Supporting Employees with Psychiatric Disabilities: Resources and Legislation for Retaining Employment

1. Retaining Employment Michele Clopper, MS, OTR/L Senior Disability Case Manager

2. This presentation will review the current resources including federal laws to offer a process to assist employers and employees with psychiatric disabilities to stay at work (SAW) or return to work (RTW).

3. Objectives • Gain knowledge of key legislation and employer benefits to support employees with functional limitations/impairments related to their disability • Identify the necessary components to facilitate the reasonable accommodation process • Gain an understanding of the interface of job analysis and functional limitations • Articulate the importance of the interactive process • Reflect on the value of developing a SAW/RTW program for individuals with disabilities

4. According to the Society for Human Resource Management (SHRM) many employers do not have a well defined return to work philosophy.

5. Costs • Depression costs employers in the United States over $44 billion annually • 55% of this is from reduced productivity ($12.1 b) and absenteeism ($11.7b). Psychosocial Issues and the Return to Work Process by Miller in 2004 • $83.1 b annually with $51.5 b in workplace costs for depression alone • The economic burden of depression in the United States: How did it change between 1990- 2000? By Greenberg…

6. Key legislation • ADA- Americans with Disabilities Act signed July 26, 1990 • ADAAA- “The Amendments Act”of 2008- lower the threshold to define disability • FMLA- Family Medical Leave Act- 1993 • State disability laws • May have a higher threshold than the ADA • Provision of state vocational rehabilitation services

7. American with Disabilities Act (ADA) • Equal Employment Opportunity Commission (EEOC) • Prohibits discrimination in all areas of employment including the application process, hiring, firing, advancement, compensation, training and all other terms of employment. • Individuals must be qualified- having the skills, education, and experience- to perform the job with or without reasonable accommodation

8. ADA • Does not include a diagnosis but a general definition • “A person has a disability if he/she has a physical/mental impairment that substantially limits 1 or more major life activity, a record of such impairment, or is regarded as having such an impairment.

9. ADA & Addictive Disorders • Anyone who engages in the use of illegal drugs is not protected by the ADA • An individual who is an alcoholic is protected under the ADA but they must be able to perform the essential job functions • Additionally, the individual can be terminated if alcohol adversely affects job performance

10. Amendment Act of 2008 Broadens the definition of disability • Reading • Thinking communicating • Concentrating • Communicating • Working • Breathing • Major bodily functions • Walking • Bending…

11. Family Medical Leave • Employers with 50+ employees or more • Employee must have worked a minimum of 1 year (1250 hours) to be eligible • With medical certification, employee entitled to job protection for up 12 weeks per rolling year for time out of work • Medical information can not exceed what is contained in the DOL form • Can be continuous or intermittent leave • Employer cannot declare hardship • Re-instatement to the same or equivalent position

12. Prevalence • 20% of the US populations is affected in a any given year using DSM criteria • ~ 44- 57.7 million individuals or 1 in 4 • 19% diagnosed with a mental disorder alone • 3% diagnosed with an addictive and mental disorder • 6% addictive disorders alone

13. Effect on the workplace • Excessive absenteeism • Poor work habits • Reduced productivity • Stress- complicating variable

14. Psychiatric Impairments • Refers collectively to all diagnosable mental disorders characterized by alterations in mood, thinking, behavior, or a combination

15. Functional Impairments • Concentration • Fatigue • Memory • Organization • Multi-tasking • Attendance Inability to screen out environmental stimuli Stress Interactive abilities Dealing with change Responding to feedback

16. Additional Factors • Stigma & discrimination • Does not self identify • Invisible disability • Disclose after a crisis • Reputation

17. Employer Benefits • Short term disability plans • Long term disability plans • Employee Assistance Plans (EAP)

18. Employer Disability Plans • STD is mandated in some states- NY, NJ,RI • Provides up to 26 weeks of income protection • Can be a salary % • LTD is usually offered by a vendor • Can have pre-existing condition clauses • Reasonable accommodation benefits • Flexible scheduling • Job coaches • Case management • Vocational rehabilitation services • Retraining

19. Unum a LTD carrier • 3 out of 10 employees between the ages of 25-65 will be out of work for three plus months at some time due to disability

20. EAP • Commonly outsourced benefit • Offers a wide variety resources • Referrals which address insurance and geographic needs • Wellness component • Coaching

21. Cultural Support • Wellness and Prevention Programs • Benefits

22. Recap • ADA & ADAAA- Civil Rights Laws • FML- job protection • STD, EAP, LTD- employer benefits • Need a way to coordinate and provide a program which coordinates/interfaces • Proactive employer who places value on SAW & RTW

