MENTAL HEALTH IN STALKING

1
 CHAPTER I

INTRODUCTION

A. Background
Mental health problems are currently the leading cause of absenteeism in most
developed countries. The impact of mental health problems is especially strong
among high-risk occupations, such as emergency service workers, or jobs in other
critical sectors where repeated exposure to stressful or traumatic incidents can have
adverse mental health outcomes.1
Management of employees' mental health at work is very important,
considering that the workplace is usually characterized by a work environment that
has a negative impact on mental health. Workers with mental health problems may be
afraid of not getting a job because of their illness, and may therefore try to hide their
mental health problems. For this reason, doctors should conduct diagnostic interviews
or screening tests to help identify hidden mental health problems.1,2
Existing literature suggests that mental checks on hiring raise concerns
regarding the lack of evidence of efficacy. Even if pre-employment screening is able
to identify high-risk workers, there may be variation in the positive predictive value
of each individual. Consequently, the pre-employment screening used may exclude
candidates offered positions and possibly some healthy and potential individuals who
will miss out on career opportunities.3,4
Despite the lack of available evidence of efficacy, pre-employment screening
can test a person's susceptibility to mental disorders on the job. Therefore, appropriate
pre-employment screening measures to predict mental health in employees are
important to decide whether the benefits of pre-employment screening outweigh the
potential risks and costs.3,4
By considering this situation, the authors try to conduct a literature review
based on existing literature to discuss mental examination on employee recruitment.
The hope is that this article will be useful for all of us, especially as general

2
practitioners in screening, diagnosing and treating mental health problems.

3
 CHAPTER II
LITERATURE REVIEW

A. Definition
Pre-employment medical examination is a medical examination carried out by
a doctor before a worker is accepted to do work. Workforce health checks are carried
out by doctors who meet the requirements based on applicable laws and regulations.5,6
The medical examination includes anamnesis, mental examination, physical
examination, physical fitness examination, radiological examination, laboratory
examination, additional examinations which are adjusted to the working conditions of
the worker.5,6
In its implementation, employers or administrators together with doctors
develop guidelines for pre-employment medical examinations that guarantee the
placement of workers according to their health and the work to be carried out and
these guidelines must obtain prior approval from the director. Guidelines for Pre-
Occupational Health Checks are developed and developed following company
capabilities and medical advances in occupational safety.5,6
Based on the Regulation of the Minister of Manpower and Transmigration
No. PER.02/MEN/1980 Concerning Workers' Health Examination in the
Implementation of Occupational Safety, a mental examination is carried out when an
anamnesis or physical examination is carried out by asking general and specific
questions regarding the following matters. Among other things, the purpose of
applying for a job, the purpose of being accepted in a certain position, the feeling of
satisfaction with various situations regarding oneself and the environment, motivation
to work and so on.6

What is examined outside of this mental examination are general functions

4
and special functions as follows:6
1. General Function:
– Circumstances
– Individual orientation
– Time orientation
– Room orientation
– Situation orientation
Attitude & Behavior
– Whether or not it is easy to adjust the attitude of behavior with the existing
atmosphere.
The inferred mental status is:
- Normal
– Disturbed and in need of treatment
– Need a consultation

B. Purpose of Mental Examination

The pre-employment medical check-up is aimed at ensuring that the
workforce received is in the highest health condition, does not have infectious
diseases that will affect other workers, and is suitable for the work to be carried out
so that the safety and health of the workforce concerned and other workers -Others
can be guaranteed.4,5
The purpose of health checks in hiring has traditionally been to ensure that
candidates can perform their jobs safely without putting other colleagues at risk.
Tests carried out haphazardly will produce irrelevant findings. The follow-up
required for these findings can delay work, result in false rejection of a candidate,
divert resources away from efforts that might benefit health outcomes, and cause
unnecessary expenses.7

All types of health checks have risks. Previous studies have highlighted
concerns about the ability of hiring screening to predict and reduce future mental

