AOOP: OOP Bulletin - Spring 2003, Volume 11 Number 1

The early deadline for renewing your membership dues is December 10, 2008. The 2009 membership dues were $690 US, if postmarked December 10, 2008. Presently, the dues are $790 US. As a reminder, dues are inclusive of both AOOP annual membership dues and the annual meeting fee. Please mail your membership dues to AOOP, c/o C. Donald Williams MD, 402 E Yakima Ave #330, Yakima, WA 98901. You can call Sandra Gabel-Onkels at AOOP with any questions (1-509-457-4611--identify your call as related to AOOP matters).

If you are a resident in training, you may be eligible for a complete fee waiver. Please contact Dr. Pflanz to explore options.

The international member rate is $150 US, but this membership category does not include meeting registration. International members who plan on attending the annual meeting must pay the full membership dues (i.e., the difference between the U.S. membership fee in effect at the time of your registration and the International member rate of $150 US).

The 2009 AOOP Annual Meeting is scheduled for April 4-5 and will again be held at the University Club of Chicago. For more information about the University Club Chicago, please see their website at www.ucco.com or call them at 312-726-2840. Special room rates have been arranged for AOOP members for the conference dates, and I encourage you to call the University Club soon to make your reservations. Attendance is open to AOOP members with paid membership dues for 2009.

A recently published study adds to the robust body of literature describing the association between multiple health concerns and greater rates of disability. In a population of 22,118 workers drawn from the Canadian Community Health Survey, 31% reported chronic work stress, 46% reported a chronic physical disorder, and 11% reported a psychiatric disorder. Compared to workers with no condition, all three groups were associated with an increased number of total disability days, partial disability days, and days that required extreme effort to meet work obligations. Importantly, the odds of experiencing any disability days increased significantly for workers experiencing two or more of these conditions. The report of work stress in this population was consistent with an accumulating body of literature documenting the high prevalence and damaging effects of work stress amongst workers. This body of literature suggests that employers can no longer afford to dismiss job stress as a fact of life or the cost of doing business. Proactive efforts to improve work climate will likely improve job satisfaction, quality of life, health status, and productivity amongst employees.

Reference: Dewa et al. Association of Chronic Work Stress, Psychiatric Disorders, and Chronic Physical Conditions with Disability Among Workers. Psychiatric Services, 58(5):652-658, 2007.

In a second study drawing from the Canadian Community Health Survey, workers with psychiatric disorders were far more likely to be absent from work during the previous week. Of the total sample of 27,332, 946 had a mood disorder, 831 had an anxiety disorder, 730 had a substance use disorder, and 966 had more than one mental health disorder. Compared to no disorder, each condition was associated with an increased risk of reporting at least one disability day as a result of mental health problems in the previous two weeks (0.4% for no disorder, 6.8% for mood disorders, 2.6% for anxiety disorders, 2.6% for substance use disorders, and 12.2% for more than one disorder). This study reinforces the literature demonstrating the substantial impact of co-morbidity on disability.

Reference: el-Guebaly et al. Association of Mood, Anxiety, and Substance Use Disorders with Occupational Status and Disability in a Community Sample. Psychiatric Services, 58(5):659-667, 2007.

Article #3: Cost-Effective Employer Program Reduces Employee Psychiatric Morbidity

Depression affects 6% of employees and costs $30 billion annually on decreased productivity. A recent study suggests inexpensive telephonic case management can reduce the costs of depression in the workplace. The researchers recruited 604 depressed employees from 16 major corporations covered by United Behavioral Health. The sample was randomized into case managed and usual care groups. The case managers recommended, encouraged, facilitated, and monitored treatment in the community for the intervention group, and maintained close telephone contact with those in the intervention group who declined treatment. Cognitive behavioral therapy was offered by phone to those who refused treatment. The case managed group outperformed the usual care group on symptom improvement (31% vs. 22%), symptom recovery (26% vs. 18%), job retention (93% vs. 88%), and hours worked (two more hours per week). The intervention costs ($100-$400 per employee per year) were outweighed by the cost savings in terms of the monetary value of the extra hours worked ($1800 per employee per year). This study joins a growing body of literature demonstrating a positive return on investment for employers who adopt proactive mental health programs for employees.

