Though illness makes the employees discomfort at the work and may stop them to work for quite a some time, most of the times, employees return to work after a short while with recovery. Recovery from physical or mental illness takes time allowing the employee taking time to resume to work activities with the old abilities and energies. During this time of complete coping with working conditions after recovery from mental illness the employee need to be supported in mental, cognitive and behavioral aspects. There are many intervention strategies available and are popular to be studied by many researchers in the physical illness realm. However, the studies concerned with return to work after recovery from mental illness are focused on occupational recovery in less severe forms of mental illness and some forms of mental disorders.
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So the current paper tries to identify the intervention strategies available to individuals who return to work after recovery from mental illness.
Why need an Intervention
Any illness has a period of recovery mentally and physically. However many people who return to work after sustained recovery still need some support from the organization to cope with the missed experience in the workplace. According to E Goldner, the return work after mental illness is associated with a significant degree of residual impairment in function even after the sustainable treatment.
The study of Burton and Conti 2000 & McCulloch et al. 2001 as cited in E Goldner states that “there is some emerging evidence that a disability management approach, similar to that applied to recovery from musculoskeletal injury, may yield significantly improved work recovery for depression-related work impairment”.
Also “there is a need to study disability management and return-to-work factors related to anxiety disorders, such as social phobia and panic disorder, given their prevalence and the low availability of appropriate treatment resources”, Lepine & et al., as cited in Elliot Goldner.
Factors behind Interventions
Certain factors influence the early recovery from mental illness and the coping mechanism with the work place issues. The authors like Brewin et al. 1983; Kenny 1994 as cited in Elliot Goldner, predict that socio-demographic characteristics, job satisfaction and referral to appropriate rehabilitation services will effect the rapid recovery and return to work. However another study conducted by Shaw et al. 2001 on return to work following occupational low back pain, it is found that the factors like “low workplace support, personal stress, shorter job tenure, prior episodes, heavier occupations with no modified duty, delayed reporting, greater severity of pain, more significant functional impact and extreme symptom” reports protracted the disability.
Most of the studies confined with return to work intervention strategies after physical disability. Some of them enlist the factors like effect on time lost from work of physical conditioning programs (Schonstein et al. 2003) as cited in Elliot Goldner and provision of information, reassurance and encouragement to engage in physical activity, Molde Hagen et al. (2003) as cited in Elliot Goldner. Disability to return to work early is also associated lack of positive recommendations by physicians. Mahmud and colleagues (2000) as cited in Elliot Goldner
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Types of Interventions
GAO recommends the following types of interventions will help for early return to work. They are: (Excerpt):
- Intervene as soon as possible after an actual or potentially disabling event to promote and facilitate return to work;
- Identify and provide necessary return to work assistance and manage cases to achieve return to work goals; and
- Structure cash and health benefits to encourage people with disabilities to return to work.
Intervene as soon as possible
When individual tries to return to work after the disability, GAO recommends that organizations should employ early interventions to address each individual’s return-to work potential and needs.
GAO suggests following practices for easy incubation of the returned workers:
- address return to work goals from the beginning of an emerging disability;
- provide return-to-work services at the earliest appropriate time;
- maintain communication with workers who are hospitalized or recovering at home.
The reason to avoid delay for intervention programs is any delay will shift the focus of employees from residual ability to their disability. Edward E. Palmer states that “time itself is a debilitating factor”. As with time, the employee motivation to do work decreases and the psychological barriers shoots up subconsciously.
Identify and Provide Assistance Effectively
Individual early assessment for transitional work program is recommended by GAO. This helps to employ use case management techniques to offer transitional work opportunities facilitating the workers to enter back into the work place with comfort.
Structuring Cash and Health – Benefits to Encourage Return to Work
GAO suggests that the transition program should include a restructuring of cash and health benefits which are different from the regular ones. This is to encourage the low levels of early performance after return to work and to support the employee with the treatment costs under health benefits. Such motivation from the management will motivate the employees to try for early return to work.
Return to Work Options
Making the Job available for Return to work employee
Jobs designs for Transitional Employment can be identified in the following order:
- Modify current job to accommodate the restrictions given by physician.
- Identify another job within the department.
- Identify job within another division of the employee’s department.
- Identify job within any other department within the corporate
The following conditions of the conditions determine the degree and time for return to work as well the implementation of intervention program for the employee. The return to work programs should be coordinated through a liaison. The treating physician may determine that the employee is:
- Able to return to normal duties with no restrictions. When an employee is instructed by the physician to return to regular duties with no restrictions, he/she is expected to return to work and complete the scheduled shift without any delay.
- Able to return to work with limitations. When the authorized treating physician or psychologist decides that the employee can return to work but with limitations, the employee will receive a disability statement to this effect. Such employees with disability statement should be put under the “modified duty restrictions or restricted workplace”.