5
problems and the risk of stigma and discrimination against those identified as at high
risk.3,4
In the hiring mental health screening situation, determining acceptance based
on mental health testing alone lacks an evidence base for its effectiveness and
appears to be expensive and unhelpful. Ineffective hiring screening programs risk
alienating individuals who would otherwise have healthy and fulfilling careers, and
limited resources may be better used in prevention and early intervention
programs.3,4

C. Regulations Related to Employee Recruitment Mental Examination

The legal basis for the mental examination for hiring employees in Indonesia
is as follows:5–8
1. Law No. 1 of 1970 concerning Work Safety;
2. Government Regulation of the Republic of Indonesia Number 50 of 2012
concerning Implementation of Occupational Safety and Health
Management Systems;
3. Regulation of the Minister of Manpower and Transmigration Number
Per.02/Men/1980 of 1980 concerning Worker Health Examinations in the
Implementation of Work Safety;
4. Regulation of the Minister of Manpower and Transmigration of the
Republic of Indonesia Number Per.03/Men/1982 of 1982 concerning
Health Services for Workers.
In Indonesia itself, there are no specific guidelines for instruments that must
be used in the mental examination of employee recruitment. And the determination
of the mental examination is formulated by each company or agency that provides
employment.7

D. Some Frequently Used Mental Examination Instruments

Formal psychological examinations regarding intelligence (intelligence) and
personality have an important role in clinical practice. Personality assessment

6
provides information regarding the patient's strengths and weaknesses, on how and
why the patient is in that situation, and what the prognosis is. This information is
useful for diagnosis and comprehensive personality assessment.9,10
Most of the instruments used are standardized against normal controls who
are asked to respond to the same stimuli or set of questions. The responses are then
tabulated in a normal distribution pattern with the subjects being compared.11–13
With standardization, the application of tests and scoring does not vary at
different times and examiners. Standardization of each test will show data related to
the validity and reliability of the test and can determine whether the test is
reproducible and the validity of the use of the test.9,11,14
Broadly speaking, psychological tests are classified as follows:9
1. Objective Test
Objective test is a written test based on specific things and questions.
The test will provide a numerical score and profile that is easy to
perform math or statistical calculations. One example of this test is
the Minnesota Multiphasic Personality Inventory (MMPI).
2. Projective Test
Projective tests provide stimuli that are not immediately obvious, thus
encouraging the patient to project his own needs onto the test
situation. Projective tests may have no right or wrong answers. The
person being tested must give meaning to the stimulus according to
his needs and abilities. Examples of these tests are the Thematic
Apperception Test (TAT), the Draw a Person Test, the Rorschach
test, and the Sentence Completion Test.
3. Individual or Group Tests
The test can be administered individually or in groups. Individual
tests have the advantage of providing an opportunity for the examiner
to assess personal motivational factors and to observe and record
people's behavior during the test. Precise response time logging is
also possible. However, group tests are usually easier to administer

7
 and score.
4. Serial Test (Battery Test)
A number of individual tests are used together to construct a
psychological or neuropsychological sequence. Test suites can
provide more information about various functional areas than
individual tests can provide and can increase the level of reliability if
there is a positive correlation between them. One example of a
sequential test is the Halstead-Reitan test.

E. Intelligence Test
Intelligence (intelligence) is defined as a person's ability to assimilate factual
knowledge, to remember recent or past events, to provide reasons logically, and to
manipulate concepts to translate abstract things into reality and from reality to
abstract things, to analyze and synthesize form, and to deal meaningfully and
accurately with issues and priorities that seem important in a given situation.9,11
Intelligence Quotient (IQ) is the ratio of mental age to chronological age,
multiplied by 100 and without a decimal value. IQ is an interpretation or a
classification of total test scores in relation to the norms enforced within the group.
IQ is a measure of current functional ability, not necessarily future potential.
Although in general terms IQ is stable throughout life, there is no absolute certainty
about its predictive nature. A person's IQ is assessed in terms of past experience and
future opportunities.9,15
IQ itself is not an indicator of the origin of reflected capacity, genetic
(congenital) or environmental. The most useful intelligence tests should measure a
wide range of skills and abilities, including verbal and performance, that are newly
learned or long-learned, over time or out of time, culturally related or
independent.9,16
The best and most widely used standardized test of intelligence in clinical
practice today is the Weschsler Adult Intelligence Scale (WAIS). The WAIS
consists of 11 subtests consisting of 6 verbal subtests and 5 performance subtests

