'm looking forward to hearing more about Joe's research as a great example of this. So it's my great pleasure to introduce Joe Bruis. Joe joined the Open University in April 2018 joining the Department of People and Organisations in the Business School. She has previously worked at the universities of Portsmouth, Essex and Leicester. Throughout her academic career Joe has been fascinated by the connections between gender, the body, sexuality, emotions, identity, organising and organisations. These interests really all coalesce and come together in her ongoing research on menopause and the workplace. Joe is co-author of the 2017 Government Report, The Effects of Menopause Transition on Women's Economic Participation in the UK. Together with colleagues from the University of Bristol, De Montfort University, Starfish Consulting and Henpict, which I have to say is my best name ever for a group, she is working with a range of organisations including the Women's Business Council, the Trade Union Congress and Sherwood Forest Hospitals Trust to further the agenda of menopause in the workplace. So it gives me great pleasure to introduce Professor Joe Bruis. Hey everybody, thank you very much for giving up your time today. I hope what I've got to say to you will be interesting, stimulating, perhaps a little provocative. I have to say I'm extremely nervous, my palms are very sweaty and for once I don't think it's a hot flush. Okay, so just to start with a fairly rapid overview of what I'm going to be covering with you today. First of all, I'm going to talk about our menopause project and I do want to stress our, this is very much not a solo endeavour on my part. Then I'm going to talk a little bit about key statistics and issues to do with menopause and specifically perhaps menopause at work. I'm then going to go into what we tend to call the four cases, so these are the four reasons why employers really do need to be paying much more attention to menopause in the organisational context. I'm then going to talk about again what we tend to call the sort of vicious circle effect because there's evidence not only that menopausal symptoms can make work more difficult for women, but also that work can make those symptoms worse. So it sort of goes round and repeats and reinforces itself. Towards the end, I'll talk about what employers can do to ameliorate some of these issues. Some of the things we don't already know about menopause in the context of work and there's a fair amount of that. Then of course we'll have opportunities for questions and answers. A whistle stop tour through our menopause project and at this point I just want to pause quickly and give a very big shout out to Vanessa Beck, Andrea Davies, Sue Fish, Deborah Garlic and Jesse Matheson and lots of other people who have been working on this and related issues for about the last three, three and a half years now. So hence the hour in italics. This all started when we were lucky enough to win a commission from the Government Equalities Office to write a critical evidence review of all the evidence dating back, all the English language evidence dating back to January 1990 on the connections between menopause transition. In other words the movement up to the point at which a woman attains menopause and economic participation. So put more simply paid work, seeking work, difficulties with finding work, unemployment and so on. So that was January 16 and the report was eventually published in July 2017 and I don't think any of us quite realised just how much this project would then take on a life of its own. We keep thinking that one of these days it will lie down and go to sleep so far more than two years or sorry nearly two years since the report was published, no sign of that at all. So just a little snapshot of the other things we've been doing. On the back of the report when Vanessa, Andrea and I were still working together at Leicester we managed in collaboration with Deborah and Sue to develop and launch the first university in the UK menopause policy and that was in November 2017. We are still working with Hempict which is an organisation set up by Deborah to support and advise and take guidance and wisdom from women over 40 and they have a specialist arm called menopause in the workplace so we've done a lot of roadshows, conferences, organisational presentations on menopause at work and then amongst many other things we're also engaged in four empirical projects. So we are just wrapping up now on a major project with the TUC, started with an international survey last summer for a survey I've ever done and that attracted 5,399 respondents. I wish we'd got just one more because it would have been a round number and a lot easier to say. We then ran a series of workshops for equalities and health and safety reps and we're just rounding out now with some evaluation to see what those participants thought of the guidance that we were offering. We've also finished data gathering on an evaluation of a vest which is produced by a company called Becom and the vest is designed to ameliorate or reduce the experience of hot flushes and night sweats for menopausal women. I'm leading on a project with Sherwood Forest Hospitals Trust which is a trust comprising of three hospitals in North Nottinghamshire and they introduced the menopause guidance last autumn so I'm doing some qualitative work with them to understand what kind of effects that's having and we're also running an evaluation trial of some menopause clinics which were offered again on a pilot basis to women at West Midlands Police. So there's quite a lot going on and that really is only just a snapshot of what we're doing. OK, so to talk about menopause in a bit more detail then, menopause itself actually means the day on which it has been 12 months since a woman last had a menstrual period. So to describe oneself as menopausal is actually a little bit inaccurate because you're menopausal literally for 24 hours. The run up to menopause is known as menopause transition or perimenopause which is when you start experiencing symptoms and then after that 24 hour period you go into postmenopause. So for most women menopause is a midlife experience. The average age of onset of symptoms is 48 and the average age at which women attain menopause is 51. But what is interesting as you can see on the graph to the right of the slide there is just how much things have changed over the last 120 years or so. Because if we look back at the early 1900s at that period of time women tended to attain menopause on average at 47 and then their average life expectancy was 49. So menopause then was very much an end of life experience and you really only lived postmenopausally for on average a couple of years. If we fast forward to today, again as I say on average we attain menopause at 51 but for women our average life expectancy is 83. So most of us are now living for more than three decades after we've attained menopause and many of those decades as I'll go on to suggest are actually now spent at work. That's not to say however that menopause is in any way a homogenous or non varied experience. It's very very varied as I'll go on to discuss and one of the ways in which it varies is that one in a hundred women attain what's called early menopause which is due to what the clinic clinicians rather charmingly call premature ovarian insufficiency and you're deemed to have attained early menopause if you go into menopause before 40. In terms of prevalence of symptoms we can look at some recent data from NICE these are from 2016 which suggests that three quarters of women experience hot flushes. Apart from very erratic periods are the most commonly reported symptoms of menopause. So three quarters of women experience hot flushes and 25% of those women experience those as bothersome. Now bothersome is a word that we all on the team absolutely hate because it makes it sound as if there's a fly flapping around your face. And if you just bat it away enough it'll disappear. B bothersome covers a whole range of different experiences and at the extreme end these symptoms not just hot flushes but other symptoms can actually be disabling. Literally they really do affect somebody's quality of life. And just before I move on there's a reason why those little asterisks are there on women on the bottom bullet point there because it's really important to say that I'm using women, she, her, hers and so on in this lecture as a placeholder. Because actually to use a very technical term anybody with the correct biological plumbing can experience menopause and that will include a lot of people who identify as trans