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Research on Depression in the Workplace.

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Mental Health Matters Journal for Psychiatrists & GP's

MHM Volume 8 Issue1

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Literacy is a luxury that many of us take for granted. That is why SADAG created SPEAKING BOOKS and revolutionized the way healthcare information is delivered to low literacy communities.

The customizable 16-page book, read by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood by everyone across the world.

We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 100+ titles, such as TB, Malaria, Polio, Vaccines for over 45 countries.

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Sally* thought she was doing the responsible thing. She had been suffering from depression for a long time, and in light of the effect it was having on her family relationships and work performance, she had chosen to go on an antidepressant medication. The medication worked well - it controlled her depression and enabled her to lead a healthy, productive lifestyle. She stayed on the medication for the next 3 years, with a break in between of about 11 months when she fell pregnant and had a son. Sally then decided she would enjoy a career change. She landed a competitive new job as a computer programmer and her family moved up to Gauteng.

The following year, Sally bought a house and applied for a life policy to cover the bond in the case of her death. She spoke to an insurance consultant who quoted her Life, Disability and Dreaded Disease for about R120 p.m. After asking all the medical questions and discovering that Sally was on an antidepressant, she was then only offered a loaded policy for Life Cover at R163 p.m. It was suggested that for a better deal it would count in her favour if she went off her medication. A few weeks later, Sally mentioned the loading to a consultant from another insurance company. The consultant sounded sympathetic and was prepared to give her an assessment. Needless to say, the consultant didn’t even drop the forms off as promised.

All these events made Sally very angry so she took up the challenge and went off the medication (Feb 98). She wasn’t ready for it yet, and 7 months later found that she had sunk back into a heavy depression. Even though she still hadn’t missed a day of work, she chose to go back onto medication because it was affecting her family life. She now sits in the awkward position of having to chose between her medication or being loaded unfairly by the insurance companies. She felt she was doing the right thing by seeking medical advice and treatment for her depression, she now feels that she has been labelled for life.

Sally is far from alone when it comes to being a mental health sufferer facing this kind of treatment from an insurance company. Westville Psychiatrist, Dr Maud, finds that the Majority of her patients battle with what they perceive as unfair treatment from insurance companies. “Sally’s kind of complaint is very common. Basically psychiatric patients are seen as high risk cases by the insurance companies” confirms Dr Berk, Head of Psychiatry at Wits University. And there are similar statistics documenting the kinds of problems that face sufferers of other mental illnesses too.

But if mental health sufferers face higher statistical risks than your average, mentally ‘stable’ person, surely the insurance companies have a right to load them so heavily? “What the insurance companies appear to be overlooking is that there are varying degrees of mental illness,” explains Dr Maud. “Depression, for example, can come in a variety of severity’s and forms. It is a difficult area to police but I think that the insurance companies should look at each case on its merit. For example, in Sally’s case, they should grade the severity of the depression and assess her past history with it. If someone has never been institutionalised before or made any previous suicide attempts, and the profile shows that person to be a capable worker, as in Sally’s case, the insurance company should be far more lenient on her.”

And that is the crux of Sally’s complaint. ‘ I feel like apparent outsiders are judging me on a chemical level, irrespective of my success in life. I have never missed a day of work because of my depression, and have always been competent at my job. But, the insurance company has overlooked all of this and focussed on the fact that I am on an antidepressant as evidence that I am unstable or incapable.”

What does the insurance company involved in Sally’s case have to day in their defence? Firstly, they denied ever having recommended that she go off her antidepressant: “We are not in a position to tell anyone to go off medication, “ said a spokesperson for the company. Secondly, they claim that they always assess each client on an individual basis and take a full profile and case history before deciding on a rate.

But if this is really the case, then why are so many psychiatric patients finding that they are getting ridiculous rates from insurance companies? Time and time again, case studies of irate psychiatric patients have shown that the majority of insurance companies tend to see mental illness as a global term instead of looking at the case history of an individual and assessing the risk according to their performance.

Dr Berk, Head of Psychiatry at the Wits Medical School, believes that the treatment that Sally received from the insurance company in question was “highly prejudicial and ill-founded.” “The fact that she was (allegedly) advised to come off her antidepressant for a better rate is particularly worrying,” he says. “Coming off your medication for a reason like that is flirting with disaster.”

“My personal view”, says Pretoria psychiatrist, Dr Potgieter, “is that the large majority of insurance companies tend to discriminate against psychiatric patients regardless of whether the patient is functioning poorly or not. Sufferers who are doing the responsible thing by going for treatment are stigmatised as a result. They find themselves in a catch twenty-two scenario.”

The Depression and Anxiety Support Group is one institution that is committed to fighting the discrimination that is associated with mental illness in South Africa.

And so the millions of South Africans battling with some kind of mental disorder (be it mild depression, panic disorder, bipolar disorder or schizophrenia) are finding themselves in a precarious position. Get treatment but at what price? Literally and figuratively, they face the consequences of “paying the price” for having the courage to approach a mental health professional and learn more about their problems.


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