Return-to-work support for employees with mental health problems: Identifying and responding to key challenges of sick leave

Abstract

Introduction: This research explored return-to-work and sick leave experiences of workers with mental health issues in contact with acute or community mental health services. Method: Using a critical realist methodology with a comparative case study and collaborative design, 21 employed participants recovering from mental health problems participated in semi-structured interviews. Data were analysed using inductive and deductive thematic and constant comparative analysis. Findings: While on sick leave, despite a range of challenges, participants treasured their work identities. They were sustained by positive and troubled by negative memories of work. People missed the routine of work and felt isolated. To varying degrees of success, they searched for alternative activities to fill this gap and promote recovery. Conclusion: The need for sick leave was not disputed, but an important discovery was its iatrogenic ('side-') effects, whereby isolation and reduced activity levels could exacerbate mental health problems. Negative impacts of sick leave need to be mitigated by support to maintain worker identity and orientation and by opportunities and encouragement to sustain routine, activities and social contacts. A new concept of 'occupational capital' emerged, comprising accessible external opportunities and supports for occupational participation, and internal capacities and skills required to access these.

Womenʼs experiences of being in the sick leave process

“…That study proposed a new concept, occupational capital, highlighting the occupational dimension in public health areas such as the sick leave process. In this sense, occupational capital is defined as a combination of external opportunities and support for occupational performance and the internal capacities to access this [44]. This is in accordance with the results of our study, where keeping up meaningful, everyday occupations leads to feelings of competence and importance.…”

“…This is in accordance with the results of our study, where keeping up meaningful, everyday occupations leads to feelings of competence and importance. Adding a focus on participation in everyday occupations could thereby be proposed to support recovery against a more resilient worker-role [44]. In addition, such a focus is also compatible with findings from another study [45], where coping-developing interventions were found to have an impact on work ability as well as other everyday activities.…”

“…that of being unemployed, the self-image of a worker's occupational identity is negatively influenced and in more need of support from others to be regained [43]. The struggling with retaining a worker role identity is emphasized in a study of Cameron et al [44], describing that recovery has been promoted by sustaining routines, activities and social contacts. That study proposed a new concept, occupational capital, highlighting the occupational dimension in public health areas such as the sick leave process.…”

Soutenir le retour au travail après un arrêt de travail en raison d’un trouble dépressif : pourquoi et comment faire en soins primaires ?

“…Des répercussions négatives sur la santé sont également présentes chez les personnes qui ont un emploi, mais qui se retrouvent en arrêt de travail prolongé en raison d'un trouble mental. Parmi ces répercussions négatives, il y a le fait de se sentir isolé et désoeuvré en l'absence de l'effet structurant associé à la routine de travail 14 , ainsi que de ressentir un niveau élevé de honte 15 . À cet égard, les personnes en arrêt de travail en raison d'un trouble mental seraient de quatre à cinq fois plus à risque de ressentir un niveau modéré à élevé de honte par rapport à tout autre trouble de santé.…”

Special Issue: Vocational rehabilitation (I)

“…Two qualitative studies examined established workers diagnosed with mental illness or a psychiatric disorder. Cameron et al (2016) explored the experiences of being on sick leave among people with severe mental illnesses. The results showed how much people treasured their work identity, and how potentially damaging sick leave can be to those that benefit from the structured routines and social interaction that employment provides.…”