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Assessing Capacity for Patients 2019 Transcript

As a treating psychiatrist working in occupational health I understand just how challenging it can be assessing work capacity in someone with a psychological condition.

In the next few minutes I'm going to share with you an approach that should take some of the guesswork out of the assessment enabling a more objective assessment and hopefully resulting in your patient being able to remain at work while they recover.

As clinicians we're so often taught to hone in on symptoms and diagnosis but in the assessment of work capacity these things aren't quite as useful. For example we all know that diagnosis of itself does not equal a work incapacity that plenty of people around to continue to work despite mental illness such as depression and anxiety.

In this same way symptoms also don't give us the complete picture. Rather when we're evaluating capacity functioning becomes of increasing importance.

Take the example of a patient who's got quite significant agoraphobia and spends all their time at home in the confines of their safe house. Their symptom free but I think we'll probably agree they're more unwell than our patients who do suffer from anxiety and perhaps even a bit of panic but are out and about doing their usual activities of living.

The next thing I think about when I'm evaluating work capacity is what it actually means to be fit for work. My approach to this is to have some understanding as to what the person's job involves but then also understanding the key features of work capacity in my mind these include.

An ability to attend work regularly and reliably.

Perform at an acceptable standard, abide by a code of conduct at work and also for work not to create an unreasonable health and safety risk for our patients.

The next thing I do is an objective functional assessment the way I like to do this is to break functioning down into the core capabilities required to be able to work. My approach is to first look at someone's architecture and structure of their day.

For example what's their sleep-wake cycle like?

Can they get up at a reasonable time each day?

Are they able to engage  necessary activities of daily living such as self-care and domestic chores? If they can't get out of bed to even shower I'm unlikely to send them back to work.

The next thing I look at is their energy levels their endurance can they get through their day with enough energy are they needing to nap for several hours a day we regard to their cognitive capacity I need to know that they have the attention of concentration to be able to manage at work.

Things I asked include whether they're able to read the newspaper or books?

Can they get to the end of a page and remember what they have read?

Are they on emails are they on social media?

Are they remembering things?

Look at their interpersonal skills one way to look at this is to evaluate whether they're engaging with friends or family or whether they were treating off to their room. I think about their coping mechanism are they going to be able to cope with the simple frustrations of day-to-day work activities?

I then look for evidence of work capacity. Often times patients will be engaging in things that were consistent with an ability to work such as study or volunteer work.  I then think about the medications they may be on and whether these are going to impact on work capacity either through sedation or cognitive side effects.

Once I've completed the objective functional assessment I then think about whether the person can do their full job or whether perhaps they need some modifications to their job. Keeping someone at work with modifications is obviously going to result in a better health outcome than keeping someone off work altogether if they do have some capacity.

Remember also that employers have a legal obligation to provide modification and the certificate of capacity has a space at the bottom for you to fill in appropriate modifications. When I think about modifications from a psychological perspective I think about a few things I think about does the person need alternate hours for example do they need shorter days or do they need a later start time?

I think about whether they need lower expectations in their role for example do they need longer time frames to complete tasks perhaps because of mild cognitive in efficiencies which means they have to check and recheck their work so they don't make mistakes and I think about whether they might need an alternate line of reporting or some modifications to their duties perhaps not multitasking seven different things at once in the early stages of a return to work.

Following this approach should enable a more objective assessment of work capacity a more considered assessment the ability to help keep your patient at work while they recover and therefore resulting in better outcomes in terms of their health and well-being of the evidence suggests.

Page last updated: 28 May 2019