men, agended, gender variant, gender non-binary, gender fluid and so on. So just an important caveat before I move on. I've already suggested that menopause is an extremely varied experience. It is quite literally unique to every woman that experiences it. So in actual fact it's not very accurate to talk about menopause full stop. We should really be talking about menopause is. So hence the capital S on the slide there. And we can start to explain just how varied those experiences are if we actually set aside the biological or the medical model of menopause. Now that's a model which is very much based on fluctuating hormones. So hormones including estrogen, progesterone and yes testosterone starting to go another technical term, slightly bonkers in middle life. But that's to base the analysis, the understanding, the diagnosis and the treatment of menopause purely on biology. And actually there are really some quite strong data which tell us that that is not sufficient. Apart from anything else, the medical model talks about failure, decline, deficiency. It's hardly the most positive and rose-tinted image of midlife for women. What we tend to use in the team is another approach, the bio-psychocultural approach. And that of course acknowledges that biology is important, that hormones do play an enormous part in women's experience of menopause. However what the bio-psychocultural approach also insists on is understanding the experience of those symptoms in the context of a woman's own psychological makeup. So for example our attitudes to ageing. And also in terms of the socio-cultural context in which she lives. Again in terms perhaps of how that particular society or community views women as they get older. And just to illustrate how varied symptoms can be, there was a meta-review of a great deal of evidence published on menopause. And this was published in 1997. I tell you who it's authored by but it's an extremely long name which I can never remember. And their meta-review actually suggested that some evidence from Mayan women telling us that none of those women reported suffering hot flushes. Whereas a study that was done on Dutch women showed that 80% reported suffering from hot flushes. Now there is absolutely no biological or physiological or medical explanation for those data. The only explanation are the variances in psychology and perhaps more significantly here socio-cultural context. And just to add a little more complexity to the mix. Midlife which of course is a period of time when most women attain menopause can be a very complex and challenging stage of life. So for example it's the time of life when many women are moving upwards in their careers. It's the time of life when many women will take on responsibility for caring for elderly parents or elderly relatives. Increasingly now because women are having children later it's often the case that midlife women will have teenagers at home. So actually trying to unpick what might be the effect of menopause and what might be the effect of all the challenges of midlife can be a really complicated process. I think it's really important to understand it as a very multifaceted time in anybody's life but perhaps women most specifically. Now I've been banging on about the menopause now for over three years so it really doesn't faze me at all to talk about it. I talk about my symptoms freely probably too freely for a lot of people. But I think it's still true to say that despite growing interest and some very very positive moves by employers which I'll talk about in a little bit more detail later on I think in general and especially in what I would call the global north menopause is still regarded as quite sensitive, private to the woman who's experiencing it even to boo a bit too much information. Older women please, older women have bodies. So there isn't a great deal of discussion about it even now. And I think that's especially the case in the workplace where we are expected to be professional, we're expected to leave our bodies, our emotions and so on at home and to be always rational and very cool and calm demeanor. However, we think there are four very good reasons why that should not be the case and why employers really do need to be paying more attention to this very natural, very normal for most women, universal experience. And the first of those is the demographic case. So some very recent statistics here from the Office for National Statistics, these are the most up-to-date ones. If we look at the growth in the employment rate of women aged between 50 and 64 on the graphic there, you can see between the last quarter of 1992 and the last quarter of 2018 that group of women rose by 20.9 percentage points. That's a very significant increase and that trend has been going on for a long time. If we look at the comparative increase for men, we can still see that there is an increase there, but it's only slightly over half the increase for women. The midlife women are returning to or staying in work in very, very, very much greater numbers. I've been watching these statistics now for about three years. They're released quarterly. It's not changing. If we look at the United States, we can see something very similar. So there, 28% of the female working population aged between 50 and 64, sorry, that one again, 28% of the female working population of over 16 are women aged between 50 and 64. That's something like 20 million women and that's current population survey data from the United States from 2017. Similarly, if we look at Australian data, and this is from the OECD, we can see similarly dramatic rises as the ones we've seen in the UK. So these participation rates are for Australian workers between 55 and 64. We can see a 10.2 percentage point rise for women between 07 and 16, and we see that the equivalent rise for men is less than half, 4.2 percentage points. The final bit of the demographic case for employers to pay serious attention to this are two things. One of them I think will be familiar to most people in the audience and that's the gender pay gap. So the gender pay gap for 16-17 was 18.4%. In other words, women earn on average 18.4% less than men. What's also interesting about that is that the most significant gender pay gap is for men and women aged between 50 and 60. So women aged between 50 and 60 are even further behind their male counterparts than the average of 18.4% suggests. But what's even more horrifying are the estimates for the gender pension gap, and 2017 data again suggests that women have on average 39.5% less in their pension pots by the time they retire. Now some of that can be explained away by the fact that until recently women had a lower retirement age than men. Obviously the mandatory retirement age has been abolished now. So we may see some shifts in that over time, but my personal belief is that the gender pay gap very much contributes to the gender pension gap and specifically that issue about midlife women workers being on average worse off even than their younger and older female companions or colleagues. There's also the economic case and this is one that we tend to roll out to try and persuade employers. They find this one particularly convincing, if you like. First of all Oxford Economics data tell us that it costs a lot of money to replace somebody if they quit their job. So let's say a menopausal woman who decides she can't handle her symptoms anymore the only solution that she'll have is actually to leave her job. Now if you look at the graph there the Oxford Economics number crunchers tell us that if somebody owns £25,000 this is in the UK which is also quite a long way behind the median salary in this country which is over 29.5k a year to replace somebody on 25k is going to cost the employer £30,000 or to be more accurate £30,614 and that's the direct cost of recruitment and selection but it's also any cost of training up a new employee any lost productivity while they get up to speed any burdens that their colleagues are carrying while having to cover for them while they get fully socialised. It's also the case that despite the stereotype about older workers there is inconsistent evidence about performance at work in midlife overall. So the stereotype is that older workers start to decline in terms of what they're able to bring to work and the level of their performance. Actually the research data show that the jury is still very much out on that so there is evidence to suggest that strength declines there's also some evidence limited that cognitive capacity declines however there's evidence that counterbalances that which says that the older people get the more