How’s Work Going for You? Your Mental Health Provider Should Be Asking.

Depression is the number one cause of disability in the United States. In this week’s post Dr. Jorge Petit provides guidance on how clinicians can support individuals in attaining success at work and assist them in staying employed.

How’s Work Going for You? Your Mental Health Provider Should Be Asking.
Jorge R. Petit, M.D.

In last week’s post Ken Dolan-Delvecchio shared that mental health professionals underestimate the impact of work on a person’s mental health and explored how work can aid a person’s recovery.

As a psychiatrist, I can—unfortunately—confirm that employment and employment-related issues are often given short shrift in mental health settings. I think we (mental health providers) tend to minimize the relevance of work and ignore how impactful it is on our patients’ day-to-day experience.

This is problematic because a person’s employment is actually one of their defining characteristics: we spend most of our waking time at work and our work gives us a sense of purpose, identity and value. Studies have shown the correlation of employment to self-perception and well-being.

Yet many providers (myself included) weren’t trained to explore how work relationships and a person’s work environment contribute to his or her mental well-being, making providers and patients reluctant to delve into employment-related issues. As a result, we tend to give work only cursory attention. For example, I always inquire about a patient’s employment history, but rarely dive deep into how work and work relationships contribute to his or her current situation. As providers, we tend to view work in the context of symptoms, rather than overall function, not recognizing that work may be at the heart of a patient’s presentation and or at the very least an exacerbating factor. Frankly, we tend to ask more about how someone is performing sexually than how they are doing at work.

In this way, we fail our patients because we potentially ignore a major contributor to their health and well-being. What’s more, by not exploring employment matters in depth as they relate to the patient and their treatment, we are inadvertently affirming their fears of discussing and/or disclosing their mental health condition. How can we expect people to be comfortable discussing a mental health condition with their employer when work is not discussed with their mental health provider? Separated and siloed like this, mental health conditions will forever remain stigmatized within the workplace.

There are steps we can take, though, to overcome the current disconnect. By engaging in conversations like this, both providers and patients can raise the profile of work within mental health treatment and, as a consequence, raise the profile of mental health within the work setting.

What providers don’t do
Speaking as a psychiatrist, I know that our training does not emphasize work or how work can contribute to or detract from our patients’ health and well-being. We are taught that work is part of the overall assessment, but only at its most rudimentary levels: is the patient employed, for how long, etc. We are not trained to explore the nuances of a person’s relationship to his or her work, peers, and supervisors, and how he or she might be impacted when faced with work conflicts. We learn to inquire about issues within the family and community, but there is little discussion of work and work relationships.

In the up to 60 minutes I spend with a patient, employment may or may not get enough attention. But work is not likely coming up in the 10- to 15-minute primary care visit where most people today seek and receive their healthcare.

By not exploring employment-related issues, we do not create a space for work within the mental health treatment. As a result, some patients may be reluctant to bring up work conflicts and concerns. Indeed, some don’t even know how or even whether to bring up work, as they may not be fully aware of the impact it is having on their mental health.

When patients come in, they may cite their stressors, with work being one of several. I don’t think patients attribute the same level of primacy to their work stress that they do to other relationships and issues in their lives. Many people tend to minimize the conflicts that may arise in the work setting and not give it as much credence as a conflict with a spouse or sibling. Perhaps they don’t recognize that all the work issues they are trivializing might actually be at the core of their stressors and symptoms.

What providers should do
As providers, it’s our responsibility to weave work into our understanding of patients and explore this territory in more depth. We must create a space for talking about work and investigating how work impacts our patients’ lives. Medical students and practitioners should receive training that encompasses employment and employment-related issues/stressors so they are comfortable exploring and managing the subject of work with their patients.

We also must factor employment into the patient’s treatment plans and goals. Whether that means addressing work conflicts that may be stressors, helping the patient determine what workplace accommodations could be helpful, or changing the time of day a person takes his or her medication to maximize functioning, work must be fully considered and factored into the treatment planning process. Including employment issues in the treatment planning process allows for documented progress to be made and for goals to be set in this aspect of a patient’s life.

What patients can do
There is some progress on this front. More providers are thinking about employment and incorporating work-life issues into a patient’s evaluation and treatment plan. However, we need patients to tell us about work stressors and we need to explore this aspect of their lives further. We must also include family members who support people with mental illness to educate us about the role work plays in the patient’s life. As providers become more adept at navigating the relationships between work and mental illness, so too will patients become more confident in discussing their work-related issues with their provider.

Your Turn

  • How does your (or your loved one’s) mental health provider assess and address work-related issues?
  • What would you want to tell your mental health provider about how your mental health is affecting your work life, or how your work life is affecting your mental health?

Dr. Jorge R. Petit is a psychiatrist and president and founder of Quality Healthcare Solutions Group. He is the Clinical Director for a Robin Hood grant to develop an Integrated Delivery System in NYC working in several FQHCs and an advisor to the North East Business Group on Health (NEBGH), Mental Health Task Force – Depression Screening and Management in Primary Care/One Voice Initiative; a member of the NYC Regional Centers of Excellence (RCE) Team (NYS Office of Mental Health); member of the ACMHA: The College for Behavioral Health Leadership; a member of the Committee on Psychiatric Administration & Leadership in the Group for the Advancement of Psychiatry (GAP) and a member of the Mental Health Association of New York City’s (MHA-NYC) Professional Advisory Committee (PAC). In addition, Dr. Petit maintains a small private practice in Manhattan.

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