January 30, 2016

Mental health and work

An employer must make reasonable accommodation for an employee with a disability. That includes a mental disability such as depression or anxiety. It's the law.

Occupational therapist and psychotherapist Rosemary Lidstone pointed out this fact during a recent presentation at Ottawa’s Royal Ottawa Hospital. She and psychiatrist Sanjay Rao gave a lecture on mental health and work.

Lidstone expanded on her point by explaining that an employer needs to make efforts to accommodate but not to such an extent that it would be unduly burdensome or costly.  Adjustments might include such arrangements as shorter hours, a less demanding assignment, and time off for therapy appointments.

Rao said that depression costs the Canadian economy $51 billion a year, $16 billion due to absenteeism.  An unknown cost, possibly greater, is due to presenteeism, being at work when depressed and not functioning well.

Since, he noted, work is an important part of life, unemployment can result in a decline in well-being and in general health.  Unemployment is associated with increased risk of mental illness, suicide, and death.  Even if a person gets a new job, it takes time to recover.  Yet, the new job does increase quality of life. 

When a person suffers from depression or anxiety, work serves as part of recovery. 

As well, work in general helps a person to stay in good mental health.  He spoke of treatment for depression, anxiety, and a need to return to work. 

Cognitive behavioral therapy (CBT) is his preferred therapeutic approach.  It is an approach focusing on reviewing behavior to develop more flexible ways of responding to situations identified as threatening and in facing situations that are experienced as threatening.

Lidstone explained the role of the occupational therapist.  Occupational therapists are frequently engaged in helping people who have experienced disability, helping them to return to work.

In her practice, she must identify the person’s barriers, determine their functional impact, and develop a recovery plan.  Her role includes intervention, advocacy, and follow-up. 

Advocacy may take place in various realms, with physicians, insurers, and employers, for example.  The occupational therapist determines the perceived severity of symptoms and looks at the person’s daily functioning.  Then it is necessary to see how work factors fit into this picture.

There are several factors to consider in a person’s ability to return to work.  Are others in the person’s life supportive of a return?  Dos the person feel ready?  Has the person had a positive work history?  Are job conditions suitable, and is there good management support?

A treatment plan could include CBT, exercise, workplace contact while off work, workplace accommodation, and social support while at work.

Certain demands at work could be problematic for reintegration.  Possible difficulties include the need to remember things, exposure to stimuli (noise, for example), detail work, multi-tasking, time pressures, relations with co-workers, and situations creating emotional stress.  A recovery plan needs to take these into account.

A recovery plan might address these barriers by accommodation.  It might involve a gradual increase in responsibilities, frequent short breaks, flexibility to permit appointments with physicians and therapists, supportive management and co-workers, clear expectations, written instructions, memory aids, times for constructive feedback, and varying of tasks.

Rao addressed some general issues in mental health and work.  He spoke of the need to translate evidence into practice, at least in part referring to CBT.  In this same context, he called for better access to quality treatment and for greater awareness of issues of work and mental health. 

He stressed that an improvement in general health also promotes good mental health.   

Rao called for early detection and mental health first aid.  Where a person is off work for depression or anxiety, there should be a rapid response, with treatment plan geared to return to work or other alternatives. 

If services are to succeed, he said, they need to be convenient.  He sees a need for collaboration among management, mental health practitioners, and general physicians. 

Dealing with the problem of mental health and work is, he held, cost-effective.