Moving Minds, a psychological management and rehabilitation service, responds to Keith Bushnell's recent article on mental health and workplace absence.
Medical and Psychological Opinions
The nature of failed interventions such as "Pathways to Work" caused their lack of success. Delayed return to work has features of many medical and psychological conditions and the effective management of any medical or psychological condition depends on two parts: the accurate diagnosis and secondly the appropriate treatment.
Sick notes or fitness to work certificates do not provide meaningful diagnoses and, as has been frequently pointed out, do not in particular identify mental health issues, which may be present either separately or in conjunction with a physical condition.
Not infrequently, mental health conditions, commonly depression, anxiety or both, often maintains the perception that physical problems are still as serious as when the illness or injury commenced. In an ideal world one might ask a clinical psychologist or a psychiatrist to provide a diagnostic opinion.
However, this is ruled out by cost. A compromise would be to employ psychology graduates, guided by a clinical flow chart, supported by the use of standardised psychometric tests and under the supervision of a senior clinical psychologist, to find out this information.
Once a mental health condition had been identified at six or eight weeks after the onset of sick leave, evidence-based treatments could be offered. NICE (The National Institute of Health and Clinical Excellence), has provided widely accepted clinical guidelines for the commoner psychological conditions, such as anxiety and depression, this should be less of a problem.
Most of the recommended treatments are based on those talking therapies, with a firm evidence base, rather than non-focused "counselling". Focused treatments are usually effective and time limited. Their costs are modest and usually less that allowing a sickness absence to run into a lifelong absence from work.
Keith Bushnell is to be congratulated for introducing this topic to Cover's pages.
We put forward the above suggestions in the hope that the debate will move forward and that the above pragmatic steps will be made by Income Protection providers. There is likely to be opposition from the current nominal providers.
However, over the decades these same nominal providers have not responded effectively to the affected persons needs and have helped convert a self-limiting period of illness into a long term disability.
Dr Manda Holmshaw is a clinical director and J Wilson Carswell OBE FRCS. is medical director at Moving Minds.
