Psychiatric Illness in the Workplace Guidance for Heads of Departments and Admin

Notes Of Guidance for Heads Of Departments and Administrators:

1. Purpose of this guidance note

Mental health problems can provide very challenging human resources management tasks for University administrators and heads of department. The University Occupational Health Service has produced this written background material in response to requests from departments. It is short, covering only the effects of work on mental health, the effects of psychiatric disorder on work performance, the early detection of mental ill-health, and the management of the affected individual. It is not intended to be a comprehensive manual for managing work performance when mental health is a factor – this is covered by capability guidance from Personnel Services. Nor can it replace the detailed case-by-case advice that the University Occupational Health Service can provide for managers in person. Please send comments or suggestions on this document to the University Occupational Physician (physician@uohs.ox.ac.uk).

The key summary points in the guidance note are:

The University Occupational Health Service is available to advise – please telephone the general enquiry number ((2)82676) to be directed to focussed advice on the management of individual cases or on generic issues.
Although the guidance note uses some technical terms, please do not feel it is asking you to make diagnoses – your experience, judgement and common-sense will usually be a reliable guide telling you that someone could be ill. If you have queries, even if you think they may be trivial, please telephone the University Occupational Health Service for informal feedback, brainstorming, and advice.
Always refer to the University Occupational Health Service when concerns have been raised that a mental health problem may be caused by some aspect of the workplace, or made worse by work. The University's legal responsibility to prevent work-related ill-health means that all cases of possible work-related ill-health, including psychiatric illness and stress, must be investigated carefully.
Always refer to the University Occupational Health Service when concerns have been raised that someone's thinking or judgement may affect safety-critical work, because they or other people could be harmed.
Treat mental ill-health like physical ill-health, referring to the University Occupational Health Service if you need specialist input to guide you in dealing with performance management, fitness for work, adjustments to disability, sickness absence, or any other "management" issue.
There are no new action points in this document – please refer to it for background material.

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2. Introduction

2.1 Psychiatric disorders are common in the general population. It follows, therefore, that a proportion of University staff is experiencing psychiatric symptoms at any one time. Most of these symptoms are mild and are not caused by work nor do they impact on work performance. However, questions that may arise for managers are whether the illness may have been caused or made worse by work, the condition, or its medical treatment, may impair work performance, especially in the context of safety-critical work or responsibility for other people, and how best to manage a return to work after ill-health.

2.2 The University Occupational Health Service accepts self referrals, which is an important factor in the early detection of health problems at work. However, this document discusses "management referrals" because, in our experience, most major psychiatric disorder seen in the University Occupational Health Service is by referral from a manager. This is in contrast to stress, where many referrals are self-referrals.

2.3 UK health and safety legislation requires employers to do everything reasonably practicable to prevent work-related ill-health. This includes mental ill-health as well as physical ill-health.

2.4 Employment legislation is also relevant. The Disability Discrimination Act covers mental illness which meets its criteria, as well as physical illness. It requires employers to avoid discrimination on the grounds of disability, unless discrimination can be justified, and to make reasonable adjustments to help employees (or job applicants) who suffer from a disability.

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3. The effects of work factors on mental health

3.1 Physical and chemical hazards.
There are very few University occupations with potential exposure to hazards with potential for a specific toxic effect on brain functioning. If in doubt about carrying out a risk assessment, contact the University Safety Office. If in doubt about whether health surveillance is required, contact the University Occupational Health Service.

3.2 Potential stressors
Stress at work is covered by separate guidance (University Policy on the Prevention and Management of Work Related Stress) and is mentioned here only for completeness. Whilst stress itself is not, in itself, an illness, stress at work can sometimes be a factor in anxiety and/or depression (see paragraph 4.2). There are several features of job organisation or work culture which may be experienced as stressful. These include low job control, service roles involving face-to-face contact with people, lack of clarity about a job's role and responsibilities, and uncertainty about job security.

3.2.1 Interaction with stressors (and supporting factors) in personal life
Personal history and personal life play an important role in influencing the response to stress at work. On the one hand, a major life event, such as divorce or bereavement, may leave someone more vulnerable for a period of time to adverse factors at work which previously had no effect. On the other hand, a strong social network can support an individual through a difficult time at work.

3.2.2 Variability between individuals
People vary greatly in both the response to stress and in what is perceived as stressful. A change in the individual may indicate a potential problem.

