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The Psychiatry of Work: Is Residency Training Adequate?

The Psychiatry of Work: Is Residency Training Adequate?

  • Mental health issues have a major impact on the workplace. Many patients present to psychiatrists for work-related issues. Conservatively, the estimated number of working age Americans with chronic mental health issues is 23 million. It has been estimated that depression alone results in a loss of $31 billion per year for employers.
  • Although the importance between employment-related issues and mental health has been described, it has been suggested that many psychiatrists may be unaware of the issues involved in assessment and treatment of workplace issues, and possibly lack training, especially in the area of disability evaluations.
  • A survey was developed by GAP to assess resident training in work psychiatry. The survey consisted of 23 items to assess demographics, amount of training in work psychiatry, and desire for training in work psychiatry. Three common workplace scenarios were included to determine resident comfort with the role of the psychiatrist in such situations.
  • These are common scenarios in which people in the workplace regularly seek help. Psychiatric expertise must be balanced with the needs of the workplace, as well as the insurance and legal (forensic) processes.
  • New onset work related disability
  • The survey was completed by 83 residents from 11 institutions. Responses were collected from residents in their third and fourth year of training, as these residents would have the greatest familiarity with their training program curriculum.
  • Residents reported very strongly believing psychiatric functioning impacts work ability, performance, and satisfaction.
  • Residents reported a lack of familiarity with the specialty of workplace psychiatry.
  • A minority of residents reported their program provided curriculum in work psychiatry.
  • Residents strongly believed training in work psychiatry should be included in training programs.
  • Few residents feel comfortable evaluating and addressing workplace issues.
  • To address the desires and needs for training in work psychiatry, GAP is developing a curriculum that can be used by residency training programs.
  • References

Work is not only the means by which our patients survive, it constitutes a central aspect of identity and serves as the context within which many—if not most—of our interactions take place. Most of our conscious waking hours are spent at work.

Problems encountered at the workplace frequently drive the decision to seek psychiatric consultation and treatment. Problems with one’s supervisor, the perception that one is being treated unjustly by a boss or employer, and fears relating to job security are commonly associated with the development of affective and anxiety symptoms.

Workplace problems are important to address as outcomes worsen and crises deepen.1 Long-term unemployment typically leads to a spectrum of poor clinical, economic, and functional outcomes; and job loss contributes to feelings of depression, purposelessness, social isolation, and even suicide.

Despite the central importance of work to mental health, many psychiatrists are unable to effectively assess and address the workplace problems presented by their patients. Psychiatrists who focus on occupational and organizational problems frequently cite lack of adequate education and training in the area. Assessment of functional capacity—and optimal clinical approaches to patients who present with claims work incapacity—is a frequently remarked upon, and well-documented, manifestation of the above-described problem.2

The Committee on Work and Organizations of the Group for the Advancement of Psychiatry (GAP) has studied the adequacy of existing psychiatry residency training in this area. This slideshow features the study findings. Results of this study found:

• Residents are aware that they receive insufficient training in the psychiatry of work
• Residents do not feel confident evaluating or treating common workplace problems
• Many are interested in being trained to evaluate and treat common workplace problems

To address the desires and needs for training in work psychiatry, GAP is developing a curriculum that can be used by residency training programs.

Disclosures: 

Dr Brown is Lead Psychiatrist for the Boston Police Department and President of the Academy of Organizational and Occupational Psychiatry. Dr Long is Chair of the Committee on Work and Organizations, Group for the Advancement of Psychiatry, and consults to industry and the legal profession about workplace problems. Dr Sassano-Higgins is Associate Professor at the University of Southern California Department of Psychiatry in Los Angeles, California, and recently served as the Work and Organizations Committee's Cotswold-Looney Fellow. Dr “Daven” Morrison is an independent advisor to senior management, Past President of the Academy of Organizational and Occupational Psychiatry, co-author of the ABCs of Behavioral Forensics, and Clinical Assistant Professor at Chicago Medical School.

References: 

1. Group for the Advancement of Psychiatry. Committee on Psychiatry in Industry. What Price Compensation? New York:Group for the Advancement of Psychiatry;Volume IX (99):1977.
2. Adler D, GAP Psychopathology Committee. Psychiatrists’ knowledge of their patients’ job functioning. Psychiatr Serv. 2013;64:395-396.

Comments

AADEP is a multispecialty organization that focuses on occupational medicine. The resources are already in place for this kind of training. There is a course through them called CEDIR that is a certification in the are of workplace disability evaluation.

http://www.aadep.org/en/certification_exams/

One problem is that the APA rejected the idea of a quantitative psychiatric chapter in the AMA guides to disability several years ago, so the method of rating disability remains very subjective and controversial. Since they are claiming parity with the rest of medicine, the APA may want to rethink that position.

James @

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