23. EmployeeReasonable accommodation can occur with any scenario

24. Interactive Process • Facilitates the accommodation process • Identifies the employee’s need for support for success at work • Employer must acknowledge the request • Act quickly • Assign responsibility • Conduct trainings JAN

25. Responsible Party • Identify stakeholders • Identify essential job duties • Obtain information: functional abilities & limitations • Job analysis • Maintain confidentiality

26. Role of the supervisor/manager • Pivotal role in any SAW or RTW process • Study –Journal of Occupational Rehabilitation • The supervisor is the key person • Being a support • Making demands • Acknowledging every employee • Setting the tone • Collaboration & communication

27. Medical documentation • Documentation of disability • Be careful as only need the scope to establish need and functional limitations and abilities • Implement reasonable accommodations

28. Job Descriptions • Jobs have essential and marginal functions/duties • Essential duties are the reason a job exists • % of time performing this function • If remove this function the job would be significantly altered • What are the consequences of not performing this duty? • Can other employees perform this duty, if necessary? What is the impact? • What are the minimal qualifications? Including skills, training, and experience Accommodation(s) are given to support the individual in performing the essential duties of the job

29. Job analysis • Observe the physical requirements • Force, distance, dimension of tools & materials necessary to operate the equipment or perform the activities • The frequency to which the activities need to be performed • Number of workers that perform the activities • Amount of time spent on each essential function • Degree of skill, education, specialization • Physiological considerations

30. Analysis continued: • Psychological considerations • Environmental considerations • Cognitive considerations

31. Cognitive & Psychological Considerations • Distractions (number of alternating tasks) • Interpersonal demands • Attention to detail • Accuracy • Stress level • Complexity • Critical reasoning • Risk (effect on end result)

32. Stakeholders • Employee • Employer- Supervisor, Human Resources, Benefits • Provider • Union • Council • Others

33. SAW /RTW Process • Triggered by a medical condition • Step 1 • Questions requiring answers: • What is the individual’s functional capacity? • What are the functional limitations/ impairments • What are the medical recommendations/restrictions?

34. SAW/RTW Process • Step 2 • What are the essential duties of the position? • Job Analysis • Comparing the essential duties with the functional abilities and impairments of the individual while incorporating the medical restrictions

35. SAW/RTW Process • What response can the employer make to keep the employee at work or to facilitate their successful return? • Journal of Occupational Medicine-

36. Examples of Reasonable Accommodation • Flexible schedules • Office/workstation location • Lighting • Job restructuring • Head phones • To do lists • Job coaches • Additional time to learn new responsibilities • Tape recording

37. Model • Prevention Model from Michael Melnick, OTR/L, President of Prevention Plus, Inc. • Accountability • Commitment • Communication • Consistency • Flexibility • Inclusion • Respect • Fun

38. Cases • Lab employee • Research • Animal care • Office worker • Accountant/Customer Service Representative • Faculty Assistant • Librarian

39. References & Resources • Americans with Disabilities Act. Retrieved from: http://www.ada.gov/ • Amendments Act. Retrieved from: http://www.ada.gov/ • American College of Occupational and Environmental Medicine. (2006). Preventing Needless Work Disability by Helping People Stay Employed. Retrieved from: http://www.acoem.org/guidelines.aspx?id=566. • American Occupational Therapy Association. Self Study. • American Occupational Therapy Association. Practice Framework • Boston University Center for Psychiatric Rehabilitation. http://www.bu.edu/cpr/ • Equal Employment Opportunity Commission. http://www.eeoc.gov/ • Family Medical Leave Act. http://www.dol.gov/whd/fmla/ • Gray, K. (2005). Evidence-Based Employment Services for Persons with Serious Mental Health Illness. AOTA Mental Health Special Interest Section Quarterly.

40. References and Resources • Greenberg, P.E., Kessler, R.C., Birnbaum, H.G., Leong, S.A., et al. (2003). The economic burden of depression in the United States: how did it change between 1990-2000? Journal of Clinical Psychiatry. 64, 1465-1475. doi: 10.4088/JCP.v64n1211. • Holmgren, K. DahlinIvanoff, S. (2006). Supervisors views on employer responsibility in the return to work process. A focus group study. Retrieved from: http://www.springerlink.com/content/h858365q4t37838u/fulltext.html • Job Accommodation Network. http://askjan.org/ Miller, D. (2004). Psychosocial Issues and the Return to Work Process. Retrieved from: http://aota.org/Pubs/OTP/1997-2007/Features/2004/f-020904.aspx • US Department of Labor. • http://www.dol.gov/