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Mental Illness in the Workplace: Psychological Disability Management. Henry G. Harder, Shannon L. Wagner, and Joshua A. Rash (2014) Farnham, England: Gower Publishing, Ltd. 389 pp.

Schwartz, Bruce J. MD

The Journal of Nervous and Mental Disease: October 2015 - Volume 203 - Issue 10 - p 812
doi: 10.1097/NMD.0000000000000374
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Deputy Chairman and Professor of Clinical Psychiatry Department of Psychiatry and Behavioral Sciences Montefiore Medical Center Albert Einstein College of Medicine Bronx, NY

Harder, Wagner, and Rash have produced a well-written and highly readable textbook covering many of the issues regarding mental illness in the workplace. In their concluding chapter, they note that the book arose out of their frustration with the lack of resources available to address workplace mental health issues and the resistance of employers regarding mental health problems. One looks no further than the recent tragedy regarding the German Wings crash as to the relevance of psychiatric issues to society in general and the workplace in particular. Of note, the authors are Canadian, and especially when addressing health insurance, regulations and laws governing disability are solely concerned with their applicability to Canadians.

Chapters cover the diagnosis, prevalence, economic burden, and undertreatment of mental illness; societal perspectives and stigma about mental illness and the workplace; and specific disorders such as depression, anxiety, PTSD, and occupational distress. These chapters review differential diagnosis, etiologic theories, and the impact of these illnesses on the work environment and the employee as well as possible workplace accommodations. Other chapters address psychological assessment, creating a healthy workplace, toxic work environments, bullying in the workplace, and workplace positivity to name a few of the other topics reviewed. Any large employer or human resources professional has to be concerned about the burden of mental disorders on their work force. In addition, given the prevalence of comorbid mental and physical disorders and the association with poorer outcomes, any self-insured business should recognize the value and potential savings in medical and disability costs of treating mental illness. There is a concise discussion regarding medical and psychiatric comorbidities. Unfortunately, there is no chapter about the seriously mentally ill and the workplace problems and issues associated with their employment. Of note was that substance abuse disorders were not adequately discussed by the authors. With estimates by SAMHSA of 10% of employees with substance abuse disorders, this is generally one of the most common reasons for workplace evaluation and one with both substantial potential liabilities for the employer and negative effects on a work environment. A criticism of the book is this omission of a discussion of the impact and relevance of workplace alcoholism and substance abuse.

The chapter on psychological assessment for the workplace left me somewhat confounded. The authors list autism spectrum disorder, developmental delay, and fetal alcohol spectrum disorder as among the more likely and expected disorders which might require a referral for psychological assessment. It seems to me that these disorders would more probably occur and be referred for evaluation in an early childhood or school setting rather than the workplace.

As I read the text, I wondered who would most benefit from this textbook. Several of the chapters devoted to psychiatric disorders review in detail diagnostic criteria and differential diagnosis and seem intended for non-mental health professionals such as human resources (HR) staff and managers who do not have any expertise or knowledge of common mental disorders. I suspect this may be one of the target audiences as many of the chapters seem designed to help HR staff and managers make the argument with employers as to the importance and potential return on investment (ROI) of workplace mental health programs. The inclusion of economic arguments in many of the chapters for addressing mental health issues in the workplace is one of its greatest strengths. Other audiences would be students preparing for careers in management and HR. Of particular usefulness are three appendixes designed to help in estimating the ROIs for programs addressing depression, anxiety disorders, and bullying in the workplace.

Clinicians often need to interface with a patient’s place of employment. In addition, many clinicians provide independent psychological or psychiatric evaluations at the request of employers. There are many ethical, privacy, advocacy, and legal issues which clinicians need to be aware of and navigate. The conflicts inherent in providing behavioral services in a work environment often feel as if they run counter to our training as clinicians. Obtaining informed consent from employees undergoing evaluation is critical as well. From the book’s title, I hoped that there would be more discussion of these issues from the perspective of clinicians interfacing with a work environment. However, it does not seem to me that the authors intended this textbook primarily for a clinical audience. I would have liked to see more discussion and attention to confidentiality issues and the professional challenges for clinicians providing services to places of employment.

Psychiatric and psychological evaluations in a work setting can be highly useful and essential to the workplace. Clinical and workplace evaluations can as well be opportunities to positively intervene in the lives of employees and to educate and inform. Work and job jeopardy can as well provide significant motivation to individuals to participate in treatment and return to full productivity.

Employers need to recognize the value of recovery and returning well-trained and qualified employees to their jobs. In addition, maintaining a psychologically healthy work environment can generate a substantial return on investment for businesses. This textbook helps to advance this cause. The authors of this text successfully communicate the argument and wisdom of addressing workplace mental illness.

Bruce J. Schwartz, MD

Deputy Chairman and Professor

of Clinical Psychiatry

Department of Psychiatry and Behavioral Sciences

Montefiore Medical Center

Albert Einstein College of Medicine

Bronx, NY

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DISCLOSURE

The author declares no conflict of interest.

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