Reference: Wang et al. Telephone Screening, Outreach, and Case Management for Depressed Workers and Impact on Clinical and Work Productivity Outcomes: A Randomized Controlled trial. JAMA, 298(12):1401-1411, 2007.

If you want to provide feedback on any of the topics discussed here or bring up other matters of interest to AOOP, please feel free to contact me at Steven Pflanz or the AOOP office at cdonald@aol.com.

Preparations for the 2008 AOOP Annual Meeting are essentially complete and I am looking forward to seeing everyone again at the meeting in March. In this bulletin, I would like to remind members that 2008 membership renewals are due December 10 and also announce the agenda for the Annual Meeting in Chicago on March 15-16, 2008. The meeting is largely organized around presentations related to PTSD in the workplace and we aim to continue to provide an educational forum on organizational and occupational psychiatry. In this Bulletin and in December, I will highlight recent publications in the field of workplace psychiatry. In 2008, the Presidential Bulletin is planned as a bi-monthly e-bulletin with AOOP announcements and articles related to occupational psychiatry. You can visit our website to find the latest information on AOOP. We are pleased to present programs designed to support the needs our members.

AOOP has a long tradition of bringing together psychiatrists with a special interest in both occupational health and organizational dynamics, and remains the premier professional association dedicated to the exploration and study of occupational and organizational psychiatry. The 2008 membership dues have been set at $690 US (if paid by 10 Dec 2006--after December 10, dues will rise to $790 US--this is to aid organizational budget planning) and are inclusive of both AOOP annual membership dues and the annual meeting fee.

Please mail your membership dues to AOOP, PO Box 343, Ridgefield Park, NJ 07660. You can call Ms. Julie Prink at AOOP with any questions (1-877-789-2667). You can download this form and mail it to the above address.

The theme for our 2008 Annual Meeting is Trauma, PTSD, and Organizational Culture. The 2008 Annual meeting is scheduled for March 15-16, 2008 and will again be held at the University Club of Chicago. For more information about the University Club Chicago, please see their website at www.ucco.com or call them at 312-726-2840. Special room rates have been arranged for AOOP members for the conference dates. Attendance is open to AOOP members with paid membership dues for 2008.

1:15-2:45 pm Organizational Approaches to the Management, Treatment, and Prevention of PTSD

3:00-4:00 pm Training Supervisors and Managers to be Aware of PTSD and Deal with it Proactively--Part I

4:15-5:15 pm Training Supervisors and Managers to be Aware of PTSD and Deal with it Proactively--Part II

8:30-10:00 am Learning from EMDR and Using Psychiatric Skills to Effectively Treat Occupational Posttraumatic Stress Disorder to Resolution

10:15-11:45 am The �Complete� IME: Integrating the file review with literature references, interview findings, the MMPI-2, and the SIRS, or what I have learned from 31 years of mistakes

If you want to provide feedback on any of the topics discussed here or bring up other matters of interest to AOOP, please feel free to contact me at steven.pflanz@pentagon.af.mil or the AOOP office at Aoopadmn@verizon.net.

The Academy of Organizational and Occupational Psychiatry is moving forward in 2007 with a financial plan structured to maintain our role as a psychiatric society dedicated to the exploration and study of workplace psychiatry. I am pleased to report that our revamped and simplified dues structure has attracted a membership sufficient to finance our operating expenses and annual meeting on a continuing basis. This financial security enables AOOP to host scientific meetings on an annual basis. I am looking forward to the discussions we will have on a range of current issues in occupational psychiatry at our meeting in April 2007.

The Academy of Organizational and Occupational Psychiatry�s 18th Annual Meeting, titled Responding to the Mental Health Needs of Industry: The Role of Occupational Psychiatrists in the Modern Workplace, will be held next month (April 14-15, 2007) at the University Club of Chicago. For details about the meeting agenda, please go to our website at www.aoop.org--or simply scroll down one page. For hotel arrangements, please call the University Club Chicago at 312-726-2840. I am pleased to announce that the American College of Occupational and Environmental Medicine (ACOEM) is again co-sponsoring our meeting and has approved this activity for 10 Category 1 CME credits.

