Hugh Koch looks at the implications for assessment and absence management at the interface between personal injury and employment stress.
Two groups of lawyers and medical experts recently attended break-out sessions at the Legal & Medical 2007 Conference in London to address this topic. The outcome of the debate covered the areas of classification of employment stress, responsibility for identifying and resolving this stress, the role of anger and resentment in maintaining ‘disability’, and the benefits of CBT therapy and a phased return to work approach following absence. There is no robust classification of the types of psychological stress which is seen in the workplace.
Brainstorming elicited many types of work-related adverse events plus non-work adverse events (diagram 1 below). The DSMIV (TR) classification (APA, 2000) (and its European ICD 10 counterpart) is an important tool for aiding a reliable categorisation of moderate to severe psychological disorder in the work place. The complexity of workplace presentations was discussed by one group, where it was recognised that work and non-work factors were frequently at play when an employee was absent from work or working at reduced efficiency or satisfaction, as the case study below exemplifies.
Simple View Two years’ sustained work stress (work overload, harassment, insufficient support from management) resulting in nine months’ absence from work due to depression.
Complex View Pre-work stress history: a) Two recent severe road traffic accidents, one resulting in chronic back pain, the second resulting in difficulties tolerating a stressful journey to/from work. b) History of job dissatisfaction and work relationship conflict.
Post-work stress history: a) Concurrent relationship and domestic/financial pressures b) Ill health and threat of cancer diagnosis. Who is responsible? Two themes emerged as to a) who is responsible for the problem(s) occurring (i.e., causation) and b) who is responsible for the resolution or change in the situation or disorder. The issue of ‘foreseeability’ was particularly relevant in relation to employment litigation and the DDA. The key ‘players’ in terms of potential responsibility for resolution included:
- Line Manager
- Employer (corporate)
- Employer Insurer
- Occupational health
- Family ‘significant others’
The importance of thorough assessment of the psychological, social and occupational factors contributing to, reinforcing and maintaining work-related stress was highlighted. It was agreed that absence due to psychological difficulties needed to be followed by a gradual ‘re-exposure’ to work on a phased RTA basis. This required liaison and commitment from line management and a high level of motivation from the employee.
It also needed to be accompanied by appropriate work environment changes. Much workplace conflict and litigation can be prevented or resolved with an apology. Provided this is sincere, the employee is likely to feel more validated and understood. The level of resentment which accompanies an ‘injury’ from the employee’s perception of an apologetic perpetrator is likely to be less. A high frequency of employees who received apologies were satisfied, and this aided their return to work and greater work confidence. It was agreed that where an individual psychological problem was identified, then CBT was often the ‘treatment of choice’ for rapid resolution. It was essential for this therapy to be accessed via the GP (under the NHS) or on a private basis or via an Employment Assistance Programme (EAP). Work skill or career guidance was also considered, as were organisational difficulties, which required a more systemic type of intervention. The Legal & Medical Conference provided an effective vehicle for approximately 80 participants to share their skills and experience on this topic.
For a diagram detailing specific and sustained work-related and non work-related events, please download the article (.doc) by clicking the button in the top-right of this page.