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Return to work after mental illness: best
practice guidelines
Dr Nicola Reavley
Senior Research Fellow
Mental health problems in the workplace
 Mental health in the workplace
 Prevention of mental health problems in the
wor...
Mental health problems in the workplace
 Mental disorders are the leading cause of
sickness absence and long-term work
in...
Mental disorders in the workplace
 Work Outcomes Research Cost-benefit
(WORC) Project involving 60 000 Australian
employe...
Mental disorders in the workplace
 Factors increasing risk of high psychological
distress:
 not married/cohabiting
 low...
Effects on productivity
 High psychological distress led to:
 18% increase in absenteeism in blue collar
workers but not...
Effects on productivity
 Mental health conditions (including drug and
alcohol problems and psychological distress)
have a...
Effects on work performance
 Many workers with high psychological distress
work longer hours to complete tasks
 May affe...
Effects of treatment
 Treatment of mental disorders that results in
improvement of symptoms restored
productivity (absent...
Mental health in the workplace
Phase Interventions Examples
Development of
mental health
problems
Address the risk
factors...
Work as a protective factor
Work is good for mental health!
 socioeconomic position
 identity
 self esteem
 social con...
The workplace as a risk factor: poor
work environment
 Physical environment
 Psychosocial environment
 job strain
 eff...
The workplace as an intervention
setting
What does the current evidence tell us?
 Some evidence for:
 organisational level interventions (job control or
bullying...
What does the current evidence tell us?
 Recent systematic review and meta-analysis of
universal interventions in the wor...
Helping employees return to work
following depression, anxiety or a
related mental health problem:
Guidelines for organisa...
Return to work after mental illness
 Relatively little research evidence on what
works:
 provision of alternative jobs
...
Guidelines on helping employees
return to work
 Delphi consultation process
 recruitment of expert panel
 survey develo...
Guidelines on helping employees
return to work
 Expert panel
 66 health professionals
 30 employers
 80 consumers
Guidelines on helping employees
return to work
 Survey development
 Data collection
 participants rate strategies they ...
Guidelines sections
 Policy
 The organisational environment
 Role of supervisors and/or RTW coordinators in:
 managing...
Have a policy
 As part of a broader health and wellbeing policy, the
organisation should have a specific policy around
re...
Foster an environment that
supports mental health
 The organisation should be committed to reintegrating all
workers with...
Actively manage absence
 The organisation should maintain an appropriate
level of regular contact with the employee.
 Th...
Actively manage return to work
 The organisation should have a coordinator who
facilitates employees' return to work. Thi...
Actively manage return to work
 The supervisor should make reasonable adjustments for
the employee in the workplace. Thes...
Develop a return-to-work plan
 A clear written return-to-work plan should be
developed by the return-to-work coordinator ...
Involve the employee
The employee should:
 talk to their supervisor and raise any concerns they
might have about their re...
Encourage support from others
 Colleagues should welcome back the employee
who is returning after sick leave due to a men...
Some differences between panels
 Health professionals (vs consumers) more likely to rate:
 remaining in work
 maintaini...
Implementing best-practice
guidelines for return to work after
an episode of anxiety or
depression
Consultation on barriers to RTW
Face-to-face or telephone interviews with:
 11 employers/employer representatives
 14 he...
Main barriers/areas of difficulty -
employers
 Lack of capacity in organisations
 lack of confidence in dealing with the...
Main barriers/areas of difficulty -
employers
 Difficulties communicating with worker
 Contact when they are absent/who/...
Main barriers/ areas of difficulty –
employees and colleagues
 Colleagues don’t know what to say/how to
approach the retu...
Guidelines for organisations
http://returntowork.workplace-
mentalhealth.net.au/
Website
 324 survey respondents - more likely to be female,
from Victoria and to work in the Health Care and Social
Assis...
Future directions
 Need for better understanding of interaction between individual and
workplace risk factors
 Intervent...
Dr Nicola Reavely - Centre for Mental Health, Melbourne School of Population and Global Health - Return to work after ment...
Dr Nicola Reavely - Centre for Mental Health, Melbourne School of Population and Global Health - Return to work after ment...
Dr Nicola Reavely - Centre for Mental Health, Melbourne School of Population and Global Health - Return to work after ment...