knowledge they acquire the more skills they acquire the more experience they acquire so this is a very inconsistent picture there's actually no evidence that suggests concretely that as workers get older they're not able to give as much at the workplace. Then there's the legal case this is also one that tends to set the employer's hairs running. So it may surprise you to know that there's already been two successful UK employment tribunals one of which is as far back as 2012 and this was taken against British Telecom by a woman called Miss Merchant who was dismissed on the basis of inability to focus and concentrate which was all to do with her menopausal symptoms. She took BT to an employment tribunal and she won on the basis not only of unfair dismissal but also on the basis of sex discrimination. Last January we also saw the most recent decision so this is January 2018 an irony of ironies this case was taken by a woman called Miss Davies against of all people the Scottish Courts and Tribunals Service so a bit of a case of physician heal thyself and again Miss Davies was dismissed for I can't even go into it it's such a horrible story it's really really distressing what happened to this woman. She was dismissed on the basis of unprofessional conduct at work basically which again was completely down to her menopausal symptoms and I think it very much depends on what your definition of unprofessional conduct is. So she took STSS to court and she won and again she won on the basis of unfair dismissal but interestingly the second part of her case was disability discrimination which she also won. Now it's important I think to emphasise that the menopause is not a disability. However as I said earlier on for some women the symptoms can be incredibly disabling and can very much fit the legal definition of a disability. So the Equalities Act which was passed in 2010 covers gender discrimination it covers disability discrimination and it also covers age discrimination each of which could be the basis for a claim about something that's happened to somebody on the basis of their menopausal symptoms in the workplace. It's also worth pointing out that we've had health and safety at work legislation almost as long as we've had protection on the basis of gender dates back to 1974 and there's been various updates of that health and safety legislation since then and what the law basically says is that employers have a duty of care to ensure their employees health welfare and wellbeing at work and you can actually conceive although this hasn't happened yet that somebody could take a case of a breach of duty of care if an employer wasn't paying sufficient attention to menopause in this context. And then finally this is our favourite case the social responsibility case because it's just the right thing to do case. We can see for example that the survey data which were collected by ITV in conjunction with wellbeing of women and this was in November 16 these are really quite horrifying I think so 50% of the women that responded said that work actually made their menopausal symptoms a lot worse and 25% of the women who responded they'd seriously thought about leaving their jobs so that's a very very large number of women who are not coping at work because their symptoms aren't being accounted for there's no support in place for them. It's also true that in order to continue working for as long as they would like women may well need support for a short period of time to be able to cope with their menopausal symptoms and if they are able to continue for working as long as they wish that may help us to start to address the gender pension gap and to make sure that they're able to enjoy financial security once they leave work and perhaps even more persuasively there's also evidence to suggest that employment for midlife women is a really important element in their mental health because it provides them with a very good source first of all of social support and secondly for self-esteem so this is our kind of banner statement we need to normalise menopause at work so that it becomes as unremarkable a topic of conversation as risk assessments during pregnancy or arrangements for a woman returning to work after maternity leave. So I'm now going to take you into the vicious circle part of the lecture and really what I'm going to do here is give you a little bit of a sneaky peak into some of the preliminary data that we've been gathering from our empirical projects. So the first slide here is about how symptoms can affect work and based on our TUC survey data we came up with what we rather laughingly call the top five so these are the top five symptoms that came out as creating particular problems for women at work. The stats that I'm going to put up I say stats, their percentages are based on the 72.5% of women sorry 72.5% of respondents to the survey who identified as either perimenopausal or post-menopausal so that's something of the order of 3,900 women so the percentages here are of just slightly less than 4,000 women. Coming in at number five in Somnia 29.5% of those women said that was a real issue for them at work 31.9% said anxiety and worry was a symptom that really affected their quality of working life then we have focus and concentration hot flushes and perhaps surprisingly at least to us fatigue because quite a lot of the workplace data pinpoints hot flushes as the most significant symptom but you can see that fatigue actually outstripped that by knocking on 6% or so I've also got some qualitative data and this is from the West Midlands Police study so this is Kate who is a staff supervisor at West Midlands and she's talking about how fatigue causes her to be emotional and it also affects her memory she says I need to remember things I'm dealing with staff, we have regulations policies and procedures and she says that her tiredness leading to a lack of focus making her more emotional really knocked her confidence so now she writes everything down she ticks it off, she's double checking constantly second guesses herself she says I make decisions all day every day my work is fast paced it's quick and my brain doesn't work that fast anymore and she says it's frustrating more than anything else because 2 or 3 years ago I could do my job standing on my head this is Josie who is a detective and she's talking here about her hot flushes so she says I know I can get quite a lot of colour quite easily and I'm very conscious when I have a hot flush my head must look like a boiled beetroot now she hasn't actually gone to check what colour her face goes but she says it does worry her because she's kind of you know do people see this I feel it so intensely I can't believe that other people wouldn't notice and in her job she says when I'm meeting with people who I've not met before so lawyers from CBS CBS, CPS who are mainly men she says I'm not necessarily self conscious but I'm very aware that I have when I have a flush are they going to look at me and go oh she's just a silly woman at a silly time of life having a flush if we now flip that relationship and go into the second part of the vicious circle I'm going to talk a little bit now about the data that I've been gathering from Sherwood Forest Hospitals Trust and the two snippets that I'm going to give you here are about how work can make symptoms worse so this is Claire who's a senior educator at the Trust and she's talking about her hot flushes now interestingly Claire says that when she goes on holiday she never has a hot flush she only has them when she's working and she says stress brings them on so easily and she says it can only be low level stress doesn't have to be anything major just something that really requires my attention quickly immediately I have to put my fan on and she says I feel very conscientious about my role I want our department to do the best possible job that we can so if there's anything else that needs attention it immediately affects my temperature control and I can be up and down like a yo-yo within a day this is Allison now Allison is a nurse on a rehabilitation ward at one of the other hospitals in the Trust and due to my complete technowid I couldn't get the recording device to work which is why these are more field notes if you will so at Sherwood Forest there's a policy that says nurses are on the ward they have to be in view of patients at all times and this is sort of all part of providing excellent standards of patient care and Allison totally understands that absolutely understands that and accepts the reasons but she says that when she's writing up charts if she does it while she's in a patient bay very often