Article: Lo Sasso et al. Modeling the Impact of Enhanced Depression Treatment on Workplace Functioning and Costs: A Cost-Benefit Approach. Medical Care 44(4):352-358, 2007

While the impact of depression and other psychiatric disorders on worker productivity and absenteeism has been clearly documented in the literature, relatively little research has been published on whether or not depression interventions are cost-effective for employers. Clearly, individual employees benefit from treatment for their depression, but do employers see a corresponding financial benefit when they invest in treatment services? Lo Sasso and his colleagues compared usual care to enhanced depression treatment, which included education for physicians and case managers on state-of-the-art depression care, case management services, two-year follow-up with patients, and regular reports to physicians from case managers about patient symptoms. In this study, the researchers sought to answer, from the employer�s perspective, whether or not there was a financial incentive to provide enhanced depression treatment for workers by weighing the benefits resulting from the intervention against the costs of providing the intervention. Theoretically, better treatment of depression amongst workers leads to improved productivity on the job and decreased absenteeism, resulting in direct and measurable financial benefits to employers. The fact that this was exactly what Lo Sasso and his colleagues found comes as no surprise to many of us working in this field. Even using the most conservative of assumptions, employers realized a return on investment of $1.20 for every $1.00 invested in enhanced depression care. This study joins a small but growing body of literature demonstrating that providing excellent mental health care is not only humane, but actually good for business. The paper�s discussion section raises interesting questions on how might this investment in optimal care be financed, including direct employer contributions to health plans, amortization of costs across all employees� insurance premiums, and government incentives. The authors suggest the most likely scenario is that business will voluntarily adopt this sort of case management approach based on its projected return on investment, once the results of this and similar studies become widely known in industry.

Submissions from members are welcome for inclusion in this bulletin, subject to editorial review and approval.

February 2007

Greetings!

I’m pleased to announce that nearly 25 individuals renewed their membership or joined AOOP for 2007, providing us with the financial security necessary to guarantee AOOP can continue to host the premier professional meeting dedicated to organizational and occupational psychiatry. Also, Don Williams updated our website (www.aoop.org) to ensure currency, accuracy, and relevance. I’m looking forward to seeing everyone at the meeting in April.

2007 AOOP Annual Meeting – April 14-15, 2007

Our 18th Annual Meeting, titled Responding to the Mental Health Needs of Industry: The Role of Occupational Psychiatrists in the Modern Workplace, is scheduled for April 14-15, 2007, at the University Club of Chicago (76 East Monroe Street, Chicago, Illinois 60603). Rooms have been set aside at special rates for meeting attendees, but reservations must be made before March 13. For more information on the University Club, please see their website at www.ucco.com or call them at 312-726-2840

Meeting Agenda:

Saturday, April 14, 2007

7:30-8:00 a.m. Continental Breakfast

8:00-8:05 a.m. Introduction - Greg Couser, MD

8:05 -10:00a.m. Psychiatry’s Role in the Stay-at-Work/Return-to-Work Process

C. Donald Williams, MD, Jennifer Christian, MD, Greg Couser, MD

10:00-10:15 a.m. Break

10:15-11:45 a.m. Combat and Operational Stress Control in Iraq: Extreme OOP

Paul Hammer, MD

11:45 a.m.-1:00 p.m. -- Lunch on your own

1:00-2:30 p.m. Toxic Leadership

Vineeth John, MD

2:30-2:45 p.m. Break

2:45-4:00 p.m. Engagement and the Role of the Manager: Finding Common Ground Where the Hard Science of Psychiatry can Support the Basic Needs of Management and an Organization

Daven Morrison, MD, Don Albert

4:00-5:3 0 p.m. Panel: Organizational & Occupational Psychiatry: Who are we?

5:30-6:30 p.m. Reception

Sunday, April 15, 2007

8:00-8:30 a.m. Continental Breakfast

8:30-10:00 a.m. Posttraumatic Stress Disorder and Conversion Disorder: Determination of Cause in the Context of Injury Claims

David McCann, MD

10:00-10:15 a.m. Break

10:15-11:45 a.m. Work Overload, Burnout, and Empathy: The Struggle to Maintain Work-Life Balance in Psychiatric Practice

Steven Pflanz, MD

11:45 a.m. Conference Conclusion

Article: Mental Health Care and Negative Career Outcomes – Myth or Reality?

