Occupational Psychiatrists Foster Healthier Workplaces

• A national company has chosen final candidates for a new group of regional manager positions. Even though the firm likes its choices, it wants an outside opinion to assess those candidates' leadership and management skills and make suggestions for their executive development.
• A pharmaceutical company thinks that enhanced care for psychiatric illness can help its corporate bottom line and wants a study designed to collect convincing data.
• A steady long-term employee has been on an ill-defined disability leave for months when his company's medical department decides it wants an independent medical evaluation of his disability status and recommendations to improve treatment for the employee.
• A small company has redesigned its work processes and wants some help with engaging all employees in the new team approach.
• A factory decides its manager needs executive coaching because he has trouble managing employees who handle creative functions in the plant.

These are some scenarios that enlist Jeffrey P. Kahn, M.D., a New York City psychiatrist and president of WorkPsych Associates Inc. WorkPsych is an executive and corporate mental health consulting firm that combines a business perspective with mental health care expertise. Designed to complement existing management and mental health care programs, WorkPsych's wide range of services includes individual and corporate consultation, policy development, prevention programs, and management training.

Sitting in his Central Park West office on a recent morning, Kahn, who is also a clinical assistant professor of psychiatry at New York Weill Cornell Center of New York Presbyterian Hospital in Manhattan, discussed psychiatry in the workplace and how he got involved in the field.

"The context is that, until recently, psychiatry has not paid enough attention to the business world," he explained. "Rather, it was mostly concerned with feelings in patients' personal lives and, to a great extent, overlooked both the emotional importance of the work environment and interactions between work and home. But as people focus more on work and there are more dual-career families, the workplace has [acquired] even more of a social focus. At the same time, people find less support from their communities and extended families. So there is now a much greater recognition of the importance of work for people's emotional lives and a much greater recognition of the importance of people's emotional lives to the well-being of business."

Kahn's interest in business stems from his childhood.

"I come from a business family on both sides," he said. "Both of my grandfathers were factory owners and my father was a company president."

He decided to become a psychiatrist while an undergraduate at Swarthmore College, where he received a B.A. in psychology. In 1979, he received his M.D. from Columbia University's College of Physicians and Surgeons, then remained at Columbia for his psychiatric residency and fellowship.

"In medical school and during my residency, I did a lot of work with the relationship of stress to heart disease and, over time, became increasingly interested in the way organizations work and in the strengths and weaknesses of different types of organizational structures," Kahn recalled.

About 12 years ago, he began consulting to businesses in New York City, initially doing disability evaluations and on-site psychiatric consultations for a large corporation. Since then, he has consulted to about two dozen firms.

"Much of my work has developed by word of mouth," Kahn explained. The value of psychiatric skills is not always obvious to corporations, and there is also a natural psychological resistance to using any professional who is aware of underlying emotional issues. Most companies also know the importance of not intruding into employees' private lives, so they often rely on stress management programs that seem less threatening and more popular, despite having limited benefits."

Once companies realize that a psychiatrist has something more to offer, however, opportunities start to grow, Kahn added.

"In fact, before two recent executive coaching assignments, [both] companies pointed out that psychiatric awareness of psychotherapy and medication issues was an important factor to them. Some companies are starting to better understand what we can offer."

In 1990, Kahn, together with 12 other psychiatrists, formed the Academy of Organizational and Occupational Psychiatry (AOOP), based in McLean, Va. Today, AOOP has about 200 psychiatrist members nationwide and offers training, networking and an annual conference. Its published mission is: "To enhance psychiatry's contribution to the well-being and productivity of workers, leaders and work organizations."

In 1992, Kahn edited the textbook, Mental Health in the Workplace: A Practical Psychiatric Guide (Kahn, 1992). Two years later, he incorporated his workplace consulting business.

"I felt that incorporating would give me a vehicle to interact with companies that are more comfortable working with another corporation rather than an individual," he stated. Kahn estimated that at least 30 of the several hundred psychiatrists who consult to businesses around the country have also formed workplace consulting companies.