they'll chat to her or they'll have the television on if she sits at a nurses station social worker will probably come in and start asking her questions one of her menopausal symptoms is inability to concentrate she just loses focus and sort of comes back and what am I doing, not really sure what I've written have I written it out clearly enough and she says that obviously it's absolutely vital that charts are written up properly absolutely vital for the care of these patients and these are patients with quite severe neurological neurological problems so in order to deal with this she takes herself off somewhere quieter or she goes to the staff room so she can write her charts off that's actually a breach of the formal policy but she's having to manage the best way that she can and she says that if she does this her notes are then much quicker to do and much more articulate okay, so getting towards the end now just to talk a little bit about what employers can do the Equality Act stipulates that employers should make reasonable workplace adjustments for people who belong to the protected categories so for example women people who are older or younger at work, people with disabilities and this is really the kind of thing that we're advocating reasonable workplace adjustments some of which are very cheap, very quick and very easy to begin with though no women should be forced to disclose her menopausal status that will be totally inappropriate it should always be her personal choice another decision an employer will need to make is just how formal they want to be so in some organisational cultures like the University of Leicester for example a policy was the only thing that would have stuck if we called it guidance or something similar it just would have been ignored whereas at 7 Trent the decision there was to call it guidance in the case at Sherwood Forest they felt that the organisational culture there wouldn't take kindly to yet another piece of paper or something else entirely that's very much dependent on the kind of culture that exists within that workplace and indeed culture is absolutely vital in order to make any of these things stick you can have all the policies and guidance in the world but if the workplace culture if the norms and beliefs and attitudes don't start to change around accepting menopause as normal and natural and just a stage in a woman's life then really you're onto a bit of a losing battle there so it's really important that awareness is raised through education and that's education for everybody at work including midlife women themselves I will freely admit that I had no idea that I was menopausal until I started working on this project but what is interesting about normalising menopause at work which is the expression that we always use is that very often we find that employers are pushing on an open door that as soon as they start working in this area there are lots of women across that organisation that will just go thank god and I'm seeing this in all the projects that we're doing I was coding some data from West Mids the West Mids Police project this morning and that comes out loud and clear was so pleased that they're taking this seriously we would advocate training for line managers in things like reasonable adjustments in listening skills sensitivity how to have difficult conversations we would advocate occupational health and other specialist provision perhaps employee assistance programmes we'd advocate tailored absence policies that take account of menopause and don't allow a day off here and there because of menopausal symptoms to be treated something that might escalate into a performance management issue we'd like it to be badged as an ongoing health condition and dealt with accordingly informal support groups for example the menopause cafes that have been running at Leicester for about the last 18 months have been extremely popular flexible working arrangements coming in late perhaps if you've had a bad night's sleep and making up the hours at another time worth pointing out that everybody in this country who's worked for the same employer for six months has a legal right to request flexible working arrangements anyway environmental adjustments fans and good ventilation temperature control decent toilets which are accessible and clean cold drinking water lighter layered non synthetic work where we've heard stories from female police officers having to wear stab vests we've talked to midwives who hate having to wear tights we've heard stories about even women being in the middle of literally doing cardiac surgery and having the most intense hot flush in what already is an incredibly warm environment so asking whether or not their surgical scrubs could be slightly less constricting and slightly less warm rest areas so women can go and decompress for short periods of time natural light can really help women only showers if at all possible and actually as we saw when I was talking about Alison's experience at Sherwood Forest rejection of noise exposure and all of these folk are UK employers who have acted already I think that's quite an impressive list actually and it's also worth pointing out that there is and I'm going to get this wrong I think it's the national police menopause action group so there's lots of stuff going on in the police which perhaps will come as a surprise to some of you that such a sort of masculinist organisation is doing such good work in this area as you can also see they're in no particular order they're both private and public sector and they operate in a range of different sectors within the economy so just to finish off completely these are some of the evidence gaps so these are evidence gaps about menopause at work as opposed to menopause per se there's a massive clinical literature on menopause the literature on menopause at work is much smaller so first of all and harking back to the beginning of the lecture we know nothing about the experiences of workers who identify as LBTQI so lesbian bisexual transsexual queer or intersex absolutely no evidence from them whatsoever we don't have any data about women who experience early menopause the only data I have there is anecdotal I've got a friend who's a police officer and has done some amazing crusading work at Nottinghamshire police she went into menopause at 39 I know about Keely's experience she's very vocal about it they've done some amazing work there but it is just anecdotal we don't know anything very much I can think of one paper about women who experience what's called or what we call cliff edge menopause so these are working women who go into a very sudden menopause because they've had a hystorectomy or anuforectomy or perhaps they are taking drugs like tamoxifen to combat breast cancer and literally that will plunge you into menopause overnight we don't know very much at all about black and minority ethnic women workers experience menopause most of the data comes from white women we also know very little about women in so-called lower skills or manual occupations again most of the data about women at work or women who are in professional or managerial jobs and we know literally nothing about women in the gig economy so the gig economy is people who work for people like Uber or Sports Direct or Deliveroo it's that kind of contract that's spilt over from the music industry whereby you literally don't know how many hours you're going to get in any given week or any given month you don't really have a contract of employment to sick leave you have no rights to holiday you have no pension plan you are literally living from pay packet to pay packet and it can be an incredibly stressful existence employers like to talk about the flexibility that it gives employees I think actually the flexibility that it gives the benefit there is very much for the employer not the employee and one of the most horrific stories I've ever heard and I'd better say a major sports retailer I think a lot of you will know who I'm talking about a woman on a zero hours contract in one of their warehouses had to give birth in the toilet at work because she was so terrified to take time off when I tell that story I literally go cold I'm shivering now and I can just imagine there's lots of women out there in the gig economy who are menopausal and are perhaps going through similar experiences and just to round off on a happier note the other thing we don't know anything about really snippets of data are women who in the vernacular sail through menopause and actually may even find their working life is improved because they don't have any periods anymore thank you very much