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Joan Arehart-Treichel http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1745504 An expert on depression and workplace disability urges psychiatrists to view employers as partners in restoring workers with depression to mental good health. What Is a Psychiatrist’s Role in Treating Patients on Disability? Paul Pendler, Psy.D.: “We rely on the clinical judgment of the psychiatrist to determine when a depressed patient on short-term disability is capable of returning to work. But there is also the question of whether the patient’s symptoms have been reduced enough that he can handle his job demands.” Paul Pendler, Psy.D. Psychiatrists often evaluate and treat patients who have depression that is interfering with their ability to continue in their jobs, at least temporarily. An expert on depression in the workplace and workplace disability offers guidance to psychiatrists involved in the disability-evaluation process. That expert is Paul Pendler, Psy.D., a vice president at J.P. Morgan Chase and Co. in the firm’s Employee Assistance and Work Life Program, an assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine, and a member of the advisory council for the American Psychiatric Foundation’s Partnership for Workplace Mental Health. During the APA Assembly’s May meeting in San Francisco, then-APA Assembly Speaker Scott Benson, M.D., invited Pendler to talk about depression in the workplace and workplace disability. Psychiatric News recently interviewed Pendler about the subject. The following are highlights from the interview: Q: How many American workers are impacted by depression in the course of a year? A: Research has shown that 6 percent to 7 percent of the American workforce meets diagnostic criteria for major depression annually. It is important to point out, though, that just because someone has a clinical depression, it does not necessarily mean that he or she is unable to work. That is one of the points I made before the APA Assembly. Q: What are important issues that psychiatrists should know about impairment in job performance due to depression? A: First, since a depression diagnosis is not necessarily the same as being impaired, psychiatrists should evaluate depressed patients for functional limitations that might interfere with their work. For example, someone who is depressed and periodically tearful because of it might have difficulty functioning in a position where she has to have a lot of contact with customers. Another important concern is that once a patient reaches the point where he is so severely impaired in function that he would be better off not going to work, then he should receive aggressive treatment. By this I mean he should not just receive psychotropic medications and/or psychotherapy, but be encouraged to maintain a daily routine that approximates his work schedule—for example, getting up at a certain time, getting dressed, and so on. Q: When should a psychiatrist suggest to a patient with depression that he or she may want or need to apply for disability leave? A: All too often we’ve seen psychiatrists and mental health professionals recommend that patients be put on disability without knowing what their tasks at work are. It could be that perhaps they don’t need to be off work—that they simply need some of their existing coping strategies bolstered. Q: How is disability leave defined—a specific time off from work with pay? A: Often people think about permanent disability, which is a federally managed program under the Social Security Administration. But many companies offer a temporary, short-term period of paid disability leave, which has nothing to do with permanent disability. It is sometimes managed through private insurance companies, or in our case at J.P. Morgan Chase, we manage it ourselves. Q: How does an employee with depression go about obtaining short-term disability leave? Does the person talk to his or her supervisor or to the human resources department? A: Each company has its own policy. It is usually a user-friendly system, and the employee takes the initiative. However, he usually has to provide documentation from his psychiatrist, another physician, or mental health professional that he is unable to function in specific ways because of his depression. Q: Once a patient is on short-term disability leave, does his psychiatrist have to make progress reports to the insurance company? A: Depending on how disability is managed, there are usually some narrative reports required. The disability timeline varies based on the diagnosis, level of impairment indicated, and specific symptoms that are being targeted. While there may be guidelines such as approximate time period for time off due to depression, each case needs to be examined on a case-by-case basis. Q: And each time, does the psychiatrist have to get permission from the patient to release the information? A: This relates more to medical practice of the practitioner. Typically a disability entity will have a release initially, but I would think it’s sound clinical practice to ensure that the patient authorizes the release of new information each time. Q: At any point do the patient’s psychiatric records have to be evaluated by an independent psychiatrist? A: Depending on the insurance company, chart notes may be required if forms are not filled out in a timely manner, and the disability company wants to learn more about the frequency of visits and specific symptoms being targeted. If there is a determination for an independent review, then of course the request for notes would be made. The recommendation for an independent review is made on a case-by-case basis. It relates to the exact short-term disability benefit that a company has. So if a physician recommends the maximum time off without supporting evidence, there could be a recommendation for an independent evaluation. Q: A patient already in treatment with a psychiatrist for depression can use that psychiatrist for the disability evaluation and necessary periodic evalutions. But suppose the psychiatrist doesn’t want to get involved with the disability process? A: Yes, some clinicians elect not to “contaminate their treatment” by placing themselves in an evaluative capacity for off-work determination. That is the psychiatrist’s right. Q: What are some issues surrounding return to work for patients with depression on disability leave? A: In today’s workforce, almost all jobs require people to manage multiple expectations at the same time. Thus, if patients with depression who are out on disability leave could return to work on a reduced schedule, that would probably be ideal to how well they can handle the various demands on them. And if they were making good progress, then they would eventually be expected to return full time. Q: Do patients on disability leave sometimes malinger? A: Yes, sometimes they do. The psychiatrist needs to tell them up front, “I’m going to be exchanging information with your disability company about your functional limitations. And once we see signs of progress, we will probably encourage you to come back to work—perhaps even sooner than you estimate.” On the other hand, when patients with depression are reluctant to return to work, it may be because there are things going on at work that they want to avoid—say, a boss they don’t like. You need to have a frank conversation with patients about such matters and perhaps suggest that they contact their human resources department or employee assistance program for help in this regard. Q: If an employee is impaired because of substance abuse, can the employer request that he be evaluated, and if so, can he see any psychiatrist, or must it be an employer-selected psychiatrist? A: Every company has its own drug-free-workplace policies. In our experience, we encourage a patient with a substance abuse problem to get evaluated and begin active treatment for it. Often this is done via a person’s health insurance. Q: Finally, if you could give psychiatrists only one piece of advice about workplace disability leave due to depression and return to work afterward, what would it be? A: That the employer is not the enemy in the process. We employers are just as invested as psychiatrists in patients’ feeling better and being functional. Actually, I tried to underscore this point before the APA Assembly—that if psychiatrists saw us employers as partners in the process of healing, it would probably be beneficial for everyone involved. ■