Ill, or just think you're ill? Professor of Neuropsychology Peter Halligan tells Georgina Kenyon that better understanding of long-term absence could save UK businesses millions of pounds
It is difficult when talking to PeterHalligan, Professor of Neuropsych-ology at Cardiff University, not to be taken in by his beliefs about health.
After all, this man knows how to hypnotise people and is a very persuasive speaker. Sitting comfortably in his office at the university's campus, he talks about his beliefs on illness, rehabilitation and people's attitude to illness.
A key part of Prof Halligan's work is to understand some of the reasons behind why people are long-term absent from work and to address the social and psychological factors that contribute to sickness absence.
"We need to get away from a purely biomedical model of illness to consider instead what is called the biopsychosocial model," he urges.
"Disease and illness are not the sole result of biological damage, but may be caused or shaped by psychological and social factors," he explains.
Over the past five years, Prof Halligan has been investigating the psychosocial factors that determine illness behaviour, chronicity (having a long history of disease) and potential treatment. He has just co-edited a book, called The Power of Belief, on disability and medicine with his colleague Mansel Aylward. This book brings together for the first time current thinking on how development within the biopsychosocial model can better explain the rise in symptom-based illness and work-related absence.
As with many peoplewho become interested in psychology, Prof Halligan became keenly interested in asking why people behave as they do and believe what they do.
After studying psychology at University College Dublin, Prof Halligan says he realised that science does not always provide a full understanding of why a person says, believes or reacts the way they do.
"Like many others I became very interested in the how and the why of philosophy and psychology while at university," he says.
One of the key reasons why the developments in biopsychosocial theory is significant for the insurance industry is that it provides a much needed theoretical platform to begin to better explain sickness absence, the reasons why people claim insurance – as well as long-term absenteeism.
"You could say that a large part of illness and illness behaviour comes down to beliefs," says Prof Halligan.
"Beliefs define who you are and it is not just the patient who has beliefs that affect their health. Doctors have beliefs too, and this impacts on the treatment that a patient receives," he explains.
"It is only by knowing what a person believes about their condition that you can successfully predict how they will behave in certain situations. Knowing what they believe about their condition is clinically relevant for understanding and managing their condition," adds Prof Halligan.
He cites the example of how a patient will behave differently if their doctor believes they are ill. "If your doctor believes you cannot work, you will probably believe this too."
He explains that a patient's beliefs can predict their capacity to cope and recovery, as well as their treatment, compliance to treatment – and behaviour.
For instance, it has been shown that after a stroke, negative attitudes and beliefs have been associated with length of survival of a patient and is thought to hinder recovery.
Prof Halligan also discusses the example and incidence of repetitive strain injury (RSI) and its treatment in Australia.
In the early 1980s, the Australian state of New South Wales saw an 11-fold increase in disability claims. Some psychologists say that doctors played an important part in the belief that RSI was the primary result of an occupational injury caused by inhumane working conditions. Prof Halligan suggests that sometimes too much health information can have a negative impact on our health. In the case of RSI, it seemed that people sometimes started to believe that they had the condition and so did their doctors, even when the physical evidence was not strong enough to prove it.
Prof Halligan explains that the importance of the biopsychosocial model is illustrated by the fact that of the 2.7 million people in the UK who are currently not working due to illness-related conditions, 70% of them do not have formal medical disorders that can fully explain their incapacity to work.
This figure mirrors the trend for some of the most common claims under income protection cover, which are mental health issues – including stress. But how is it explained?
Again, Prof Halligan says looking at a person's beliefs may well show their ability to react to pressurised work conditions. Stress, is one attributed cause for illness, where people's beliefs can be seen to be very strong.
"Stress is not necessarily bad and is a normal part of life that can help us learn and grow. Pushing yourself and feeling stressed can be a good thing and may be needed – for instance, to excel in your profession. But stress considered as the inability to cope with the demands of their job is understandably recognised by the public and medical profession as negative," says Prof Halligan.
"There are situations where because of the work environment, management or personal reasons, people find that they are unable to cope," he adds.
"In these situations many factors are at work, but the patient's beliefs regarding their own capacity is an important factor," he explains.
In terms of treating sickness absence, he thinks the biggest challenge is the current lack of what he feels is a coherent set of policies from the Government addressing sickness and absence as well as occupational health.
That said, Prof Halligan adds that he and his colleagues have responsibility to educate the Government: "As academics and experts we also have a challenge to educate the gatekeepers. You cannot assume they understand all the issues."
One positive trend in the UK, explains Prof Halligan, with regard to sickness absence and the medical profession is how doctors are now being encouraged to ask a patient on sickness benefits what sort of work they can do, rather than what they cannot. Doctors often have detailed discussions on the legitimacy of the underlying medical condition.
Another encouraging development is how well the medical community and Government received the Confederation of British Industry's announcement that it is good for a person's health to work – and such evidence is now being used by doctors to try to incentivise people to work again.
But how could more people be encouraged to work in a job they used to do, even after illness or injury?
"It is by the adoption and use of a psychosocial model that would improve the delivery of better healthcare, more than any other change in healthcare organisation," states Prof Halligan.
"And this is the challenge," he concludes.
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