Effective Biopsychosocial Treatment of Disability Associated with Chronic Psychiatric Conditions. Richard Marlin, Ph.D., and Susan Abbey, M.D.

Transcription

1 Effective Biopsychosocial Treatment of Disability Associated with Chronic Psychiatric Conditions Richard Marlin, Ph.D., and Susan Abbey, M.D.,

2 4 th Annual Canadian Congress for Research on Mental Health and Addiction in the Work Place Toronto, October 28 th 30 th, 2009

3 Disclosure Odyssey Health Services is a private interdisciplinary facility that provides assessment and treatment for complex disability cases including the various syndromes discussed in today s presentation. Most of the funding for our services comes from third party insurers and employers.

4 The Problem Individuals off work more than 2 years with multiple DSM-IV diagnoses (often Axis I and II) and frequently concurrent somatic difficulties (with and without definable disease and pathology).

5 Can they return to work? While much is written about the importance of a biopsychosocial model to address these cases, there are few examples of the translation of research and conceptual writings into effective approaches to return such individuals to gainful employment.

6 Method Truly Interdisciplinary Assessment and Treatment; Behavioural Science and Medical Science on Equal Footing; Not a Presumptive Disease Model

7 Method Assessment Team: Psychologist as Senior Clinician Psychiatrist Internist Field Consultant for In Vivo assessment and treatment

8 Assessment Data, Data and More Data: Patient, Partner/Family, Employer, Insurer, Current Health-Care Providers; Every Last Page of Previous Clinical Records; Extensive Psychological Testing; In Vivo Ecologically Valid Assessment of Environment and Behaviour

9 Treatment Collaboration, Collaboration and Collaboration Patient; Family; Health Care Providers; Employers; Insurers; Others

10 Treatment Optimal Medical Management of Non- Mental Health Disease and Pathology; Judicious Pharmacotherapy for DMS-IV Diagnoses: Not too much; Not too little; Just right.

11 Treatment In Vivo cbt: Behavioural Activation; Exercise; Relaxation Techniques; Exposure/Decreased Avoidance; Sleep Hygiene; Increased Socialization; Contingency Management; Judicious Cognitive Therapy.

12 Treatment Vocational Assistance: GRTW; Transferable Skills; Skill Acquisition; Volunteering; Job Search and Acquisition

13 Treatment Relapse Prevention: Careful Follow-up; Transition Back to Primary Care; Fading Away of Therapeutic Support; Continued Accessibility;

14 Outcomes 338 files reviewed: 124 deemed Psychiatric/Psychological 214 deemed Somatic/Physical

15 Result of Assessment Treatment Recommended Treatment Not Recommended

16 Result of Request to Treat Entered Treatment Patient Refused Treatment Funding for Treatment Refused

17 Outcome of Treatment Completed Treatment: Working or Able to Work Discontinued Treatment Completed Treatment: Unable to Work

18 Demographics (105) Average Age: Female; 29 Male Average Time Off Work: 6+ years Number of DSM-IV Diagnoses: 1: 19 2: 44 3 or more: 42

19 These patients can restore their functioning and return to work. Outcomes

20 Problem: High Drop Out Rate Why? 1) lack of collaboration: health care providers employers insurers

21 Problem: High Drop Out Rate Why? 2) conflicting contingencies you can t get better while proving yourself sick

22 Problem: High Drop Out Rate Why? 3) patient disbelief, resistance

23 Solutions? How to engage: the patient? the health care providers? the employer? the insurer?

24 References Dewa, C.S., Hoch, J.S. Carmen, G., Guscott, R. and Anderson C. (2009) Cost, Effectiveness, and Cost-Effectiveness of a Collaborative Mental Health Care Program for People Receiving Short-Term Disability Benefits for Psychiatric Disorders. The Canadian Journal of Psychiatry 54(6) Krupa, T. (2007) Interventions to Improve Employment Outcomes for Workers Who Experience Mental Illness. The Canadian Journal of Psychiatry 52(6) Parker, K.M., Wilson, M.G., Vandenberg, R.J., DeJoy, D.M. and Orpinas, P. (2009) Association of Comorbid Mental Health Symptoms and Physical Health Conditions with Employee Productivity. Journal of Occupational and Environmental Medicine 51(10) Dewa, C.S., McDaid, D. and Ettner, S.L. (2007) An International Perspective on Worker Mental Health Problems: Who Bears the Burden and How are Costs Addressed? The Canadian Journal of Psychiatry 52(6)

25 References Rollnick, S., Miller, W.R. and Butler C.C. (2008) Motivational Interviewing in Health Care. Guilford Press. Arkowitz, H., Westra, H.A., Miller, W.R., and Rollnick, S. (2008) Motivational Interviewing in the Treatment of Psychological Problems. Guilford Press. Miller, W.R., and Rollnick, S. (2002) Motivational Interviewing 2 nd Edition. Guilford Press. Martin, C. and Pear, J. (2007) Behavior Modification: What it is and How to do it. 8 th Edition Pearson Prentice Hall. Peterson, C., Maier, S.F. and Seligman, M.E.P. (1993) Learned Helplessness. Oxford University Press.

26 References Hadler, N.M. (2008) Worried Sick. University of North Carolina Press. Dersh, J., Polantin, P., Leeman, G. and Gatchel, R. (2005) : Secondary Gains and Losses in the Medical Legal Setting, in Schultz, I.Z. and Gatchel, R.J. (Eds) Handbook of Complex Occupational Disability Claims. Springer. Fordyce, W. E. (1976) Behavioral Methods in Chronic Pain and Illness. Mosby. Mechanic (1961). The Concept of Illness Behavior. Journal of Chronic Disease 15:

27 References Marlin, R. The Culture of Illness and the Medicalization of Suffering: Behavioural Science Suggests a Paradigm Shift. Invited Address to the Canadian Psychiatric Association, 54th Annual Meeting, Montreal, October White, P. (Editor) (2005) Biopsychosocial Medicine: An Integrated Approach to Understanding Illness. Oxford University Press. McHugh, S. and Vallis, T.M. (Editor) Illness Behaviour: A Multidisciplinary Model (1986) Plenum Press.

28 Dr. Richard Marlin Psychologist, Director and Chief Executive Officer Odyssey Health Services

29 This presentation was given at: