Assessment of impaired or disruptive executives and professionals. These evaluations are requested by regulatory agencies, diversion programs, employers, practice groups, or partnerships and attorneys. They can be highly complex, with significant consequences for the evaluee's and the organization's future. In addition to the direct examination, record review and information from collateral sources required for other assessments, these involve significant clinical questions. The requesting party generally wants to know the nature of the problem and whether something can be done about it, and if so, what. The evaluator may be asked for specific recommendations regarding potential referrals to provide the recommended interventions (e.g., finding a therapist to treat the disruptive executive).
Interventions for impaired or disruptive executives and professionals. Organizational and occupational psychiatry practitioners may be called upon to provide direct interventions, either by a third party, the individual or a colleague who has performed the initial assessment. These interventions involve our traditional psychiatric skills, such as psychotherapy and medication management, but must be informed by knowledge of the patient's field, organization and its specific stresses.
Organizational consultations. These consultations are among the more complex activities of OOP specialists. They tend to be requested when one or more members of a work group engage in behavior that is disruptive to the organization or where conflict among individuals and its impact can no longer be ignored. Diagnosis of the problem generally requires extensive interviews with individuals at all levels of the organization and an understanding of both the micro and macro environments of the organization. Solutions are generally found in looking at the system as a whole and how individual behaviors and pathology interact with that system.
Policy and procedure development. Organizational and occupational psychiatry practitioners with expertise in workplace violence, sexual harassment and disaster management are retained to help organizations develop policies and procedures. In addition, they may be retained to help provide training to the organization and its staff.
In-house consultants. Organizations with an appreciation for the importance of mental health issues may retain an OOP specialist as a consultant or, in some cases, as a full- or part-time employee.
Employee assistance program services. Employee assistance program services have traditionally been the province of alcohol(Drug information on alcohol) counselors, social workers and psychologists. Psychiatrists are often sought out to provide consultation to EAPs and several psychiatrists have developed and operated successful EAPs.
Threat assessment/crisis management team members. Psychiatrists with expertise in workplace violence and crisis management, especially those who have helped develop disaster plans or workplace violence policies, can be valuable members of organizational threat assessment or crisis management teams on an ongoing basis.
These are just some examples of areas where OOP specialists practice. Some of this work can be, and has been, done by general psychiatrists or other subspecialists. Organizational and occupational psychiatry subspecialists are generally preferred for these assignments, however, because their interest in and familiarity with the world of business adds value. Beyond the standard mental status examination that is used as part of a fitness for duty evaluation, for example, OOP specialists apply their knowledge of the stresses inherent in the evaluee's specific occupation; the status of the industry; conflicting business, personal and legal concerns; organizational dynamics; psychotherapy; psychopharmacology and general medicine. As noted above, few aspects of psychiatry provide such an opportunity to integrate as much of our psychiatric skill sets.
Organizational and occupational psychiatry is not an easy field in which to get started. The business world has traditionally been skeptical of psychiatry and its potential contributions to the workplace. It is unclear whether this is due to the association of psychiatry with severe pathology, a perceived bias against business on the part of psychiatrists, or a combination of these and other factors. Psychiatrists who have been successful in the field have done so by building it as a part of their general or other subspecialty practice. For example, forensic psychiatrists who develop expertise in employment-related forensic matters and relationships with employment attorneys may be called upon to assist with other workplace mental health issues. Psychotherapists who work with executives and professionals may be asked to work with larger groups to assist them with organizational issues. Regardless of the starting point, personal relationships and trust are essential to building a practice in OOP. The party seeking the service, whether it is an insurer, attorney, employer or government agency, must have confidence in the psychiatrist's ability to consider the often-complex individual and organizational issues, to be sensitive to the needs and concerns of the workplace, and to be objective and accurate. Perhaps most importantly, the psychiatrist must be able to express how psychiatric theory applies to the situation at hand, and to do so in plain English. The successful OOP consultant blends into the business environment through language, dress and interest in the field. The psychiatrist who fulfills these qualifications on the first assignment is often asked to provide additional consultation or other services.
One of the dilemmas when offering a new service is deciding what to charge. Organizational and occupational psychiatry services are generally not covered by insurance, although certain types of government-ordered evaluations may have a set hourly rate. There are no hard and fast rules in setting a fee, but there are certain pitfalls to avoid. Organizational and occupational psychiatry consultation services can generally be charged at the psychiatrist's fee for service rate for psychotherapy (assuming that the psychotherapy rate is within the standards of the community). An additional premium can be charged above and beyond that rate, depending upon the complexity of the assignment and the experience level of the consultant. The fee and how it is charged, i.e., flat fee or hourly rate, should be established before the assignment is begun. The consultant should be prepared to negotiate the fee with the client. Common errors, in addition to failing to set the fee in advance, include overcharging, failing to itemize the charges for services provided, poor record-keeping and lack of responsivity to client needs.
Training and Resources
At present, there are no fellowships in OOP. Subspecialty continuing medical education courses are offered, such as the Door County Summer Institute, and isolated OOP-related presentations can be found at the annual meetings of the American College of Occupational and Environmental Medicine, APA, and the American Academy of Psychiatry and the Law. The greatest concentration of OOP courses and practitioners is at the AOOP annual meetings. The AOOP is the subspecialty body dedicated to OOP issues and development, with the largest offering of seminars and training.