When people with psychiatric illness run into trouble at work, they're
often advised to take some time off. But they probably will function better in
the long run if they can continue working while they get treatment, said
speakers at APA's 2004 annual meeting at a workshop on assessing workplace
disability. The session was presented by APA's Corresponding Committee on
Psychiatry in the Workplace.
"People treated before they lose function can go on with their
lives," said Marcia A. Scott, M.D., committee chair. Treatment also can
help prevent repeated episodes, she said.
That's important news for employers and employees, since 10 percent of
workers will have an episode of psychiatric illness in any given year, and 25
percent will do so at some time in their lives.
Consider the employee whose performance has been mediocre for years,
suggested Scott, a lecturer in psychiatry at Harvard Medical School and
consultant to the Boston police department. If a new boss pushes for greater
productivity, the employee may complain of harassment. He or she may claim,"
I can't think, can't remember, can't sleep." Such symptoms may
not indicate a disability, Scott said, but simply trouble paying attention
If the person could deal with the crisis, he or she might be able to work
better. Treatment and support can facilitate that. The downside of a few
weeks' break, Scott cautioned, is that some individuals may never return to
"Leaving work itself is a crisis," she noted. It's not
sufficient for a psychiatrist to see a person, prescribe medication, and next
see that person four weeks later, after medication kicks in. In that month,
she noted, some people forget how to get up every morning. People who have
lost contact with work lose their attachment to work. Co-workers, particularly
if they've had to assume a heavier load to cover for those who are out, also
lose interest in them.
Work performance is a core indicator of both psychological functioning and
treatment outcome, said Air Force Maj. Steven Pflanz, a psychiatrist who is
the life skills flight commander and assistant chief of the medical staff at
McGuire Air Force Base in New Jersey.
A thorough evaluation involves numerous questions, he said. How does the
job affect the person's self-esteem? Why did she choose that job or that
career? Does she hate her job but love her career? How does being laid off
affect how he feels about himself as a person? How does work affect family
relationships? Does the person socialize with peers from work? Military
officers, said Pflanz, a career officer himself, typically find that work
dominates their social networks.
If a patient says he can't work, Pflanz suggested, ask what specific tasks
he can't do and why. Because employers today ask people to work longer and
harder, he said, asking people whether they feel stressed is less useful than
asking, "How are you coping?"
People who want to get out of their jobs, he observed, sometimes have
accidents or manifest symptoms such as headaches. Some people use sickness to
justify failure. Some complaints of cognitive impairment may require objective
Physicians can't attest to the person's having been ill before they first
saw that person, Pflanz said.
A treating psychiatrist can't determine whether a person is disabled with
respect to a particular job, said Andrea Stolar, M.D., a consultant to MetLife
Individual Disability Income Center in Tampa, Fla. "That's a claims
decision," she said. The psychiatrist can report, however, whether the
person shows up in clean clothes and on time, remembers facts, and talks
Scott agreed. All that psychiatrists can communicate on a disability form,
she said, are impairments of functions in multiple domains. You need to
document how people are functioning in your office and their life, she
advised, and what they need to get back to functioning well.
Scott recounted the case of a man who had obsessive-compulsive disorder and
had worked at the same company for 30 years, steadily rising through the
ranks. After his grown daughter left home, his illness worsened, and he spent
most of his workday in the bathroom washing his hands. One night he went home
early. Having misplaced his house key, he called his wife, who told him a key
was under the doormat. He would not lift the mat, however, because he did not
want to get his hands dirty. Conveying such details about daily life, Scott
suggested, can help such patients get benefits.
Creative solutions, Stolar related, may enable some people to stay in their
jobs. One woman used earphones to listen to music at her desk, thereby
blocking out distractions. An emergency room nurse who found daily exposure to
trauma too stressful switched to a job coding medical records. Some people can
work successfully from home.
In contrast, Stolar noted, someone with an anxiety disorder that keeps her
from participating in required large-group meetings won't be able to stay in
Even patients who take time off from work benefit from continuing their
usual daily activities, she added. That includes eating and sleeping at
regular hours. Participating in outside activities reinforces staying in
treatment. Day treatment programs, she said, sometimes can provide the needed
For people who are not working, Stolar said, psychiatrists can assign
homework with specific goals to accomplish each day. Helping those who have
adopted a sick role improves their productivity, she asserted, and speeds
their return to their prior level of functioning. ▪