MHM Magazine

38 | MENTAL HEALTH MATTERS | Issue 2 | 2022 MHM User/Downloads/Medical-Board-- -Information-Sheet---Information- on-the-Management-of-Impaired- Practitioners-and-Students.PDF ) The big question is when to go back to work. “Work is important and therapeutic but returning to work too early can be detrimental,” says Prof Christoffel Grobler. The role of the independent assessor is vital to balance the potential risk for the individual and the public and patients; the capacity the individual being assessed has, and their tolerance for sustained stress and strain – not only physically but cognitively as well. The education of insurers is critical – ultimately income protection and insurance needs to focus on the long- term health and wellness of the professional. SICK NOTE VS FIT NOTE Assessment of work disability for a healthcare professional is complex and most tools don’t measure the non-physical aspects of work and don’t simulate cognitive and psycho-social complexities appropriately. In addition, distrust and issues of confidentiality continue to hinder HPCSA assessments of practitioner impairment. The WHO’s ‘International Classification of Functioning, Disability and Health” (ICF) is a framework for measuring health and disability considering environmental factors like stigma. (https://www.who . int/standards/classifications/ international-classification-of- functioning-disability-and-health) The aim of the OT assessment is to gauge the individual’s ability to manage body functions and structures like attention and concentration, range of motion. The ICF aims to create a ‘common language’ amongst professions, although uptake in South Africa has been lagging. Work disability is associated with personal suffering, loss of productivity and income, limitations in functioning, and increased medical bills. When the work disabled person is a healthcare practitioner, there are far-reaching consequences. “Functioning and disability always occur in a context,” says Matty van Niekerk (Occupational Therapist). “While it’s tempting to start with a person-centered approach, it’s important to start a practical assessment with the job requirements. Whether a sick leave assessment or a disability assessment, start with the job description, then match it to the person being assessed. “The challenge is to find ways to mitigate work disability related burden and to sustain optimal work participation.” Return-to- work may be a process or an end-point. One of the proven ways to do this is through vocational rehabilitation. This starts with the assessment of a person’s work ability. Steps/Phases of Work Disability Assessment (ICF): • Short-term absence/sick leave a. Simple evaluation b. Usually only a physician c. Must relate to work ability of the patient d. What can the worker do rather than what can’t they do • Intermediate phase of rehab e. Start early in the process f. Long-term inability to perform job tasks • Long-term absence/disability benefits g. Unsuccessful RTW h. Comprehensive process with multiple expert involvement Prolonged absence from work is unhealthy. The HPCSA evaluation is a process within a process. The world is certainly shifting away from disability to ability – from ‘sick notes’ to ‘fit for work notes’. THE HPCSA & THE HEALTH COMMITTEE The Health Professions Act 56 of 1974 defines impairment as “a mental or physical condition which affects the competence, attitude, judgement or performance of professional acts by a registered practitioner”. (https://www. hpcsa-blogs.co.za/assistance- for-impaired-professionals/) Section 51 provides for the Health Committee which was established to advise impaired practitioners suffering from “mental or physical conditions or the abuse of or dependence on chemical substances” in order to protect both the practitioners and the public. “It’s not all about the diagnosis – think of anxiety, somatic disorders, allergies and personality disorders,” explains Prof Gerhard Grobler. “The key issue is the impact on a practitioner’s judgement, attitude and competence.” There must first be a complaint or a report, including self-reporting. An informed investigation is carried out by the treating physician as well as an independent physician. In 90% of cases, there is no further investigation. The biggest issue the Committee deals with are substance-related problems – analgesics, benzodiazepines, and alcohol. The second biggest issue is Bipolar Disorder. The Health Committee is, by law, a non-punitive body. It provides a supportive and guided approach to a practitioner with health concerns in addition to overseeing implementation. “The Committee has both a duty and an opportunity to lessen the stigma surrounding practitioners who may be impaired from time to time,” adds Grobler. HEALTHCARE IS MORE THAN THE ABSENCE OF DISEASE The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” There is ‘no health without mental health’ and it’s critical we look for consistent, long-term approaches to addressing stigma. Dr Margaret Chan, Director-General of the WHO, said: “Mental health matters, but the world has a long way to go to achieve it. Many unfortunate trends must be reversed—neglect of mental health services and care, and abuses of human rights and discrimination against people with mental disorders and psychosocial disabilities.” (https://www.who.int/ mental_health/action_plan_2013/ bw_version.pdf) References available upon request