Mental fitness certificates: are psychiatrists in the dock?

Issuing mental fitness certificates is always a challenge for the psychiatrist. Employers tend to seek mental fitness certificates for employees who display unusual behaviour either at the workstation or at home, with the intention of safeguarding the working environment.

The word “cured” is seldom or never used for a patient following a psychiatric illness and the term “mentally fit” is rarely considered appropriate. Unlike patients with organic lesions, the judgement of whose medical status is supported by laboratory investigations; in the case of mentally ill patients, biological changes may not be substantially reflected by investigations. Every human being has a tendency to succumb to mental illness and the spectrum of mental illnesses is divided into sanity and insanity by a thin line. This line is almost unique to an individual and depends on factors such as culture, education, genetic make-up and family upbringing. To make a prompt judgment of the status of a person’s mental illness.the psychiatrist should ideally make a longitudinal assessment of the records and reports which the patient has or the hospital concerned maintains. In the absence of this, the psychiatrist will have to completely rely on the history narrated by the patient or relatives. This is subjective and liable to change quite often.

In India, there has been a dramatic rise in the number of employers who want their employees to obtain mental fitness certificates from the psychiatrist. Giving such certificates is a daunting task for psychiatrists, especially in government hospitals, where the maintenance of records is poor and hardly any time is devoted to quality discussions with patients. Employers sometimes put undue pressure on psychiatrists for outcomes conducive to management needs. Many employers fear unwelcome legal procedures in case of untoward incidents at the workplace. Though the possibility of erring is less, the mental fitness certificate is a double-edged sword. Carrying out circumstantial/ situational analysis and setting aside quality time to interview patients will help psychiatrists to take a decision which is fair to employees and employers.