JEA 2nd quarter 2020
A Difficult EAP Case

You’re the EAP, What Would YOU Do?

Editor’s note: The following depicts an actual EAP case and then asks several EA professionals what they would have done had it been their case. JEA readers are encouraged to share their opinions by contacting either individual below or by emailing journal@eapassn.org.

A senior IT executive is dropped off at an external EAP office via a client company’s limousine. The employee is very agitated and thought disordered to the point of incoherence. He cannot articulate why he has been sent to the EAP. The client company did not call you to give you a heads up or explain the situation. You are momentarily paralyzed. You wonder if you can contact the company or whether that would violate the client's confidentiality. You also aren't immediately sure what to do with the client. What should you do?


Mike Klaybor, Houston, Texas states:
drmike@klayborandklaybor.com

First of all, yes, this is quite a difficult case and situation as it raises many questions. I developed my response and then called Dr. Debra Reynolds, retired EAP/Behavioral Health Benefits Director from United Airlines to discuss her reaction to the scenario from a manager’s perspective. We concurred on the following response after our discussion. 

Determination of referral: Even though the client arrived in a company limo, it could be reasoned the company was aware of the client’s incapacity to drive and did not want to incur liability by allowing the client to drive. You must assume that this is technically a self-referral, since you have no release, no information or opportunity to make any contact with the referring company. Therefore, you need to maintain confidentiality.
 
Action plan: Since the person is “incoherent”, it is unlikely there will be any reliable expectation of getting a release or communicating in a rational manner. Therefore, an immediate determination should be taken to decide if the employee needs to be sent by EMS to transport to the ER for medical or psychological stabilization and/or detox. Given the situation it is highly likely the client will be transported to the ER. You could always ask for information of next of kin, significant others etc. to discuss transportation or meeting the client at the hospital. If the client declines this information, you know the ER will be asking the same information. Stabilization of the client needs to be the focus of this interaction, the company can be involved at a later date.

If any assessment is possible after observation and attempt to have a coherent discussion, obtain permission and a release to contact the your company representative or HR to get additional information about the reason for sending the employee to you
 
Opportunity: This is a good example of why companies need EAP, with understanding of how and when to communicate with the EAP. In the above example, it could be said that the company was “dumping” the client to the EAP. Keep in mind, companies are not trained in mental health and they understand EAP deals with emergencies and mental health concerns. The EAP may use this an opportunity to open the door to other consultation or training with the company upper management or other staff in how to use the EAP and obtain the best results for the company and its employees.


Kristin Matthews, VP, Clinical and Work Life Services, KGA says:
matthews@krgreer.com

The good news is that someone in a senior leadership role noticed that this employee was in trouble and attempted to get him some help. Many leaders look away or dismiss troubled employees outright. The bad news is, without more information and collaboration with the client company, the only choice is to call 911 and get the person to the ER. This employee may be psychotic, under the influences of substances, or suffering from an acute medical condition. He requires a complete medical and psychiatric evaluation, which are clearly beyond the scope of the EAP.

Ideally, the employee could provide permission, in writing or in front of the ambulance crew, to contact the company and next of kin. But given the emergent nature of his presentation, this is a situation where breach of confidentiality may be warranted. I would likely reach out to my contact at the company, let him/her know there was a medical emergency with an employee just referred to the EAP, and try to obtain any background information as well as names of emergency contacts. The client’s health is clearly in danger and the company, as well as family members, may have critical information for the employee’s medical triage and care.

Once the immediate crisis is over, I might use this situation as an opportunity to review best practices when referring employees to the EAP. I would likely suggest manager trainings and perhaps leadership training in recognizing behavioral health symptoms in the workplace.