Mental health in the workplace
I READ with interest the article “Working for mentally healthy offices” ( Sunday Star, Oct 7) but I couldn’t help thinking that the ideal situations described therein are exceptions rather than the norm.
In fact, some employers are actually moving in the opposite direction. For example, a national utility company recently issued the directive that only psychiatrists could initiate antidepressant therapy for its employees. This directive has caused much mental anguish among its panel doctors because many patients with psychosomatic symptoms but only mild anxiety and depression do not like the stigma of visiting psychiatrists. Yet the panel doctors’ hands are tied when it comes to initiating antidepressant therapy for them.
As at July 2018, there are 381 psychiatrists on the National Specialists Registry. They have to serve a Malaysian population of more than 30 million. Singapore has a population of 5.6 million but it has more than 300 psychiatrists in service.
The latest National Health and Morbidity Survey (2015) revealed that the prevalence of mental health issues among Malaysians aged 16 and above was 29.2% or about 4.2 million. It is obviously impossible for a psychiatrist to treat more than 10,000 patients at any one time.
You do not need a rocket scientist to tell you that this gap in service can only be fulfilled if non-psychiatric physicians and general practitioners step up and step in as gatekeepers.
Employers take care of their employees when they are physically ill but they often consider mental health issues as a character weakness, not realising that the latter reduces productivity. It leads to absenteeism (throwing in medical certificates) and presenteeism (employee is present at work in body but not in spirit).
When it comes to the mental health of their employees, employers tend to be reactive rather than proactive. It took the suicide of an employee to spur a major multinational company in Melaka to organise a workshop on depression for its workers, for example.
Employers often pay the medical expenses of their employees through a group insurance policy purchased for them. It is well known that insurance companies do not cover psychiatric illnesses. So what happens when investigations for a symptomatic patient draw a blank after admission?
These situations often lead to over-diagnosis, where minor or insignificant abnormalities picked up during investigations are blamed as the cause of the patients’ symptoms. Otherwise, a diagnosis of one of the myriad of functional disorders will be made.
While some functional disorders like irritable bowel syndrome, functional dyspepsia, non-erosive reflux disease, fibromyalgia and tension headache have diagnostic criteria, others like non-cardiac chest pain, chronic backache and functional pain syndrome are more nebulous. So, in order to facilitate insurance claims, doctors often hide behind these medical euphemisms instead of directly making the diagnosis of depression or anxiety disorder.
Insurance companies and employers alike should also realise that mental illnesses predispose a person to physical ailments through suppression of the immune system. Employees who are psychologically healthy are also more likely to be physically healthy and hence less likely to require subsequent payouts for physical illnesses.
Malaysia still has a long way to go when it comes to mentally healthy workplaces. Greater acceptance by employers and insurance companies will certainly help to destigmatise psychiatric illnesses.
Baby steps to be taken should include empowering non-psychiatric physicians and general practitioners to diagnose and treat depression and anxiety disorders. Do not hinder them until there are enough psychiatrists to serve the whole population.