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

2. Overview Assessment Rehabilitation Mental well-being at work

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

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

5. PART 1 ASSESSMENT

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

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

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

9. Useful Diagnostic Tools CAGE (alcohol dependence) Hospital Anxiety and Depression [HAD] Scale

10. 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

11. 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

12. WORKPLACE PARTNERSHIPS Employee LineHuman ManagerResource Manager OP/OHA

13. Communication During Absence Agree with employee frequency and nature of contact with HR/line management Liaise where appropriate with employee’s treating practitioner(s)

14. 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

15. Clinical Case Management II Monitor employee’s clinical progress Obtain agreement from GP/Consultant when employee fit for rehabilitation

16. PART II REHABILITATION

17. Rehabilitation Facts Rehabilitation starts at recruitment Longer employee absent from work, less likely that they will return

18. Best Practice Framework Early intervention Good communication Robust case management Partnership with treating practitioners Well designed rehabilitation plan Support during rehabilitation back to work

19. 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

20. 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

21. 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

22. 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

23. PART III MENTAL WELL-BEING AT WORK

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

25. 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

26. REACTIVE vs PROACTIVE Ill Sickness Learning & Fulfilment Health Presence Development Reactive Proactive

27. Improving Mental Well Being Training Policies & Risk Identification of Action Procedures Assessment Stressors Support

28. 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

29. HSE Risk Factors for Work-related Stress Culture Demands Control Relationships Continued….

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

31. Mental Health Risk Assessment Effects of pressure Need for change Suggestions for improvement

32. 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