The Psychiatry of Work: Is Residency Training Adequate?

Author(s):

Andrew Brown, MD,Barbara Long, MD, PhD, FABPN

It has been estimated that depression alone results in a loss of $31 billion per year for employers. This slideshow reports findings from a survey on work psychiatry.

Work is not only the means by which our patients survive, it constitutes a central aspect of identity and serves as the context within which many-if not most-of our interactions take place. Most of our conscious waking hours are spent at work.Problems encountered at the workplace frequently drive the decision to seek psychiatric consultation and treatment. Problems with one’s supervisor, the perception that one is being treated unjustly by a boss or employer, and fears relating to job security are commonly associated with the development of affective and anxiety symptoms.Workplace problems are important to address as outcomes worsen and crises deepen.1 Long-term unemployment typically leads to a spectrum of poor clinical, economic, and functional outcomes; and job loss contributes to feelings of depression, purposelessness, social isolation, and even suicide.Despite the central importance of work to mental health, many psychiatrists are unable to effectively assess and address the workplace problems presented by their patients. Psychiatrists who focus on occupational and organizational problems frequently cite lack of adequate education and training in the area. Assessment of functional capacity-and optimal clinical approaches to patients who present with claims work incapacity-is a frequently remarked upon, and well-documented, manifestation of the above-described problem.2The Committee on Work and Organizations of the Group for the Advancement of Psychiatry (GAP) has studied the adequacy of existing psychiatry residency training in this area. This slideshow features the study findings. Results of this study found:
• Residents are aware that they receive insufficient training in the psychiatry of work
• Residents do not feel confident evaluating or treating common workplace problems
• Many are interested in being trained to evaluate and treat common workplace problemsTo address the desires and needs for training in work psychiatry, GAP is developing a curriculum that can be used by residency training programs.

References:

1. Group for the Advancement of Psychiatry. Committee on Psychiatry in Industry. What Price Compensation? New York:Group for the Advancement of Psychiatry;Volume IX (99):1977.
2. Adler D, GAP Psychopathology Committee. Psychiatrists’ knowledge of their patients’ job functioning. Psychiatr Serv. 2013;64:395-396.