Hello! In the previous video, we looked at the importance of considering work as a determining factor in the illness processes of workers who arrive at the health services looking for care. We also saw some tips, some situations that can be suggestive, and which may help us suspect the relationship of a mental illness with a work situation.
In this video, we are going to continue talking about assessment and assistance, and get into more detail about how to establish this causal relationship between mental disorders and work situations. So, when we receive this worker, when we suspect that this worker has some mental health condition that is related to their work, we need to advance in this assessment, this investigation, in order to further understand this situation. “Why?
” So that we can establish the causal relationship between mental health and work. This is what we call a causal link. This is a widely used term in health services specialized in mental health and in Social Security as well.
And what is this causal link? It is the association of a known and diagnosed disease and the patient's working conditions. So, in addition to the worker’s mental disorder diagnosis, we must also establish a causal relationship, a causal link.
The establishment of this causal link is very important not only for social security purposes, but also, for us to be able to plan the comprehensive care of that worker. Well, if I recognize, if after an assessment I come to the conclusion that the disorder is due to work, I need to incorporate this finding into my therapeutic project for that worker, considering, for example, the possibility, or the need to remove this worker from the job, among many other interventions within this work environment, such as a conversation with the employer. So, the establishment of this causal link, in this context, is essential for the continuity and the qualification of this care provided to the worker.
How is this relationship established? How do I arrive at this causal link? I will now go through the steps.
Firstly, considering the premise that a mental disorder is a multicausal condition, that is, several factors take part in the emergence of a mental disorder. In this assessment, this establishment of the causal link, a first task, one thing that has to be on the horizon, is knowing how to separate elements of this subject’s life history, and their work history, the subject's work trajectory. It is not easy to separate these elements.
In order to identify the work history factors, it is very important that we do what we call occupational anamnesis, which is a structured script with several questions aimed at characterizing the work history and search for elements that explain the illness. To Maria Elizabeth Antunes Lima, a professional who has been working in this area for a long time, proposes some steps to perform this investigation. First, it is important that we look for epidemiological evidence indicating the incidence of clinical conditions in certain professional categories or in certain specific groups.
What do I mean by that? Let's say I'm dealing with a worker who is a teacher. First, I need to know if it is common for this professional category to present mental disorder conditions.
So, I'll look for elements in the literature, in the INSS data, and other research, to find out if it is documented, if it is proven that the category of teachers is a category in which the occurrence, the incidence of mental disorders is considerable. If so, this finding is an important element which will be added to other evidence to help me establish this causal relationship. Then, as I said earlier, it is very important to describe that person's work situation in as much detail as possible.
Another important detail, is to not focus only on the person's current job, but also, past activities, because often this suffering, these destabilizing situations started long before that person's current job. So, during this investigation of work situations, it is also important to ask about the person’s previous jobs. A third step would be to carry out a study of the real work.
What does that mean? Whenever possible, it is desirable to go to the person's workplace, and be able to investigate their working conditions. Investigate their daily routine, observe what that work environment is like.
After that, it's also very important to review this worker’s life history. Their relationships with their family, and the community. Their educational process, and how they entered the job market.
Another step would be to identify stressors, the psychosocial risk factors that may be involved in the illness situations. And finally, when necessary and pertinent, complement this information with medical, and psychological exams whenever possible. Part of the assessment, and establishment of the causal relationship, is the classification of the type of relationship between the illness and the work.
What does it mean to classify the type of relationship? It is not just showing whether the work acts or not as a trigger for the illness. It is also showing at what level, and how this work contributes to the process.
The Ministry of Health proposes a classification called the “Schilling Classification”, in which work-related illnesses are distributed and classified into three specific groups. In the first group are those diseases in which work acts as a necessary cause, that is, work is the main cause of the worker’s illness. In group two, are those diseases in which the work operates as a contributing factor, but it is not necessary, which means that the work contributes in some way, but it is not the main cause.
It is a concurrent cause with others. It has a similar weight to other causes. And in group three, are those diseases where work can trigger a latent disorder or aggravate a pre-existing condition.
According to the Ministry of Health, work-related mental disorders are mostly located either in group two or in group three. That is, they are situations in which work is either a concurrent cause of illness, a trigger for a latent disorder, or an aggravator to a pre-existing condition. Another important form of classifying these disorders, these conditions, is in relation to the etiologic agents, that is, regarding those factors that are at the origin of these conditions.
Thus, the cases can be classified into one of the following categories of causes: First, exposure to chemical products; Daily exposure to risks that threaten physical integrity; Disorders linked to the forms of work organization; Repercussions resulting from work-related accidents or diseases; And, unemployment or threat of unemployment. And to end this video, I would like to invite you to find out more about the “Schilling Classification” and the classification regarding the etiological agents. If you want to know more about this, you can consult the Ministry of Health’s publication, entitled, Work-Related Illnesses: A Procedure Manual for Health Services.
That's it for now. Until the next video.