It is estimated that 25% of American workers suffer from psychiatric illness in any given year. Numerous studies have also found that only 20% to 30% of Americans with mental illness obtain adequate treatment each year. Access to care is certainly an issue for many, but even employed Americans with health insurance do not consistently seek treatment for psychiatric symptoms. Stigma clearly remains a major barrier against seeking psychiatric care. In a recent study of soldiers and marines returning from Iraq and Afghanistan with identified psychiatric problems (Hoge et al, NEJM, 2004), only 38-45% reported an interest in receiving mental health care and only 23-40% actually sought treatment. These military personnel were twice as likely to report concerns about stigmatization (e.g., being perceived as weak or harm to their career) than those without psychiatric problems. These findings occurred in a population receiving intensive scrutiny, support, and outreach education regarding the benefits of available services.

While many studies have examined the role of stigma in discouraging treatment seeking, few studies have objectively measured the putative negative impact of receiving mental health care on career outcomes. A recent study on military personnel may provide a valuable object lesson on this issue. Military medical fitness standards are similar to (or even less stringent) than those for many civilian occupations, including those set by the Federal Aviation Administration, the Department of Transportation, the Nuclear Regulatory Commission, law enforcement organizations, and medical licensing authorities. Rowan and Campise (Military Medicine, Nov 06) reported on the career outcomes for 1,068 Airmen treated at eight Air Force mental health clinics over a one-year period. Of these personnel, 93% suffered no adverse career outcome, 3% experienced temporary duty restrictions, 1% were recommended for a career change within the Air Force, and 3% were recommended for discharge from the service. In addition, the overwhelming majority of patients I’ve recommended for discharge from the service happened to also want to be discharged, making discharge a positive outcome in many instances. So, in a profession with strict medical fitness standards, negative career outcomes during and after mental health care are uncommon and losing one’s job is exceedingly uncommon. Of course, this study examined only objectively measurable career outcomes, and it may be that more subtle negative consequences (such as changes in how the individual is perceived by co-workers or supervisors) may be more common. However, in over 12 years of clinical practice in the Air Force, my patients have rarely complained of discrimination as a result of treatment seeking. I suspect that, were this study to be replicated in civilian occupational settings, the results would be quite similar.

I often say that, regarding mental health care and career outcomes, perception is nine-tenths of reality. If employees believe seeking treatment will hurt their careers, the truth doesn’t matter – they’re not coming to see the psychiatrist for help. To effectively combat the stigma associated with receiving mental health care, employers need to disseminate data amongst workers regarding the absence of negative career outcomes after such treatment. The Air Force has been doing this for several years. Only time will tell if this positive information will erode the negative perceptions about treatment seeking.

Feedback:

Steven Pflanz
President

The Holidays are upon us once again, and I hope the season finds everyone in AOOP happy and healthy. The deadline for renewing your membership for 2007 is fast approaching (Dec 10). In this bulletin, I’ll discuss another highlight from our upcoming Annual Meeting in April and will follow-up last month’s discussion of the evaluation of workplace issues in routine psychiatric practice with a 12-point workplace psychiatry assessment checklist. In addition, I invite members to submit short articles from a few paragraphs to a few pages for this bulletin.

Our 18th Annual Meeting, tentatively titled Responding to the Mental Health Needs of Industry: The Role of Occupational Psychiatrists in the Modern Workplace, is scheduled for April 14-15, 2007 , at the University Club of Chicago. Last month, I discussed planned presentations on PTSD and Conversion Disorder, Reengineering Our Disability System, and Work Overload. In this issue, I will highlight a presentation on enhancing the training of supervisors.

Don Albert, Director of Employee Relations at Hospira, and Dr. Daven Morrison, MD, will present an overview of their training program: EMPAT - Effective Management Principles and Techniques. EMPAT is designed to address the gap between what organizations know about the critical role of the supervisor to the employee and the virtual absence of training to help supervisors make the most of their role.

