Hello! In the previous video, we covered the prevention strategies in work-related mental health talking about the importance of spreading information about this issue among workers. In this video, we will initiate another topic.
We will talk about the assessment and assistance to workers that present some kind of disorder, some type of mental illness. This topic is thought mainly for those health professionals that in some way deal with people who are also workers in their daily professional routine. To begin, we need to go over some basic premises about the assessment and assistance to the working person.
First, we need to have as a premise that work is a factor that determines the health-disease process. Let's recap the first videos you viewed in our course talking about work as a social determinant of health. This premise needs to be present in all our activities when we assist a worker.
Given this premise, it is essential for these health professionals to incorporate the listening and the analysis of the work dimension of the people being assisted, and who will be monitored by the service, into their everyday practice. It is very common in these consultations that the professional investigates the person’s previous pathological history, family history, and individual and behavioral characteristics. However, it is uncommon to investigate that person's work, their current or previous job.
Thus, what I am proposing is that when we come across a person with a mental illness condition during our interventions and consultations, let us question them about their work. Another important premise is that mental disorders are multicausal, which means they can be triggered or aggravated by different biological, psychic or social factors, and that among these factors, there are those related to the person's work. With that in mind, healthcare professionals should get used to investigating the work situation of every person who seeks health care services with a mental health related complaint.
We can initiate this conversation by asking the person how they feel about their work or how their work is going. This is a suggestion made by Professor Álvaro Merlo, who is an occupational health specialist with extensive experience in the care of workers, including mental disorders. He proposes that from the outset, in the beginning, we ask the worker, “How is your job?
” “How have you been feeling about your work? ” And let the person talk. If during the consultation and from the mobilization of this worker, through these initial questions we observe that there is a suspicion, a possibility that this illness is due to work situations, then we need to gather information about the psychosocial risk factors that may be present at work.
We should start by asking for more details about these factors. You may recall, we covered these psychosocial risk factors in one of the previous videos. We talked about hierarchical issues, work pace, working hours, shift work, pressure for productivity, among many other factors.
So, it is important to investigate if any of these factors appear in the worker’s statements. If the complaint is related to work, if this is a possibility in the health professional’s opinion, the next step is to conduct a more detailed assessment. The protocol developed by the government of the state of Bahia for investigating work-related mental disorders, generally proposes situations in which we should suspect that the mental disorder is work-related.
What situations are these? First, every worker with a clinical mental disorder condition, who makes an explicit reference to the possibility of a relationship between their illness and their job during their consultation. It is the type of situation that the worker spontaneously says "Oh, I'm like this, I'm feeling this anxiety because my work has been very demanding, I've been working too many hours, I don't have a break.
I have no rest, and I'm quite exhausted. " This is an example of such a situation. Another situation in which we may suspect that the mental disorder is related to work is when we are faced with a worker with a clinical condition of the disorder, who, during the consultation, due to the characteristics of their clinical and occupational history, leads the health professional to suspect this relationship.
Thus, it is implicitly important that this professional review the worker’s life history, and work history during consultation. A third situation, which can also be configured as a suspicion of the relationship of a disorder with a work situation, is when a worker with a clinical mental disorder condition has been forwarded either by the INSS, or by a Labor Union, or by other health services, such as the company's occupational health service, to investigate the relationship between the mental disorder and work, that is, those situations in which the health service receives a referral from one of these institutions with the explicit demand of establishing a causal relationship between the mental disorder and work. Another issue that we need to observe relating to the suspicion that the mental disorder is being caused by work situations is related to the symptoms that the worker presents.
Professor Álvaro Merlo, based on his practice, and his experience, says the following: “In general, when workers seek health services, they present very nonspecific complaints. What are these nonspecific complaints? They are symptoms, they are signs that may be present in many different pathologies.
And what are these symptoms? Insomnia, back pain, regular use of alcoholic beverages, cannabis or tranquilizers. Physical symptoms and signs such as asthenia, abdominal pain muscle and joint pain, sleep or appetite disorders, emotional signs and symptoms such as increased irritability, distress, anxiety, excitement or extreme sadness, undefined feelings of unease.
And, intellectual signs and symptoms, such as, concentration disorders, memory disorders, difficulties in taking initiatives or making decisions. Also, behavioral signs and symptoms, that include changes in eating habits, violent or aggressive behavior, social isolation, when a person closes in on himself, and difficulties in cooperating at work. So, faced with signs and symptoms like these, we do need to inquire about work.
That's it for now. In the next video, we will continue talking about worker assessment and assistance.
