Returning to Work?

Things to Consider

Evelyn Sparks, B.A, B.Sc.OT, MBA, OT Reg. (Ont.)Acting Vice President, Professional Practice

Statistics

Mental illness-related disability claims (short-term

and long-term) account for up to one third of the

workplace claims, equaling approximately 70%

workplace costs and translating to 33 billion dollars

to the Canadian economy on an annual basis

(Sroujian, 2003).

Disability Rights

People living with mental health problems and illnesses

must not only be able to access the services and supports

they need to assist in their journey of recovery, but must

have the opportunity to be active citizens and to

participate fully in community life, as employers, workers,

students, volunteers, teachers, caregivers, and parents.

(Mental Health Commission of Canada, 2009).

Disability Rights

Mental illness is a disability which is explicitly recognized

under the Canadian Human Rights Act. Section 25 of the

Act defines disability as including “any previous or existing

mental or physical disability…” The Act prohibits

discrimination in employment on the basis of a

disability or on the basis of a perceived disability and

requires accommodation.

Canadian Human Rights Act.

Return to Work after Mental Illness

Time Away from Work

• May occur gradually due to accommodations,

decreased ability to the job due to symptoms of

illness

• May occur suddenly when it no longer becomes

possible to work, possibly due to hospitalization

Signs of Mental IllnessLook for changes and patterns. We all have off days.

Clues:

• Confused thinking;

• Difficulty in completing tasks

• Decreased tolerance of routine

• Emotional outbursts or withdrawal

• Heightened anxieties, fears, anger or suspicion; blaming others.

• Loss of interest in preferred work

• Feedback from others, “you are not yourself!”

And Still More Signs

• Denial of obvious problems and a strong

resistance to offers of help,

• Dramatic, persistent changes in eating or

sleeping habits,

• substance abuse,

• thinking or talking about suicide or self-harm.

“How does mental illness interfere with work performance?”, Centre for Psychiatric Rehabilitation, http://www.bu.edu/cpr/reasaccom/employ-func.html#howrecog

Possible Impact of Illness on Work Performance

Essential Psychological Factors Needed for Work (Fischler et Al.)

• Cognition• Pace• Persistence• Conscientiousness and Motivation• Interpersonal Functioning• Stress Tolerance• Job Specific Requirements (typing speed, people skills etc.)

Supporting Work

The primary goal is to continue work or to return as soon as possible to work with appropriate

supports.

Are You Ready?

• Consult with your physician and care team• Consult with Occupational Health

Judge for yourself:• Symptoms are coming under control• Sufficient energy to get through the day• Daily routines are in place• There is a return to work plan

Which Work?

• One thing to consider is that your previous work

might not be the best going forward

• Some workplaces are difficult and lacking

support

• Some work does not “fit” and therefore creates

stress

• Some work is difficult to re-enter gradually

Strategies for a Successful Return

http://www.gwlcentreformentalhealth.com

Employee Issues Impacting Return to Work

• Symptom Management

• Level of shame related to leave

• Level of fear of negative judgment

• Perceived level of support in the workplace

• Current stress/frustration tolerance

• Coping strategies with interpersonal conflicts

• Level of interest/satisfaction with work prior to leave

• Recovery expectations

Environmental Issues• Supervisory support (crucial)

• Organizational culture/ willingness and ability to accommodate

• Co-worker perceptions of mental health leaves

• Prior relationship with employer/co-workers

• Physical environment (lighting, noise level etc.)

• Degree of control over work/work schedule (night shifts may no longer be possible.)

• Communication between worker, insurance company, employer and health professionals.

Supporting Recovery

Programs that address workforce needs may

include:

• Facilitated access to professional advice (EAP,

Occ Health);

• Flexible work scheduling practices;

• Union representation and consultation in

addressing needs where available.

Flexibility

• Flexibility at the start or end of work hours to

accommodate effects of medication or for medical

appointments.

• Part-time or split shifts

• More frequent breaks

• Graduated return to work

http:/www.gwlcentreformentalhealth.com

Flexibility, con’t• Assigning minor task to other employees (balance

of work)

• Modifying the way instructions are given (i.e. written instructions may help employee focus on tasks)

• Having brief weekly meeting (i.e. 10 mins) to deal with issues before they become a problem.

http:/www.gwlcentreformentalhealth.com

Maintain Stamina

• Vary tasks throughout the day

• Take on some opportunities to learn new skills

• Request a self-paced workload

• Where possible do some of the work from home

• Consider job sharing/temporary shift to part-time work

• Break up big tasks into smaller ones

www.gwlcentreformentalhealth.com

Employees Dealing with Stress

• Request clear expectations

• Ask for help from counselors or EAP

• Ask for constructive feedback and positive

reinforcement

• Take needed time for doctors appointments,

therapies

www.gwlcentreformentalhealth.com

Employee Support at Home

• Let loved ones know that returning to work may

cause fatigue and added stress. Let them know

how they can provide support.

