Mild mental disorders are often overlooked

Workers’ health, performance can be improved

Severe mental disorders may be attention-grabbers, but many employers and occupational health professionals are missing the boat by overlooking less serious disorders among employees.

"There have been a lot of occupational programs for severely psychiatrically impaired populations," says Gary L. Fischler, PhD. "However, there has been little, if any, attention [paid] to the mild to moderate disorders more likely to be encountered in competitive work situations. These are invisible disorders, but they have enormous effects on job performance."

These disorders, says Fischler, include chronic depression; personality disorders (which can be mild, moderate, or severe) that can involve chronic problems relating to others, or inflexible and ineffective ways of dealing with the world; and post-traumatic stress disorders.

Fischler is director of Gary Fischler & Associates, PA, in Minneapolis, and director of the Institute for Forensic Psychology. "Our practice specializes in assessing and consulting with individuals with a variety of either work-related or legal issues," he explains.

Fischler is also co-author, along with Nan Booth, MSW, MPH, of Vocational Impact of Psychiatric Disorders: A Guide for Rehabilitation Professionals, published by Aspen Publishers Inc., which lays out many of those issues.

Why are disorders overlooked?

Fischler admits he is a bit baffled by the inattention that has been given to those milder disorders. "I just don’t know [why]," he says. "I’ve been working in this field for over 10 years and have been chronically frustrated with the lack of attention to this area; so, we have been practicing largely without the benefit of a lot of research or practical data that would help us."

One possible explanation he offers is that "this is kind of a bridge area between serious disorders and the vocational rehab domain — physical and psychological chemical dependency, usually handled by the EAP [employee assistance program] or human resources."

Through the years, he says, corporations — especially through their EAPs — do tend to be more tuned in to employees who face psychological problems. "But EAPs frequently focus on getting help to a troubled employee, rather than focusing on what an organization can do to accommodate the employee," he adds.

Practical accommodations available

Corporations can, and do, make job accommodations to ensure that an employee dealing with a mild or moderate psychological disorder can function more comfortably, and therefore more productively.

"The most frequent accommodations are flexible scheduling — where the employees work their own hours, or sometimes even work extra hours," says Fischler. "One of the more common symptoms [of those disorders] involves concentration and memory issues. An employee may actually need to work 50 hours to get 40 hours’ worth of work done. If he’s willing to do that, it sounds like a good solution to me."

Memory problems can also be associated with certain physical settings, Fischler notes. In those cases, the company may arrange for an employee to work in a more private area, so he will not be so easily distracted.

In other cases, the appropriate accommodation may involve changing supervisors or work teams. "This can be especially important in personality disorders, where the employee may have trouble get along with others," says Fischler.

A common occurrence involves employees who have been at a company for a number of years. "An employee with a personality disorder may have limited flexibility to adapt to and meet new people," Fischler explains. "Let’s say that for 10 years they may have had marginal job performance, but a laid-back, understanding manager. That manager leaves, and a new super’ comes in who wants to run a tight ship, and won’t give Joe’ any slack. So, you get into personality problems."

The type of supervision can also be adapted to accommodate such employees. "If they have not received consistent, timely performance reviews you might consider giving them more frequently, or providing instructions in writing, so the employee is in a more structured environment," Fischler suggests. "Or, you might want to use co-workers to help balance things out through the trading of tasks. The employee may be made anxious by telephone work; perhaps the employee could make a formal — or informal — arrangement with a co-worker for more phone work, while they agree to do more bookkeeping or computer work."

Another strategy Fischler recommends is bringing in a professional consultant to debrief either the manager or co-workers. "This must be with the full understanding and permission of the employee in question," he emphasizes. "You can talk about what kind of problems people with mental health disorders may have at work. This can reframe the problem. Without such knowledge, employees with these disorders may be seen as lazy, stupid, or mean."

Paradigm shift required

To properly address those problems, employee health promotion professionals and mental health professionals must adopt an entirely new way of looking at employees with milder mental disorders, says Fischler.

"One of the most important things we can do is de-medicalize these situations," he says. "Rehab and EAP people tend to use a medical model to view these employees. This model asks, How do we fix them?’ The real issue may be, How do we get the employee and the job to fit together?’"

Fischler recognizes that this represents a "paradigm shift" in the way those employees are viewed. "The best thing wellness and human resource professionals can do is have open discussions with these employees about what their problems have been, what they need, and bring in a professional consultant to separate out what is necessary and what is not; which accommodations are unreasonable and which are reasonable. You have to get past the garden variety complaining — which everyone does."

When your company has an employee — especially one who has been productive in the past — who is having real problems, the first thing to do, says Fischler, is to get the facts. "First, get a report from the employee’s doctor; what is the diagnosis, and what problems has he been having," Fischler suggests. "Next, bring in your own consultant. Treating doctors are not rehab specialists, and they are notorious for taking the employee/patient’s side. That’s what we’re trained to do, and that’s why the employer should bring in [its] own expert." (For an example of how employees can be helped, see article on p. 46.)

Finally, says Fischler, be realistic in your expectations. "Most of these disorders will respond positively to the interventions we’ve discussed; whether they will be sufficient to cure the disorders is questionable," he says. "We’re not offering magic cures, but common sense."

[For more information, contact: Gary Fischler, PhD, Gary Fischler & Associates, PA, 825 S. 8th St., Suite 604, Minneapolis, MN 55404. Telephone: (612) 333-3825. E-mail: Web site:]