Mental health is a specialist area. Specialists include consultant psychiatrists, clinical psychologists and occupational therapists in mental health. Clinicians who provide occupational mental health assessments should have undergone professional mental health training and hold a specialist mental health qualification.
Occupational mental health specialists require an even higher level of expertise, as they must be able to formulate clinical opinions on matters including return to work prospects, reasonable adjustments, disability and advice to HR.
It is highly unusual for medical and non-medical clinicians and occupational health advisers who work in occupational health services to have undergone specialist mental health training and hold a specialist mental health qualification. This means that, as non-specialists, virtually all occupational health clinicians and advisers in occupational health services are not adequately equipped to carry out mental health assessments. Nor are they trained to express a clinically sound opinion on fitness to work/attend employment-related meetings on mental health grounds, without relying on an additional specialist mental health assessment report.
Counsellors and psychotherapists should not be regarded as mental health ‘specialists’ as, with rare exceptions, they have not undergone specialist mental health training prior to, or in addition to, their counselling and psychotherapy training. In particular, they are not professionally equipped to carry out mental health assessments, formulate diagnoses or prognoses and provide clinically sound opinions about fitness to work/attend employment-related meetings on mental health grounds.
Grespi provides a Providers Checklist on request to help when commissioning occupational mental health services.
Occupational mental health assessment reports: core features
The list below provides a framework to which HR managers may wish to refer when evaluating occupational mental health assessment reports, and in determining what they should reasonably expect from reports.
Clinical assessors should address the core features listed below in any occupational mental health report, whether a three-page psychiatric report or a 30+ page medico-legal report.
Features covered by occupational mental health assessment reports include:
1. background of the referral
2. ‘the brief’
3. description of the assessment consultation: face-to-face or via internet video-conferencing or telephone; the duration of the consultation; and whether it was at a consulting room or the employee’s home
4. current circumstances regarding work and sick leave absence, as appropriate
5. relevant references to personal and family history
6. relevant references to work-related history
7. relevant references to medical history
8. relevant references to mental health history
9. mental state – with reference to risk and safeguarding, as appropriate
10. diagnostic formulation and clinical impression: ICD-10 or DSM-5
11. clinical opinion on factors relevant to a determination of disability under the Equality Act 2010, as appropriate
12. prognosis –
– fitness to – work, and attend employment-related meetings
14. return to work prospects
15. recommendations, including –
– treatment (medical and/or psychological)
– advice on support re: return to work/end of employment
– advice on reasonable adjustments
– advice to HR/employers
16. reference to copies of the occupational mental health assessment report being sent to the employee, their GP and other clinician(s), as appropriate
It is good medical practice for the clinical assessor first to send the report to the employee for factual accuracy-check. The clinical assessor should also ask the employee for consent to send the report to their employer.
Once completed, the assessment report should be sent simultaneously to the employer, employee, their GP and other clinician(s), as appropriate.
This process ensures that the report can withstand challenge on the grounds of accuracy, and also ensures the employee provides fully-informed consent to the sharing of the final report. Following receipt of the occupational mental health assessment report by HR, it is good practice for HR to seek further clarification regarding the report from the clinical assessor, mostly in the form of a telephone conversation.
The consent form signed by the employee at the outset includes a specific reference to consenting to the direct contact between HR and the clinical assessor for clarification purposes, to take place after HR receives the report. The assessing clinician would not share any additional clinical information during the conversation as this would amount to a breach of the employee’s confidentiality.
Dr William Badenhorst