Behavioral disabilities pose thorny problems
Behavioral disabilities pose thorny problems
Survey shows longer recovery periods required
A survey just released by New York City-based consulting firm William M. Mercer shows that the majority of employers find it more difficult to return an employee with a behavioral health disability to work than one with a physical disability. Just over half the respondents (53%) gave that indication, with 74% citing employee reluctance to return as the most common problem.
This comes as no surprise to Stephen Heidel, MD, MBA, CEO of San Diego-based Integrated Insights, which provides occupational mental health services including employee assistance programs (EAPs,) work/life programs, and behavioral risk management services. "We deal with employees who are at risk for self-destructing - people who have emotional and/or psychological problems that may lead to impaired work performance or disability," he explains.
The survey's findings mirror Heidel's own experiences, he says. "It is part of the nature of how we respond to a behavioral illness. When a person starts to recover from a depression, for example, the first thing that happens is you will have improvement in their overall sense of well-being; then, the symptoms will subside and ultimately go away. Their ability to function in a work capacity follows at a later date."
A reluctance to return
Exacerbating the problem is a common reluctance on the part of the employee to return to work. Employees who have been off work for a long time may become "deconditioned," and afraid of the rigors of going back to work. "They may have a conflict with their supervisor; this is extremely common," says Heidel. "There could be discrimination involved, a subtle issue of harassment, or a clash between what the employee views as fulfilling work and the actual quality of their of current job."
To make the transition back to work as smooth as possible, Heidel recommends having an individual with mental health training talk with the employee, the supervisor, and the case manager and with the treating physician and discover the potential barriers returning to work.
"If you don't know what underlying problem you're dealing with, you're in big trouble; it's like working with a blindfold on," Heidel says. "For example, if a female employee was harassed by a supervisor and that supervisor lost his job, and if that supervisor was good friends with most of her co-workers, she may be afraid to come back to work for fear her co-workers may turn against her. In that case, you may have a real opportunity to work with the employee and her co-workers to facilitate a dialogue around this issue. Her fears may very well be irrational fears."
Prevention is best cure
Because of the extensive time and expense often associated with behavioral health disability. "The first thing you want to do is prevent the disability from occurring," Heidel says. There are reasonable steps employers can take to help prevent these disabilities, he says. "They include having good mental health benefits and a good EAP program, which I feel has become the workplace continuum of care for emotional problems and mental disorders."
According to the Mercer survey, work/life issues are the greatest source of potential problems. "Such problems occur in every employee's life from time to time," Heidel notes. "Prior to managed care, you could turn to your mental health benefits and get counseling. In my opinion, that prevented small problems from become big. Now, EAPs fill that void."
In his own work, Heidel addresses the problem by developing a worksite multidisciplinary team, which can include the wellness coordinator, a medical officer or occupational health nurse, employee relations, workers' comp, the safety department, and risk management. "We serve as a member of the team," he explains. "We help them define goals, such as identifying and providing oversight and management for employees thought to be at risk." In addition, team members are taught:
· how to identify at-risk employees, and which part of the population might be at risk;
· what some the significant psychiatric illnesses that occur in the workplace are - i.e., major depression, panic disorder, post-traumatic stress disorder - and what they look like.
· how to understand some of the major behavioral health syndromes.
(How do you identify at-risk employees? See the checklist below.)
Once at-risk employees are identified, the team decides what resources need to be brought to bear. "Do they need a medical evaluation? An EAP referral? Would they benefit from a referral to the wellness center for stress management or exercise? It's a kind of triage," Heidel explains. "In severe cases, we might request a fitness-for-duty evaluation."
Heidel recognizes the enormity of the task. "If we impacted half of the [at-risk] people and prevented a disability, we'd be doing a phenomenal job," he admits. Especially when, according to the survey, 24% of employers are uncertain they event want the employees back. What does Heidel say to them?
"One of the realities of our disability system is that [behavioral health disability] is a dumping ground," he says. "What I say to the employer is, 'Do you want this person back? Will you accept them back? If not, don't ask me to get involved; don't waste my time.'"
[For more information, contact: Stephen Heidel, Integrated Insights, 9370 Sky Park Court, Suite 140, San Diego, CA 92123. Telephone: (619) 278-3626. Fax: (619) 278-3648. e-mail: [email protected].]
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.