Ask the Doctor

One of the biggest challenges facing Human Resources departments is the rapid rise in workplace absences due to stress or mental health concerns. Can you account for why this is occurring and why it seems to be increasing?

Employers throughout Canada are experiencing the effects of mental health issues in the workplace, not only in absences, but also in costs associated with health care benefits (drug plans), short-term disability, long-term disability and presenteeism. Presenteeism is when an employee is present at work, but is not as productive as possible due to a health concern.

The Global Business and Economic Roundtable on Addiction and Mental Health (February 2004) stated that the costs associated with mental health are $33 billion a year in lost production. They estimate that 20 - 25% of the Canadian and U.S. labor force suffers depression and anxiety disorders in any given year and that depression and ischemic heart disease are on track to become the leading causes of work years lost in the global economy by 2020 through human disability and premature death.

There is no one factor that is the cause of this trend. In the Watson Wyatt Staying @ Work Survey, 2005, “mental health issues continue to be the leading cause of short- and long-term disability claims in their organizations (75% and 79% respectively).” “Only about one third of organizations said they have enacted return to work processes specific to mental health claims (35%).”

Global competition in the workplace (e.g., 50 – 60 hour work-weeks, reductions in the workforce, continued or increased output requirements) and changes within the family structure (e.g., single-parent families, lessened family support due to distance) can account for the increase in stress to the individual and family. The lessening of stigma, legislation validating mental health as a legitimate health impairment, along with Human Rights protections for the employee, can additionally account for the rise in absences. Lastly, a major contributing factor is the increasing difficulty with timely access to medical care, particularly psychiatric services.

What kind of steps can an employer take to effectively manage issues, particularly complex cases, associated with mental health in the workplace?

In order to deal with complex cases, often involving a mental health component, the 85/15 rule applies (15% of the cases take 85% of your time). A comprehensive disability management program involving the use of a medical consultant will be necessary. It is essential to encourage collaboration among all stakeholders to obtain resolution. A small minority of cases will require the use of an adversarial process.

Instituting state-of-the-art health promotion and organizational health practices can prevent the development of complex cases of absenteeism and increase the productivity of those remaining at work.

The training of supervisors and front-line managers to develop skills to assist their employees during the early stages of difficulty and upon re-entry to the workforce from a mental health leave can be quite worthwhile.

Current practices should include 1) collaboration between the stakeholders and an emphasis on rehabilitation (rather than solely on disability determination) and, 2) the belief that the majority of employees would rather be healthy and working than absent and/or chronically ill.


Notations
*The advice provided in this column is for general information purposes only and is not intended to be relied upon for any particular case.

S. W. Dermer, MD, FRCP(C) is an Occupational Psychiatric Consultant on mental health in the workplace. His interests range from disability management and executive coaching to improving job satisfaction and productivity through strategic planning. Dr. Dermer is an Associate Clinical Professor at McMaster University, Department of Psychiatry and Behavioural Neurosciences. He can be reached at: drdermer@bellnet.ca