Psychiatric conditions in worker fitness and risk evaluation.

This chapter has reviewed the specific techniques of measuring fitness for work in individuals with psychiatric impairment. The discussion also considered the estimate of risk associated with various specific conditions and diagnoses. The use of psychiatric measures in work-fitness estimation is warranted in the following situations: 1. applicants with known or suspect history of psychiatric disorder; 2. employees returning to work after an episode of emotional illness or substance abuse; 3. employees referred to the medical department by management for evaluation of performance decrement, absence, abrupt indebtedness, unusual behavior, etc.; and 4. individuals evaluated for high stress or high risk jobs. Applicants' evaluations begin with a thorough medical history, a physical examination, a mental status examination, and basic laboratory studies. The personal history must include a complete work history, with particular attention paid to job duration and reasons for leaving employment. The mental status may be extended by specialized scales, e.g., the Griffiths work behavior rating scale. Unless an applicant has evidence of cognitive dysfunction, the usual battery of psychometric tests will not be helpful. Instruments that measure self-concept and ego strength, e.g., the Stotsky-Weinberg Sentence Completion Test and Miskimins Self-Goal-Other Test, may assist in resolving difficult questions about work fitness, especially in people with a history of schizophrenia. When an employee returns to work after an episode of psychiatric illness, the major questions for the occupational physician are: Is this person capable of returning to his current job? If not, what type of work is he capable of performing? In this instance, the fitness evaluation must add management data about the job to medical data about the patient. The patient-job fit is the crucial issue. For example, a socially-isolated, withdrawn paranoid schizophrenic functioned adequately for years as a third-shift computer operator. The scale of his operational responsibilities allowed him to work alone most of the time, a work environment unsatisfactory to most people but quite suitable for him. To aid in maintaining patient compliance with the treating physician's regimen, the patient should be asked to authorize release of medical information about the illness and to allow continued contact between the occupational physician and the treating doctor. Regularly scheduled follow-up visits are very helpful in maintaining patients on the job. They should include a brief interval history, an abbreviated mental status, relevant laboratory data (e.g., urine chromatography), and support.(ABSTRACT TRUNCATED AT 400 WORDS)

The troubled employee. The psychiatric patient at work.

Despite the prevalence of psychiatric illness in society there has been only limited research on vocational rehabilitation of the psychiatric patient. The work that has been done, however, suggests that the prevailing pessimistic attitude is unjustified. A committed occupational medical department working closely with the patient-employee, management, and the community treatment resource can frequently assist the employee in a satisfactory return to gainful employment.

The psychiatric patient at work.

Psychiatric consultations and job performance of 135 IBM employees were studied. Psychiatric referrals were made by management and the company medical department or were self-referred. The consulting psychiatrist conducted interviews, met with management, personnel representatives and other physicians to coordinate treatment with job requirements. Every effort was made to retain employees and improve performance. After a two-three year follow-up period, 82 employees (61.7 per cent) were with the company; ten were rated outstanding, 38 exceeded job requirements, 25 were meeting job requirements, and four were not. Performance data for five employees were not available. Forty-nine of 83 employees (59.0 per cent) rated unsatisfactory in job performance at the initial referral were performing satisfactorily at follow-up. The results support an optimistic attitude toward the working patient with psychiatric disease and highlight the value of a full-time medical department with consultation facilities leading to secondary and tertiary prevention.