so what a fantastic lecture thank you very much now it's time to hear from our audience so I think we'll go and sit over there and take any questions or comments that the talk has raised so if you've got any questions for Jo can you please introduce who you are and where you're from and if we can keep the questions reasonably brief we'll try and take as many as possible if you're online and you'd like to join in if you could use the email provided or use the hashtag OU Talks and we'll get some of those from the audience online as well so I think we've got someone up here no Nella you're not allowed just one one small question thank you for this presentation I really really enjoyed it I think it's really important to talk about it I was just wondering whether you had an opportunity to speak to some of those women in the workplaces where they have already implemented some of the guidance or policies yeah that's a really good question actually because the work that we're doing or specifically the work that we're doing at Sherwood Forest we started with a survey last September which was just before they introduced what they call their guidance and a programme of support I then started doing interviews which ran sort of November and December that was the first tranche of interviews I'm just about to do the second set and then I'll do a third set in the late summer followed by a final survey so that's actually tracing a sort of to use the positivist language it's tracing a baseline what was it like before tracing as the policy or the guidance I should call it, beds in similar sort of thing at West Mids where there's been sort of baseline interviews before the menopause clinics and that was what I was coding this morning and then what we're going to do is a second set of interviews following up with those women when they've had their menopause clinics because I think their menopause clinic appointments I think West Mids are keen to see whether or not this is something else they could provide but this would be something else to add to that repertoire That was fantastic, thank you so much and great to get a lot of what I already knew confirmed. My name is Lauren Sharon I'm an executive health coach and I do some menopause training in the workplace largely in financial services but I work with executive women who are at the peak of their career and suddenly silently struggling with menopausal symptoms and it's very difficult to access those women because they typically don't know how they seem to be asking for help What I tend to find is working really well is working with lifestyle factors and psychology background and as well as being a coach and very much looking at the back to basics with hydration, nutrition stress management, relaxation etc and I'm just curious if you've looked at any of the lifestyle factors because when you put the my in Dutch slide up it would strike me that on the western world that lifestyle factors are highly contributing towards symptoms I'm seeing in a lot of clients Yeah, I think that's absolutely right and I would really reinforce that I suppose our focus is primarily on what happens at the workplace but I absolutely take your point Lauren, in fact we've talked to some very senior women who say that I could not possibly because if I came out and said I'm menopausal it would destroy my credibility in my organisation which I've worked so hard to build up It's a fine line though isn't it because I think that it's really important that women are aware of what they can do for themselves and you're absolutely right hydration, diet, exercise stress relief, I take a lot of supplements I don't eat certain things now I concentrate on eating more of other things and that's that one very important part of the equation but I think that there are other things as well so it's important that they're supported at work I think there's also quite a lot of evidence that GPs aren't particularly well equipped to advise women on menopause and actually in a 10 minute appointment when you've got a really busy clinic and it's been like 20 minutes of your training what are you going to do and I think I'd also like to there's small ambition here but to normalise menopause just in everyday life really so that it isn't that to be subject, it isn't sensitive so I think it's a kind of many pronged attack if that makes sense, but you're absolutely right lifestyle is really really important and we're working with Marion Stewart I don't know if you've come across Marion so Marion's very much on the sort of natural side of things so it's a lot of supplements and diet really Hi, is there... No trends, no It's Ginzae Breola my senior lecturer in the business school and my colleague Ojo I don't want to put necessarily thank you very interesting by the way really enjoyed it it's not our organisation on the spot but I'd like to know what is the OU at 50 doing about the menopause at work So now Paula, Helene and Babette are ringing lab groups going right our bets come in this was the one question which they said I would get now I think what is very good about the OU is that quite a lot of the stuff that I think employers should be doing is already here however it's not bad just for menopausal women and whether that's good or whether that's bad I think we can have a debate about it I think what it does mean is that perhaps unless it's very visible like the cold water fountains and the showers I think sometimes if it's not visible and in front of you then it can get hidden in a moras of HR policies and procedures we don't have anything specific on menopause however I know that with all the movements towards upping our Athena Swan accreditation in some parts of the uni and getting Athena Swan in other parts of the uni sorry Athena Swan is a gender equality award specifically for higher education there are discussions that are taking place they're at a very early stage but it won't surprise you to hear that I'm doing as much shoving in that direction as I can which I can promise to join in with I think you will be pushing on an open door here as well absolutely sorry we've got one online here so sort of thank you Joe that was really really well received on Facebook and a lot of the comments that people are making are backing up a lot of the evidence that you've been showing us and one of the questions that's coming up not to the same as what we've just had is how can people start those conversations with their employers especially if it's a smaller employer we've got people who are really embarrassed and don't really know where to begin have you got any advice for them I can understand that that's a really difficult one and especially in the small and medium size company context and actually it's just occurred to me that that's another evidence gap we know very little about the experience of women who work in that sort of environment and I think I'm right in saying that SME's far outstrip in terms of numbers because bigger employers employ more people but you're more likely perhaps to be working for a SME than you are to be working for a larger organisation and again these aren't necessarily tactics that will work for SMEs but some of the things that we've seen work quite well are champions so if you get a group of women together who are really quite determined that things are going to change if there is a collective it can be a quite useful way to start pushing things in the right direction so not one woman on her own because I think that's too much to ask but a group of women who are willing to go to perhaps HR to begin with and start those conversations off something else which we've found helpful and certainly I think this worked well at Leicester so when we launched the policy it wasn't just people who worked at Leicester giving the presentations we also had Deborah Garlick and Sue Fish in the room and it wasn't because they'd worked with us on the policy so it was completely logical that they were there and that they presented on various aspects of what we've been doing but when I look back on it I think what worked brilliantly was that they were the neutral brokers so it wasn't just oh god here go the crazy women banging on again the other thing that I think it was either Rheon or Seven Trend I can't remember which but I absolutely love this and this is something that can be done with almost no embarrassment to anybody you basically get people excuse me to send in questions anonymously and that also worked really well at Sherwood Forest they developed an app that people could use just to fire questions at the speakers didn't have to identify themselves didn't have to say why they