Work Accommodation and Retention in Mental Health

Psychiatrists often have a less than optimal understanding of how psychiatric disorders affect work functioning, one of the most important aspects of life. Forensic psychiatrists rarely if ever see patients or evaluees in their work environments. Psychiatry residencies, forensic fellowships, and continuing medical education typically offer little education or training in evaluating occupational functioning and disability.^1,–,3 Nevertheless, requests for disability evaluations not infrequently accompany clinical treatment or are referred to forensic psychiatrists.^4,5

Work Accommodation and Retention in Mental Health goes a long way toward addressing this unfortunate gap in knowledge and training. The book is a comprehensive and well-organized text on an underexplored but important area of research and practice. For example, chapter authors explore in depth the effect of specific psychiatric disorders on occupational functioning. They review the existing research and discuss the correlations and effects between specific symptoms, related occupational impairments, and disability, at times with user-friendly summary charts. The chapters that examine the stigma associated with mental illness in the workplace and of workplace disclosure of mental health problems are unique and should be considered essential reading for all mental health professionals.

Schultz and Rogers are to be commended for offering a well-organized, well-written, and academically thorough text that goes beyond the limitations of the medical model of disability. The historically dominant medical model of occupational disability assessment and management emphasizes establishing diagnoses and treating psychiatric symptoms. In this text, the editors' central theme is the disparities between the dominance of the medical model for persons with mental health disabilities and the reality of workplace environments.

The editors point out that although medical models are useful for optimizing treatment and controlling symptoms, they are not useful as a framework for maximizing work capacity, designing or implementing job accommodations in the workplace, or improving occupational outcomes for individuals with mental disorders. This book, which summarizes recent research regarding effective outcomes and evidence-informed best practices involving employment, institutional, and community policies, is intended to help mental health professionals perform effective occupational assessments and interventions for a range of mental health disabilities.

The text is divided into six major sections. Part I is an overview of the legal, epidemiologic, and economic considerations and ramifications in the area of mental health disability. Part II, described above, provides information about predictors of work capacity, occupational functioning, and work outcomes for individuals in specific diagnostic categories. In Part III, chapter authors utilize research to describe combined interventions that are very usefully organized to correspond to the diagnostic category chapters from Part II. These include individual treatment, employer-based approaches, organizational interventions, community interventions, and descriptions of best practices intended to minimize impairment and decreased function, maximize improvement, and preserve occupational functioning.

Part IV examines barriers and facilitators to job accommodations by exploring employer attitudes toward accommodations and the effects of stigma in the provision (or lack thereof) of work and job accommodations. Part V reviews evidence-informed practice in job accommodation. This section examines the role of social processes, organizational culture, and known best practices in providing accommodations. Mental health professionals who read these sections will learn about the kinds of accommodations that may be needed and available to support continued occupational functioning and the kinds of problems that may block access to these accommodations.

The book concludes with a section that discusses current and future research and the policy and practice implications raised by the discussions in the preceding chapters. The editors consider current model development, research, and evaluation for mental health disabilities limited by the lack of the emergence and guidance of an encompassing conceptual framework. They call for an integrated biopsychosocial approach that combines clinical and occupational interventions to address the complexities of the problems faced by persons with mental health disabilities and the equally complex work environments in which they are expected to function.

Within the sections, chapter authors also include discussions of traumatic brain injury and personality disorders, two diagnostic categories not often addressed systematically in mental health disability literature. In contrast, a discussion of substance use disorders, another major source of mental health disability in the workplace, unfortunately is not offered. In addition, the chapters move back and forth between discussions of supported and competitive employment environments and interventions, which at times can be confusing.

Nevertheless, this text is an excellent and comprehensive resource. Schultz and Rogers have provided an integrated research and evidence-based approach intended to facilitate the development of new effective clinical and occupational practices and policies for individuals with mental health disabilities. This book will broaden the understanding of mental health disability, stigma, and discrimination in the workplace, and the variety of evidence-based interdisciplinary, social, and occupational interventions that can maximize or preserve occupational functioning. This text can assist general and forensic psychiatrists in understanding their patients' or evaluees relationships to the workplace, in methods of utilizing the benefits of employment to improve mental health and occupational outcomes and in providing disability evaluations that look beyond the limitations of the medical model.

• © 2011 American Academy of Psychiatry and the Law