• There are support groups for family, friends or

others to help them understand illness and how

to best help the individual recovering from

mental illness and to provide support for

careproviders.

Reluctance to Disclose

• Stigma

• Safety / employment security

• Privacy

• Toxic workplace

• Assumptions about impact on career progression

Whether to Disclose

Reasons to Disclose:

• Allows opportunities for accommodations

• Creates opportunity to educate and reduce stigma

• If the employee becomes unwell, work adjustments can

be made more quickly

• If there has been a prolonged absence the employee

may wish to share the reason with the supervisor /

colleagues

Whether to Disclose

Reasons Not to Disclose:

• Judgment, expertise, and actual performance

may be devalued

• Negative attitudes about mental illness

• Illness may not impact on your performance

Stigma and Employment

In a study by the Canadian Mental Health

Association, it was shown that employees with

mental health problems tend to be more loyal, have

an attendance rate comparable to other employees

without mental health problems and their

performance level is at about the same or above

those of other employees.

Impacts of Stigma

• Delays in seeking medical attention. One-fifth

will have significant mental illness, one-third of

those will seek help for it.

• Shame (“pull up your boots” mentality).

• Reluctance to take time off work from

employment with attendance management

systems.

• Pressure for early return as disability is invisible.

Self Stigmatization

People with mental illness often face a double

problem: symptoms of their mental illness and public

stigma

Brief Reports: Self-Stigma, Empowerment, and Perceived Legitimacy of Discrimination AmongWomen With Mental Illness

Nicolas Rüsch, M.D., Klaus Lieb, M.D., Martin Bohus, M.D. and Patrick W. Corrigan, Psy.D.

Psychiatr Serv 57:399-402, March

Self Stigmatization

• Review your strengths• Be aware of your rights• Make use of therapies• Use the time for honest reflection• Decide what parts of the problem are actually

yours and what parts are the environment• Make a plan• Celebrate successes

Resources Available

Mental Health Works http://www.mentalhealthworks.ca/

Mental Health Commission of Canada http://www.mentalhealthcommission.ca/English/Pages/default.aspx

GWL Mental Health http://www.gwlcentreformentalhealth.com/index.asp

ReferencesToward Recovery & Well-Being : A Frame Work for a Mental Health Strategy for Canada (2009). Mental Health Commission

of Canada. Retrieved on 10-11-2010 from http://www.mentalhealthcommission.ca/English/Pages/Strategy.aspx

Fishchler, G. Assessing Fitness-For-Duty and Return-To-Work Readiness for People with Mental Health Problems in the Minnesota Career Development Association Newsletter, The MCDA Communique, summer 2000. Retrieved on 15-11-2010 from http://www.psycheval.com/assessing_ffd_rtw.shtml

Fischler, G., Booth, N. Vocational Impact of Psychiatric Disorders, An Aspen Publication : Maryland, 2009.

Definition of the word ‘work’, Merriam-Webster Online Dictionnary (2010). Retrieved on 17-11-2010 from http://www.merriam-webster.com/dictionary/work

Ross, J. Occupational Therapy and Vocational Rehabilitation, John Wiley & Sons Ltd : England, 2007.

Saint-Arnaud, L., Saint-Jean, M., & Damasse, J. (2006). Towards an enhanced understanding of factors involved in the return-to-work process of employees absent due to mental health problems. Canadian Journal of Community Mental Health, 25(2), 303-315.

Workplace strategies for mental health : Mental Health Facts and Figures. Retrieved on 10-11-2010 from : http://www.gwlcentreformentalhealth.com/display.asp?lc=1&l1=2&d=2

Workplace strategies for mental health : Accomodations that work. Retrieved on 10-11-2010 from : http://www.gwlcentreformentalhealth.com/display.asp?l1=182&l2=6&d=6

Evelyn Sparks, OT Reg. (Ont), Rosemarie Lidstone, OT Reg (Ont), Mood Disorders: Employment Issues and Dealing with Stigma, November, 2011

Emily Deacon MSW, Claude Lurette, Recovery Is Possible, Stats Can Presentation, September, 2012.