Dr Nicola Reavely - Centre for Mental Health, Melbourne School of Population and Global Health - Return to work after ment...
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Dr Nicola Reavely - Centre for Mental Health, Melbourne School of Population and Global Health - Return to work after mental illness: best practice guidelines

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Dr Nicola Reavely delivered the presentation at the 2014 Return to Work Forum.

The 2014 Return to Work Forum brought together speakers from multiple sectors to share best practice in return to work, injury management and rehabilitation.

For more information about the event, please visit: http://bit.ly/returntowork14

Published in: Recruiting & HR
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Transcript of "Dr Nicola Reavely - Centre for Mental Health, Melbourne School of Population and Global Health - Return to work after mental illness: best practice guidelines"

  1. 1. Return to work after mental illness: best practice guidelines Dr Nicola Reavley Senior Research Fellow
  2. 2. Mental health problems in the workplace  Mental health in the workplace  Prevention of mental health problems in the workplace  Return to work after an episode of depression or anxiety: Guidelines for organisations  Barriers to RTW after an episode of depression or anxiety
  3. 3. Mental health problems in the workplace  Mental disorders are the leading cause of sickness absence and long-term work incapacity.  Estimates of the 1-month prevalence of mental disorders in employees range from 10.5% to 18.5%.  Most are high prevalence disorders such as anxiety and depression. Lim et al. 2000. Kessler et al, 1997.
  4. 4. Mental disorders in the workplace  Work Outcomes Research Cost-benefit (WORC) Project involving 60 000 Australian employees.  In any given month, 4.5% of full-time employees had high levels of psychological distress and 9.6% had moderate levels.  Only 22% in treatment  Hilton et al. 2008a
  5. 5. Mental disorders in the workplace  Factors increasing risk of high psychological distress:  not married/cohabiting  lower level of education  clerical/admin, sales and service job categories  communications and finance industries  being expected to work 60+ hours per week (or 1- 5 hours per week)  females in traditionally male roles and vice-versa  jobs that involve interacting with the public  Hilton et al. 2008a, 2008b; Hilton and Whiteford 2010b
  6. 6. Effects on productivity  High psychological distress led to:  18% increase in absenteeism in blue collar workers but not white collar workers (equates to an annualised loss of 8.8 weeks)  6% increase in presenteeism in both blue and white collar workers  Hilton et al. 2008b.
  7. 7. Effects on productivity  Mental health conditions (including drug and alcohol problems and psychological distress) have a greater impact on productivity than other chronic health conditions.  Loss of employee productivity of $5.9 billion (based on 2009 figures).  Holden et al. 2010
  8. 8. Effects on work performance  Many workers with high psychological distress work longer hours to complete tasks  May affect balance between work and other areas of life and potentially worsen mental health  Increased risk of workplace accidents and workplace failure  Decreased risk of workplace success  Poor job retention and potential for discrimination  Hilton et al. 2009. Hilton and Whiteford 2010a.
  9. 9. Effects of treatment  Treatment of mental disorders that results in improvement of symptoms restored productivity (absenteeism and presenteeism) to levels similar to those of employees with no history of mental disorder.  However, clinical treatment alone may not be sufficient to reduce the impact of mental disorders in workplace settings.  Hilton et al. 2009: Sanderson and Andrews 2006; Nieuwenhuijsen et al 2008.
