Mental Health - Return to Work

A return to work program focuses on finding meaningful and suitable work for workers coming back to the workplace from injury or illness. Through collaboration, the goal of the program is to return the worker to their pre-injury or pre-illness job, where appropriate, and in a timely manner. The process is not about diagnosis, and medical confidentiality must be respected at all times.

The details of the overall return to work program should be communicated to all staff (ideally, before it is actually needed). This open communication makes sure that everyone understands their role and has clear expectations.

The guiding principles are very similar when planning for a return to work due to mental illness as it would be for a physical injury. The focus of the plan should be on the functional abilities of the worker, not the symptoms of the injury or illness, or the causes. You do not need to create a separate RTW program, but be sure your existing program will accommodate workers returning from mental illness related absences.

It's important to create and foster a safe, supportive work environment. Such an environment can be created by focusing not just on physical hazards but also the psychosocial risk factors.

Note, however, that the emotions and experiences of the worker may be different from those that are away due to an injury. When workers are absent due to a mental illness, they may experience concerns about being a bother to others, rejection, isolation, and shame. They may also fear potential harassment and associated stigmas. During the planning stages, it should be discussed how the absence will be explained and what level of information will be shared with the rest of the team.

A comprehensive return to work plan should involve the returning worker, manager, human resources, and the treating health care professional. Each party has a shared responsibility in the return to work plan.

Each RTW accommodation will be different. For each situation and depending on the length of time the worker has been away, some of the following steps will not be necessary.

1. Based on a completed functional abilities or fit to work form, the employer can determine meaningful jobs and tasks that are suitable for the individual.
2. Create a plan that is detailed with milestone dates, times, tasks, and expectations. Discuss the plan with the individual before they return. Be sure to engage the individual and ask them if they anticipate any issues with the plan. This planning period is also the time to review any procedural, department, or organizational changes that may have occurred while the individual was off work.
3. When the individual returns to work, complete an orientation checklist. The orientation should review any changes to the procedures, department, or the organization. Ideally, this would be communicated before the individual returns.
4. Communicate with the team that the worker will be returning so the individual can be welcomed back and any retraining can be organized. Be available to support the team as needed. Do not allow gossip and other uncivil behaviours to occur which can lead to stigma and unsupportive work environments.
5. During the first two weeks back, review the return to work plan. It's important to check in with the returning worker to see how they are doing and if they need any further accommodation to remain functional in their job. The plan should be reviewed by the worker at set intervals to ensure the work is still appropriate and a gradual increase to full duties can be achieved.

Accommodations should be based on the current functional abilities of the worker. Discussing options is a cooperative process and involves the individual with input from their health care professional. Sharing completed job descriptions and assessments with the health care professional can be helpful in determining the best "fit to work" status. Recall that diagnosis or details of treatment do not need to be disclosed. Focus on current abilities and functionality as well as the needs of the organization. Create benchmarks and check-in dates. When discussing accommodations, if possible, ask what were some of the challenges before the absence and what could potentially be a challenge now that they are back at work.

Requests for accommodations should be made in good faith and every effort should be made to accept the request. However, it may not be possible for the employer to accommodate a request, and equally, not every request may be appropriate. It is important to work collaboratively to determine suitable work and accommodations for the individual, the situation, the team, and the workplace involved.

Examples of accommodations include:

• Flexible scheduling for medical appointments, working reduced hours, or to allow for more frequent breaks.
• Changes to the work space that consider the needs of the individual with regards to noise, space, light, and other factors that may impact mental health, concentration, and wellbeing.
• Allow the worker to work from home, if desired and possible.
• Consider the energy and concentration levels of the individual, and schedule the work accordingly throughout the day.
• Modify the way instructions and feedback are given.  Examples include written instructions or weekly meetings.
• Have more frequent meetings to ensure success with the work or the RTW plan.
• Help the individual prioritize work and activities. This step may involve breaking work into small, achievable tasks, or to remove any non-essential tasks.
• Modify job duties, such as by exchanging minor tasks with other co-workers.
• Review training needs, and provide any necessary re-training or reorientation.
• Allow more time to learn tasks, or providing one-on-one training.
• Use technology such as a lamp instead of fluorescent lights (to help reduce flicker), a recording device to assist with memory difficulties, or noise-cancelling headphones to reduce the impact of loud noises.
• Provide a job coach such as a peer, someone from human resources, or an outside agency.

As with other components of your workplace health and safety program, you should regularly review and evaluate your program to look for areas of improvement.