Mental Health: assessment and rehabilitation Dr Doreen Miller FRCP FFOM Managing Partner Miller Health Management

Overview Assessment Rehabilitation Mental well-being at work

Why is mental health the 2 nd highest cause of sickness absence? Growth in service industry Advances in communication technology Customer facing activities

Common Mental Health Presentations Alcohol dependence Depression/anxiety Stress Chronic Fatigue

PART 1 ASSESSMENT

Mental Health Assessment - I Referral route Current problem History of recent problem Family History and personal history Childhood and education Occupational history

Mental Health Assessment - II Past medical and psychiatric history Alcohol & Drugs Current circumstances Premorbid personality Forensic history

Mental Health Assessment- III Appearance & behaviour Speech Mood Thoughts Cognitive assessment Insight

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 first Prognosis & 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 LineHuman ManagerResource 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 progress Obtain 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 intervention Good communication Robust case management Partnership with treating practitioners Well designed rehabilitation plan Support during rehabilitation back to work

Rehabilitation Back to Work Social re-entry into work Update/training on changes Guidance on hours and nature of work Communication with HR, line management and GP Monitor 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 job Return to modified job until fit to return to pre-illness position Return to modified/alternative job permanently IHR/PHI Termination on capability grounds

PART III MENTAL WELL-BEING AT WORK

Organisational Goal - Fulfilment Healthy work environment Healthy jobs Healthy and productive employees

Occupational Health’s role at the Organisational level Raise awareness of relationship between work and mental well-being Train managers Help management assess and control workplace stressors Identify 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 Culture Demands Control Relationships Continued….

HSE Risk Factors for Work-related Stress Change Role Support, training and factors unique to the individual

Mental Health Risk Assessment Effects of pressure Need for change Suggestions 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