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Psychological Issues in Chronic Absence from Work
Hugh Koch and Ron Bracey
Abstract:
Assessing the causes of and ongoing reasons for chronic absence from work is complex. This paper outlines a framework for understanding the psychological and social aspects of this assessment and points the way forward for proactive re integration.
“Work-related stress” describes a range of situations, both psychological and social, from normal mild reactions to sustained anxiety and depression. Any level of stress can, depending on the situation and the individual, have an adverse effect on an employee’s ability to function effectively both at work and at home. Litigation arising either within a Personal Injury or an Employment/Disability Discrimination context requires careful assessment of:
- Causation (what is causing, and prolonging the problem)
- Condition (how severe is the problem)
- Prognosis and Treatment (what needs to be done to rectify the problem and how long has it/will it last)
Without a rigorous understanding of these issues, both the individual and the organisation can, at best, cope with the ongoing difficulties, (and inadvertently prolong it) rather than resolve it. Fortunately, employment-related stress is, and should be considered, a short lived problem or condition, provided the appropriate steps are taken to assess and provide the most effective interventions both in terms of individual treatment or change and/or organisation change. Individual change includes:-
- Awareness of one or more causes of the stress
- Awareness of location of stress (work, health, family, social)
- Accessing effective individual therapy or occupational advice
- Consideration of alterations at or consideration of alternative to current employment
Organisational change includes:-
- Awareness and resolution of interpersonal relationship conflicts
- Amendments to working environment (physical environment, work load, type of work)
- Phased return to work (hours of working, type of work)
- Provision of support and constructive, proactive appraisal meetings
The interaction or interplay between the individual’s reaction to “stress” and the organisations perception of what is happening is complex. The risk of conflict between the two parties resulting in litigation is considerable. When this occurs, the need for clear and independent opinion on “causation, condition and prognosis” is essential to resolve the litigation as rapidly as possible and as effectively (for both parties) as possible.
The first author is currently compiling a summary of recent cases to exemplify the medico-legal aspects of such litigation and will provide an update in due course.
Work-related stress will often continue to be problematic unless rapid advice and intervention is provided. The time constraints are typically more acute in the situation where an employee is absent from work and rapid advice is crucial. The norm for obtaining professional opinion within the personal injury field of 4 – 6 weeks is inadequate within the employment/absence field. An employer ideally requires their employee to be assessed within 1 – 2 weeks of instruction, and a plan of action provided within 1 – 2 weeks of instruction, and a plan of action provided 1 – 2 weeks later at most. This is a “tall order” for experts but, provided the appropriate documentation, including the full GP records, is available, then this time scale is possible. Following provision of the disability-related opinion, significant liaison between relevant parties (employee, employer, clinician, lawyer, insurer) is beneficial, as each may/will have a slightly different “slant” on what has and what needs to occur. Understanding employee health in the context of organisational stress rests on sound psychological assessment and recommendation of valid interventions, both individual and organisational.
Reference:
Koch HCH + Kevan (2005) Psychological Injury. XPL Press. St Albans
Further information can be obtained from Hugh Koch Associates, 1 Crescent Bakery, St Georges Place, Cheltenham, Glos, GL50 1XY, Tel: 01242 263715 Fax: 01242 528299 or at www.hughkochassociates.co.uk.
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