| February 2003 |
Managing Psychiatric Disability Mark Raderstorf, Behavioral Management Inc. Kate Harri, Behavioral Management Inc. “When you look at mental illness issues, you have many players that may be involved in a person’s medical leave and return to work, and somebody needs to manage it. EAP counselors are being asked more and more to manage these situations. There are employer issues, especially if there is acrimony in the workplace. You’ve also got co-workers and supervisors you need to deal with, and you have the HR representative that may be involved. And what we really find challenging is if there are attorneys involved in this process at the beginning. Then you have family members. How many of you come across families where the spouse is on medical leave or maybe on Social Security? You also have provider issues. There may be three or four providers--the well-meaning family doctor who’s prescribing the Prozac, and then you may have a group therapist and a family therapist. And everybody’s giving us a different message about how to handle the employee. There are four or five factors we look at that we think contribute to a prolonged disability leave. We like seeing a psychiatrist involved and the psychiatrist having a session with the employee at least once a month (if not more frequently) to manage the medications. We like seeing the word “behavioral” in the therapy--whether it be cognitive behavioral or dialectic behavioral or just straight-out behavioral therapy--and a frequency of at least twice a month. And when we see the notes--and we see a lot of notes from therapists when we conduct claim reviews--we really don’t like notations such as “Discussed disability. Still hasn’t gotten clarification from employer.” If that’s what they talked about, they weren’t dealing with how to get the person back to work. Sometimes we have cases where a person can’t get in to see a psychiatrist for six weeks, or the person can see a therapist but it will be four weeks. What we try to do in these situations is provide telephonic intervention with a psychiatrist or therapist. We try to do it in a collegial way; we say, “We know you have a challenging schedule, but could you please devote some attention to this, because we want to see this person get good treatment and return to work as soon as possible.” Occasionally we come across physicians who are protective of their patients and think they’re in a fine treatment plan. That’s when we go toe-to-toe with the provider. There are lots of journal articles out there--and the New England Journal of Medicine has a couple of really good studies that have come out--that say that most optimum treatment for depression is a combination of both cognitive behavioral therapy and medication management. Physicians usually won’t argue with good research, and they’ll back down. Sometimes we’ll go back to the client and use the added leverage of saying, “We’re also going to refer this back to your disability carrier.” The language in most disability plans now reads that the client has to be in “appropriate care and treatment.” And if the person isn’t getting a legitimate standard of care, we tell him or her, “Your benefits can be terminated, and we don’t think you want that. So let’s figure out a way to get you where you need to be.” So if any of you who have relationships with employers and can influence their medical leave plans, we really encourage having some good language in there that says the person must be under “appropriate care and treatment.” Not “under the care of a licensed physician,” because that leaves them the option of pursuing treatment with the family doctor. Often a phone call from the supervisor or manager or an HR representative when an employee takes a medical leave can work wonders in terms of changing the person’s viewpoint toward the work environment, especially if the employee perceives the work environment as stressful. You want the employee to stay connected to the workplace, and this phone call helps maintain that connection. So we encourage employers to make a phone call soon after the person takes a medical leave to keep in touch. We frequently come across well-meaning physicians who don’t understand the work environment or job demands of a patient and base their diagnoses entirely on the patient’s self-report, with very little input from the employer. This is a role that you can fill by explaining what’s going on in the work environment and helping the physician obtain a balanced point of view. Because frankly, the physician is only going to get the employee’s point of view until and unless someone provides the employer’s perspective.” DISCUSSION (Member Exchange Forum) |
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© 2003 Exhange On-Line is a publication of the Employee Assistance Professionals Association, Inc. (EAPA). Reproduction in whole or in part without written permission is expressly prohibited. Publication of bylined articles does not constitute endorsement of personal views of authors. Appearance of paid advertisements does not constitute endorsement by EAPA. |
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