8
which provide verbal IQ, performance IQ and combined or full scale IQ.9,16
The order of the tests is described in the order in which the subtests are
administered to the patient
A. verbal
1. Information
Includes general information and general knowledge and is influenced
by cultural variables. People from a lower socioeconomic group and low
schooling did not perform as well on this test as people from a higher
socioeconomic group with higher schooling.
2. understanding
Assess the subject's ability to participate in social gatherings and
understand social considerations by being asked about speech and how
one should act in certain situations.
3. Arithmetic
Ability to perform arithmetic and other simple calculations is reflected in
this subtest, which is impaired by anxiety and poor concentration
attention.
4. Similarity
This subtest reveals abstract abilities, by asking the subject to explain the
similarities between two objects. This subtest is a sensitive indicator of
intelligence
5. digit range
Immediate memory is assessed with this subtest. Subjects were asked to
learn a sequence of two to nine numbers, which they immediately
memorized both forward and backward. Intelligence, poor attention span
and brain dysfunction affect memory.
6. vocabulary
The subject was asked to explain 35 words from increasingly difficult
vocabulary. Intelligence has a close correlation with vocabulary, which
is related to the level of education. Weird word definitions can provide

9
 clues to personality structure.
B. Performance
1. Complements the picture
It is the beginning of the performance section and consists of completing
an incomplete drawing. Visuoperceptive defects become apparent if
mistakes are made
2. Stacking blocks
This subtest requires the subject to match the colored blocks and the
visual design. Brain dysfunction including left-right dominance
disorders interferes with performance.
3. Arrange pictures
Subjects are asked to Arrange a number of pictures in an order that tells
a story. Besides assessing performance, this subtest provides data on the
subject's cognitive style
4. Mounting image
The subject must put up an object, in the right order and arrangement.
Visuoperceptive, somatoperceptive, and manual dexterity were tested
here.
5. digit symbols
Subjects are given a code that pairs symbols and digits. The test consists
of matching a number of digits with the corresponding symbol in the
shortest time possible.
The interpretation of the WAAIS IQ score has very high reliability. The
verbal scale assesses memory of previously acquired factual information, and the
performance scale assesses visuospatial capacity and visuomotor speed in problem-
solving tasks. The performance scale is sensitive to normal age compared to the
verbal scale. Discrepancies between verbal tests and performance (usually more than
15 points) may suggest the presence of psychopathology and require follow-up.

Table 1. Classification of Intelligence by IQ Range9

10
Classification IQ Range
Mental retardation (RM) is very severe <20-25
RM is heavy 20-25 to 35-40
Medium RM 35-40 to 50-55
Light RM 50-55 to 70
Threshold 70-79
Normal Low 80-90
Normal 90-110
Normal Smart 110-120
Superior 120-130
Very superior 130 and over

F. Personality Assessment
Personality is defined as the long-lasting and persistent motivations,
emotions, interpersonal styles, attitudes, and individual traits. Personality assessment
is a systematic measurement of these personality characteristics. Personality tests
measure hard-to-define concepts such as depression, anger, and anxiety. Even more
challenging personality concepts such as somatization, the ability to delay
gratification, or suicidal potential can be measured by means of personality
assessments. Personality assessment can be very important in the scientific study of
psychology and psychiatry.17,18
Objective personality tests are relatively straightforward in their assessment.
Patients are usually asked specific, standard questions in a structured written or oral
format. Each patient is usually asked the same questions. Data obtained from
selected patients were compared with similar data obtained from the normative
group. The extent to which the patient deviated from the norm was recorded and
used in the interpretation process. Patient response was assessed according to certain
agreed criteria. The scores obtained are then compared with normative tables and
often converted to standard scores or percentiles, or both. The MMPI is an example

