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Mental illness case management Hide

Case background

A full-time member of staff has been noted to have had five periods of one to two week's absence over the past 18 months, with different diagnoses being given including migraines and stomach upsets. His manager has also identified that a trend is developing in relation to the employee being late for work or off sick on Mondays or after bank holidays. His manager has talked to the employee on several occasions but has been told the absences are not related to work or any other issue, he has just been unwell.

Colleagues have commented that while he was never very gregarious he has become more isolated and has missed quite a lot of deadlines over the past few months, resulting in others having to pick up his work. They are becoming annoyed by this behaviour.

HR is looking at commencing the disciplinary route to manage his performance and absence issues. They would like advice from the 3HH as to whether there are any issues they should be aware of, or if they should proceed as indicated.

The employee has recently been diagnosed with bi-polar disorder but has not informed HR or his manager and does not want to do so.

The report

Call the referring HR manager or line manager for full history and availability of alternative duties, reduction in contracted hours, re-training, (eg what adjustments would be considered reasonable). Also seek permission to discuss pending disciplinary with the employee.

Call employee and get a full history and confirm that he is currently receiving consultant-led psychiatric care. In two-thirds of cases bi-polar disorder is incorrectly diagnosed and can be confused with thyroid problems, therefore underlying disease of the thyroid needs to be excluded by the consultant. Discuss with employee at first or second telephone call (once the case manager has gained the trust of the employee), that the employer has to be informed that there is a medical problem and agree the exact nature of the information that can be disclosed to the employer.

Where the employee is not receiving consultant-led psychiatric care, the case manager will arrange this utilising private medical insurance benefit with a preferred consultant psychiatrist who specialises in occupational psychiatry and mental illness and its impact on the workplace.

Gain employee's consent to refer and receive a report from treating consultant psychiatrist.

Case manager would manage the case as per Bupa case management mental healthcare pathway that links into the Medical Disability Advisor (MDA).

Specialist confirms diagnosis and liaises with GP about a medical treatment plan and psychotherapy for continued support. Following treatment of any acute phase, the employee would be referred to the community mental health team for ongoing treatment in the primary care setting.

Compliance with medication (treating symptoms of mania and depression) and psychotherapy treatment is imperative to ensure the stability of the condition. It is not uncommon for there to be some problems initially in stabilising the condition with a suitable treatment plan and the employer needs to understand this.

Employee agrees with case manager what can be disclosed to HR in respect of the nature of his condition and has agreed a health and wellbeing plan concerning his work and adjustments being released in full.

Return to Work (RTW) programme

The following is an example summary that would be included in the RTW programme.

The employee has an underlying medical condition which has undoubtedly affected his behaviour and attendance at work over the past 18 months. His condition has been confirmed and is being treated by a specialist in consultation with his GP. Once the right treatment plan has been found and, providing the employee complies with this treatment plan long-term, I am hopeful that both his behaviour and attendance at work will improve, although at this early stage this cannot be guaranteed. You should also be aware that it can take up to six months for this condition to stabilise and, even then, throughout his working life he will have periods when he will incur a higher than average absence from work, which is reasonable with this type of condition.

While the employee's condition is being stabilised he will require time off to attend out-patient appointments at least weekly over the next four weeks, but this should decrease as he responds to treatment.

The risk assessment of this employee's duties should be revisited. It is highly likely that the Disability Discrimination Act will apply in this case, however, the condition may be exacerbated by a high-pressured job where he is required to work extremely long hours over extended periods to meet deadlines. From what you tell me of his role and responsibilities, although he is required to meet deadlines, they can be easily met within his normal contracted hours. It is recommended that you monitor his working hours and manage his workload closely in a supportive manner. You should be aware that although the employee should not in the future undertake shifts without you seeking further medical advise, I do note, however, that this is not a current requirement.

At present I do not think an occupational health psychology appointment is necessary, as his specialist is aware of his workplace issues. However, if I have concerns about his fitness to work as his treatment progresses, I shall discuss this with you direct. Likewise, if you have any further concerns, please do not hesitate to telephone me, although when we spoke I understood you were happy with the ongoing management of this case at present. I shall keep in regular contact with the employee.

