Letters to the Editor |
Common mental health problems in the workplace: how can occupational physicians help?
Dear Sir,I am writing with reference to the recently published editorial by Grove [1]. Unless an enterprise achieves an operating surplus, it cannot afford to provide resources to support its employees within the constraints of its effective function. That surplus already funds human resources within the organization, therapy in the National Health Service, social security benefits and statutory and company sick pay. It is itself reduced by the burden of the absent employee, no longer participating in production or service. Additional expenditure on an occupational physician (OP) is expensive and rare and expects a return. In taking no account of the demanding environment of an effective organization, Grove's compassionate advocacy of the patient's need lacks the steel of competent occupational medical practice. Rather than dabbling in cognitive behavioural therapy, the OP must be aware of the hygiene factors which keep a workforce motivated, satisfied and healthy [2].
Distress becomes pathological only when the diagnostic criteria of pathology are met. Within days of its onset the OP must forecast as best she/he can the likely severity of the episode, evaluating and helping to resolve the conflict of interest between the employer and the employee. ‘Rehabilitation should begin in the ambulance’ [3]. The sound of a bell after 4–6 weeks absence is more likely to be the knell of the OP who has failed to advise the manager struggling to make deputizing arrangements to maintain production or service tomorrow. It is essential to establish immediate communication with the general practitioner [4]. Recovery is encouraged when case management in a therapeutic environment takes due account of the unavoidable challenge of returning to a demanding production or service environment.
The employer pays for credible sapiental authority, helping management to decide whether recovery is likely in the short term, and if it is not, in negotiating the timing and terms of retirement into the therapeutic environment of care outside the organization. Everyone concerned contributes to that end. To paraphrase the view of Field Marshal Slim [5] in a far more lethal contest than economic competition, ‘Doctors are no good without discipline (management). Half the battle against disease is fought not by doctors, but by regimental officers (managers). This seemed a difficult concept for them to grasp until I sacked one or two. The rest rapidly got the message!’
If competent assistance to management in a central component of occupational health practice is not forthcoming spontaneously from the expensive retained resource claiming expertise, expenditure on poor value will be terminated, understandably, to the disadvantage of those concerned and to the detriment of the Society and Faculty.
Past President, Society of Occupational Medicine
e-mail: joekear99{at}hotmail.com
References
- Grove B. Common mental health problems in the workplace: how can occupational physicians help? Occup Med (Lond) (2006) 56:291–293.[CrossRef][Medline]
- Hertzberg F, Mausner B, Snyderman B. The Motivation to Work (1966) New York: Wiley.
- Kearns JL. Return to work. In: Going Home—Simpson JEP, Levitt R, eds. (1981) London: Churchill Livingstone. 254–264.
- Kearns JL, Lipsedge M. Psychiatric disorders. In: Fitness for Work—Cox RAF, Edwards FC, Palmer K, eds. (2000) 2nd edn. Oxford: OUP. 122–143.
- Slim W. Defeat into Victory (1956) London: Cassell.
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