  10. 10. Mental health in the workplace Phase Interventions Examples Development of mental health problems Address the risk factors (1° /indicated intervention) Job redesign, workload reduction, skills development Transition from reduced working capacity to full or partial absence Minimise the impact on employees (2° /indicated or selective intervention) counselling, stress management, health education Absence (sick leave) Medical treatments Full or partial return to work Rehabilitation and return to work (RTW) programs RTW plans
  11. 11. Work as a protective factor Work is good for mental health!  socioeconomic position  identity  self esteem  social connectedness  Wilkinson and Marmot 2003
  12. 12. The workplace as a risk factor: poor work environment  Physical environment  Psychosocial environment  job strain  effort – reward imbalance  organisational justice  low social support  level of job satisfaction  low decision latitude  high psychological demands  job insecurity – temporary employment, shift and casual work  bullying and harassment  traumatic events  Individual factors  Stansfield and Candy 2006
  13. 13. The workplace as an intervention setting
  14. 14. What does the current evidence tell us?  Some evidence for:  organisational level interventions (job control or bullying prevention) to reduce job stress and improve employee wellbeing (self-reported mental health)  individual level interventions (CBT, resilience training, relaxation training, stress management, meditation, exercise, screening and referral) to improve depression and anxiety symptoms - but generally small effects  screening and treatment interventions cost-effective  However, there is:  very little direct evidence for prevention of depression and anxiety  limited evidence for cost-effectiveness  LaMontagne et al. 2007, Bambra et al. 2009, Martin et al. 2009, Dietrich et al. 2011, Hamberg et al. 2012, Czabala et al. 2011
  15. 15. What does the current evidence tell us?  Recent systematic review and meta-analysis of universal interventions in the workplace:  9 randomised controlled trials  most used CBT techniques  “There is good quality evidence that universally delivered workplace mental health interventions can reduce the level of depression symptoms among workers”. Tan et al. 2014
  16. 16. Helping employees return to work following depression, anxiety or a related mental health problem: Guidelines for organisations
  17. 17. Return to work after mental illness  Relatively little research evidence on what works:  provision of alternative jobs  management support and concern  collaborative care  social support from family and friends  work-focused treatment
  18. 18. Guidelines on helping employees return to work  Delphi consultation process  recruitment of expert panel  survey development  data collection  guideline development
  19. 19. Guidelines on helping employees return to work  Expert panel  66 health professionals  30 employers  80 consumers
  20. 20. Guidelines on helping employees return to work  Survey development  Data collection  participants rate strategies they consider most important (three rounds)  Guideline development
  21. 21. Guidelines sections  Policy  The organisational environment  Role of supervisors and/or RTW coordinators in:  managing absence  managing return to work  Awareness – what staff need to know  Employee responsibilities  What colleagues can do  What trade union representatives can do  What friends and family can do
  22. 22. Have a policy  As part of a broader health and wellbeing policy, the organisation should have a specific policy around return to work for employees with a mental health problem.  The organisation should promote awareness and a clear understanding of the policy to all employees, and should ensure that it is implemented, supported and promoted by all stakeholders.  The organisation should also ensure that everyone understands their responsibilities relating to return to work, that everyone has the skills and knowledge to put their responsibilities into practice, and that the policy is implemented consistently for all affected employees.
  23. 23. Foster an environment that supports mental health  The organisation should be committed to reintegrating all workers with a mental health problem and should make this known to both employees and supervisors.  Mental health training should be provided for supervisors and colleagues to ensure a supportive work environment and decrease stigma surrounding mental health problems, while providing further training for supervisors to enable them to support employees with a mental health problem to remain in or return to work.  The organisation should never assume that an employee diagnosed with a mental health problem needs to take leave to recover and should support employees with a mental health problem to stay in work and prevent long- term sickness absence.  The organisation should encourage employees with a mental health problem to obtain treatment.
  24. 24. Actively manage absence  The organisation should maintain an appropriate level of regular contact with the employee.  The organisation should make sure that the employee understands their responsibility to keep it informed of the reasons why they are absent from work and, when known, how long the absence is likely to last.
  25. 25. Actively manage return to work  The organisation should have a coordinator who facilitates employees' return to work. This person should be someone who is acceptable to the employee.  The return-to-work coordinator should consider the approach to managing return to work that they would take if an employee had a physical illness, as many of the principles will be the same for a mental health problem.  The return-to-work coordinator should agree with the employee exactly who else, if anyone, might need to know about their mental health problem, and what information they need to be provided with.  With written consent from the employee, the return-to- work coordinator should also contact the employee's healthcare provider.
  26. 26. Actively manage return to work  The supervisor should make reasonable adjustments for the employee in the workplace. These should remove any barriers that prevent an employee from fulfilling their role to the best of their ability.  The supervisor should examine the employee’s work role to determine whether there are any factors in the workplace that may have contributed to their mental health problem. This includes thinking about how the workplace or the person’s workload may be contributing to the problem and considering if any changes can be made.  A return-to-work assessment of both the job and the employee's mental health should take place.  If there are signs of a relapse, the supervisor should review options for making further adjustments and talk realistically with the employee about the best way to move forward.
