Organizational and occupational psychiatry (OOP) is the subspecialty of psychiatry that focuses on work, its importance in the lives of individuals and work organizations. The importance of work to the mental health of individuals is reflected in the quote attributed to Sigmund Freud: "Love and work are the cornerstones of our humanness." Freud is also purported to have said that the goal of psychotherapy is to be able to "love and work" and that the ability to "love and work" defines mental health. Precise sources for these quotes are difficult to find, but Freud was certainly not alone in this view, with multiple thinkers and researchers sounding the same theme (Hazan and Shaver, 1990).
Organizational and occupational psychiatry represents the extension of psychiatric knowledge and skill to the day-to-day functioning of individuals in the workplace and their organizations, with the goal of helping both function better. To this end, psychiatrists have played an important role both in the treatment of workers and consultation to organizations since the early part of the 20th century. These roles have included service as in-house medical directors to major corporations, retained consultants and providers of employee assistance program (EAP) services (Sperry and McLean, 2003). The level of psychiatric involvement in work-related issues has fluctuated over the years; however, the importance of mental health issues in the workplace has grown steadily.
Recognizing that patients and their employers would benefit from the services of psychiatrists who are knowledgeable about workplace issues, the American Psychiatric Association formed the Committee on Psychiatry/Business Relations in 1998. That committee has given rise to the National Partnership for Workplace Mental Health, among other projects.
Organizational and occupational psychiatry is a field with tremendous growth potential and practice opportunities for those psychiatrists who are open to understanding the business world, interested in functioning outside traditional clinical settings and willing to take on the challenge of building a new area of practice.
What Does OOP Do?
Broadly speaking, OOP can be divided into issues related to the functioning and health of the larger organization (organizational) and issues related to individual work-related mental health concerns (occupational). Yet the distinction is not always clear, as the interface between individual and organizational workplace issues is often significant and complex.
Perhaps more than any other subspecialty of psychiatry, OOP provides an outlet for the diverse training and interests of psychiatrists. The field offers opportunities for those with interests ranging from psychoanalysis to psychopharmacology, from executive coaching to disaster medicine. Organizational and occupational psychiatry services can be as straightforward as a single session Social Security disability evaluation or as complex as a consultation to a large organization experiencing disabling conflicts among leadership. The educational offerings at the most recent meeting of the Academy of Organizational and Occupational Psychiatry (AOOP) reflect the diversity of OOP; AOOP information is available on their Web site at <www.aoop.org>.
In many cases, OOP involves consulting to and working as part of a team, with the OOP consultant playing a leading role. The pressure on the consultant can be significant, as important business decisions that may affect an individual's employment or the financial status of a company may turn on the consultant's recommendations. Organizational and occupational psychiatry consultations are often clinical in nature and aimed at improving the functioning of an individual or organization. In some cases, the entire organization is the patient, while in others, it is a single employee. Engagements may be short- or long-term, with the successful consultant commonly re-engaged by the same client for assistance on similar and sometimes unrelated issues.
The best way to explain the work of OOP specialists is to offer some examples of the assignments frequently undertaken by practitioners.
Social Security disability or workers' compensation evaluations. These are single session evaluations (one to two hours) that include record review and follow guidelines established by the Social Security Administration or state administrative agency requirements, respectively. Of the many OOP activities, these evaluations and initial workers' compensation evaluations are most similar to standard psychiatric evaluations (Williams, 2001, 1999). They are an excellent way to become familiar with workplace issues and meet attorneys and others involved in the field. Second-opinion evaluations in both settings are more complex, requiring the review of additional records, administrative decisions and reports.
Disability insurance evaluations. These evaluations may be requested by employers, insurers or attorneys representing individual applicants, insurance companies or employers. They can range from fairly straightforward to more complex assessments, depending upon the issues involved, the stage of the application and whether the matter is headed toward litigation. Medical and personnel record review is involved, as well as direct evaluation with a detailed work history, and interviews with collateral sources, including family members. Insurers generally provide a set of questions to guide the examination and report-writing. As practitioners gain experience and exposure in the field, they tend to be asked to evaluate claims at higher levels of the process (e.g., second opinions of previous evaluations).
Fitness for duty evaluations. These are primarily requested by employers who have concerns about an employee's cognitive abilities or emotional stability as they relate to ability to function or the employee's potential for violence. Like disability evaluations, these can range from fairly simple to highly complex. Fitness for duty evaluations rely even more heavily on interviews with collateral sources familiar with the evaluee and the job functions. In some cases, background investigations, police reports and other nontraditional information sources are utilized. An appreciation of organizational dynamics and an understanding of such concepts as "person-environment fit" increase the quality of these evaluations (Sperry, 1993).
Hazan C, Shaver PR (1990), Love and work: an attachment-theoretical perspective. Journal of Personality and Social Psychology 59(2):270-280.
Sperry L (1993), Anatomy and physiology of organizations. In: Psychiatric Consultation in the Workplace. Washington, D.C.: American Psychiatric Press, pp17-47.
Sperry L, McLean AA (2003), Psychiatry, productivity, and health: a brief history of psychiatry in the workplace. In: Mental Health and Productivity in the Workplace: A Handbook for Organizations and Clinicians, Kahn JP, Langlieb AM, eds. San Francisco: Jossey-Bass, pp71-87.
Williams CD (1999), Social security disability evaluations. Available at: http://aoop.org/archive-bulletin/1999winter04.shtml. Accessed April 23, 2004.
Williams CD (2001), Worker's compensation IMEs-Part 1. Available at http://aoop.org/archive-bulletin/2001fall04.shtml. Accessed April 23, 2004.