24 Jun Getting People Back to Work: Acknowledging the Importance of the Mental-Physical Nexus
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Getting People Back to Work: Acknowledging the Importance of the Mental-Physical Nexus
In the modern global economy businesses are under increasing pressure to reduce operating costs yet simultaneously increase productivity. These competing pressures can too often lead to more injuries due to higher risk work environments, safety shortcuts and/or quick-fix solutions that end up costing companies more in the long run. In addition to identified physical risks, cognitive functioning and mental health among staff is increasingly under strain in an ever more demanding workplace environment. Consideration of reciprocal mind-body interactions (including identifying potential psychogenic factors in physical illness) is increasingly coming to the fore as a central consideration in this space.
Return to work is not possible for everyone in the short-term after injury, but long-term absence from the workplace can have significant adverse health effects (including increased rates of overall mortality, poorer physical health and poorer mental health). Indeed, it is increasingly being appreciated in the context of ‘work focused health care’ (Waddell et al, 2008) that a positive work experience itself represents therapeutic intervention and thereby forms part of an effective treatment regimen (see, for example: Australian and New Zealand Consensus Statement on The Health Benefits of Work). By contrast, staying away from work may lead to isolation, poorer health and adverse mental health issues (Waddell and Burton, 2006). In addition, it has been noted that treatment of mental health issues is more effective when people are working – and that the health benefits of work are relevant for people with any mental health condition or diagnosis (OECD, 2014).
However, it is challenging when health professionals and patients do not prioritise treatment goals in the same way. For example, in a study which asked young people with a mental health diagnosis to list what mattered to them most, employment and education were identified as priority goals relative to physical health issues (Iyer et al, 2011; Ramsay et al, 2011). Unfortunately, this is frequently the reverse of how these issues are prioritised in many healthcare and rehabilitation frameworks. Indeed, health practitioners are generally well versed in the diagnosis and treatment of physical workplace injury, and most are now aware of the health benefits of a return to work as early as practicable after such injury. However, there is more limited consensus when the central issues concern thinking skills and/or emotional status and how these factors may impact in a ‘top down’ manner on functional capacity (including physical capacity and return to work rehabilitation). This is where the role of the neuropsychologist and/or the psychiatrist is crucial.
People with mental health/cognitive issues should not have to choose between their health or their employment but if properly assessed by a neuropsychologist and/or psychiatrist they should more often than not be equipped with tools that help them to manage both.
Fortunately, rather than considering the mind and body in separate ‘black boxes’ there is now emerging awareness of their close interplay in mediating a healthy status via complex mind-body relationships. It is to be hoped that this trend will continue in the future, especially when one considers increasing acknowledgement of complex interactions through:
- burgeoning inter-disciplinary fields such as psychoneuroimmunology;
- the mushrooming of empirical data with respect to the flow of neural information along the gut-brain axis;
- the acknowledged role of the mind in pain perception;
- treatment placebo and nocebo effects.
Despite these and other recent important findings in fundamental medical science concerning the interplay of mind and body, there is a relative paucity of information available to date concerning the impact of cognitive and mental health on workplace performance reviewed in the context of overall health, including significant psychosocial causes and effects of workplace disability. It is to be hoped that this significant lacuna will be addressed in future through government and other funded studies and via publications which raise awareness of this important emerging field.
Getting people back to work after injury or ill health is increasingly important in an era when organisations make enormous investments training staff to exacting technical, employment and health/safety standards. The true costs of treating a workplace injury or illness are far higher than most employers realize. Indeed, the direct costs of treating a workplace injury or illness are just the ‘tip of the iceberg’, forming a relatively small percentage of the total liability from a workplace injury. Direct and indirect costs to employers and society can end up in the millions of dollars. Governments, life insurers and workers compensation schemes are continually aiming to reduce the high costs of work disability. Optimizing case management through the acknowledgement of complex, reciprocal mind-body relationships can assist significantly with respect to these considerations.
Australasian Faculty of Occupational & Environmental Medicine (AFOEM). (2011). Australian and New Zealand Consensus Statement on The Health Benefits of Work. https://www.racp.edu.au/docs/default-source/default-document-library/afoem-pos-aus-nz-con-health-benefits-work-pack.pdf?sfvrsn=0;
Iyer SN, Mangala R, Anitha J, Thara R, Malla AK. An examination of patient-identified goals for treatment in a first-episode programme in Chennai, India. Early Interv Psychiatry (2011) 5:360–5. 10.1111/j.1751-7893.2011.00289.x
RACP. (2019). Health Benefits of Good Work. https://www.racp.edu.au/advocacy/division-faculty-and-chapter-priorities/faculty-of-occupational-environmental-medicine/health-benefits-of-good-work
Ramsay CE, Broussard B, Goulding SM, Cristofaro S, Hall D, Kaslow NJ, et al. Life and treatment goals of individuals hospitalized for first-episode nonaffective psychosis. Psychiatry Res. (2011) 189:344–8. 10.1016/j.psychres.2011.05.039
Waddell G, Burton AK. Is work good for your health and well-being? (2006) London (UK): The Stationery Office.
Waddell, Gordon, Burton, A. Kim and Kendall, Nicholas A.S. (2008) Vocational rehabilitation – what works, for whom, and when? Report for the Vocational Rehabilitation Task Group. TSO, London. ISBN 9780117038615.
**This article was written by Professor Jonathan K. Foster. All views, opinions and conclusions expressed are those of the authors and/or speakers and do not necessarily reflect the view, opinion, conclusion and/or policy of ExamWorks and its affiliates.