Lack of Specialty Care Can Extend Disability Time
Not being able to work is a crisis for employees and their families.
That belief was the driving force behind a two-year effort by the Partnership for Workplace Mental Health to develop recommendations and tools for employers and clinicians to use when dealing with psychiatric disability. Negotiations are now under way to conduct a pilot test of these recommendations and tools.
In 2005 the partnership established the Task Force on Disability and Return to Work, and this summer the task force released its first report,“ Assessing and Treating Psychiatric Occupational Disability: New Behavioral Health Functional Assessment Tools Facilitate Return to Work.” The partnership, a program of the American Psychiatric Foundation, is a coalition of employers, insurers, and APA.
Stephen Heidel, M.D., M.B.A., represented APA on the Steering Committee of the task force and talked about the committee's sense of urgency on the issue.“ The number of psychiatric disability cases is steadily increasing worldwide, and most employees on psychiatric disability do not receive good psychiatric treatment. We wanted to do something about that,” he said.
“Not being able to work,” Heidel continued, “threatens the individual's livelihood and finances, independence, identity, and place in the family, which can lead to more serious psychiatric illness.”
For many people, the workplace is the basis of their social network.“ Can you imagine,” Heidel asked, “how a psychiatrist would feel if he or she could not work?”
He noted that employers have been receptive to APA's ideas on how to improve psychiatric treatment for disabled employees and are collaborating with APA as the project moves forward. “They're on board,” he said.
Joining Heidel on the Steering Committee were David McDowell, Ph.D., formerly with Unum Provident Corporation; Michael Klachefsky of The Standard; and William Yang, M.D., of the Coca-Cola Co.
Report Offers Range of Help
“Assessing and Treating Psychiatric Occupational Disability” includes background material on psychiatric disability, specific recommendations for employers and clinicians, and forms for clinicians to use in assessing a patient's work function status.
The task force also conducted a survey of employers about their psychiatric disability procedures, and those results are also included in the report. Here are two of those findings:
Less than one-third (30 percent) of managers who directly supervise employees are trained to recognize an employee who may be at risk for a behavioral health absence. | |||||
Nearly one-half of the employers (47 percent) said that the greatest barrier in returning employees to work was attributable to employees' dependence on their primary care physicians for treatment rather than seeking treatment from a mental health specialist. | |||||
Clinical Recommendations Offered
The report identified several overriding problems with the current treatment of employees who are out on psychiatric disability:
Employer policies for behavioral health disorders encourage treatment by primary care physicians rather than psychiatric professionals. | |||||
Many physicians do not know what their patients do at work. | |||||
Clinical training does not include practice in assessing an individual's functioning. Furthermore, no functional assessment tools for mental illnesses are generally available. | |||||
“One of the major clinical problems we found,” said Heidel,“ was the fact that employees don't see psychiatrists soon enough in the treatment process. We all agreed that from the start these employees must receive a thorough psychiatric assessment followed by early and adequate treatment by a psychiatrist. If this is done, we can facilitate an individual's recovery; if not, the employee may face a prolonged psychiatric disability.”
Specific recommendations for clinicians included the following: clinicians should (1) conduct a routine evaluation and exam, including a standard mental function assessment, and confirm the diagnosis; (2) use the assessment tools developed by the task force to complete a job-function evaluation (determine elements of the job) and complete a work-function assessment (determine impairments that interfere with that job); and (3) develop a plan to treat impairments in mental function that interfere with work and other major life activities.
The recommendations and clinical tools developed by the task force must now be tested and validated. Irvin (Sam) Muszynski, J.D., director of the APA Office of Healthcare Systems and Financing, said that negotiations are already under way to conduct a pilot test with a large employer in the Pacific Northwest.
“From the beginning,” Muszynski said, “APA reached out to employers and insurers, and now they have joined with us in developing this pilot project.” A key element of the pilot test will include psychiatrists performing thorough diagnostic assessments of each employee on disability and writing the treatment plans so that increased functioning becomes a goal of the treatment plan.
“Assessing and Treating Psychiatric Occupational Disability: New Behavioral Health Functional Assessment Tools Facilitate Return to Work” is posted at<www.workplacementalhealth.org>.▪