were asking but it got the conversation going I have to say though that especially in the larger organisations where there are a lot of midlife women I think as soon as these conversations start to happen the open door will swing having said that I think the other thing that people can do is just set up informal support groups they don't even need to be physical they can be online there's loads of good groups on Facebook and Twitter and so on but it wouldn't take very much for women to set up something for themselves even if all that was was sharing experience because some of the other data that we're seeing are that women find it so comforting when they realise it's not just them first of all they find it comforting when they realise they're not going mad and they haven't got some awful disease and secondly they find it comforting when they realise that lots of other women are going through similar sorts of things I think we've got another one over there Hi I'm Susan Cara I'm Senior Employment Development Manager and and I work for the OU and currently I'm doing research into menopause and the workplace and employment so when we were talking about the door being open it is well and truly open and I'm working with Dr Christina Schwabenland I think you know as well one thing I wanted to ask you is a lot of the respondents seem to be concerned about the embarrassment or being embarrassed in front of men or colleagues do you think it's important to get the male perspective on how they actually perceive it is it how we perceive it rather than what they actually think I think that's absolutely right I think that you know it's and I can look around today and see that there are a lot of women in the room but there's also a fair sprinkling of men which is extremely positive one of the things that we noted in the report actually was that there was a lot of I can't tell my manager because he's a man I can't tell my manager because he's a younger man and he just won't be able to handle it at all but what we're also starting to see now in some of the primary data that we're gathering is counter evidence and again some stuff I was coding earlier a woman at West Mids who had a cliff edge menopause because she had a hystorectomy and she had a terrible time when she went back to work because her female supervisor wanted to insist that she worked a certain shift pattern and that just didn't fit on the symptoms and so she really had to push and push and push and eventually she got switched over into another team and now her supervisor is a younger man and he's absolutely fantastic she says you know couldn't be better he's so much more understanding than she was despite the fact that she was the same age as the woman who was experiencing the symptoms so I think it's absolutely vital to get the male perspective and I think it's also really important that you know one of the other slogans we tend to use is a bit mad when you first say it but we always say that menopause is not a woman's issue and what we mean by that is menopause is not just a woman's issue it's really important for everybody to understand what this is I mean kids aren't taught about it at school even GPs don't get a lot of training about menopause and of course in lots of ways if a woman's having a particularly bad time with her symptoms that is going to spill over into other people around her it's going to spill over to her family her kids, her friends her colleagues, her managers who will be all ages and all genders so I think it's very important to get the male perspective which rightly as you say Susan almost certainly isn't quite as horrendous as we'd like to assume but it's also important to understand that symptoms might be experienced by a woman that can have a knock-on effect to those around her Should we take an online one next and then I'll go I think you've had your hand up for a while in the middle there This must come in on live stream from Lydia Lauder Quality manager, careers and employability services at the Open University in Manchester How do we know that anxiety in the workplace is linked to the menopause rather than general workplace stress What are the symptoms of menopausal anxiety in the workplace from your qualitative data stroke case studies Lydia first of all I think that's a really good question I'd kind of like to go back to slide two or three I can't even remember now when I was talking about the complexities of midlife and the biopsychocultural approach to menopause the answer is it's difficult to tell The evidence that we have though is the step change So for example again to go back to the west mid status only because it's so fresh in my head and I've seen this at Sherwood Forest as well women self-reporting fair enough but then you can only ever self-report your symptoms really but saying I always used to be quite happy go lucky, I used to be quite calm I used to take life in my stride and suddenly I'm a nervous wreck or suddenly I'm snapping at everybody and walking around being a real bully and people are noticing and this isn't to do with anxiety or psychological issues necessarily but I had a woman tell me a very senior woman at Sherwood Forest that she'd switched jobs basically half way through what she thought was her lead up to menopause and her cognitive problems are really quite serious and she's really worried that the people around her think she's an idiot because they didn't know her before so the answer I would give is we don't necessarily know whether or not it's menopause but what we can do is find out what is happening for midlife women at work where suddenly they're realising that they're more anxious or they're not able to cope or their emotion or their memories gone or their focus has gone and that really is a two, three years ago I used to be able to do this job standing on my head going back to one of the police correspondence and now they're really struggling Hello my name is Priscilla Hulgan I thank you Jo for your informative research I'm very pleased to read that my question really is so simple in your research have you found about how old a woman needs to go to until the menopause stops Thank you Priscilla that is the $64,000 question or at least it's one of them the answer is I'm sorry proper academic answer here and it really does depend it's important to say that some women literally do sail through menopause so the only change they notice is their periods go a bit haywire for a while and then they stop okay the average in terms of symptoms to menopause itself as I said was three years afterwards it can be anything up to 12, 15 even longer it's unusual it has to be said for symptoms to go on much longer than six or seven years after menopause and not all women get post menopausal symptoms but again I've talked to women who are in their 70s still taking HRT and they say believe you me if I wasn't in HRT you would not want to be in the same room as me now I think that is the rare case going on for so long and again it's extremely variable and we don't really know exactly who explains all these different experiences that women have but I would say you could expect symptoms for something like two to however many years after menopause it is unusual for them to go on later than about five or eight years though I'm not sure if that's reassuring or disturbing but it's true of both over there, thanks Julie hello my name is Christine Davies something that's not mentioned does really affect women in the workplace and that's actually coming up to menopause and that's women often suffer very very heavy periods and no allowances are made at work for having to have more breaks or perhaps not even being able to turn up at work which is very very embarrassing can that not be included in this? Yeah I mean it's interesting I'm fully with you there one of the things that we have tried without success it has to be said to advocate for is actually free sanitary provision with the kind of acknowledgement now that period poverty is very real in this country and it's affecting hundreds of thousands if not millions of women then we thought we could maybe hook on to that and persuade employers that this would be a good thing to do it doesn't seem to have got much traction I think the issue though is that any of the issues around having access to clean comfortable and decently equipped toilets having access to rest areas flexible work and so on would also be ways that women could ameliorate or at least not have to be at work when periods were really really problematic or being able to cope at work when periods were really problematic because we've read data in other research on women