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Guideline-based care saves money with mental health
Guideline-based care provided by occupational physicians is a cost-effective way to treat workers with common mental health problems, according to new research.1
Researchers compared two approaches to care for 240 Dutch police officers on sick leave because of mental health problems. One group was given standard care with a referral to a psychologist for evaluation and treatment, and the other group received guideline-based care provided by occupational physicians. This approach emphasized a gradual return to work and gave employees help in dealing with stress on the job and building problem-solving skills. In both groups, total missed work time averaged about 150 days, but guideline-based care resulted in equal treatment outcomes at a lower cost. About half of officers in the guideline-based care group eventually were sent to see a psychologist, compared to nearly all of those in the standard-care group.
The researchers also found that the occupational physicians followed only part of the recommendations in the guideline. "The most complex part of the guideline, counseling workers using cognitive behavioral therapy techniques, was skipped often by the occupational physicians," says David J. Bruinvels, MD, PhD, one of the study's authors and a senior occupational physician in Amsterdam-based Vrije Universiteit's Department of Public and Occupational Health. "We feel that there is a lot of room for improvement on this."
Bruinvels says it didn't surprise him that the outcomes from psychologists were no better than occupational health professionals. "Occupational physicians have a major advantage compared to psychologists, and that is that they are much closer to the workplace," he says.
In the 2007 guideline from the Netherlands Society of Occupational Medicine, more emphasis is put on the problem of "stagnation" than in the 2000 guideline from the same group. Occupational health professionals "should be more alert to signs that predict a prolonged recovery." Bruinvels says.
Occupational health professionals often see the early signs of mental health problems in workers, but they fail to take action, he says. "In a lot of cases, prolonged mental health problems lead to presenteeism," Bruinvels says.
Interestingly, the police officers in the study often claimed sick leave based on other complaints, such as low back pain, instead of mentioning mental health problems. "When we started with our study, it was unthinkable that a police officer would discuss his or her mental health problems with the supervisor," says Bruinvels. "Supervisors were also sent questionnaires, by which they became more involved with the topic. At the end of the study, we found that mental health problems were more openly discussed and were more acceptable in the police force."
1. Rebergen DS, Bruinvels DJ, Bezemer PD, et al. Guideline-based care of common mental disorders by occupational physicians (CO-OP study): a randomized controlled trial. J Occup Environ Med 2009; 51:305-312.
For more information on employees with mental health problems, contact:
David J. Bruinvels, MD, PhD, Department of Public and Occupational Health, Vrije Universiteit, University Medical Center, Amsterdam. E-mail: firstname.lastname@example.org.