Mental Disorders – Ability to Work

In October 2019 South Africa commemorated Mental Health Awareness month.  It is widely reported that the prevalence of mental disorders in South Africa has risen to alarming levels.

This trend is however not an isolated phenomenon.  According to the World Health Organisation, 1 in 4 people in the world will be affected by mental or neurological disorders at some point in their lives.  Presently around 450 million people suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.

The vast majority of people with mental disorders are still fully productive workers and valuable contributors to the community.  Unfortunately, only a small number of South African workers actually seek treatment for their mental disorder, and with around 450 attempted suicides per day, the number of suicides and attempted suicides illustrate the destructive effects of mental disorders.

There is ample evidence that being involved with meaningful activities such as productive work is essential for normal psychological and physical well-being.  Despite this fact, an increasing number of employees (workforce) find it difficult or impossible to continue to work in South Africa`s work environment.

Mental health disorders can affect the workplace in a negative way by increasing absenteeism, reducing productivity, and increasing costs.  The causes of mental disorders are multi-factorial. Some of the contributing factors can be:

  • personal factors (e.g. genetic burden, personality, emotional intelligence, physical illness, substance abuse);
  • work-related (such as one’s workload including both excessive and insufficient work);
  • lack of participation and control in the workplace;
  • having poor working conditions or poor leadership and communication;
  • family stressors and social problems (such as struggles with conflicting home and work demands);
  • traumatic experiences; and
  • economic hardship.

It is therefore understandable that the treatment and interventions are also multidimensional, depending on individual needs.  Optimal treatment might be a combination of medication, different modalities of psychotherapy, occupational therapy, social support, family support, compassion and preventative actions from the workplace.

Whilst disability management, from an employer’s point of view, focuses on absences from work due to illness, injury or disability, and on preventing and reducing the risks on workforce productivity, disability management is actually much more than that – it is concerned with reducing the impact of disability on both employers and individuals.

Sanlam Group Risk’s goal is to provide clients with a holistic, comprehensive and tailor-made disability management service, suitable for their work environment and industry.

Rather than reactive claims management, our disability management practices are based on a comprehensive, cohesive and progressive employer-based approach to managing the complex needs of people with disabilities within a given work and socio-economic environment.  We therefore promote and believe in a combination of disability case management, early notification and intervention of potential disability claims, as well as sick leave management by the employer.

Employees living with mental health disorders are confronted with many obstacles in their attempt to properly re-integrate into the workplace, which may impede full recovery.  Some of these include:

  • Access to optimal treatment and lack of compliance with treatment;
  • Late diagnosis and intervention;
  • Physical illness – we know that people with chronic physical illness have a higher incidence of secondary mental problems;
  • Lack of a mental health programs at the workplace with resultant misunderstanding and stigmatization, and possible unwillingness to offer alternative work and change in work duties even on a temporary basis;
  • There is undeniable evidence that early diagnosis and constant involvement and communication from the employer is paramount to better outcomes and effective return to work.
  • In times of economic hardship, job demands may overwhelm an employee’s coping strategies; this is reflected in the increasing rate of professionals, senior management and HR professionals reporting mental illness;
  • Younger workers also are now more often diagnosed with mental problems.  There are very valid reasons why some countries cap the maximum hours’ staff allowed to spend on work activities and minimum leave are enforced.
  • Employees stay on in unfulfilling jobs due to fear of not getting other meaningful work due to high unemployment levels;
  • Unresolved work relations or conflict, inability to do the work, lack of training and promotion beyond capabilities re red alerts to successful return to work;
  • The origin of conflict between employees can vary (such as a disagreement, debate, or harassment), and typically involves 2 or more colleagues.
  • Some employees reconstruct and simplify their illness to put all the blame on the workplace with an entitlement that they should be compensated;
  • Trauma and instability at home, financial hardship and the high levels of violence in society.

For additional reading, refer to the Special Report in the latest issue of Financial Mail regarding the high costs of mental illness.

With Disability Case Management, Sanlam Group Risk aims to minimise the impact of illness, while promoting:

  • the avoidance of disability,
  • the optimal treatment or rehabilitation; and
  • the safe return to productive employment.

A return-to-work program is essential for rehabilitation and will allow the person who is unable to perform their usual and customary duties due to injury or illness, to return to temporary, limited or modified duty while they recover e.g. professional sport, where a player is re-integrated slowly after an illness or injury.  

Despite this entrenched concept, most professional workers are expected to return to work without the benefit of a return-to-work program.  More specifically, despite the high and increasing prevalence of mental illness in the workplace, many employers do not have a mental health policy in place.  Even if they do, it is mostly enforced at arm’s length, without active involvement and training of line managers and HR professionals. The workplace provides one of the most cost effective opportunities to lessen work disability due to mental health problems.  A lack of preventative, curative and re-integration planning in the workplace will however allow no winners.  Not only is it the ethical/proper thing to do from an occupational health and wellness point of view, but it also will save costs on many fronts in the long term and result in a more engaged and productive workforce.

Warm regards

Dr Jack van Zyl