An organization’s ability to motivate, engage, and retain good employees is an ongoing fundamental challenge for its continued existence. As the economy and job market continue to improve, this challenge has become even more critical. Statistically-based studies recently have all concluded that one of the dominant reasons, if not the primary reason, why employees voluntarily leave their employer is the relationship between an employee and his/her immediate manager. However, research has also shown that managerial training traditionally focuses on telling managers what they should do and why, but has never touched on how to most effectively manage employees in order to motivate, engage, and retain employees in an increasingly diverse environment. Don Albert will share some of the critical skills and techniques taught in the EMPAT Course that enables managers to truly connect with their employees and create an inclusive work place environment that attracts, motivates, and retains employees, and which also reduces the risk of work place violence.

Don Albert and Dr. Morrison have developed and conducted this course with highly successful results. Don Albert has over 30 years of Industrial Human Resources and Employee Relations experience. Dr. Morrison will illustrate how an Occupational Psychiatrist enriches this training by showing how it promotes the overall health of organizations.

Article: Evaluating Work Issues in Psychiatric Patients: A 12-Point Checklist (Steven Pflanz, MD)

As discussed last month, work is a core indicator of treatment outcome and psychological functioning. The evaluation of work issues is as vital to the assessment of the psychiatric patient as psychiatric symptomatology, developmental history or relationship patterns. Most people spend more time working than any other single activity, except maybe sleeping. As such, work provides a powerful organizing framework for life and is a critical component to the understanding of any patient. In an attempt to provide a systematic method for evaluating workplace issues, I have developed a list of 12 parameters that can guide psychiatrists during the patient interview. This list will help psychiatrists organize their evaluations of work issues and make their assessments of work function more thorough and complete.

1. Accidents and Incidents: Ask about all injuries, property damage, arguments, and disciplinary actions by supervisors. Explore each incident carefully, regardless of causation (accidental or deliberate). The psychiatrist can learn much from both the accidental damaging of machinery and the deliberate act of destruction in a fit of anger.

2. Absenteeism: Look at absenteeism for any reason, including both mental health reasons and physical reasons. Frequent absenteeism is often a sign of stress or psychiatric illness. Oftentimes, patients manifest their emotional distress in somatic complaints. Individuals with somatoform-type presentations may be seeking treatment at the primary care clinic for headaches, low back pain, and other sorts of physical problems. Careful questioning about absenteeism may help uncover latent stress that is being manifested in psychosomatic form.

3. Timeliness: It is important to look at timeliness for work each day, for meetings, and for deadlines. Ask the patient, “Are you having difficulty meeting the time constraints and deadlines imposed by your supervisor or employer?” Patients who are consistently on time generally are functioning better than individuals who are reporting in late for everything. Disorganization is a potential indicator of stress.

4. Conflict: Look at conflict with co-workers, subordinates, supervisors and customers. Irritability certainly is a common manifestation of psychiatric illness and a common avenue through which psychiatric illness can interfere with work performance. This may also be a telltale sign of personality traits and/or personality disorders that may be a focus of treatment. In particular, narcissistic, passive-aggressive, and negativistic patients will have more conflict with co-workers. Those patients that externalize responsibility will also have more problems with co-workers and this can be a key issue to address as part of therapy.

5. Performance: Ask the patient about their work performance and the quality of their work. Ask them whether or not they believe they are turning in good quality work product. In certain instances, it can be useful to look at some of their work or ask a supervisor if the quality of their work is satisfactory.

6. Satisfaction: Ask about job satisfaction. How satisfied is the patient with their particular job? How satisfied are they with their chosen profession and their career? How satisfied is the patient with the interpersonal relationships at work? Why do they think they feel the way the do about their job?

7. Security: Does the patient worry about keeping their job or do they feel that their job is secure? Do they spend a lot of time looking for other jobs or working to keep from losing their current job?

8. Safety: Do they worry about violence at work or while traveling to and from work? Do they worry about theft or other crimes? Do they worry about being injured at work? Do they worry about sexual harassment or other types of harassment? Do they worry about discrimination?

10. Identity: Explore the role of work in shaping and reflecting the patient’s identity and self-esteem. Understand the patient’s reasoning for their career choice and career changes, as well as the impact of work withdrawal on patients in disability, job loss, or retirement situations.

