Business as usual when managing RTW and mental health?

For employers managing return to work (RTW) for staff with psychiatric disabilities, the prospect may be daunting. However, Senior Scientist Dr Geoffrey Waghorn from the Queensland Centre for Mental Health Research believes the process should essentially be “business as usual”.

Dr Waghorn has written extensively about employment and severe mental illness and said people who have a psychiatric disability have a lot in common with people who don't.

“You know what it turns out employers have to do for this group of people? Nothing other than good management," he said.

“They don't have to do anything different. The person themselves wants to be treated the same as any other worker. They don't want any special treatment. However, they don't want any additional stress caused by bad management.

“So everything that good employers or good managers do to pay attention to their workers' individual needs is all that's required."

And to look at it from a slightly different angle, we all experience mental health difficulties at some point in our lives. According to Dr Waghorn, there are three broad categories of mental illness:

• Very severe mental disorders that involve developmental changes in the brain that start at the beginning of life — things like schizophrenia, schizoaffective disorder and bipolar affective disorder, which will affect around 2% of the population in their lifetime.
• Mental disorders like anxiety and depression, which can be circumstance related — things like clinical anxiety, depression and post-traumatic stress syndrome, which will affect around 20% of the population in their lifetime.
• 'Life ache' — things like stress, grief and relationship problems, which affect 100% of the population.

To varying degrees, each of these categories of mental illness impact on a person's ability to work productively. While a lot of employers might be tempted to put individuals with severe mental disorders in the too-hard basket, the fact is that in terms of managing RTW, there is a lot more in common between the three categories than you might think.

“If you've recently had a bereavement, if somebody close to you has died, it is very difficult to function for a couple of months. And mental disorders can be a bit like that. Some days you're just in a complete fog and you don't have any get up and go," said Dr Waghorn.

“And that doesn't mean you're not a good worker. It just means that you're a good worker in a bad place."

Just as an employer doesn't need to know intimate details about an employee's experience of grief in order to provide effective management following bereavement, employers don't need to “swallow the textbook of psychiatry" in order to assist an employee with a psychiatric disability RTW.

“They don't even need to know any psychiatric terms at all. They just need to know how that particular illness in that particular person manifests those work restrictions and those work strengths in that particular job."

Employers and workers don't need to manage alone

As always, effective RTW is about finding a fit between workplace environments and individuals — and flexible management achieves the best results. The emphasis should be on practical issues: things like breaks, duties and expectations about shift work and overtime. Employers do not have to go through this process alone. Federally funded initiatives such as the Job In Jeopardy program and the Disability Employment Services provide no-cost services aimed at finding and retaining employment for people with psychiatric disabilities.

“Employment consultants are available to actually visit the workplace and help train the person and reorganise their job, or redesign their job. Sometimes they offer things like wage subsidies. If their productivity is never going to be up to par, they can be paid pro rata on wages according to their productivity via the Supported Wage Scheme," said Dr Waghorn.

This approach also makes things easier for employees, who may be more comfortable communicating with their employer about their illness via a third party. There is a lot of stigma, misinformation and sometimes even fear associated with severe mental illnesses and this can make employees wary of disclosing their condition to their employer. However, Dr Waghorn wants employers to recognise that they're probably already employing people with psychiatric conditions.

“We just don't realise how many of these people are already in our workplaces. When there's stigma out there, people apply for jobs and don't disclose these health conditions. They know they're going to be discriminated against."

Like other ill or injured people, early RTW can have enormous therapeutic value for those with psychiatric disabilities.

“People who work feel the relief from stigma, because for once they're regarded as a worker and not a mental health patient or a dole bludger," he said. “It's not possible to escape that stigma without a valued role like employment. And not only does employment help you escape from stigma, it also gives you the opportunity to improve your mental skills, and your physical skills and your strengths.

“Plus the social opportunities that come with work. So people can get their lives back through employment when they can't any other way," he added.

Adaptation is key

This isn't to suggest that all news about employment and psychiatric disability is good news. A high-functioning individual with bipolar may sometimes take unexplained absences from work or seem bereft of motivation. A person with schizophrenia may have difficulties managing their illness for a time, and experience psychotic symptoms. And even when recovery is consistently well managed, it isn't always possible for someone with a serious mental disorder to RTW in the same position or vocation they had before first onset or relapse.

According to Dr Waghorn, RTW outcomes vary considerably.

“I know architects that have gone back to their same job. I know other people who have had to change their career direction completely... allow the possibility that the same job might be possible, but they might have to reduce the hours, they might have to change the mix of tasks a little or they might have to retrain for something much different."

But again, this is 'business as usual' for RTW. While the preferred option is always to get individuals back into the same job, within the same department and for the same employer as before illness or injury, it isn't always possible. That's a fact of life. But good management can, however, make a real difference.

“Employers can help a lot. They can help identify a person's strengths and match that to the right mix of duties," said Dr Waghorn.

For psychiatric disability the best results are achieved, as always, when employers, employees and health professionals collaborate for RTW.

Read the original article here.

Image credit: ©iStockphoto.com/David Jones