wearing two or three maxi pads and a tampon just in case they flood which is the term that's used when your period starts very suddenly and very heavily we've heard stories about women only ever wearing dark clothing to work we've heard stories about women stockpiling sanitary towels and tampaks at work we've also heard and this is kind of comical but kind of awful as well I find ingenious uses for sanitary towels so one woman we talked to used to strap them under her arms to help with her hot flushes so I think you're absolutely right Christine that heavy periods or perhaps more accurately erratic and often heavy periods can be a real issue we know a lot about how women manage themselves employers don't seem hugely willing to make provision for sanitary wear but I think as I say some of the other things that we're abdicating for some of which are legal entitlement anyway at least in terms of requesting flexible work would at least help women to deal with that particular symptom Hi, Louise from Communications I'm speaking on a personal level from my mum I was just wondering what your views are were on HRT and the fact that a lot of GPs nowadays refuse to actually prescribe it my mother had a cliff edge menopause was given HRT and then had a hysterectomy and 20 years later she's still suffering what are your views on that that's a really good question what I will say is that I am not clinically trained so I wouldn't I don't want to give advice or any kind of recommendation my opinion based on the reading on the people that I've talked to is that there were some very very very very scary stories about HRT in the early 2000s specifically about his connection with breast cancer I think those stories haven't exactly been discredited but what seems to have emerged latterly is a sense in which the data were leaked too early and actually the proper analysis haven't been done now I don't know if anybody saw the Mariela Frostrock program a couple of months ago I won't say what I thought about it but no when I've had a glass of wine one of the things they said on that which I thought was really important and that was proper scientific data was that actually the risk factor of HRT in terms of its contribution to breast cancer it's there, undeniably it's there but the real risk factor is alcohol and above that obesity HRT is like anything else you maybe have to try a few before you get one that works for you the nice guidance on prescribing HRT which came out in 2015 I think is actually extremely good it's very very thorough but it's a great big fat thing and even though there's an executive summary GPs don't necessarily have the time to read through it and there are lots of GPs who will say things I'm not prescribing you HRT because it causes breast cancer it has other side effects or I'm going to put you on HRT but you can only be on it for a very limited amount of time now all of those things have some basis in truth but it's actually quite slim I think there is a lot of misunderstanding of HRT I don't take it myself but I would say categorically that if my symptoms got really bad I would happily go to my doctor he's already indicated that he would prescribe it for me and I wouldn't have a problem with that it just doesn't work for all women it can have side effects and yes there are risk factors but there are also protective factors so there's evidence I think I'm right in saying that it can guard against osteoporosis which is very common in postmenopausal women your poor mum I hope she manages to get some help of some sort yeah I bet it is if you email me I can give her some links to some naturally type stuff which may or may not help so thank you very much everybody and thanks especially to Joe for an excellent lecture


The President of the United States, thank you, thank you very much. Thank you very much. I appreciate your presence here today and all that you are doing to ensure that our country is secure and that this hemisphere is free in the years ahead. It doesn't seem so long ago when it was widely recognized that our freedom depended on helping those who were desperately fighting for their liberty. Warwick was the arsenal of democracy, for example, during a time when the outcome of the Second World War was seriously in doubt. One can only imagine what incredible totalitarian challenges we would have had to overcome and our had our precious supplies been withheld and thus permitting England to fall to the Nazi onslaught. And no one my age can forget the massive commitment we made after the war to rebuild Europe and to thwart the expansion of communism. Part of that effort was the help we gave the democratic forces in Greece during their struggle against communist insurgents, which was not dissimilar to what we're doing in El Salvador today. And all of this was not without opposition in the United States. Nevertheless, America unflinchingly met its responsibility. A bipartisan consensus permitted us to leave politics at the water's edge and do what was necessary to keep the country safe. Some historians believe the trauma of the Vietnam War irreparably destroyed the spirit of cooperation. Well, I think otherwise, I think America is leaving the Vietnam syndrome behind. We face serious challenges. It was great wasn't it on television last week to see that parade in Chicago. They finally had come home. Well, I expect the upcoming vote on aid to the Nicaraguan freedom fighters will signal the reemergence of bipartisanship in areas of national security and an end to the pessimism and disunity of the last decade. Over two months ago, many Democrats voted for aid to the freedom fighters. And we're reaching out now to many more Democrats to make this truly a bipartisan issue and carry the day for the freedom fighters. We're looking to win this next vote because it's becoming irrefutably clear that helping those fighting for freedom in Nicaragua is important to the safety of the United States and it is the right thing to do. And under those circumstances, there are no Republicans and no Democrats, just Americans. Some of those opposing our efforts have been hoping that the regime in Managua would reform and seek reconciliation with its opponents, but instead the Nicaraguan communists have taken every opportunity to smash internal opposition and annihilate the armed resistance.  The last House vote on this issue has barely been taken when Nicaraguan troops crossed over into Honduras to attack resistance forces. This was hardly the gesture of goodwill that many members of the House had hoped for. That many invasion received much attention, but just as important was the major attack, an unproved assault launched against Mosquito-Indian villages at the same time. I said, unprovoked assault launched against the Mosquito-Indian villages at the same time. This bloody operation triggered a panic that led to an exodus into Honduras of nearly 11,000 villagers and others suffered a fate who didn't leave for those camps, such as being herded into camps, and then left with no provision for supplies of food, and yet they could not go beyond the fences that hemmed them in. Since the House vote, repression against independent labor unions, the press, the church, and opposition political parties has continued. The jails remain swollen with political prisoners, such as this one near Minagua, and many of the prisoners are democratic union leaders. And today even the smallest vendor finds his or her tiny bit of private enterprise threatened. In the period since the last House vote, Minagua has signed economic and cultural agreements with the Soviets. Foreign advisors remain ever present throughout the Nicaraguan military and secret police. The regime for all its youth and designer glasses is doing its best to turn Nicaragua into an Eastern European style communist dictatorship, and this is absolutely inconsistent with the values and traditions of the Americas, and we're not going to let it happen. The Soviets, on the other hand, after a brief respirator against stepping up the flow of weapons into Nicaraguan. For the first time since 1984, a ship coming directly from the Soviet military port of Nikolayev delivered cargo to Nicaragua, and another significant step has been the arrival in Nicaragua of a reconnaissance aircraft with highly sophisticated equipment as shown in this photo here to the right, which gives the communist regime a significant advance in its military and intelligence capabilities. There's little room for doubt. The communists show no intention of compromise, no intention of keeping their promises of democratic pluralism or of refraining from aggression upon their