11
of an objective personality test.17,19

Table 1. Summary of Personality Objective Assessment9

Name Information Excess Weakness
Minnesota Multiphasic More than 500 Providing various data on a number of Tends to emphasize brat
Personality Inventory numbers, true false; personality variables; strong research psychopathology
(MMPI) self-report format; base
17 scales (many
special scales)

175 numbers, true-

Millon Clinical false, self-report The short test time corresponds well to Needs more validation;
Multiaxial Inventory format, 20 scale the DSM-III-R diagnostic there is no information on
(MCMI) classification the severity of the disorder
True-false, self-
report format, 16 Usefulness is limited in
16 Personality Factor personality Sophisticated psychometric clinical populations
Questionnaire (16PF) dimensions instruments with fairly well research
done in nonclinical populations
True-false, self- Usefulness is limited in
California Personality report format, 17 Accepted method for assessing patients clinical populations
Inventory (CPI) scale who do not have severe
psychopathology
True-false, self- Significance has not been
Jackson Personality report format, 15 Designed according to advanced proven in a clinical setting
Inventory (JPI) personality scale psychometric techniques, it controls
the response set
Forced choice, self- Not widely used due to the
Edwards Personality report format Following Murray's theory of limited nature of the
Preference Schedule personology, socially favorable information obtained
(EPPS)
Self-report on Likert Assess mood and thoughts
type format; measure well but inadequately on
Beck Depression depression Following Beck's theory of depression, neurovegetative symptoms
Inventory (BDI) it is widely used
The STAI number is
Self-report on Likert transparent
type format; measure
State-Trait Anxiety anxiety Allows for different states and traits of
Inventory (STAI) anxiety, well researched
130 numbers, true- The scale is short and has
false, self-report low reliability
Generates 4 scores, which can be used

12
 format as a screening tool for the possibility of
Psychological needing psychological assistance
Screening Inventory The scale is short, the
(PSI) True-false, self- Useful as screening tools, tests have a number used is transparent,
report format theoretical basis with research support not recommended for
screening
Eysenck Personality
Questionnaire (EPQ) Can be used to judge yourself or others Relative score is closely
or Inventory (EPI) True false, self- related to conventional
report format personality
Using factor analytic techniques with
Adjective Checklist high sophistication in the preparation Not widely used, problems
(ACL) True False, self- of the test with the interpretation of
report format, 6 scale analytical factors

Comrey Personality Testing time is short and provides a

Scales (CPS) 100 numbers, true fair amount of information Abbreviation is also
false, self-report detrimental, undermines
format, 14 scale reliability and legitimacy,
serving only as a screening
Tennessee Self- tool
Concept Scale
(TSCS)

G. Management of Mental Health in the Work Environment

The economic impact of mental health problems is a growing concern for
many employers around the world, thus spurring the development of mental health
in the workplace. Recognition of, and response to, mental health problems in the
workplace has increased significantly over the past 10 years, through the
development of practices and legislation to expand compensation for work-related
mental injuries.1.20
Mental health is determined by many factors, namely from within a person,
their environment, and their work. Interventions to address symptoms of mental
health problems have an impact on performance at work. These contributions can
range from organizational interventions to promote psychological health and safety
in the workplace to group or individual interventions to promote recovery from
mental health.21,22
Prevention strategies aim to improve well-being and reduce the incidence of

