HELPING EMPLOYEES SUCCESSFULLY RETURN TO WORK FOLLOWING DEPRESSION, ANXIETY OR A RELATED MENTAL HEALTH ISSUE – ORGANISATIONAL GUIDELINES

These guidelines consist of actions organisations can take to facilitate return to work for employees following an episode of depression, anxiety or a related disorder. They were produced using the Delphi method, http://en.wikipedia.org/wiki/Delphi_method, which is a systematic way of assessing the consensus of a panel of experts. The actions have been rated as
important or essential by expert panels of consumers, employers and health professionals. It is hoped that the guidelines will be used to improve the practices of organisations as they support those returning to work after mental health problems. Helping employees successfully return to work following depression, anxiety or a related mental health problem.
GUIDELINES FOR ORGANISATIONS What organisations can do
The work environment
The organisation should foster a supportive work environment that
is conducive to good mental health and the enhancement of mental
wellbeing. This can be achieved by:
• encouraging staff to discuss stress and seek support when
experiencing mental health problems
• fostering a culture in which disclosure of mental health problems
is accepted
• taking action to reduce the stigma surrounding mental health
problems
• adopting a positive attitude towards those recovering from
mental health problems.
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.
RESPONSIBILITIES TOWARDS EMPLOYEES WITH A MENTAL HEALTH PROBLEM
When an employee discloses to a supervisor or other organisational
representative that they have a mental health problem, confidentiality
should be respected unless there is an immediate danger to the
person or to others in withholding that information. To reduce
misunderstandings which could lead to fears of discrimination, the
organisation should make clear the purpose for which they request
or require information about an employee’s mental health problem.
The organisation should ensure that the employee knows who they
can talk to other than their supervisor about their mental health
problems (e.g. a human resources professional, occupational health
provider or trade union representative).
The organisation should provide information to employees with a
mental health problem on taking sick leave due to a mental health
problem or returning to work after a mental health problem. This
should include information on the positive role of work in recovery
from a mental health problem. 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. Where practicable, the organisation
should offer their employees the support of occupational health
advisers or counsellors. The costs of mental health treatment may
be offset by gains made in reduced absenteeism and improved
productivity at work.
Managing absence
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. The organisation should also provide advice to supervisors on
how to appropriately contact an employee who is on leave because of
a mental health problem.
If the supervisor has contributed, or is alleged to have contributed,
to the employee’s mental health problem, the organisation should
delegate someone else to maintain contact with the absent employee.
If the employee’s mental health problem is related to conflicts
at work, the organisation should engage the services of qualified
workplace mediators.
MANAGING RETURN TO WORK
The organisation should have a coordinator who facilitates employees’
return to work. This person could, for example, be a human
resources professional. The coordinator needs to become familiar
with the employee’s work environment and job content, be able to
communicate and negotiate with staff at all levels, and be sensitive to
the needs of the employee concerned, including any disability issues.
The return-to-work coordinator should also check that the supervisor
of the employee has been informed about the return-to-work process,
and agrees with it and its possible financial consequences.
The organisation should provide a clear set of behaviours that can
be referred to when guiding supervisors on how to manage an
employee’s return to work, as well as provide additional support,
guidance and training to supervisors when they are preparing to
manage an employee returning to work from sick leave due to a
mental health problem.
A return-to-work assessment of both the job and the employee’s
mental health should take place, and the organisation should make
sure that the supervisor understands their role, the employee knows
what to expect and everyone is clear about who is responsible for
action in the return-to-work process. A return to work plan should
be developed for the employee.

