Psychiatric Disability in the Workplace – A Powerful Return-to-Work Model

Like everyone else, employers are much more confident dealing with issues that are visible and tangible – things that they can see and touch as opposed to factors that are unseen or difficult to quantify. Most of us are uneasy about dealing with anything that is hard to “get a handle on”. 

These dynamics are very much at play when most employers respond to disabilities that are invisible. When accommodating an employee with a visible disability like the need to use a wheelchair, most employers are quickly ready to build a ramp or buy a piece of equipment. When an employee’s disability is unseen, like a psychiatric disability, and the needed accommodations are usually intangible, employers more hesitant in their responsiveness.  It can be hard to know what to do.

Yet, “psychiatric disabilities” are actually commonly experienced by people in our workplaces. Frequently, they are ongoing disabilities that the employee has learned to manage or stabilize from an early age and that their employer is not even aware of. Some employees, however, acquire psychiatric disabilities at some later point in their employment with a company. When a flair up of previously controlled symptoms, stressors, or other triggers occur and the symptoms interfere with the employee’s performance, both the employer and the employee are often caught unawares. Insights on employer ability to retain valuable employees while accommodating mental health issues is the focus of the focus of the January (see the lead story of Rapid Refill Ink, Salem) and February editions of Inclusion @ Work, with more planned throughout 2007.

To help employers in the Oregon Business Leadership Network understand how to better manage the issue of psychiatric disabilities in the workplace, we arranged an interview with Michael Klachefsky. Based in Portland, Michael is the Assistant Vice-President, Managed Disability Programs and Services for Standard Insurance Company. Michael has had decades of experience in this area and The Standard’s return-to-work program for people with psychiatric disabilities is exemplary among disability insurance providers. 

OBLN: Michael, personally, how did you get involved in the area of return-to-work for people who experience psychiatric disabilities?

Michael Klachefsky: Years ago, Boston University’s Center for Psychiatric Rehabilitation developed a supported employment model for people with psychiatric disabilities which they tested in academic and social service settings. They called it the “Choose, Get and Keep” model. They helped people choose, get and keep jobs. When I was working for the Employment Development Unit of the Government of Manitoba in Canada, we piloted this model in the City of Winnipeg and we helped people with chronic severe mental illness choose, get and keep jobs - with an 80 percent success rate.  Eighty percent of the participants were still on their jobs six months after they started.

Later, I entered the insurance industry as a consultant and helped some insurance-based plans work with people with psychiatric disabilities. This was actually an easier model to work with because people had jobs to go back to – we didn’t have to find new jobs for them.

As a consultant I worked with a teachers union with a high rate of psychiatric claims. Using this model, we dropped the average duration of Long Term Disability (LTD) claims by 32% - from 19 months to 13 months. We did this with a university and we reduced their expenditures on LTD claims by 33%. That is the magnitude of financial benefits that employers can experience but, what is really cool, is that a lot of people got helped. A lot of people went back to work when, had their claims had been handled the way they typically used to be, these people would probably have never returned to work. One of the people at this university was able to get back to work after having been absent for seven years.

It is a powerful model! It works really well when it is done right. Still, the insurance industry as a whole has not adopted this model.

OBLN: I understand that, now with the Standard Insurance Company, you have successfully incorporated much of this model into The Standard’s return-to-work programs?

Michael Klachefsky: Here at The Standard, we have the only dedicated return-to-work program for people with psychiatric disabilities amongst all the disability insurers in the United States – likely in all of North America. We call it our Mental Health Unit.

Approximately, eighty percent of the people the unit works with have anxiety-related disabilities and most of the rest have forms of depression. The salient features of our model are: 

• We have trained vocational rehabilitation professionals that we subcontract to meet with these individuals face-to-face and meet with their employers face-to-face - and they work with both of them to develop effective return-to-work plans.
   
• In these plans, we emphasize and identify what support the claimant needs to be successful in the workplace. Sometimes that support will be provided by a coworker. Sometimes that support will be provided by a Supervisor. Sometimes that support will be provided by a Vocational Rehabilitation Professional.
   
• This proactive planning for personalized emotional supports is the most effective feature of our model. We are not aware of any other insurance company that does that. At The Standard, we do that.

When an employer is open to providing accommodation for an employee to return-to-work our Mental Health Unit’s success rate is 50% - half of the people that enter its return-to-work program have succeeded in returning to work and retaining their jobs – whereas one of our competitors has a published success rate of only 15%.

In general, the insurance industry responds to psychiatric disabilities as a strictly medical phenomenon. We are also treating them as a psychosocial phenomenon. In other words, it isn’t just about the diagnosis and the medication, it is also about what kind of personal assistance the individual needs to get back to work.

OBLN:  What are the key considerations that an employer should keep in mind in helping an employee with a psychiatric disability return to their workplace?

Michael Klachefsky: Employers are not supposed to know the medical condition of an employee who goes off work. But, particularly if it is a small company, they usually do, or they may have authorization from the employee to work on an accommodation...

The first thing the employer should do is talk to their disability insurer and find out if their insurer does anything different for people with psychiatric disabilities than they do for people with physical disabilities. If employers want to become more proactive in helping someone get back to work, either they themselves, or their insurer should engage a vocational rehabilitation consultant to help them – someone who will give the claimant and the employer face-to-face (not telephone-based) assistance.

OBLN:  There is pretty convincing data that, for people with physical disabilities, the earlier the person begins reintegrating back into the workforce, the quicker their recovery time. Is this the same for people with psychiatric disabilities?

Michael Klachefsky: Yes, although it may take longer to begin that early work. Many people are put on medication. Medication is a great tool, but often it can take some experimentation for the doctor to determine which medications are the best for the claimant. This can take several months and the claimant shouldn’t be returning to the workplace until their medications are stabilized.

However, the evaluation and planning process can begin beforehand - before the person is ready to actually return to their job. Early on this lets a claimant know that he is valued by his employer and wanted back in the workplace.

OBLN:  What kind of accommodation do you typically see put in place for the people that you have worked with?

Michael Klachefsky: Experience has shown that accommodations for people with psychiatric disabilities seldom cost anything. What they typically need is accommodations like different work hours, different locations, or a little more time from their supervisor. Accommodations for these folks are usually not a financial issue or even a workplace issue.

OBLN: Some psychiatric disabilities seem to be a little cyclical in nature – someone might come back, settle into their job fine, and then experience another episode several months later. Do you see this?

Michael Klachefsky: The model that we use for people with physical disabilities has three phases - assessment, planning and implementation. The model that we use for people with psychiatric disabilities has an additional phase – follow up. Depending on the individual claimant, this is a period of up to three months where the vocational rehabilitation professional follows up with both the employer and the employee once or twice a week. They do this to ensure that everything is going well and also to be able to anticipate and avoid any problems that might come up.

OBLN: Given the nature of psychiatric disabilities, is it more typically on a part-time basis that they start back to work? Or do they jump right in?

Michael Klachefsky: Yes, it is more typically on a part-time basis. In fact, that is commonly the biggest accommodation that we encounter.

We don’t wait until everyone is “100%”, because none of us is really ever at 100%. We want people reconnected to the workplace as quickly as possible. The longer you stay away from work, we believe, the greater the odds are that you will never go back. So, we try to get people back to work as soon as possible. For all folks, whether with a physical or psychiatric disability, it usually means shorter hours to begin with.

OBLN: Many employers, when confronted with the prospect of their employees acquiring a “psychiatric disability” consider it to be an alarming notion. Yet, based on your familiarity with this area, you seem to be saying that, if these situations are handled properly, they are nothing to get one’s feathers ruffled about. Is that correct?

Michael Klachefsky: It is. It is also amazing how much potential is being wasted with these folks when an effective return-to-work program isn’t available to them – just because employers are generally more frightened about dealing with this type of disability than with others.

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