13
mental health problems for workers. Primary prevention of mental health problems
in the workplace can include strategies such as assisting employers in adopting
national standards or providing workplace health education. Health workers can also
collaborate with employers on modifications to working conditions, such as the
environment or workload demands, so as to reduce the risk of mental health
problems, and/or provide resilience training, such as stress management.
Occupational therapists can also provide training to supervisors and managers to
support them in efforts to prevent mental health problems and to support initiatives
to keep up with their work. Strategies that focus on increasing employees' sense of
control; promoting health behaviors, such as exercise; and teaching stress
management techniques has moderate to strong evidence to support their
effectiveness in improving mental health.1.23
Secondary prevention of mental health problems targets individuals with
mental health risk factors and is designed to promote early intervention and support
through strategies such as screening, mental health literacy training and supportive
counselling. A large study found that many of these strategies may be effective for
improving symptoms, but their effects on job outcomes, such as attendance and
productivity, have not been well studied in the literature.1,21,24
Tertiary interventions aim to treat those with mental illness and build workers'
capacity to cope with stress at work, advocate for employers for workplace
accommodations, and support workers returning to work after recovering from
illness. Health workers who have expertise in cognitive behavioral job demand
analysis can facilitate return to work planning through the process of adapting
workers' abilities to job demands. Another therapeutic approach is cognitive work
enhancement, which uses increasingly difficult tasks to develop occupational
performance skills, focusing on stress management, interpersonal conflict resolution
skills, and functional skills directly related to work. Interventions to help workers
with mental health problems with recovery and return to work, such as cognitive
behavioral therapy and problem-focused return to work programs, have strong
evidence to reduce symptoms and improve work-related outcomes. In addition, a

14
timely and gradual return to work, in addition to accommodation and social support,
is considered best practice in encouraging individuals to return to work.1.23

15
 CHAPTER III
CLOSING

A. Conclusion
Medical check-up at employee recruitment aims to improve and maintain the
degree of physical, mental & social health so that work is more efficient and has
high productivity. This inspection also aims to protect workers from harmful factors,
due to disease transmission, occupational diseases, which are caused by vulnerable
physical conditions. Regulations related to mental examinations on hiring
employees are contained in statutory regulations, and are a shared responsibility
between the government, employers and the workers themselves.
Mental health in the work environment is one of the main aspects that plays
an important role in work productivity. So that proper management of mental health
in the work environment must be given attention to encourage performance and
improve the quality of life for workers.

16
 BIBLIOGRAPHY

1. Moll SE, Heino CM, LeBlanc AH, Beck LB, Kalef LM. Workplace mental
health: Current practice and support needs of Ontario occupational
therapists.Can J Occupy Ther. 2018;85(5):408-417.
doi:10.1177/0008417418822491

2. Jeon SW, Kim YK. Application of Assessment Tools to Examine Mental

Health in Workplaces: Job Stress and Depression.Investigative Psychiatry.
2018;15(6):553-560. doi:10.30773/pi.2016.10.24

3. Opie E, Brooks S, Greenberg N, Rubin GJ. The usefulness of pre-employment

and pre-deployment psychological screening for disaster relief workers: a
systematic review.BMC Psychiatry. 2020;20(1):211. doi:10.1186/s12888-020-
02593-1

4. Pachman J. Evidence base for pre-employment medical screening.Bull World

Health Organs. 2009;87(7):529-534. doi:10.2471/blt.08.052605

5. Law No. 1 of 1970 concerning Work Safety.

6. Regulation of the Minister of Manpower and Transmigration of the Republic of

Indonesia Number Per.03/Men/1982 of 1982 concerning Health Services for
Workers.

7. Regulation of the Minister of Manpower and Transmigration Number

Per.02/Men/1980 of 1980 concerning Health Checks for Workers in the
Implementation of Work Safety.

8. Government Regulation of the Republic of Indonesia Number 50 of 2012

concerning Implementation of Occupational Health and Safety Management
Systems.

