Health is rarely static. People develop health conditions with time, which can improve and resolve but can also deteriorate. As well as this, day to day things including stressors in personal life and at work can impact health negatively.
Organisations are tasked with understanding what these health fluctuations mean for their employees. Specifically, they need to know how to support their staff when there are concerns about their health. This is crucial not only for supporting the individual but also for meeting legal obligations as employers and ensuring a productive workforce.
Common presentations without a formal diagnosis
We often encounter situations where employees are referred to occupational health but do not have a formally documented health condition, including:
Employees awaiting a diagnosis: Individuals on waiting lists for medical assessments.
Stress: Otherwise healthy employees experiencing significant stress due to work, factors in their personal life, or both
Employers' common questions when worried about an employee who may not have a formal diagnosis
Employers often feel they are in a grey area with employees they are worried about, who may not have a formal clinical diagnosis. They frequently ask us:
Can occupational health assist these individuals?
Is occupational health able to diagnose and treat these employees?
Do employers have a legal duty toward employees without a formal diagnosis?
Focusing on Function Over Diagnosis
When addressing issues at the intersection of work and health, it's important to focus on an employee's function rather than a specific diagnostic label. Health conditions affect people differently due to variation in biological responses, psychological resources, and social factors including finances and support networks.
For example, someone with multiple chronic health conditions might function well at work without any issues. Conversely, an individual with no significant medical history may struggle in their role due to unseen factors.
The role of occupational health in supporting employees who may not have a formal clinical diagnosis
At Insight Workplace Health, we encourage employers and managers to refer any employee they are concerned about. Equally, we encourage individuals worried about their own health or the health of their colleagues to come forward for support according to local referral structures. Our occupational health clinicians can:
Detect changes in health: Identify if something has altered in an employee's well-being.
Signpost to care: Support and signpost employees to approach medical professionals for formal diagnoses and management plans.
Recommend workplace adaptations: Suggest adjustments to optimise health at work while awaiting diagnosis and treatment.
Identify mental health concerns: Determine if stress has evolved into mental health conditions like anxiety or depression.
Assist with undefined symptoms: Provide support even when symptoms don't fit neatly into a specific diagnosis.
Legal obligations without a formal diagnosis
Understanding the Equality Act 2010
The Equality Act 2010 outlines an employer's duty to make reasonable adjustments for employees with disabilities. Importantly, the Act generally does not define disability based on specific diagnoses. Instead, it focuses on:
Physical or mental impairments
Substantial and long-term negative impact
On someone’s ability to do normal day-to-day activities
Case law insights
Questions often arise about whether a clinical diagnosis is necessary for an impairment to be considered a disability under the Act. Case law provides some direction:
1. J v DLA Piper
In this case, the court distinguished between:
Mental illness (e.g., clinical depression): Considered an impairment under the Equality Act.
Reactions to adverse life events (e.g., work problems): May not amount to a clinical health condition.
Yet, the court emphasized:
"The Tribunal should not proceed by rigid consecutive stages... In cases where there may be a dispute about the existence of an impairment, it makes sense to start by making findings about whether the claimant's ability to carry out normal day-to-day activities is adversely affected on a long-term basis and to consider the question of impairment in light of those findings."
This means that assessing the impact on day-to-day functioning is more useful than fixating on clinical categorisation as a starting point.
In this case, the judge examined whether work-related stress without a medical diagnosis could be an impairment under the Equality Act. The findings were:
Substantial adverse impact: Phillips experienced significant limitations in her abilities over a prolonged period.
Mental impairment without diagnosis: It was determined that functional limitations due to mental impairment could constitute a disability, even without a formal clinical diagnosis.
Conclusion
A formal diagnosis can be important but is not always necessary when addressing concerns about work and health. Focusing on how an employee's health affects their daily functioning is crucial. Employers have legal obligations to support employees with disabilities, even without a specific clinical diagnosis. Occupational Health can play a vital role in assessing functional impairment, recommending workplace adjustments, and guiding both employers and employees through the process of optimising health at work.
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