3.2.3 Interaction with effects of alcohol and/or drugs
Alcohol and/or prescription or non-prescription drugs can interact with stressors at work at several levels. For example, people whose performance is already impaired may become more vulnerable to adverse factors at work. Furthermore, people often use alcohol and prescription or non-prescription drugs to suppress anxiety in the short term in order to allow themselves to continue in a difficult job. This may (or may not) lead to further difficulties in the longer term.

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4. The effects of psychiatric illness on an individual's work performance

Psychiatric illness can be treated and, in milder cases, has little effect on an individual's capacity to work. However, illness, or its treatment, can sometimes lead to impairment of memory or concentration, often on a temporary basis. Furthermore, there are a small number of occupations (such as nursing) where a history of certain psychiatric disorders might preclude employment. Contact the University Occupational Health Service for advice about whether someone's illness affects their capacity to carry out a particular job. Some examples are given below. Long term illness with effects on day-to-day functioning is covered by the Disability Discrimination Act.

4.1 Psychosis
Major psychotic illness (eg schizophrenia) causes seriously disordered thinking. People who are untreated are ill and almost certainly not fit for work until treatment has taken effect. People who are treated are usually fit for work. However, some anti-psychotic medication may affect co-ordination or concentration which, in turn, may have consequences, for example on fitness to drive, or to handle dangerous machinery. It is therefore important that, when departments become aware of a case of major psychotic illness (usually on a sickness certificate), it is referred to the Occupational Physician for assessment, even if the member of staff is in hospital, or otherwise uncontactable. The need for an accurate occupational health assessment over-rides the usual requirement that the member of staff should give consent to a "management referral", though you should inform the member of staff of the referral.

4.2 Depression or anxiety
Although depression and anxiety do not usually give rise to major distortions in thinking, in a minority of people these illnesses can be severe and prolonged, leading to absence from work and even ill-health retirement. Most affected people are fit for work but minor modifications to work organisation may be necessary on a temporary basis. Adverse effects of medication may also prompt adjustments at work. Performance, conduct or disability discrimination issues possibly related to these illnesses should be referred to the University Occupational Health Service in the same way as for physical ill-health. There is further guidance in Memo M 4/01 "Management referrals" to the occupational physician. Individuals may also self-refer, in confidence, if they believe that their ill-health is either caused by work, or is adversely affecting their work.

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5. Early detection of mental health problems

People must be allowed privacy and autonomy about their health and medical care. If a department's sole concern is the member of staff's welfare, all that is necessary is encouragement to self-refer to the general practitioner or, if the problem is affecting work, to the Occupational Health Service. Questions of work capacity, or adjustments to disability, should be dealt with in the same way as for physical illness. There are, however, some exceptions, listed below, when it is important to detect mental health problems at an early stage and to take prompt and effective action.

5.1 Emergencies
Psychiatric emergencies at work (for example, attempted suicide, or hallucinations which interfere with everyday life) must be referred to the Accident and Emergency Department at the John Radcliffe Hospital, by ambulance if necessary. Departments should refer the member of staff to the Occupational Health Service for assessment before the return to work.

5.2 Safety-critical work
The individual must be referred to the Occupational Health Service if there is any question that performance in safety-critical work (eg driving, operation of dangerous machinery, immediate responsibility for the safety of others) may be impaired by psychiatric illness or its treatment. If there is any delay before assessment, the department should temporarily suspend the individual from this element of their work on safety grounds.

5.3 Occupational disease
If the ill-health is thought to be caused, or exacerbated, by work, the member of staff must be referred to the University Occupational Health Service for further assessment. This possibility may be raised by a certificate or letter from a general practitioner, psychiatrist, or other doctor, by the member of staff, or by a work colleague or manager.

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6. Management of the affected individual

The medical management of an individual affected by psychiatric disorder (or stress) goes hand-in-hand with their management in the department.

6.1 Referral to the University Occupational Health Service
The Occupational Health Service accepts "management referrals" and self-referrals.

6.2 Counselling
Focussed, short-term work-related counselling is now available from a panel of experienced external counsellors and can be accessed by referral to the University Occupational Health Service, which will make an assessment. There is separate guidance on how the scheme operates (M1/02 Counselling Code of Practice).

6.3 Employment issues
The Occupational Health Service will provide appropriate feedback to departments on the medical aspects of employment issues which may arise from the ill-health eg modifications to work or ill-health retirement. Consult the relevant sector personnel officer for advice on employment matters.

6.4 Investigation of working environment/work practices
The Occupational Health Service may recommend review of the working environment and/or work practices if the ill-health appears to be caused or exacerbated by work. The Service will discuss the issues with you in order to find the best solutions.

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