Counselling of Mental Health Problems by Occupational Physicians on Return to Work: the Co-op study
Author(s): David S Rebergen, David J Bruinvels, Allard J van der Beek & Willem van Mechelen Country: Netherlands
Is the intervention sector specific?	No
Is the intervention usable with different enterprise sizes?	Yes
Is the intervention equally applicable to both genders?	Yes
Is the intervention based on theory?	Yes
Can the intervention approach be adapted/ tailored?	Yes
Does the intervention promote CSR and how?	The intervention was not explicitly linked to responsible business practices although it does promote employee well-being.
Does the intervention promote social dialogue and how?	Social dialogue is not a core component of the approach.
Overview (including risk assessment and law – legal requirements etc.): In early 2000, the Dutch Association of Occupational Physicians (NVAB) published a set of guidelines concerning the management of employees with mental health problems by occupational physicians. These guidelines are based on national-driven evidence and aim to promote the active attitude and activating approach by occupational physicians. Specifically, the guidelines seek to teach occupational physicians how to identify and diagnose mental health problems, and in turn how to facilitate and provide early intervention by using counselling techniques, positive behavioural instruments and return to work. Within the guidelines, return to work is viewed as part of the recovery process; not solely as the desired outcome.
Implementation: Occupational physicians were provided with training on the guidelines and in their effective implementation in a three day course. The training course reflected the structural components of the guidelines; namely, occupational physicians were trained in multiple cognitive-behavioural prescriptive interventions (with the overall aim of promoting problem solving skills and to structure the patients’ daily activities), and were trained to diagnose mental health problems using a simplified classification system as outlined in the guidelines. Additionally, occupational physicians were trained on delivering a graded activity treatment:phase 1, educating patients on the causes and consequences of loss of control; phase 2, patients are asked to create an inventory of stressors and to develop problem solving strategies to address these stressors; and phase 3, patients are asked to put these problem solving strategies into practice and extend their activities to include more challenging and demanding ones.
Practical applications: The guidelines are outlined and detailed in a protocol, making it easily accessible to all occupational physicians. The delivery of the training course, to further inform and develop the implementation of the guidelines, was conducted by four professionals: including an occupational physician with experience on the guidelines, a psychologist/therapist, an experienced general practitioner/researcher on emotional distress, and a psychiatrist. The guidelines have been widely distributed to all occupational physicians, in a large variety of occupational sectors; however, they have only been formally evaluated in the police force.
Innovative aspects: The use of a non-regulatory approach in psychosocial risk management, specifically in rehabilitation of workers with mental health issues and problems; with the overall objective of facilitating increased return to work.
Evaluation (including process issues, outcomes and sustainability): The effectiveness of the guidelines was tested by randomly assigning participants to two groups: those who were treated by occupational physicians trained in delivering treatment in accordance to the guidelines; or to a group receiving usual care, consisting of minimal involvement from the occupational physician and, if applicable, access to the services of a psychologist. These two groups were comparatively assessed on a variety of outcome measures to determine their effectiveness. The primary outcome measures used to assess the effectiveness of the guidelines were levels of depression and anxiety, return-to-work, treatment satisfaction measured in all key stakeholders (patient, employer and occupational physician), and the overall cost-effectiveness of the programme (specifically, assessing both the direct cost to health care and the indirect cost associated to the consequences of absence from work). Additionally, the compliance and adherence level of occupational physicians to the implementation guidelines was examined. Measurements were taken at four time points: pre-intervention, post-intervention, at partial/full return to work and at a one year follow up point to assess the effectiveness of the guidelines and the sustainability of the observed effects.
Benefits (including cost effectiveness): Presented observed benefits are preliminary findings as the study and its analyses are currently on going. The observed benefits resulting from the use of the guidelines by occupational physicians in the treatment of individuals on sick-leave due to stress-related illness were: A significant difference can be observed in return to work. Occupational physicians reported a higher level of treatment satisfaction, and preferring to work according to the guidelines. The guidelines were found to be more effective for minor mental health disorders (like stress related disorders); however usual care was found to be more effective for more severe disorders (in part due to the easier access to a psychologist). The cost-effectiveness measurements suggest that the guidelines have a positive effect.
References: Rebergen, D.S., Bruinvels, D.J., van der Beek, A.J. & van Mechelen, W. (2007). Study Protcol: Design of a Randomized Controlled trail on the effects of Counselling of Mental Health problems by Occupational Physicians on Return to Work: the Co-op Study. BMC Public Health: BioMed Central Open Access, published July 26 retrieved from http://www.biomedcentral.com/content/pdf/1471-2458-7-183.pdf
Comments: One primary result of the preliminary investigation of the implementation and effectiveness of the guidelines was the observation that mental health problems in the workplace were highly prevalent; and, moreover, were more prevalent than previously believed by the occupational physicians.