11. Relationships: Explore and understand the nature and quality of the relationships that the individual has with their work subordinates, peers and supervisors, as well as ascertain the impact of the patient’s psychiatric illness on these relationships. Evaluate the impact of work on family relationships and the ability to fulfill important life role obligations, as well as the role of work and work organizations in shaping the patient’s social network.

12. Health: Ascertain the relationship between work and the patient’s physical and emotional health, and understand specific work issues or events that impact on the patient’s psychological functioning.

As psychiatrists go through this organized list, it covers 12 barometers of work functioning. These parameters will be the basis for the psychiatrist’s formulation of the patient’s work life. It will help understand the patient’s ability to function in the work arena, a key life task necessary for every patient to master. It provides a critical perspective on the patient’s personality, psychological functioning, and psychiatric illness. The evaluation of work is an essential component of the routine psychiatric evaluation. Work function must be viewed as an important developmental task of adulthood.

Preparations for 2007 at AOOP are in full gear. The 2007 membership renewals are due in December and the Board is putting the final touches on the Annual Meeting agenda, which promises to meet or exceed our long track record of providing outstanding educational forums on organizational and occupational psychiatry. We are revamping the bulletin as a monthly to bi-monthly Presidential Bulletin, and are laying plans to makeover the website. We are truly excited about these improvements and programs designed to support the needs our members.

The annual meeting was held at the University Club in Chicago on April 1-2 of this year. The meeting evaluation forms were uniformly positive, the speakers received high marks, and attendees remarked what an enjoyable and educational experience it was. Jerrold Post, MD, from George Washington University delivered a scintillating keynote address, titled When Hatred is Bred in the Bone: Psychocultural Foundations of Contemporary Terrorism, covering the typology, psychology, socialization, and organizational dynamics of terrorist groups.

Barry Greiff facilitated a panel discussion of a case written by Daven Morrison that followed a multinational organization and the changes impacting it. The case illustrated how a psychiatrist can consult with senior leadership to help them manage and adjust to the many different organizational dynamics stemming from of the workplace changes. Later, David Morrison facilitated a workshop on a consulting to a multinational organization facing a failed merger. Through small and large group exercises, as well as lectures, the role of the psychiatrist was explored regarding consulting to the senior HR team and the board, as well as the successful rolling out of a change process.

On Sunday morning, Don Williams described a two year consultation to a non-profit community health organization in an isolated community. The organization underwent a change of CEO, established uniform HR policies, and instituted an organization-wide culture of accountability. It was crucial that the consultant behaved in the consultation with the directness, transparency, and commitment to performance that he advocated the organization adopt. The distant location of the organization made on site presence impractical, and limited access to important information, although broadband internet video conferencing overcame some of the limitations.

Lastly, I gave a presentation on exploiting the strength of organizational and workplace infrastructures to promote the emotional health of employees, using the Air Force Suicide Prevention Program as an example.

AOOP invites you to attend our 18^th Annual Meeting, tentatively titled Responding to the Mental Health Needs of Industry: The Role of Occupational Psychiatrists in the Modern Workplace, scheduled for April 14-15, 2007 . The complexities and stresses of the modern workplace have created new opportunities for psychiatrists. As consultants or clinicians, psychiatrists address a wide variety of organizational, clinical, and medical-legal problems that arise at work. The entire meeting will provide practical and stimulating information about the roles psychiatrists can play in the workplace. This conference provides an outstanding opportunity to network with colleagues in the field of organizational and occupational psychiatry. The meeting is being held again at the University Club of Chicago. Attendance is limited to AOOP members, who must have paid their membership dues for 2007.

Effectively immediately, the AOOP will no longer accept payments by credit card. Despite the convenience of paying by credit card, this move will significantly reduce our fixed operating costs. I’m certain our members will understand the necessity of this cost-saving decision.

Spring 2003
Volume 11 Number 1

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Presidential e-Bulletins

Spring 2003
Volume 11 Number 1

Visit the Archives

Table of Contents

Articles

Presidential e-Bulletins

Spring 2003 Volume 11 Number 1

Visit the Archives

Table of Contents

Articles

Spring 2003
Volume 11 Number 1