Few physicians have sufficient training in the nuances of occupational medicine, yet all of us have the capacity to remove a patient from the workforce completely. I have observed that when a person is sitting at home, his or her pain usually worsens.
- Without the distractions of work, pain is more noticeable.
- It’s usually not known when the patient can go back to work, which is anxiety-inducing.
- Being labeled a “chronic pain patient” by everyone, including the medical profession, begins early.
NBC News Post
NBC News in 2012 reported that with the recent economic downturn, many Italians were committing suicide. Here are excerpts from the notes left by the victims:
- “I decided to end it because I am a failure. I can’t live without work.”
- “I can’t live without a job.”
This feeling of failure and loneliness is at the heart of acts of desperation among the business community in Italy. These messages left are the same mantra repeated by workers and businessmen who either tried to kill themselves and lived to tell the tale or by those who thought about trying but found other reasons to live.
Another excerpt:
- “My business is like my family. I feel responsible for each of my employees. If my business fails, I fail with it.”
(This article was called “In debt or jobless, many Italians choose suicide,” by Claudio Lavanga. NBC News World Blog, May 9th, 2012)
Mental health and work
My old attitudes
I can speak only for myself in mentioning some of my old perspectives. However, my old attitude might generalize to what some physicians think about this issue.
- I had the impression that many patients wanted to stop working.
- Only some wanted to stop working.
- Most did not.
- Only some wanted to stop working.
- I did not understand how devastating it was to a patient and his/her family to lose a job.
- The mental health consequences of being home and disabled are severe.
- Social isolation creates the same symptoms as chronic pain
- It is often easier for me to take a person off of work.
- It’s time-consuming to go into the details of light duty, etc.
My approach changed
- There are major implications of losing a job.
- Being out of work creates further health problems.
- Any time off work should be as short as possible, with specific dates prescribed for returning to work.
- If a patient is already off work, quickly broach the subject of returning to work.
- If they have no intention of returning to work, the issue has to be clearly discussed and an alternate plan implemented.
One of many papers on the connection between mental health, disability, and not workikng is from Australia. They documented that almost 50% of people not working had issues with their mental health, and it was a lesser issue in those who were working. It was noted that returning to work was an important aspect of healing, but mental health also needed to be addressed. Unfortunately, in the Workers Comp system, mental health interventions are not covered, and they are more disabling than physical pain. Regardless of whether the unpleasant sensory input is from a mental or physical source, the danger signail originates in similar regions of the brain. You cannot solve physical pain without addressing mental pain.
People inherently want to be a part of society and contribute. Being active in the workforce is an important part of that need.
Social determinants of health are 80% of a person’s chronic illness and disease. Doctors can only make about a 20% difference. Contributors include poverty, lack of opportunity, oppressive work evironments, ongoing physical, emotional, or sexual abuse, societal instability, homelessness, bullying, social media, overexposure to social media, lack of police protection, and authoritarianism. If a person’s income is less than $40,000 annually, the incidence of a diagnosable anxiety disorder is 100%. It is challenging, if not impossible to help a person heal and keep blinders on regarding their environment. Mainstream medicine has refused to address this problem with a widespread public health approach. Return to work is just one of the issues. As long as we only treat symptoms without addressing root causes, our nation will buckle under the burden of chronic disease. Currently, it consumes a little over 20% of our gross national product.
Additionally, by implementing strategies to cut health and human services, homelessness will go up, chronic diseases will contiue to increase with less access to treatment, preventive care will be less emphasized, and the mental health of individuals and our nation will be severely compromised. How are current mental health resources going to stem this juggernaut? I have not even mentioned the problems caused by the opioid epidemic, alcholism, and domestic abuse,
What does our nation want? Humans first need is to seek safety, and when you feel unsafe, you’re anxious, and then angry. Safety also means living your life in freedom based on your values, if they don’t interfere with others. How safe to you feel when you are being criticised or told being told how to live your life? It is time for the world of medicine to step up and implement known effective approaches with a public health mindset.