Canadian Association of Occupational Therapists

Volume 6 (5), September/October • 2004

Reducing the economic costs of mental illness requires a wider circle of action

by Kathy Hatchard and Lynn Shaw

Time can shift imperceptibly. But sometimes the realization that times have moved to a new era comes in a wave, rather than a ripple. Such was the dialogue at a recent province-wide gathering of stakeholders in the field of vocational rehabilitation in mental health. As the incidence of mental illness continues to rise, the personal and financial costs become everyone’s issue and demand a strategic plan. One in six Canadians will seek help for a mental health problem during their life with one in eight being hospitalized (Vandergang, 2002). Currently, 30 percent of long-term disability claims encompass individuals with some type of mental health concern at an annual cost to the industry of $15-$33 billion (Canadian Mental Health Association, 2004; Dewa, Lesage, Goering, & Caveen, 2004). This economic reality, the skyrocketing costs of claims, has intensified the need for inclusive practices in the way individuals, programs and communities work to foster optimal participation by all workers.

Opportunities for greater inclusion of persons with mental health concerns in workplace environments was the aim of a conference held in British Columbia in May. Presentations and workshops at this conference provided fruitful ideas and innovations on how best to begin the process of change and ideas on how to overcome system barriers. Workplace inclusiveness in this context is not about choosing to include individuals with a mental illness in the workplace. It is about the development of basic societal practices that extend "respect and opportunities to people of differing abilities and characteristics" (Townsend, 1997, p. 146). For employers, insurers and health-care workers, this involves the development of programs, practices and attitudes that empower all individuals to participate in a manner that utilizes their maximal abilities. One of the key areas of focus to overcome barriers is to foster an affirming workplace environment (Rebeiro, 2001) whereby those with disabilities are encouraged to participate and are not relegated to the periphery, waiting to be invited. The conference itself was the result of ideas generated by mental health consumers at the Penticton Cooperative Enterprise Centre. Their many hours of volunteer effort, with the guidance of vocational counsellor Lise Ecclestone, are testimony to the desire to construct more navigable pathways.

Keynote speaker Joe Marrone, of the Institute for Community Inclusion in Boston stated that, while economic pressure is a key catalyst for organizational change, the external pressure is not sufficient to create change but must be combined with internal recognition of the need to change. Presenters offered a broad spectrum of endeavours in contributing to this awareness. The need for collaborative growth in return-to-work practices was echoed repeatedly throughout the conference. Seventy-five delegates representing consumers, vocational counsellors, job coaches, representatives of human resources programs, community support agencies, health-care administrators, advocacy groups, special needs educators, mental health workers and occupational therapists met for two and a half days to look at the current challenges. Topics varied from transitional work programs, educational programs, resource coordination, government funding initiatives, navigating legalities in return-to-work and the unique challenges of special populations such as those dealing concurrently with an addiction or young adults facing mental illness at the outset of their vocational development. Keynote speaker Victoria Maxwell energized the crowd with her heartfelt message of hope as a survivor, actress, playwright and activist. Several occupational therapists presenting at the conference helped to bring perspective to these intertwining themes.

Occupational therapist Joyce MacKenzie of Penticton Mental Health provided an experiential workshop about matching resources with personal strengths. Joyce challenged participants to think about the concept of ‘flow’ (Csikszentmihalyi, 1990). This included a critical self-assessment of skills, work requirements, environmental needs and desired supports that would enable a sense of mastery. Participants gained an increased awareness about building manageable goals and being proactive in seeking the right amount and type of assistance from the myriad of services. Promoting ownership of performance issues is an integral way that occupational therapists enable progress toward workable solutions on the way back to work.

Kathy Hatchard’s presentation (first author of this article) addressed taking ownership at a different level. It focused on preparing for the complex decision making around disclosing a disability to an employer and in requesting needed accommodations in the workplace. The need to maximize mental health through a mindful approach to balancing daily activities while moving forward was discussed. Ownership of mental health in this way not only benefits the individual but also potentially decreases the cost to employers by minimizing recurrent illness where possible. Speaking as a survivor, she underscored the importance of this "orchestrated healing of the whole" (Hatchard & Missiuna, 2003, p. 14) in correlating to positive vocational outcomes. Accommodations that may be useful in creating successful return-to-work outcomes in both the re-integration process and in maintaining employment were also discussed. Dialogue from the delegates indicated that employers tend to be very receptive to accommodating workers when needs and rationale are made clear. Occupational therapists are often key players in twinning needs with accommodations. Assessing functional recovery in relation to workplace demands is a cornerstone of occupational therapy practice and is approached scientifically through analysis of the multitude of interacting variables (Shaw & Polatajko, 2002). When barriers are systematically broken down, concise, efficient and cost-effective return-to-work plans can emerge.