- Unable to return to normal duties, temporarily. The authorized treating physician or psychologist may determines the period of restriction and recommends that the employee should stay out of work for a limited period. However after such period, the employee can resume working under the same conditions. No need of modified duties or changed workplace.
Workplace Modifications is supported by the Act of Americans With Disabilities Act (ADA; Bruyère & O’Keeffe, 1994) to benefit the return to work employees with mental illness. Fischler & Booth (1999) suggests some strategies where the work modification can help both the employees and organization.
- Making the work environment filled with the tasks to aid memory and concentration through simple math type problems to boost their confidence and make them cope with the work environment.
- Giving predictable work tasks to avoid confusion and mental strain to the employees. 3. A clear written guidelines on each task will help them to achieve it faster
- Allowing for flexibility about pace of work and timing of breaks will make them comfortable with the work environment.
- Team working environment will also result in eliminating the loneliness and isolation.
Levels of Intervention strategies
There are 3 levels of interventions observed with return to work individuals from mental illness:
They are Individual-Level Interventions, Employer-Level Interventions and Organizational Frameworks that enable Employment Interventions.
Organizational Frameworks That Enable Employment Interventions
In the world of downsizing and resizing for cost cutting, organizations many times feel burden to employ intervention strategies for the recovered employees of mentally illness. However, when it is compared with the cost of experience and expertise that is associated with the valuable employees, the cost of interventions become less.
So organizations need to establish an organizational framework to support the integration of such intervention programs into the main course of organizational operations. Such support from the management will result for cost effectiveness and will eliminate the jitter in operations.
Disability Management: “In workplaces where there is a high risk of traumatic events, evidence-based approaches to disability management and return to work are needed in order to support individuals with post-traumatic stress disorder and work-related injuries”, Asmundson et al. (1998) as cited in Elliot Goldner,.
Disability management is one such employer-directed programs and practices aimed at the prevention of disability and rapid return to work. Habeck R & Currier.K as cited in Terry Krupa.
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Disability management programs are typically characterized by a single management plan designed to ensure the implementation of key practices. Westmorland M as cited in Terry Krupa.
The Disability management not only offers the employment provisions to the individual employees but also strengthens the labour–management through the well-being programs for workforce.
Though Disability management designed primarily focusing on the physical disability. Later it included the components to address mental illness in the workplace.
Early Identification, Diagnosis, and Treatment: As observed in the previous section, the Early identification of employees result in early intervention and strategy implementation.
Assessment and Planning
The individual problems are different and their intervention strategies. A person recovered from anxiety should be treated differently from a person recovered from depression. The coping mechanism to work place stress will be differed in both the cases. A client-centric assessment and planning will ensure the right kind of treatment and work modification methods to be employed for the returned worker.
“Evaluations of functional capacity that are situational and are performed in the actual job context or in environments constructed to closely resemble the real work site have demonstrated promising results in predicting vocational capacities”, Girard D & et al., as cited in Terry Krupa
The functional impairments of many mental illness spread across the social–interactional, cognitive, emotional and behavioral. And such impairments at work place may have residual impact towards the
coworkers and supervisors and may reflect in the form of fatigue, and ineffective coping strategies. When such issues were settled with individual assessment, a proper care can be taken to avoid the other employees interest and motivation.
The employee returned to work is expected to be aware of his condition and abilities compared with the actual work expectations. This is to encourage him growing towards the working conditions and making himself prove day by day. In the absence of such bench mark the returned employee remain sluggish and uncompetitive for long time. and About employment.
Also when the employee becomes aware of his disability, personal strengths and limitations in the context of work. Mental illness related issues can create many workplace conflicts with other employees and result in job strain. Control develops the individual perception in dealing with other colleagues and reduces the conflicts.
Counseling in the work place environment concerning day to day work problems will result in early coping by developing the risk identification, problem solving skills in the return to work employees.
Counseling efforts will improve the self-view reflects by balancing the of strengths and limitations and make them adaptable to work-related issues in a positive manner.
Coping Skills Training
The personal intervention programs need to include coping skills training. Such programs are aimed at individual’s personal development aspects rather than developing the professional elements of the work.
Such trainings will help to support the personal attitude of the employee by aiding hope and control in the employees.
The structure tainting interventions for return to work after mental illness can include relation therapies, assertiveness, stress management, anger and frustration management, energy conservation and communication skills training, and training on employee oriented problem-solving techniques.
Developing behavioral competencies are the major concentration of such programs. Though most of the times these competencies does not directly related to the workplace activities they help in coping with the work place challenges like stress and anxiety.
A liaison can refer a case of individual return to work from the recovery of PTSD to the anxiety coping training that helps him control anxiety in his daily work life and to concentrate on more challenging tasks easily.
