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  • Mariel Irvine


I need not have prepared a formal presentation for the seminar on stress at work last week. Debate was so well informed and engaged, the presentation was soon abandoned. The trigger for delegate participation was a reference to occupational health, and its failure to facilitate early returns to work in many cases.

When an employer makes a referral to its occupational health provider, it requests an assessment of fitness for work. If an employee is off sick, it asks for an indication of when the employee is likely to return, and what can be done to achieve an early resumption of full duties.

The doctors, nurses and counsellors who specialise in occupational health tend to be medical generalists, expected to give opinions on a wide range of injuries and conditions, and how they impact on a person’s working capacity. Few seem to have any specialist knowledge of how to manage stress at work, and the sort of illnesses it can cause.

In these cases, many absences are caused by disagreements with management, frequently following changes to working practices or personnel. A recurring theme, is occupational health’s failure to carry out any critical analysis of the employee’s account of his symptoms, or any objective evaluation of what is causing his difficulties at work.

It is not unusual for the health professional to accept the employee’s account at face value, and to advise the employer that no return is likely until the employee’s expectations are fully accommodated. The ramifications of this approach, and how a return to work is to be achieved, are left to the employer to determine.

An independent assessment of the employee’s mental health and whether it is work related is often missing. Instead, the diagnosis of the GP is adopted. Sometimes the doctor’s sick notes simply record “stress at work”, which is a state, rather than a medical condition. Conversely, I have known occupational health professionals suggest employees visit their GP and ask him to sign them off sick with stress.

Staying at home may not be the best option for the employee who feels under pressure. In most cases, his mental health is better served by remaining at work, where there is interaction with colleagues and others. At home, he may become isolated, withdrawn and lose perspective.

It is accepted by psychiatrists that those who remain off sick with stress for three weeks find it significantly more difficult to return to work than those who have been away for a shorter period. By the time a person has been away from work for six weeks, the prospects of securing a return to work drop to under 50%.

Early meaningful intervention is key, in order to secure an early return, and to preserve the employee’s career. When faced with an unhelpful occupational health report, rather than relentlessly quiz the maker of the report, as I saw a Human Resources professional do in a recent case, there are two options that might be considered:-

1. Mediation

2. A second opinion from a psychiatrist who specializes in occupational health.

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