Psychiatr News December 7, 2007
Volume 42, Number 23, page 9
© 2007 American Psychiatric Association
Lack of Specialty Care Can Extend Disability Time
Sandra Hass
Sandra Hass is a consultant to APA's Office of Healthcare Systems and
Financing and executive editor of "Mental HealthWorks."
Not being able to work and getting inadequate psychiatric care can put
individuals on disability into a downward spiral.
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>.
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American Psychiatric Association.
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