  27. 27. Develop a return-to-work plan  A clear written return-to-work plan should be developed by the return-to-work coordinator in discussion with the employee.  The plan should be agreed to by everyone affected by it, should be flexible and adjustable and should last for a sufficient time period to allow the employee to recover.  The plan should be monitored to ensure that tasks and hours remain appropriate and sufficient supports and resources are available.
  28. 28. Involve the employee The employee should:  talk to their supervisor and raise any concerns they might have about their return to work.  learn the symptoms and triggers of their mental health problem.  identify perceived barriers and prioritise solutions for a safe and early return to work.  discuss with a healthcare professional about how to approach their return to work and manage their mental health problem in the workplace.  ask for support when they need it, whether from family, colleagues or supervisors, and should have an agreed plan with their supervisor to manage the possibility of relapse.
  29. 29. Encourage support from others  Colleagues should welcome back the employee who is returning after sick leave due to a mental health problem and should not avoid talking with the person for fear of saying the wrong thing.  Colleagues should be respectful of a fellow employee's confidential mental health history and should not pry for details about it.  Family and friends should be aware that positive emotional and practical support can assist the employee's recovery and return to work, while negative interactions outside the workplace can affect the employee's ability to return to or remain at work.
  30. 30. Some differences between panels  Health professionals (vs consumers) more likely to rate:  remaining in work  maintaining contact with employers during absence  Employers less likely to rate:  working with trade union representatives  remaining in work  communication about keeping the position open  phased RTW  Employers more likely to rate:  monitoring working performance and health  offering on-the-job support and mentoring schemes  maintaining contact with employees on sick leave  explaining absence and RTW procedures  discussing treatment issues
  31. 31. Implementing best-practice guidelines for return to work after an episode of anxiety or depression
  32. 32. Consultation on barriers to RTW Face-to-face or telephone interviews with:  11 employers/employer representatives  14 health professionals (including 5 occupational physicians)  13 others (including 6 workplace mental health promotion providers)
  33. 33. Main barriers/areas of difficulty - employers  Lack of capacity in organisations  lack of confidence in dealing with the issues (managing RTW, reasonable adjustments)  Lack of awareness of mental health issues, discomfort, stigma (HR and supervisors)  Lack of a supportive culture/interpersonal environment/lack of trust  Fear of liability  Blurring of mental health and other (interpersonal/ underperformance/personality) issues
  34. 34. Main barriers/areas of difficulty - employers  Difficulties communicating with worker  Contact when they are absent/who/when etc.  Having the first conversation/first RTW meeting  Managing the risk of relapse  Liaison with GPs/ GPs often not ‘work-focused’  Resentment around claims  Liaison with rehabilitation providers/selecting providers  What to tell/managing colleagues  Getting employees that need it into treatment
  35. 35. Main barriers/ areas of difficulty – employees and colleagues  Colleagues don’t know what to say/how to approach the returning person  Employees anxieties – being a burden, nor knowing how much they can cope with
  36. 36. Guidelines for organisations http://returntowork.workplace- mentalhealth.net.au/
  37. 37. Website  324 survey respondents - more likely to be female, from Victoria and to work in the Health Care and Social Assistance Industries.  Most commonly OHS professionals with responsibility for RTW, RTW coordinators and employees with mental health problems.  84% of users found the site useful or very useful.  52 respondents to follow-up survey one month later: 69% looked at all or most of the site, 77% learned at least ‘a fair bit’ and 73% found the information useful or very useful.  52% said information positively affected their involvement in RTW after mental illness, while 40% reported no affect on involvement.  77% likely or very likely to use site in future.
  38. 38. Future directions  Need for better understanding of interaction between individual and workplace risk factors  Interventions that focus on both the organisation and the individual levels – address manager attitudes  To develop and evaluate workplace interventions in a variety of contexts, including online interventions  Need for better methodological standards, indicators and measures  Studies that include measures of organisational outcomes, such as absenteeism – to help further build the business case  Further explore barriers and enablers to implementation  Building on practice-based evidence – enormous wealth of experience in the private sector  Need for better communication between mental health promotion and business – development of a shared language  Need for more Australian research – tailoring to different contexts  Policy focus which places an equal importance on mental and physical health in the workplace
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