9. Sadock BJ, Sadock VA, Ruiz P.Kaplan & Sadock's Synopsis of Psychiatry :
Behavioral Sciences/Clinical Psychiatry.; 2015.

10. Xiong GL, Joseph AM, Suo S, et al. Understanding preventive health
screening services use in persons with serious mental illness: how does
integrated behavioral health primary care compare?Int J Psychiatry Med.
2015;48(4):279-298. doi:10.2190/PM.48.4.d

11. Sadock BJ, Sadock VA, Ruiz P, Kaplan HI.Kaplan & Sadock's Comprehensive
Textbook of Psychiatry.; 2017.

12. Richardson R, Trépel D, Perry A, et al. Screening for psychological and mental

17
 health difficulties in young people who offend: a systematic review and
decision model.Health Technol Assess. 2015;19(1):1-128.
doi:10.3310/hta19010

13. Shields RE, Korol S, Carleton RN, et al. Brief Mental Health Disorder
Screening Questionnaires and Use with Public Safety Personnel: A Review.Int
J Environ Res Public Health. 2021;18(7). doi:10.3390/ijerph18073743

14. Haberer JE, Trabin T, Klinkman M. Furthering the reliable and valid
measurement of mental health screening, diagnosis, treatment and outcomes
through health information technology.Gene Hosp Psychiatry. 2013;35(4):349-
353. doi:10.1016/j.genhosppsych.2013.03.009

15. Loring DW, Bauer RM. Testing the limits: cautions and concerns regarding the
new Wechsler IQ and Memory scales.neurology. 2010;74(8):685-690.
doi:10.1212/WNL.0b013e3181d0cd12

16. Shuttleworth-Edwards AB, Kemp RD, Rust AL, Muirhead JGL, Hartman NP,
Radloff SE. Cross-cultural effects on IQ test performance: a review and
preliminary normative indications on WAIS-III test performance.J Clin Exp
Neuropsychol. 2004;26(7):903-920. doi:10.1080/13803390490510824

17. Kyllonen PC, Kell H. Ability Tests Measure Personality, Personality Tests
Measure Ability: Disentangling Construct and Method in Evaluating the
Relationship between Personality and Ability.J Intell. 2018;6(3):32.
doi:10.3390/jintelligence6030032

18. Bornstein RF. Personality Assessment in the Diagnostic Manuals: On

Mindfulness, Multiple Methods, and Test Score Discontinuities.J Press Assess.
2015;97(5):446-455. doi:10.1080/00223891.2015.1027346

19. Roberts B, Jackson JJ, Duckworth AL, Von Culin K. Personality Measurement
and Assessment in Large Panel Surveys.Forum Health Econ Policy.
2011;14(3):1268. doi:10.2202/1558-9544.1268

20. Muschalla B, Henning A, Haake TW, Cornetz K, Olbrich D. Mental health

problems or workplace problems or something else: what contributes to work
perception?Disabled Rehabilitation. 2020;42(4):502-509.
doi:10.1080/09638288.2018.1501099

21. Muschalla B. A concept of psychological work capacity demands: First

evaluation in rehabilitation patients with and without mental disorders.Work.
2018;59(3):375-386. doi:10.3233/WOR-182691

22. Shah JL, Kapoor R, Cole R, Steiner JL. Employee Health in the Mental Health
Workplace: Clinical, Administrative, and Organizational Perspectives.J Behav

18
 Health Serv Res. 2016;43(2):330-338. doi:10.1007/s11414-014-9428-5

23. Proper KI, van Oostrom SH. The effectiveness of workplace health promotion
interventions on physical and mental health outcomes - a systematic review
ofreviews. Scand J Work Environ Health. 2019;45(6):546-559.
doi:10.5271/sjweh.3833

24. Wilhelm K, Kovess V, Rios-Seidel C, Finch A. Work and mental health.Soc

Psychiatry Psychiatr Epidemiol. 2004;39(11):866-873. doi:10.1007/s00127-
004-0869-7

19