1. Tugman, Kristin MS, CRC, LPC

Article Content

The National Institute of Mental Health estimates that the United States loses more than $72 billion a year due to mental illness, most of which can be attributed to lost productivity. The new millennium brought about tremendous technological advances, and with it came an increase in new mental demands on the workforce. This increase in the employers' expectations has led to the increase in stress becoming so significant that the department of labor has developed a new category of workplace illness, "occupational stress or a neurotic reaction to stress." This occupational stress has been responsible for four times as many missed workdays as all the other nonfatal work injuries combined. The following URL provides a more in-depth explanation of this mental condition because it relates to the workforce:


These new technological advances on the workforce justify the basis for establishing New Emerging Industry for the Private Sector: Psychiatric rehabilitation and short-term disability within the competitive work force.


The common source of psychiatric impairment in the workplace is major employee depression. Typical symptoms manifested as a result of depression that affects work performance include inability to concentrate, inability to complete tasks, uncontrolled crying episodes, excessive absence or tardiness, irritability, anxiety regarding work issues, mood swings, confusion, panic attacks, impaired short-term memory, becoming overwhelmed easily, and an inability to handle stress appropriately. The Washington Business Group on Health reports that psychiatric disability claims have increased by 205% since 1986.


For additional background data on psychiatric disability, visit the following two Web sites: and


Disability management is defined as an active process of minimizing the impact of impairment on an individual's capacity to participate productively in the competitive workforce. Disability management as it is related to psychiatric disability pertains to the management of an individual's short-term disability with the goal of avoiding the need for long-term and social security disability.


The short-term disability policy is an insurance policy designed to protect the individual from lost wages if he or she should become unable to work for a brief period of time as a result of an illness. The long-term policy takes over after the short-term policy has been exhausted. The beginning of long-term disability usually means that the employee is terminated from employment, but as long as the disability status continues, he or she will receive a percentage of his or her salary as well as keep healthcare insurance coverage. Social security disability application is frequently a requirement when apply for long-term disability. Visit the following Web site for more detailed information on social security benefits:


Rehabilitation consultants are key in reducing disability days while avoiding the need for long-term disability. It is important for rehabilitation professional to work closely with the psychiatrist regarding the return-to-work plan. The rehabilitation consultant may also want to consider working a referral to an individual therapist because there may be issues surrounding the client's depression and anxiety that can be best dealt within psychotherapy. It is important to address these issues prior to return to work so that the chances of an illness relapse and a recurrence of psychiatric disability are decreased. This is important to the employer in the return-to-work process as early as possible. The employer can assist in the identification of a reasonable modified work assignment that, with the appropriate rehabilitation intervention, will enable a return to the original position in an expedient manner. Rehabilitation entails the process of helping the individual obtain the appropriate coping mechanisms for a successful return to productivity.


The need for a short-term disability did not happen overnight; it was a process, and, in turn, recovery is a process. Dialogue should continue with the client, employer, and psychiatric treatment provider throughout this process with respect to the appropriateness of a return to a modified work assignment. The modified work assignment is an important piece in the recovery process because any level of productivity is therapeutic and will only improve the chance of achieving a successful outcome within the rehabilitation program.


The following are the elements to evaluate as a means to overcome the barriers to a return for full capacity.


Recognize and accept that this is an illness, not a character defect. Psychiatric disability is not a tangible disability. A common opinion can be that employees should "pull themselves up by their bootstraps and work through it." This sets the stage that the employee "will himself back to full productivity." This in fact is impossible; the effective process is a series of structured exercises.


First is "Baby Steps." This exercise is a process that any amount of productivity is beneficial for improving one's mood. The purpose here is to reduce negative thoughts relating to guilt and shame that are often associated with being out of work.


A "To Do List" is developed to set in motion small accomplishments for the day. The accomplishments are basic: get out of bed, make a small breakfast, take a shower, get dressed, and go to the mailbox. They may seem minor, but they are positive and the employee begins to feel better about himself.


Added to this routine is an activity that the person can accomplish for that day that is just for him or her as an individual. It should not be an obligation but something that is enjoyed for his or her benefit. Some examples include the following: take a hot bath, sit outside in a garden, go for a walk, and listen to music. This exercise is particularly important because it becomes evident that self-care tends to be lacking in the lives of the individuals on short-term disability due to psychiatric difficulty.


Through this experience, the individual learns the importance of self-care and begins to help himself or herself develop appropriate coping mechanism to avoid becoming overwhelmed in the future when he or she feels the need to take care.


Next, review the "Five Fears of Returning to Work." In this exercise, the employee has to write a paragraph describing what it feels like to be well. Next, it asks for the employee's top-five fears of returning to work. The goal of this exercise is to help the individual understand that he or she will not be anxiety-free upon return to work but able to identify a manageable level of anxiety. The individual will also develop a plan of action should any of the five fears begin to happen. The exercise equips the person with the appropriate tool to handle an anxiety-provoking situation.


Now review the "Warning Signs of an Illness Relapse." The employee is asked to keep the paragraph from the last exercise regarding what being well feels like in his or her mind and begin to think about symptoms of his or her illness. The employee is than asked to dissect the symptoms so that he or she can recognize the very early warning signs of the illness. The employee is asked to determine as many early warnings as possible and then develop a plan for each. A backup is for the employee to give a copy of the list of warning signs to a close friend or family member who will aid in their recognition.


Now consider setting boundaries. This exercise focuses on helping the employee learn his or her limitations to appropriately set boundaries for a successful and lasting return to productivity. It is important for the individual to learn to set limits so that he or she does not place himself or herself in the same environment upon return to work, thus setting himself or herself up for a relapse. First, the employee is asked to write a paragraph describing how he or she believes others perceive him or her, and as a result, what others expect. Next, the employee is asked to examine the paragraph determining which expectations tend to become overwhelming. Next, the individual writes a new paragraph detailing how he or she would like to be perceived. Finally, the employee processes the discrepancies between the paragraphs and determines a plan to achieve the desired perception.


Work adjustment is the final in the recovery process and is appropriate when the employee has been unable to return to work in a modified work assignment with the employer. Work adjustment is set up as a volunteer position with the employer. Work adjustment is important because it can help alleviate stress surrounding the return to productivity, as well as help the rehabilitation professional determine the need for return-to-work accommodation and identify areas that need continued adjustment. For example, if the employee has to be at a volunteer site at 9:00 a.m. and is consistently 15 min late. This is an issue that can be addressed within the program rather than upon return to work as a disciplinary matter.


It is preferable for the employee to be in a structured return-to-work program to ensure continued motivation. In addition, a structured program will aid in the identification of job readiness as well as the need for accommodation upon return to work. Proper case management with rehabilitation professional will also ensure that the necessary communication exists with the employer, the psychiatric treatment provider, and the insurance company regarding the individual's disability status. Considering that very few return-to-work programs of this nature exist, it is possible for an individual to work through the steps by using a self-help model. This method requires significant dedication from the employee with disability. Short-term disability as a result of psychiatric difficulty is a growing problem within the workforce. Despite the escalation of this issue, there are very few return-to-work programs for psychiatric disability within competitive employment. Structured and self-help models with steps for return to productivity are but a limited suggestion for successful return to work. The field of private sector vocational rehabilitation will need to develop broader based techniques to deal with these current psychiatric issues.