Some of the recent training added to the list of such interventions include, time management, financial management, medication management etc.
Disclosure training being complex and productive boosts up the entire competencies of the individual making him self reliant. However some times this disclosure training can provide outside opportunities to the employee, where employee leaves the organization in benefit of them.
Work Hardening: For Return to work individuals from mental illness, work hardening is given basing on the assumption to improve their ability in psychological, cognitive, and emotional functions.
The factors like concentration, fatigue, and tolerance for stress can be systematically improved through graded programs.
Reasonable Job Accommodations
Job accommodations are nothing but job designing with refinements to work environment, job patterns, work tasks that enable an individual with a disability to meet employment expectations. Job accommodations for Individuals recovered from mental illness should include the cognitive and interpersonal alternatives. Such accommodations can include, natural lighting, spacious cabins, rest rooms or sick rooms, noise free cabins, work from home facilities, small schedules, etc.,
Social Network Development: When a return to work individual is supported by the surroundings and the physician giving the treatment, the more will be his early return and coping with work.
Individual’s success is dependent on the social network group he is working or living in. When the organization he is working with him is supportive to his energies and imbalances the quick he will adapt to the regular course of working. The individual’s abilities will be strengthened by guidance and advice, practical and material supports, and respect and esteem.
Employer-level interventions focus on how far the employer can accommodate the return to work employees in the organization. The employer should frame his policies to be adjusted according to the government guidelines. Developing the early identification for coping strategies, organizing and funding the coping skill trainings and establishing an cooperative environment between the regular and return to work employees are the basic expected functions. In addition to this cash and other reward benefits and other motivational strategies are according to the organizational needs and interests. Workplace accommodation, disability disclosure practice, appointing of liaison to coordinate the activities and execution of return to work plan reflects the employer’s responsibility towards their organizational assets.
The Case Manager’s Role In Return To Work
The Case manager will be the person who supports and coordinates the return to work program and will be the fey person behind the successful return to work. The role of the case manager is to:
- support HR managers in identifying the return to work individuals who need to be supported and recommended for further skill development programs
- maximise the opportunity for the best possible outcomes return to work employees
- guiding the required program particulars for the Skill development training
- Ensuring that the return to work employees all the benefits of the organization including the accommodation and modified work.
Case managers should ensure sure employees feel welcome to return to work. The case manger makes the employees feel that there he is been valued for all of his career excellence and performance and he is not forgotten for his contributions in his absence from work.
The Case manager & RTW
The case manager assists the employee in developing the RTW to seek appropriate support at different instances of time to make him ease for early and safe return to work.
The case manager must develop good communication with the return to work employee and other stakeholders of the organization like co workers, Human resource managers and the managers. The best communicating tool for the early intervention is Return to Work plan
The case manager has to research to identify what helps the employee to return to work process. This will eliminate the confusion and misunderstanding and allows the easy execution of the Return to Work (RTW) process without delays at further stages.
Return to Work Plan
A return to work plan is a written action plan formed by the case manager, that contains how the organizational interventions will make the mentally ill person to return to work quickly after recovery.
If the return to work person can work in the current capacity of work, the RTW Plan must, include an Offer of Suitable Employment to assist them to return to work.
If the employee requires a modified job, then RTW includes the job requirements and the time frame involved for such resources along with other terms and conditions.
The case manager assists the employee in developing the RTW to seek appropriate support at different instances of time to make him ease for early and safe return to work.
The case manager mentions the following in the return to work plan:
- The goals of the plan: These are set out milestones for the worker to achieve until he or she reaches the final goal: a return to pre-illness employment.
- The actions required to achieve these goals: This section mentions about the responsibilities of organization, HR, supervisors, Case managers, co-workers and the employee.
- Time frames for achieving these goals: The phased implementation of the entire return to work process goes according the set timelines of this section
- Health care needs: What type of medical support the employee needs will be defined in this section along with the working conditions and the time schedules for work and medical treatments.
The paper identified different level and types of intervention strategies available for the individuals who return to work after the recovery from mental illness. Among all, th e study found that if the organization has the developed framework to support the process it can function well on the program. The early assessment for intervention and the coordination by the case manager to work out on the Return to Work plan are the major requirements for the successful return of the employee.
Return to Work Policy, Okaloosa County Safety Manual Revision, 2008, Web.
Elliot Goldner, Disability Management, Return to Work and Treatment, 2008. Web.
Joann Sim, Improving Return-to-Work Strategies in the United States Disability Programs, with Analysis of Program Practices in Germany and Sweden, 2008.
Terry Krupa, Interventions to Improve Employment Outcomes for Workers Who Experience Mental Illness, 2008. Web.
How to plan a return to work, 2008. Web.
Gary L. Fischler, Assessing Fitness-For-Duty and Return-to-Work Readiness for People With Mental Health Problems, 2008. Web.