Mental Health: assessment and rehabilitation

Dr Doreen Miller FRCP FFOM

Managing Partner

Miller Health Management

Overview

AssessmentRehabilitationMental well-being at work

Why is mental health the 2nd highest cause of sickness absence?

Growth in service industryAdvances in communication technologyCustomer facing activities

Common Mental Health Presentations

Alcohol dependenceDepression/anxietyStressChronic Fatigue

PART 1

ASSESSMENT

Mental Health Assessment - I

Referral routeCurrent problemHistory of recent problemFamily History and personal historyChildhood and educationOccupational history

Mental Health Assessment - II

Past medical and psychiatric historyAlcohol & DrugsCurrent circumstancesPremorbid personalityForensic history

Mental Health Assessment- III

Appearance & behaviourSpeechMoodThoughtsCognitive assessmentInsight

Useful Diagnostic Tools

CAGE (alcohol dependence)Hospital Anxiety and Depression [HAD]

Scale

Clinical Assessment by Occupational Physician

Diagnosis? Further investigations to exclude other

conditions (e.g. thyroid)Review of treatment plan If alcohol

dependency – treat firstPrognosis & likely return to work

Further Action by OP/OHA

Obtain reports from treating practitioners (with employee’s consent)

Liaise with GP/Consultant to explain role of OP/OHA and review progress

Provide management report

WORKPLACE PARTNERSHIPS Employee

Line HumanManager Resource

Manager

OP/OHA

Communication During Absence

Agree with employee frequency and nature of contact with HR/line management

Liaise where appropriate with employee’s treating practitioner(s)

Clinical Case Management - I

Determine if covered by Private Medical Insurance

Consider ‘one off’ payment by company for consultant opinion

If appropriate refer for private treatment with GPs’ agreement

Clinical Case Management II

Monitor employee’s clinical progressObtain agreement from GP/Consultant

when employee fit for rehabilitation

PART II

REHABILITATION

Rehabilitation Facts

Rehabilitation starts at recruitment

Longer employee absent from work, less likely that they will return

Best Practice Framework

Early interventionGood communication Robust case managementPartnership with treating practitionersWell designed rehabilitation planSupport during rehabilitation back to work

Rehabilitation Back to Work

Social re-entry into workUpdate/training on changes Guidance on hours and nature of workCommunication with HR, line management

and GPMonitor programme until employee has

reached plateau

Key issues to consider

At all stages of the rehabilitation programme there is a need to ensure that:

Employees do not pose a risk to themselves or others

The job and/or the working environment does not pose a risk to the employee

Unable to return?

Employees who are unable to return to their pre-illness job may be considered disabled under the Disability Discrimination Act 1995 and afforded protection under the Act

Rehabilitation Outcomes

Return to original full time jobReturn to modified job until fit to return to

pre-illness positionReturn to modified/alternative job

permanentlyIHR/PHITermination on capability grounds

PART III

MENTAL WELL-BEING

AT WORK

Organisational Goal - Fulfilment

Healthy work environmentHealthy jobsHealthy and productive employees

Occupational Health’s role at the Organisational level

Raise awareness of relationship between work and mental well-being

Train managersHelp management assess and control

workplace stressorsIdentify organisational trends arising out of

individual clinical assessments

REACTIVE vs PROACTIVE

Ill Sickness Learning & Fulfilment

Health Presence Development

Reactive Proactive

Improving Mental Well Being

Training

Policies & Risk Identification of Action

Procedures Assessment Stressors Support

What is stress?

Stress occurs when the pressure on the individual exceeds that individual’s ability to cope

Stress is a state and not a diagnosis

HSE Risk Factors for Work-related Stress

CultureDemandsControlRelationships

Continued….

HSE Risk Factors for Work-related Stress

ChangeRoleSupport, training and factors unique to the

individual

Mental Health Risk Assessment

Effects of pressureNeed for changeSuggestions for improvement

Review the Assessment

Initially the stress risk assessment should be reviewed every six months

After a year if no significant changes then move to an annual review period

Revise stress risk assessment in light of any significant changes