Co-ordinated treatment plan required to get staff with depression back to work

With depression rapidly becoming the primary reason for workplace impairment and disability claims, it’s important to understand the role work plays in maintaining good health.

“Love and work are the cornerstones of our humanness,” said Dr. Pratap Chokka, clinical professor of psychiatry at the University of Alberta and consultant psychiatrist at Grey Nuns Hospital, during a session at Benefits Canada‘s 2020 Mental Health Summit on Nov. 13.

North Americans spend an average of 90,000 hours working, he said, noting that’s the equivalent of working 24/7 for 10.5 years. “But what if it isn’t good work? If you enjoy what you do, it actually has benefits, such as making you a better citizen and parent. But no work or poor work is detrimental to health and long-term worklessness is as detrimental to health as smoking.”

Read: Understanding a depression patient’s journey

Although 75 per cent of people with depression are working, only 17 per cent of Canadians with depression are fully functional, he said. That means the majority aren’t productive or living up to their potential, a situation that leads to absenteeism, presenteeism and lost productivity. But treating depression adequately can restore the person’s function and regain productivity in the workplace, he explained.

However, barriers inhibit recovery from depression and return to work. Chokka described the issue of depression and work as a triad problem: the challenges faced depend on where the individual is on the triangle. “As a psychiatrist, I’m biased to think that the benefits payer has it out for the patient. Clinicians are the gatekeepers to return to work. You need a medical or clinician approach to treating depression, but often by the time we get the patient they’ve already gone through a mental-health program and been misdiagnosed. You need training to know what is a mental-health disorder and mental-health symptoms. Management of depression depends on a correct diagnosis since not everything is psychological.”

Communication between stakeholders is also key, he added. “Physicians are not usually part of return to work, but need to be integrated into a holistic approach. We need real science and evidence-backed treatment. We need national and practical guidelines and we need to bring the large business community in as partner to make mental health a priority.”

Read: Dealing with stigma of returning to work after mental-health leave

Getting a bit better from depression isn’t enough and employees with depression need to get back to functioning as they did before they were unwell, he said, emphasizing the need for a holistic, integrative approach. “Things are changing and that’s exciting, but I’m disappointed not to be further down the path to personalized treatment. We need targeted treatment that is affordable and tolerable.”

Recent research found a depressed employee’s productivity improved by 75 per cent one year after receiving antidepressants, “That put $5,000 back in the pocket of the employer,” said Chokka. “Simple measures can have dramatic impact.”

But alongside the challenges come solutions. “We need a solution involving all key players but clinicians, especially in this space,” he said, noting the Canadian Depression Work Guidelines will be published within a year. The made-in-Canada solution will help stakeholders speak a common language, work with benefits providers, ensure patients receive the best co-ordinated care and improve and bridge gaps.

“Depression is nasty. If someone is suffering from depression, it impairs their ability for working and loving. But with treatment, we see patients find hope and resilience through their illness.”

This presentation was made possible through the support of Lundbeck Canada Inc. 

Read more coverage of the 2020 Mental Health Summit.