Joanne Thompson, occupational therapist at Tri Cities Mental Health in Port Coquitlam spoke about the importance of building connections among community services and businesses in order to achieve successes on the way back to work. Successful outcomes were underscored with the testimonies of two of her team’s clients in attendance. They had participated in placements set up by the team’s vocational counsellor in partnership with a Ministry of Human Resources work experience program. The satisfied employer has subsequently hired both into paid positions.

Kim Calsaferri, Regional Manager of Rehabilitation and Recovery, Mental Health, at Vancouver Coastal Health reinforced the importance of strong vision with services built collaboratively. Her presentation showed the clear mapping of rehabilitation services that has developed in this region. Resource gaps and challenges to service coordination were identified through this process. Partnering among agencies and health-care organizations increased service offerings and awareness of options. Collaboration in the development and upkeep of information packages is ongoing. More easily accessed services also benefit employers, providing confidence that the system is responsive to the diverse needs of employees with mental health concerns through timely access to care.

This momentum for change is growing. Efforts to facilitate dialogue and action towards improving mental health in the workplace are moving forward in other regions and forums in Canada. Recently, the Canadian Institute for Health Research partnered with the institutes of Neurosciences, and Population and Public Health to conduct a workshop in April 2004. Here, stakeholders and researchers discussed a future research agenda for addressing mental health issues in the workplace. Researchers emphasized the need for evidence-based solutions to develop supportive workplace environments that encourage positive mental health as well as safe and timely return to work (Vezina, Bourbonnais, Brisson, & Trudel, 2004). Further to this several roundtables comprised of multi-stakeholder representatives (including occupational therapists), such as the Global Business and Economic Roundtable on Addiction and Mental Health and the Roundtable Project on Safe and Timely Return to Work and Return to Function are initiating system changes through informational analysis and research to prevent disability arising from mental health concerns in the workplace and to facilitate better return-to-work practices.

Insights from this burgeoning wave of interest in mental health issues suggests that actions towards reducing costs associated with mental illness requires collaboration and a conscious commitment to:

• championing awareness across society and within organizations of the need for change to address mental health concerns and reduce escalating costs;
• promoting positive mental health of employees through a purposeful and mindful attention to balancing work/life activities;
• developing interventions that can assist persons to develop confidence and a sense of ownership for performance issues and strategies for working with others to find solutions;
• developing accessible entry points to the health and social care service systems in each community that afford consumer choice;
• collaborating more with consumers, health-care providers and employers to develop supportive return-to-work practices in the workplace; and
• establishing partnerships with employers, insurers, consumers, researchers and health-care providers to study innovative interventions that can foster healthy employment relationships and supportive workplace environments.

At the forefront of all of these conferences, workshops and stakeholder initiatives is the tremendous collective support for breaking down system barriers to return to work for those experiencing mental illness. The sobering reality of the escalating costs of mental illness in the workplace is a shared concern for all stakeholders in Canadian society. Consequently, this reality has propelled a growing sense of collective ownership and a call to action. Clearly, the future lies in widening the circle, in choosing to be inclusive and not simply in choosing to include.

References
Canadian Mental Health Association. (2004). Mental health facts. Retrieved June 30, 2004, from http://www.mentalhealthworks.ca/facts

Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York: Harper Perennial.

Dewa, C. S., Lesage, A., Goering, P., & Caveen, M. (2004). Nature and amplitude of mental illness in the workplace. Discussion Paper for Working Group Mandated by the Institute of Population and Public Health and the Institute of Neurosciences, Mental Health and Addiction of the Canadian Institutes of Health Research.

Hatchard, K., & Missiuna, C. (2003). An occupational therapist’s journey through bipolar affective disorder. Occupational Therapy in Mental Health, 19, 1-17.

Rebeiro, K. (2001). Enabling occupation: The importance of an affirming environment. Canadian Journal of Occupational Therapy, 68, 80-89.

Shaw, L., & Polatajko, H. (2002). An application of the Occupation Competence Model to organizing factors associated with return to work. Canadian Journal of Occupational Therapy, 69, 158-167.

Townsend, E. (1997). Inclusiveness: A community dimension of spirituality. Canadian Journal of Occupational Therapy, 64, 146-155.

Vandergang, A. J. (2002). Working well: An employer’s guide to hiring and retaining people with mental illness. Toronto: Canadian Mental Health Association.

Vezina, M., Bourbonnais, R., Brisson, C., & Trudel, L. (2004). Workplace prevention and promotion strategies. Discussion Paper for Working Group Mandated by the Institute of Population and Public Health and the Institute of Neurosciences, Mental Health and Addiction of the Canadian Institutes of Health Research.

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