Psychiatrist Assesses Mentally Ill Employees for ‘Fitness for Duty’

To understand the employee’s job responsibilities and performance, Heidel talks to the company’s human resources personnel, the employee, and supervisor; obtains a job description; and reviews the individual’s personnel file.

“I must know the essential job functions to determine whether an employee can perform them adequately,” he said. “I review performance evaluations and any disciplinary actions or incidents at work that have been documented.”

He also asks the employee for permission to speak to his or her primary care physician, and psychiatrist if relevant, and to obtain the employee’s medical records, which could reveal a history of psychiatric illness or substance abuse.

To supplement his psychiatric assessment, Heidel often uses the Minnesota Multiphasic Personality Inventory-2 (MMPI-2).

“It provides helpful diagnostic and descriptive information about the employee’s problem that I can raise with him or her. Because the MMPI has been scientifically validated, it adds another layer of credibility to the evaluation and protection if I am ever challenged in the courts,” said Heidel.

Being familiar with the Americans With Disabilities Act (ADA) is also important. “Employers often request fitness-for-duty evaluations because they are concerned about violating the ADA. The law requires employers to provide reasonable accommodation for employees with medical disabilities. This allows me to suggest adjustments in the workplace that can help the employee perform the job. [Also,] I may recommend that an employee in a stressful job return to work part time initially or work part time at home if the environment is too noisy.”

“Once I know what the diagnosis is, I consider the severity of the symptoms, the employee’s willingness to obtain treatment, and responses to treatment. These factors basically dictate how well the employee can perform the job,” said Heidel.

During the evaluation of the airport forklift driver, Heidel discovered that he had had two previous accidents at work. “After running psychological tests, I diagnosed him with attention-deficit/hyperactivity disorder (ADHD), which explained why he was having accidents. But because he refused to seek treatment, I did not recommend that he return to the same position, and the company transferred him to an administrative job.”

Response to treatment is another consideration. Employees may experience significant side effects from medications that interfere with their job performance. A case in point was a 58-year-old delivery driver who had a series of accidents on the job.

“During my evaluation, I learned that she had bipolar disorder and was on antipsychotic and mood-stabilizing medications that caused a tremor. However, when her psychiatrist began adjusting the dosage, she became more symptomatic and volatile. I recommended that she not return to work as a delivery driver, and she accepted early retirement,” said Heidel.

Heidel’s company maintains a firewall between its EAP services and fitness-for-duty evaluations. “If we have an EAP contract with an employer, we will not perform fitness-for-duty evaluations for that company. If we are asked, I find another psychiatrist to conduct the evaluation,” said Heidel.

The demand for Heidel’s expertise in fitness-for-duty evaluations has grown steadily in the last decade. “I think employers are more aware that employees can have psychiatric illnesses. They also want a physician other than the treating psychiatrist to evaluate employees they are concerned about and provide a thoughtful opinion and advice,” said Heidel.

He recommended that psychiatrists interested in performing fitness-for-duty evaluations consider attending the AOOP meetings and joining the organization to network with experienced individuals. He also suggested contacting their local attorneys who specialize in employment issues.

APA’s Committee on Psychiatry in the Workplace also puts on useful workshops at APA’s annual meeting.