neighbors. They've been given their chance and used it to thumb their nose at those who tried to give them the benefit of the doubt. Gestures of goodwill have been scoffed at. Opportunities for peace, diplomatic solutions, compromise, and negotiated settlements have been arrogantly passed by, and all of this leads to one inescapable conclusion. If democracy is to have any chance at all, we must back up those who are fighting for freedom and back them with the weapons and resources they need. This is the only way that the communists will take the demand for democracy and negotiation seriously. Much has been said or laid about the consistency of a policy that advocates both aiding the freedom fighters and reaching out to find an agreement that could peacefully end the conflict. Well, there's nothing confusing or contradictory about supporting those who are using armed might to pressure an authoritarian regime into democratic reform. Those fighting the communists are not, as they've oftentimes been portrayed, seeking power. They want only the democracy that was promised. In 1979, the clique that now holds power in Managua made a solemn promise to the organization of American states and to the people of Nicaragua as to the democratic and pluralistic nature of the government they planned to establish. And that promise was made to the OAS and the result was the OAS asked Samoza then to step down in order to end further bloodshed. And on the basis of that promise, he did step down. What the freedom fighters seek and what we support is simply adherence to that promise of democracy. What we will not do is passively watch as a clique armed to the teeth by a totalitarian power outside this hemisphere as it beats its own population into submission and establishes a beachhead of tyranny, subversion and terror on the continent of the Americas. Thomas Jefferson once said, if a nation expects to be ignorant and free, it expects what never was and never will be. It's our job to make certain the American people get the facts about what is at stake in Central America. And I hope I can count on each one of you to get the word out, and I'm sure I can. Together armed with the facts, we can revitalize that bipartisan spirit that puts the safety of our country and the love of liberty above all else. I tell you from the bottom of my heart, I thank you for all that you're doing. And now is the time to put out the maximum effort and we'll get the job done. There are thousands of young men and women in Nicaragua who are waiting to join the countries. Well, I'm going to stop calling them that. That word was given, or appellation was applied to them by the communists. They are freedom fighters, and these young people want to join the freedom fighters. Only they don't have the arms and the equipment yet to take them on board. So we know what our job is, and God bless all of you. That's because we just signed on giving back. Oh, wait a minute, I'll straighten the hands with you. With you. Thank you. These happen to be photos with some of those people I've been talking about. Let me see the name again. This is... Oh, hello. Hi. This is Eva. All right. It's times like these I wish I had a short name like Bob Hope or something. Oh, here's your hand. What? Here's your hand. Thank you very much. We can get them back to you. And your pen. All right. Anymore I don't do what I did once in New York, back in my days on radio and pictures and television, a gentleman right out on Fifth Avenue from about 30 feet away pointed a finger and said, I know you. I see you all the time on that screen and he's fumbling for a piece of paper and a pencil and he gets up to me and he says, Rameland. So I signed Rameland. There was no sense of disappointment.


Hi Psych2Goers, and welcome back to another video. Thank you so much for your love and support, enabling us to make yet another exploration into everyday psychology and mental health. So let's begin. When you think of schizophrenia, what comes to mind? Does having multiple or split personalities make it schizophrenic? The Diagnostic and Sysciscal Manual of Psychiatric Disorders, also known as DSM-5, defines schizophrenia as a mental disorder consisting of a constellation of symptoms such as delusions, hallucinations, disorganized thinking, and abnormal behaviors. No single symptom alone is characteristic of the disorder, and people exhibit different symptoms. Today, we will be discussing six signs of schizophrenia. But before we begin, please remember this video is for educational purposes only. Do not use this information to self-diagnose. We encourage you to seek professional help from a psychiatrist or other health professionals. 1. Delusions Do you know of someone who believes they will be harmed by an individual or group, even though without evidence? This is an example of a persecutory delusion. What about someone who believes they are the richest person in the world? Grandiose delusions are exactly that. Delusions are beliefs that do not change even when there is clear, conflicting evidence present. Other types of delusions are referential delusions, such as, the trees are telling me something, or nihilistic delusions such as, the world is ending, and somatic delusions such as, there is something wrong with my body even when my doctor disagreed. 2. Hallucinations Have you ever heard someone hearing voices that seem so very real to them, occurring outside their own thoughts? These are auditory hallucinations, which are the most common in schizophrenia. Hallucinations are experiences that happen when there is no external stimulus. Hallucinations can also be visual, which is the case if you see something that is not actually there. However, hallucinations can be a normal part of religious experiences, and having hallucinations without other symptoms does not mean that you have schizophrenia. 3. Disorganized speech Have you seen someone constantly switching from one topic to another, especially when there is no obvious connection between the topics? Such is the identity of disorganized speech. Sometimes it can be so incomprehensible that others cannot understand what is going on. Another case of disorganized speech is tangentiality, which is when someone just goes off in tangents. 4. Abnormal movements or motor behaviors Catatonic behavior is a marked decrease in environmental reactivity. In catatonia is a group of symptoms that usually involve a lack of movement and communication, and can also include agitation, confusion, and restlessness. Common catatonic behaviors include showing reduced responsiveness to the environment that lasts for hours or even days, performing strange movements, and staying in uncomfortable positions without shifting. They may echo their speech, have difficulty speaking, or erratic and extreme movements. The opposite can also occur. Someone can move so much without a clear goal, which is called catatonic excitement. However, catatonia, like hallucinations, can be a symptom of other mental disorders like bipolar disorder or major depressive disorder with catatonia. 5. Decreased emotional expression Do you know of someone who shows diminished emotional expression? Do they sound very monotone, like a robot, and appear very stiff when they stand compared to a relaxed position that we usually expect? When we speak, it's typical that we display facial expressions that show how we feel. A sign of schizophrenia is a lack of emotional expression that is typically expected. Other symptoms that are signs of schizophrenia include abolition, which means a lack of motivation to do anything, aloja, which means less speech output, and asociality when someone shows no interest in social interactions. 6. Memory problems According to J. Daniel Ragland, professor of psychiatry in the UC Davis School of Medicine, people with schizophrenia have difficulty retrieving associations within a context. This creates a pervasive loss of memory that makes everyday life a challenge. For example, you can't work if you can't remember the steps in what your boss told you to do. Memory troubles are caused by the dysfunctional frontal and temporal lobe regions in the brain. We hope we were able to give you some insight into the different signs of schizophrenia. Do you now understand the six signs of schizophrenia? Do you know someone who may exhibit some of these symptoms of schizophrenia? Let us know in the comments below. If you find this video helpful, be sure to hit the like and subscribe button, and share it with someone who might benefit from it. Don't forget to hit the notification bell icon to get notified whenever Psych2Go posts a new video. As always, thanks for watching.