20 March 2020
Grespi has issued advice in response to requests for advice from HR managers on how to manage GP sick notes stating ‘anxiety’, ’stress’ or ‘work-related stress’ related to the COVID-19 pandemic and its impact in the workplace.
We would like to address this matter from an occupational mental health perspective, while pointing out that our views and advice should not be confused with or construed as an alternative to current government guidelines on the pandemic.
As a first step, we would like to clarify that ‘anxiety’ and ‘stress’ are not considered to be mental health conditions. Anxiety is a symptom that is present in a range of mental health conditions – as well as, at a non-clinical level, being an ordinary response to difficult life experiences. Stress relates to the state of mind of feeling under pressure.
Unfortunately however, some GPs may refer to ‘anxiety’ or ‘stress’ as if they were mental ill-heath conditions.
In a minority of cases where individuals face highly stressful situations, these symptom and state of mind can, together with other symptoms and signs, be indicative of a psychiatric condition. This is for example, the case in a mental health condition defined as ‘Adjustment Disorder’.
An Adjustment Disorder can develop when an intensely stressful situation well exceeds the individual’s usual ability to cope. As a result, symptoms and signs reach an intensity that severely affect their capacity to function in an ordinary day-to-day manner. This particular condition usually resolves when the situation changes, or the individual is able to make the necessary psychological adjustment – sometimes with professional help.
However, this does not mean that feeling anxious in relation to a stressful situation (such as the implications of the COVID-19 pandemic) should automatically be equated with suffering from an Adjustment Disorder. Instead, this diagnosis should be made by a mental health specialist (essentially, a psychiatrist), based on the clinical presentation and background history of the individual. Any diagnosis should be related to widely-accepted diagnostic criteria, such as those of the International Classification of Mental and Behavioural Disorders – 10th Revision (ICD-10) of the World Health Organisation.
In our view, a sensible approach in the workplace to the COVID-19 pandemic should include two steps:
1. The employer should communicate at regular intervals to employees that it recognises the difficult situation presented by the implications of the COVID-19 pandemic; acknowledge that the outbreak is an evolving and stressful situation; remind staff of current preventative health guidelines, as well as government guidelines; and clarify the steps taken by the employer to minimise the risk of contagion in the workplace.
The rationale for regularly updated communications is to actively demonstrate the employer’s efforts to meet its duty of care obligations, including its recognition of anxiety-provoking circumstances.
2. When employees indicate that their level of ‘anxiety’ or ‘stress’ about the COVID-19 pandemic exceeds their capacity to cope and present GP generic sick notes of ‘Anxiety’, ’Stress’ or ‘Work-related stress’ (particularly if the period of absence from work exceeds a few days), HR could consider two options:
(a). Ask GPs to clarify (with the consent of the employee) whether the employee is suffering from a specific mental health condition in the diagnostic terms of the ICD-10; and, if so, which ICD-10 condition, and whether/which steps have been taken to address this condition.
(b). Request an occupational mental health assessment by a psychiatrist, which should include formulation, diagnosis, prognosis, assessment of fitness for work, return to work prospects, reasonable adjustments and recommendations.
Occupational mental health assessments should not be carried out by generic occupational health services. It is extremely unlikely that medical occupational health clinicians are also mental health specialists. They are therefore not professionally equipped to provide diagnoses and advice in such a specialised field as mental health.
Referring employees to medical occupational mental health specialists is important both to ensure any potential mental health condition is responded to and managed effectively; and to protect against potential ‘copy-cat’ behaviour where other employees may claim to be anxious and suffering from ‘work-related stress’ associated with the pandemic – expecting such a claim to be accepted automatically at face value.