Follow-up programme

Case manager to ensure that the employee is referred to the community mental health team as this is a chronic/life-long condition, once the acute phase is over. This will ensure that he is compliant with treatment and has the appropriate clinical support and monitoring in this life-long condition.

Case manager will continue to monitor until his consultant and the community mental health team agree that he has stabilised, and HR/line manager are confident that he has rehabilitated back into his role and that they able to support him, given his health-related needs.

The timeline for this follow-up would need to be flexible as the employee may take several weeks or months to become stabilised on suitable medications/treatment.

It is common for HR and line managers to feel anxious and lack confidence when managing and supporting employees with psychotic mental health problems. The case manager would reassure them at case closure to call if they would like to discuss any worries or concerns that they may have in the future.

Outcome

The employee would, in Bupa's opinion, continued to have intermittent absence from work due to a lack of case management and as a result could potentially continue to be unproductive in the workplace.

When on sick leave he would have been absent for durations in excess of 90 days, but because of correct diagnosis and treatment driven by the Bupa Health Risk Management team he returned after 56 days. The Medical Disability Advisor, 2006, confirms that correct diagnosis and treatment by consultant-led psychiatry ensures prompt response and quicker RTW. Bupa estimates a reduced length of time absent from work by at least 34 calendar days. This converts into a saving of at least £2,890 based on the average daily rate indicated by The Ergonomic Research Institute, 2006.

This could be more if you take into consideration the frequent absences that would have continued and also he would have remained disruptive and unproductive in the workplace (presenteeism).

Individual employee case studies Hide

Short term sickness absence management

This employee has a high level of short-term sickness absences in spite of being with the company concerned for less than six months.

The employee called Bupa on day one (Monday) to say that he had a throat infection, which had been treated by his GP with antibiotics that he had received on Friday. He had taken them over the weekend but although he felt well enough to attend work his GP had advised him that he could not return to work until his temperature had returned to normal. He was therefore likely to be off until the end of the week when he finished his antibiotics.

As his length of absence had hit a trigger that required automatic escalation to a nurse, the call was immediately transferred. The nurse asked the employee what his temperature was and when he replied that it was 36.8 she advised him that this was a normal temperature and he should return to work as there was no other clinical reason for him to continue his absence.

The employee stated that he was unhappy with this advice and further discussion took place. It was again reiterated that as he had no other symptoms and had obviously responded to the antibiotics he should return to work.

His manager was informed by email that the employee had hit one of the company’s attendance management triggers and advised a management interview as per the company’s policy. At this interview the employee decided the job was not for him and resigned.

Reducing short-term sickness absence with clinical advice Hide

Case one

This employee had had no sickness absence in the previous two years. He reported on day one an absence that fell into the category of which 95 percent of employees report absence, which was respiratory/digestive absence lasting less than three days.

On day two he called to extend his absence for a further three days which caused him to hit the automatic clinical escalation trigger on calendar days, so his call was immediately transferred to a clinician for further advice.

His symptoms were assessed and home treatments were recommended. He was advised that if he improved with his home treatments he should be fit to return to work the next day. If his symptoms persisted then he should go to his GP without delay.

His symptoms did however improve with the home treatments and he returned to work on day three instead of day five, thus reducing the company's direct and indirect costs for that absence by at least two working days.

Case two

An employee phoned in on day one to report an absence following a wisdom tooth extraction. He stated he expected to be off for that day only having had the extraction the afternoon before.

On day two he rang to extend his sickness absence. He stated that he felt very unwell with nausea and vomiting and that he now felt he would be unable to return until at least the end of the week. This hit the trigger to warrant clinical escalation because his predicted absence would now exceed three calendar days.

During the symptom assessment the nurse determined that he was taking Ibuprofen for pain control and because he felt nauseous he was not eating. Therefore, the Ibuprofen was being taken on an empty stomach. The nurse advised the employee that this was probably the cause of his nausea and vomiting, and that he should immediately stop taking the Ibuprofen and take an alternative analgesic. If his symptoms did not improve he should visit his GP.

Fortunately, the employee's symptoms improved dramatically. He was able to return to work within 24 hours, once again reducing the cost of absence to his employer.

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