A study of psychiatric referrals for fitness for work

Abstract

Background:There are very few Indian studies regarding the psychiatric evaluation of state government workers referred for psychiatric fitness for work.Aim:This study aimed to examine the reasons for referral, psychiatric diagnosis, and outcome of psychiatric referrals for fitness for work at a tertiary-level referral government hospital.Materials and Methods:The study evaluated consecutive psychiatric referrals at a tertiary-level referral government hospital with their informed consent utilizing a specially prepared pro forma, Kuppuswamy's Socioeconomic Status Scale and the Mini International Neuropsychiatric Interview plus. Psychiatric diagnoses were based on the International Classification of Diseases 10th Edition Diagnostic Criteria for Research.Results:The study included 67 male and 8 female psychiatric referrals with a mean age of 39.5 years. Most of the psychiatric referrals were married (82.6%), Hindu by religion (97.3%), from urban areas (80%), belonged to upper middle class (46.7%), and had rotating shifts or emergency duties (50%). Psychiatric referrals were usually made for a single reason (57%), most commonly absenteeism (84%) followed by undisciplined behavior (38%). A past history of disciplinary action taken against them was given by 56% of the referrals. The most common psychiatric diagnosis was psychoactive substance-use disorder (21.3%) followed by psychotic disorders (20%) and mood disorders (14.7%). No psychopathology was detected in 18.7% of the referrals. Most of the psychiatric referrals (68%) were fit for work, though 22.67% were declared unfit for work (permanent invalidation). Psychiatric referrals with multiple reasons for referrals, longer duration of psychiatric illness (>5 years), and diagnosis of organic mental disorder or psychotic disorder received invalidation (permanent unfitness) on psychiatric grounds.Conclusions:Psychiatric referral for fitness for work is most commonly for absenteeism. The most common psychiatric diagnosis was substance-use disorder followed by psychoses. The majority (68%) were found fit for work after treatment though 22.6% required invalidment from service.

Fitness to re-join job: Neuropsychiatric perspective

“…The previous study from Pune also concurs with our findings regarding the reasons for permanent unfitness for the job, including the longer duration of psychiatric illness and the presence of an organic mental disorder or psychotic disorder. [19] Study findings differ from previous studies in some respects, particularly with regard to how fitness is associated with patient treatment compliance and attitude toward fitness in substance use disorders in different parts of the world. This could be due to differences in the assessment of illness, including subjectivity and the service rules of the state or referring authorities, as most of these evaluations were performed at the workplace rather than in institutions or hospital-based studies.…”

“…These findings on reason for referrals are comparable with the previous hospital-based studies on fitness among patients with psychiatric illness in South India and Saudi Arabia. [18,19] As expected, psychiatric disorder had a higher prevalence of sickness absenteeism and behavioural issues compared to neurological or neurosurgical disorders, which is consistent with the previous studies. [20] Other common reasons for referral include pre-employment evaluations for high-risk jobs, such as firefighting, military personnel, professional drivers, pilots, workers at toxic waste plants regulated by mandatory legislation, and during the redeployment of workers.…”

“…In comparison, higher rates of fitness to rejoin the job were reported in studies of individuals with mental illness in Pune (68%) and Saudi Arabia (52%). [ 18 , 19 ] The lower rate of fitness in our sample may be due to a coexist of neurological and neurosurgical disorders and the nature of jobs that pose a greater risk to the public (transportation and national security). The previous study from Pune also concurs with our findings regarding the reasons for permanent unfitness for the job, including the longer duration of psychiatric illness and the presence of an organic mental disorder or psychotic disorder.…”

“…Some of the most frequently cited reasons for delayed return to work include severe untreated mental illness, significant neurological damage, prolonged absence, and job requirement-related factors. [19,20] Even in countries like India, there are limited studies and a lack of clear guidelines and standardization in assessing fitness to rejoin a job, which may lead to subjectivity in evaluations and may pose legal and social issues. Hence, it is crucial to carry out a study.…”

Approach to and practical challenges in certification in Psychiatry

“…It is not advisable to issue such certificates without any request from the employer, a valid informed consent from the employee, and nature of the job in detail. [ 3 6 ] As per literature on fitness to rejoin the job or continuation of job, the following six domains are considered important: (a) health and safety risk of the individual, (b) determination of the worker's capacity, physical status, and psychological capacity for the designated job, (c) ethical considerations, (d) legal requirements, (e) predicted performance and absenteeism, and (f) economical issue. [ 7 8 9 ] Hence, an assessment of the overall fitness for a job will be done during the pre-employment period and also to rejoin the job during the course of employment.…”