Would You Use a Workplace Psychiatrist?

Medical Reviewer

Should all major employers be required to employ mental health services, including a psychiatrist? Well, even if there were a will, it would probably take decades to recruit and train the numbers required. But, putting practicalities to one side, what would be the purpose behind such a move and would we use such a service?

The British parliament recently approved funding for a mental health clinic. This, it says, is in response to the number of its members seeking help for anxiety and depression. It's a bold move but it also raises all sorts of questions about the merits or otherwise of mental health provision within the workplace.

Some big organizations already provide a level of access to medical health provision via various insurance schemes or in-house support. My former workplace, for example, offered a package that included annual ophthalmic and dental checks, a set number of counseling sessions if required, and some other options. These screenings and treatments were not in-house however and forms and receipts had to be submitted, I did wonder how many people actually made use of the stress management or counseling facilities? After all, how many people are brave enough to declare mental health issues via a claims invoice?

Still, a journey of a thousand miles begins with a single step and there are arguably some good reasons for us to consider new ideas. We know, for example, that one in four adults suffer from a diagnosable mental disorder in a given year, which translates to just under 60 million people with nearly half experiencing more than one disorder.   Around 21 million American adults have a mood disorder (major depressive disorder, dysthymic disorder or bipolar disorder). 1 More than 90 percent of people who commit suicide have a diagnosable mental disorder, most commonly a depressive disorder. Essentially, mental health issues represent a massive problem that can affect any one of us at any time. It's the sheer scale of the problem that, in most other circumstances, would make governments and businesses sit up, take notice and do something.

Anyway, back to the questions. For sake of argument let's say we move to a position where psychiatrists find themselves employed by big organizations. Obvious questions that arise are (1) would you use them? (2) Would you trust them to be completely independent of the organizational hierarchy? (3) Would you fear your promotion prospects, or even the views you express might be adversely affected by others knowing you visit the psychiatrist? And while questions 2 and 3 may seem to follow directly from question 1, it isn't necessarily the case. You may, for example, have views about psychiatry that rule out any intention of ever seeing a psychiatrist in the first place.

This brings us to an interesting place in the debate. What would psychiatrists actually do for us? There are plenty of people who will attest to the benefits they have gained from seeing a psychiatrist, and plenty more who say they haven't. Does this say something about the potential limitations of psychiatry? As the number people with mental health problems continue to increase perhaps this really says more about the way our society is developing and manages to bury its head in the sand during the process?

It's a point that psychologist Oliver James makes. 2 James states that the human genome project is rapidly showing that genes have relatively little influence in causing many mental illnesses, a fact that is also partly evidenced by the vast differences in mental health statistics in different countries. James goes further. He argues that neither pills nor cognitive behavioral therapy really work for the commonest problems such as anxiety and depression. The fundamental problem, he says, is that we are tinkering with the symptoms of mental illness rather than the underlying causes. If this is the case, maybe our hypothetical investment in workplace psychiatry would be just another white elephant?

Your thoughts?


1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.

2. (2013, February 16). The Guardian. Retrieved from http://www.guardian.co.uk/commentisfree/2013/feb/16/should-workplaces-have-on-site-psychiatrists