Mental health at work

This useful book is a joint effort by the Royal College of Psychiatrists and the Faculty of Occupational Medicine, Royal College of Physicians to give practical advice on mental illness in the workplace. Contrary to the subtitle, however, it will be of more use to doctors than employers because of its clinical focus. Most chapters are written jointly by a psychiatrist and an occupational physician, which helps to maximise relevance to the workplace. There are a few chapters written by others such as a human resource manager and an organisational psychologist.

The book falls roughly into two sections; one dealing with specific psychiatric conditions and the other with workplace stress. The former begins with a superb chapter “Assessing mental health problems in the workplace”. There are also chapters on anxiety, depression, substance abuse, critical incidents, chronic fatigue syndrome, schizophrenia and organic states. These combine a good resume of salient clinical points with a discussion of the issues in managing the employability of the patient. The high quality information on these difficult topics will be appreciated by many clinicians.

On the other hand, the chapters dealing with workplace stress are disappointing and emphasise how little progress has been made in this area over many decades. Several case studies of stress programs in various organisations are presented, including pharmaceutical, electricity and telecommunications companies. Each is claimed to have been beneficial. However, there is a distinct lack of candour in the presentations, which lessens their credibility. It is highly unlikely that so many programs were successful without some setbacks, but none are reported. Also, there is no substantial statistical data presented to support the claims of benefit even though it is stated that surveys of “staff opinion” (or similar stress indices) were done periodically. The main advance appears to arise from major legal decisions under disability discrimination law which require employers to make reasonable adjustment for the employment of those affected by work stress or other mental illness.

The book is a timely summary of mental illness in the workplace, showing both the strengths and weaknesses of current practice. It will be of much interest to those who provide medical care to workers and workplaces.

Bruce HockingOccupational Physician Camberwell, VIC