Easing employees back into the workforce after mental health leave.

Peace

One in five canadians will experience a mental illness in their lifetime, according to a 2002 Health Canada report. In any year, 12% of Cana-dians ages 15 to 64 suffer from a mental disorder

or substance dependence, as stated in a 2004 article in Healthcare Papers. Mental illness accounts for more than 15% of the burden of disease in Canada but gets only about 5.5% of public health dollars, according to a 2008 report by the Institute of Health Economics. And stigma, although on the decline, is still a big issue.

Each day, 500,000 Canadians are absent from work for mental health issues, which accounts for nearly 30% of disability claims and 70% of all disability costs, according to 2006 data from the Public Health Agency of Canada. Total costs and claims attributable to mental illness have overtaken claims associated with cardiovascular disease as the fastest growing category of disability costs in Canada. Most mental health prob-lems in the workplace occur in people who are in their prime working years. According to Mental Health: A Workplace Guide (produced by Rogers Media), “…depression is the leading cause of disability among people 15 to 44 years of age in Canada and the U.S., and the World Health Organization predicts that it will be the second-leading cause of disability worldwide by 2020.”

Realities and ImportanceRelatively few Canadians who need mental health services get help. One 2002 Statistics Canada study indicated that only 32%

of those with a mental disorder or substance dependency saw or talked to a health professional during the 12 months prior to the survey, and there are differences by age group, but it is generally accepted that between one-fifth and one-third of Canadians who need mental health services actually receive them. The profes-sionals most often contacted are family physicians, followed by psychiatrists and psychologists.

There are various reasons for such low levels of receiving help, but in the case of an employee coming back from a leave, cost may be a big issue and the health benefits package will likely be inadequate to cover more than five or six sessions with a psychologist in any one year. Of course, if the employee is see-ing a psychiatrist, that service will be covered under a provincial health plan. Knowing the returning employee’s status regarding prior and ongoing treatment if the employee has been receiving help before or during the leave will aid an employer’s readiness and ability to make accommodations for appointments.

In other words, the employee may be returning to work after a disability but not be receiving the ongoing help from a profes-sional who can treat the condition or guard against recurrence.

Employers also need to understand that getting help for mental health issues in Canada is very often a challenging proposition. And, the “system” is fragmented. There is a real lack of psychiatrists, especially in office-based practices. For every 100,000 people in Canada, there are about 12 psychia-trists, compared with 35 psychologists. In fact, 71% of Ontario

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by David Michaels

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family physicians say they have a hard time referring to psy-chiatrists, according to the 2008 National Physicians Survey.

A lot of mental health services are provided in the private health sector. If a person sees a psychologist outside of a hos-pital, he or she has to pay out-of-pocket or with private (often employer-sponsored) insurance. Employers need to keep this in mind because those returning to work are facing the same barriers to service that so many Canadians are facing. Accom-modation, then, becomes a matter of not just making sure that people have time off for appointments but understanding that those coming back may be having trouble accessing or paying for services.

For depression, early access to help is essential. There is a relationship between early, aggressive treatment and the likelihood of further episodes. According to Dr. Steven Wise-man, a psychiatrist in Vancouver, one episode puts people at risk for future episodes. “Someone who’s had one episode of major depression has a 50% chance of having another; those who’ve already had two episodes have a 75% chance of having another; and those with a history of three bouts of depression face 90% odds.”

Treatments for mental health conditions show impressive outcomes. The chart (right) shows the results of patient-perceived outcomes for users of mental health services in Ontario (2004).

The HR department or senior management should be ready to make suggestions to employees or their supervisors. Privacy and other issues such as stigma and reluctance to seek help

should not stand in the way of being ready to suggest that help be sought and giving the employee a list of resources in the community, both in the public and private healthcare sectors.

De-stigmatize the WorkplaceEven though stigma is more related to serious mental illness and strongly associated with fears of unpredictability and dangerousness, just 50% of Canadians would tell friends or co-workers that they have a family member with a mental illness, compared with 72% who would discuss diagnoses of cancer or 68% who would discuss diabetes in the family.

Patient-perceived Outcomes for Users of Mental Health Services in Ontario

Always/ Sometimes/ No/ Usually Somewhat Never

Feel better prepared to

deal with daily problems 49.4% 40.1% 10.1%

Feel more ready to participate

in usual activities 40.1% 39.2% 20.7%

Feel helped by mental

health services 70.0% 25.4% 4.6%

Source: Hospital Report Research Collaborative, University of Toronto, 2005

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Stigma is rooted in ignorance, and employers should be taking advantage of various anti-stigma campaigns, such as the one launched by the Mental Health Commission of Cana-da, to continually emphasize the realities of mental health.

Employer-sponsored BenefitsEmployers must clearly understand the role and efficacy of the employee assistance program (EAP). In general, the response from business and industry to workplace mental health prob-lems has not been adequate. Much has fallen to EAPs. Having a roster of mental health professionals to whom the employer can refer employees is a good measure. The employer need not have a formal affiliation with any professional(s) but can maintain a listing and should clearly state any fee-for-service arrangement. Workplaces can link with resources in the com-munity, directly or through their EAP.

The employer must know the limits of its health plan and how this may affect the employee’s ability to get help for a proper course of treatment. Cognitive behaviour therapy, one of the most widely accepted interventions showing excellent results, is often done over a course of 12 to 16 sessions, and most employer plans do not cover psychological services suf-ficiently to allow for a proper course of this type of therapy, even if paramedical coverage is isolated by professional. Those plans that lump paramedical providers will be even less able to provide anything approaching adequate coverage.

Being aware of issues, ensuring a workplace that doesn’t

stigmatize, educating staff and promoting optimal mental health are essential starting places for accommodating em-ployees returning from mental health leaves as well as devel-oping workplaces that address mental health issues in general.

Senior managers and HR departments must educate themselves about mental health and mental health care. Mental health literacy is sorely lacking in Canada. According to a 2009 article in Paediatric Child Health, “Mental health literacy is arguably the least developed health literacy among the public, providers and policy-makers alike. An immediate co-ordinated campaign led by a coalition...is needed to ensure that basic knowledge about mental disorders and effective interventions become commonly known and understood.”

A workplace that educates all employees about the realities of mental health will have an important advantage in accom-modating those returning to work. This should be ongoing and stress the fact that one out of five Canadians will experience a diagnosable mental health condition in their lifetime (the other four will be affected by a friend, family member or co-worker who will), that mental health is inextricably connected with physical health, and that stigma is rooted in ignorance and perpetuates the fear and resentment that is too often associated with how we deal with those with mental health issues. W

David Michaels is the CEO of The Clinic for

Emotional Wellness Inc. in Vaughan, Ont.

david.michaels@theclinicforemotionalwellness.com

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