"There's lots of room for more organizational and occupational psychiatrists," he reported. "But it's not easy to get started, so one shouldn't think of this work as an easy solution to managed care problems. You have to develop the skills you need, make the right contacts, get your name known, and become aware of how business works and what issues concern them. It's a process that takes time."

Kahn noted that one issue of great concern to businesses today is mental illness disability claims that result in enormous costs for companies.

"Many companies actually think that there's nothing they can do about this," Kahn said. "It's to the point where some of them think that if you offer mental health benefits, you increase the likelihood of stress disability claims. This is a tremendous misperception."

Kahn pointed out that the truth is that disability claims are not a result of availability of mental health benefits. Rather, they result, at least partly, from the absence of high-quality treatment for emotional problems.

"The real problem is that employees on disability have not been properly diagnosed or that the best treatment is either not offered or not accepted," he explained. Kahn added that, in his experience, only about 1% of such claims are the result of outright malingering. "Most employees on disability leave have a real but modest psychiatric problem, which has been blown out of proportion during some combination of adversities at work and at home. They're often surprised and pleased to learn that their symptoms are understandable and treatable. Problems may continue, though, because of adversarial and entitlement issues that persist."

Kahn finds some of the most interesting and rewarding challenges in his business are when companies send him executives who have run into workplace problems or who seem to have lost their "performance edge."

"Under-performing executives can have major effects on morale, profit, lost business opportunities and turnover, and they are very expensive to replace. As far as the company is concerned, the employee is offered coaching or treatment primarily as an approach to the performance issues. Even so, these are people who typically have some significant emotional issue, respond promptly to treatment and usually return to their previous high level of performance, or sometimes even higher," Kahn reported. "Many of them are psychologically adept, but have never thought in psychological terms. You can get very satisfied patients, and companies that are often surprised at how much employees can change."

Kahn emphasized the importance for psychiatrists working in business to be very clear about what their role is in each situation.

"In some cases, you're a treating clinician, and in others you're a consultant. Sometimes you answer to an employee/patient and sometimes to an employer. You want to be sure that task, payment and confidentiality lines are always very clear."

He offered an example: "In an executive development assessment, I don't determine psychopathology or suggest that an executive use Prozac [fluoxetine]. It would be highly inappropriate to assess someone's employment potential on the basis of depressive symptoms. Rather, you must use objective skill and performance criteria. Besides, we know from the clinical perspective that many very successful people do have some psychopathology, and that that should not be a criteria for how they're managed in the workplace."

Among his other activities at New York Weill Cornell Center, Kahn co-teaches a course in organizational and occupational psychiatry and supervises psychopharmacology. He is also involved in a psychoanalytic study group on business, an American Psychiatric Association task force to develop recommendations on APA/business relationships and an APA committee on occupational psychiatry.

"It's a lot of fun," he stated. "You get to do some good work, meet interesting people and see positive results. It's fascinating to focus on the interface between mental health and the workplace. It enlarges the biopsychosocial model and offers a whole new perspective on what we psychiatrists can do."

There is, however, still much work to be done to better understand the role of workplace issues in people's lives and the importance of mental health in the workplace for corporations.

"The better the business world understands what we do and how we can help their workforce, the more interested they will be in the quality of their psychiatric benefits," Kahn stated.

Kahn had several suggestions for other psychiatrists who want to start consulting to businesses. These include reading business magazines and newspapers, paying attention to workplace issues facing patients, reading up on organizational and occupational psychiatry, and learning from experienced psychiatrists and psychologists in one's own area or at national meetings.

(AOOP's annual meeting on Psychiatry at Work 2000 is scheduled for Jan. 14-16 in San Diego. For more information on the meeting and member benefits, visit AOOP's Web site at www.aoop.org -Ed.)

References:

Further Reading

Kahn JP, ed. (1992), Mental Health in the Workplace: A Practical Psychiatric Guide. New York: John Wiley and Sons.
Kahn JP, Unterberg MP, eds. (1995), Workplace Psychiatry. Psychiatric Annals 25(4).
Speller JL (1989), Executives in Crisis. San Francisco: Jossey-Bass.