‘Disability’ may expand under new criteria (Guest commentary)

Changes to diagnostic guidelines could see more people qualifying for mental condition
By Michael Duffy
|Canadian HR Reporter|Last Updated: 03/13/2012

Most employers are familiar with their obligation to accommodate employees with a disability. With addictions, depression and other forms of mental illness recognized as protected forms of disability, many employers have policies to make sure employees suffering from mental illness are treated with dignity.

But these policies could require amendments as changes to the way health-care professionals identify and classify mental health symptoms might affect how courts and tribunals categorize “disability” in the context of mental health.

Currently in its fourth iteration, the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV), published by the American Psychiatric Association (APA), assists health-care professionals with diagnoses. The manual lists a variety of symptoms for every category of mental condition and recommends a diagnosis.

In 1999, the APA began discussions surrounding the next iteration of the manual, DSM-5. The text is scheduled to be published in May 2013 and contains a number of new diagnostic categories as well as significant changes to familiar categories of mental conditions. These changes may affect employer requirements around the accommodation of employees with a mental health condition.

Perhaps the most significant implication for HR are the changes to substance abuse and addiction. The task force co-ordinating the changes to the DSM has proposed removing the categories relating to “substance abuse and dependence” and replacing them with “addiction and related disorders.”

The changes will, for the first time, separate those who engage in compulsive drug-seeking behaviours from those who merely experience certain withdrawal symptoms after a cycle of prescription medication. It’s possible this will lead to a change in the rate at which these disorders are diagnosed.

A new category of addiction disorder will also likely be introduced. “Behaviour addictions” will encompass addiction to gambling and may, in the future, expand to include addictions to the Internet or other behaviours that do not have the same characteristics as a substance addiction.

The recognition of problem gambling as a diagnosable disorder could have a major impact when an employer seeks to discipline an employee for behaviour that can be linked to compulsive gambling. For example, a chronic absentee who misses work due to an online gambling addiction will likely have to be given the same level of accommodation as an employee whose attendance problems can be traced to an alcohol addiction.

Unlike substance addictions, behavioural addictions may not be noticeable in the workplace until they cause a major, stress-induced event that could harm business.

Under DSM-5, it might also become easier for a health professional to diagnose attention deficit hyperactivity disorder (ADHD) in adults. Whereas DSM-IV required satisfaction of six symptoms to support a diagnosis, that number may be reduced to four. If an employer uses testing of employees to determine eligibility for promotions or other programs, more employees may wish to receive accommodation due to a diagnosis of ADHD.

Accommodation may not be the only HR issue affected by the new DSM. Workers’ compensation regimes throughout Canada rely on DSM-based diagnoses for evaluating claims related to workplace stress. A diagnosis of a mental condition described in DSM-IV is one of the factors necessary for an employee to receive stress leave-related benefits, according to the policies of workers’ compensation regimes around the country. With new categories of mental illness, more employees may be able to claim benefits under workers’ compensation regimes.

The revamped DSM is not without critics. There is a vociferous debate among mental health professionals and other stakeholders, with critics claiming the proposed DSM-5 will result in an unreasonable increase in the number of people classified as mentally ill.

In a blog post on the Psychiatric Times website in January, Allen Frances, chair of the DSM-IV task force, said his biggest concern is DSM-5 “would create millions of newly mislabelled ‘patients,’ resulting in unnecessary and potentially harmful treatment, stigma and wasteful misallocation of scarce resources.”

When dealing with mental health, it’s very difficult to draw a line between people who are termed “healthy” and those who are termed “ill.” The concern for employers is it may take more resources to accommodate a workforce if a greater proportion has been deemed by the medical community to have a legitimate mental condition.

This may require a greater devotion of resources to accommodation programs. It will also require HR professionals to be aware of a possible increase in requests for mental health-based accommodation.

While the text of DSM-5 is not yet finalized, it would be wise to schedule a full review of all related workplace policies by the end of 2013 and to be on the lookout for information about the finalized text in the coming months.

Michael Duffy is a product writer for Consult Carswell. He can be reached at michael.duffy@thomsonreuters.com or visit www.consultcarswell.com for more information.

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