Workplace Effectiveness and Psychotherapy for Mental, Substance Abuse, and Subsyndromal Conditions

Abstract

While it is known that psychiatric illness and subclinical psychiatric illness can be very disabling, their impact on workers' productivity has been little appreciated or appropriately addressed. Complex variables are involved in fashioning an appropriate policy to ameliorate the impact of mental illness on productivity including the identification of effective treatments and potential negative effects of controlling patients' access to them. The cost-effectiveness of such treatments is considered from the differing perspectives and goals of the various stakeholders involved, including employers, insurers, and workers with psychiatric illness. Depression in workers leads to significant absenteeism, "presenteeism" (diminished capacity due to illness while still present at work), and significantly increased medical expenses in addition to the costs of psychiatric care. In addition to the specific usefulness of psychotropic medication, there are a variety of studies on the cost-effectiveness of different psychotherapeutic treatments that improve health and productivity in psychiatrically ill workers. Research indicates the usefulness of approaches including employee assistance programs, specialized cognitive-behavioral treatments, and brief and longer term psychodynamic interventions. It is clear that substance abuse disorders and especially depression and subsyndromal depression have a profound negative effect on work productivity and increases in medical visits and expenses. The current system of mental health care suffers from ignorance of the negative effects of psychiatric illness in workers, from a lack of subtle awareness of which treatments are most appropriate for which diagnoses and from the reluctance by payers to invest in them. Access to evidence-based appropriate treatment can improve the negative impact on productivity as well as workers' health. This article considers these issues and argues for a role of psychotherapy in the treatment of mental illness and substance abuse from the perspective of worker productivity.

Improving Access to Mental Health Care by Delivering Psychotherapeutic Care in the Workplace: A Cross-Sectional Exploratory Trial

“…Implementing a new secondary care offering in the setting of the workplace gives rise to the question of acceptance, especially due to the fear of stigmatisation and stereotypic gender roles [5,13–17]. According to male utilisation rates of traditional mental health care offerings, 30% of men in our study made use of standard psychosomatic outpatient care (PSOC).…”

“…as demonstrated by dell´Osso et al [27]. Early intervention has been shown to be successful in outpatient settings [5,52–54] and as a worksite intervention [5,55]. Thus, a recommendation to address patients early in the course of disease has been drafted.…”

“…between individuals requiring care for mental ill-health and those who finally receive mental health care, has been estimated globally at 55% [9,10]. The barriers to mental health care are diverse [5]: On the one hand, they often involve a combination of insufficient resources and inadequate health policies. On the other hand, specialist services are often not utilised by affected individuals [11,12] because of the fear of stigmatisation [13–15] or because of gender role expectations [16,17].…”

Obstacles to Early Career Psychiatrists Practicing Psychotherapy

“…It describes the new field of neuropsychoanalysis showing how some of Freud's theories about mental processes anticipated new discoveries in neuroscience (McGowan, 2014)-a perspective voiced in recent years by Nobelprize winning neuroscientist Eric Kandel (1998Kandel ( , 2013. Furthermore, powerful evidence supports the cost-effectiveness of psychotherapy (Lazar, 2010;Lazar et al, 2014a, this issue) with particular importance for work, depression, and the workplace (Sledge & Lazar, 2014, this issue). The alarming rise of suicide and mental disorders in the military and in veterans highlights a pressing need for more psychotherapeutically skilled psychotherapists for that cohort (Lazar, 2014b, this issue).…”

Introduction to the Special Issue on Psychotherapy, the Affordable Care Act, and Mental Health Parity: Obstacles to Implementation

“…Because the patient population is diverse however, there are a number of situations in which it is in the patients' best interest for psychiatrists to carry out psychotherapy. It is helpful to keep in mind for example that the evidence for therapeutic effect of psychotherapy without medication in the treatment of many types of depression is as good as or better than the therapeutic effect of medication without psychotherapy (Lazar, 2014;Nemeroff, Helm, Thase et al, 2003;Sledge, 2014). Most patients can be best helped through application of a paradigm in which biological-psychological and social influences interact with each other in health and illness.…”