THE RETURN TO WORK PLAN

1. when developing an employee’s return-to-work plan,
the organisation should ensure that:
• its approach is fair and consistent, while being flexible with details
• its approach is tailored to the individual
• it offers a variety of options to the employee for a flexible return to work
• it provides the employee with adjustments, flexible working practices
or job task modifications to accommodate their capabilities
• these adjustments are carefully monitored and evaluated, with
improvements made where appropriate
• it informs employees of disability management initiatives so that
they have a greater awareness of roles and resources for making
adjustments
• those who need to know are informed about reasonable adjustment
arrangements made for employees
2. What staff need to know
The organisation should have procedures for making the supervisor, the employee and colleagues aware of the following:
• what a mental health problem is
• how common mental health problems are
• the types of mental health problems
• the warning signs and symptoms of mental health problems
• the causes of mental health problems
• the work-related causes of mental health problems
• the importance of early identification and intervention for preventing or limiting relapse in an employee with a mental health problem
• the things they may notice which might indicate that an employee has a mental health problem, such as effects on attendance, completing
work tasks and displaying unusual behaviours
• the benefits for employees of disclosing their mental health problem to the organisation (e.g. to allow access to supports)
• the fears employees may have about disclosing their mental health problem (e.g. stigma from others and not wanting to identify as ‘crazy’)
• the impact of the symptoms of mental health problems on the skills necessary for work, such as problems with concentration, memory,
decision making and motivation
• that the level of support needed by employees with a mental health problem will fluctuate, as the symptoms of most mental health problems
come and go over time
• how they can reduce stressors that increase employees’ risk of relapse of mental health problems
• how they can support employees with a mental health problem in ways that promote recovery
• how to interact with an employee who is in a distressed state
• how to respond in a mental health crisis situation
• the mental health and disability support services available through the organisation and in the community
• that the negative attitudes of others can be a major problem for an employee with a mental health problem
• the myths surrounding health problems which lead to stigma and limit the potential productivity of employees affected by mental health
problems
• the relevant laws and organisation policies that affect interaction with employees with a mental health problem (e.g. Disability Discrimination
Act 1992)
• that it is not necessary to be without symptoms of the mental health problem to function successfully at work
• that symptom improvements and work performance improvements may happen at the same or different rates
• that, despite looking fine, the employee may still be ill
• that most people with a mental health problem who receive treatment respond with improved work performance
• the value of work for health and recovery
• that the employee might be anxious about returning to work
3. The role of the return-to-work coordinator
Organisations will vary in size and whether or not they have specialist
staff to deal with return-to-work issues. In a large organisation, the
return-to-work coordinator may be a human resources professional,
while in a small organisation it may be the employer or the
supervisor. In this section, the ‘return-to-work coordinator’ refers to
any of these people as appropriate.
Managing mental health problems in the workplace
The return-to-work coordinator should be someone who is
acceptable to the employee. They should not see everything that
the employee says or does as linked to their mental health problem,
and should avoid making assumptions about the employee’s medical
circumstances or what the employee finds stressful or demanding.
If the employee is having great difficulty functioning at work,
the return-to-work coordinator should discuss appropriate leave
arrangements with the employee.
Once an employee has disclosed their mental health problem, it is
vital that the return-to-work coordinator discusses and agrees with
them exactly who else, if anyone, might need to know, and what
information they need to be provided with. The return-to-work
coordinator should also make the employee aware that anything they
discuss with them about their mental health problem will be kept
confidential, unless there is an immediate danger to the person or to
others in withholding that information.
Contact during the employee’s absence
Where an employee is on sick leave due to a mental health problem,
the return-to-work coordinator should maintain an appropriate
level of regular contact with the employee. What is appropriate will
depend upon the circumstances, and an employer should avoid
putting pressure on an employee. The return-to-work coordinator
should negotiate and develop a plan for how they will keep in touch
with the employee and how often. The return-to-work coordinator
should ask the employee who they would prefer to have as their main
contact.
When keeping in contact with the employee, all communication
between the return-to-work coordinator and the employee should
come from a position of care and concern for the employee. The
return-to-work coordinator should let the employee know that they
are not checking up on them, just keeping them up to date, and
should avoid mentioning that colleagues or teammates are under
pressure or that work is piling up. The return-to-work coordinator
should keep a record of contact made with the employee while on
sick leave.
When contacting the employee, the return-to-work coordinator
should use these contacts to:
• find out what help and support the organisation can provide
• explain the return-to-work process to the employee
• discuss any work-based issues that would assist them to feel
confident and comfortable about returning to work
• discuss reasonable adjustments to assist them upon their return
• reassure the employee about practical issues such as their job
security and deal with financial worries
• encourage absent employees to talk to their own doctor, or other
healthcare adviser, about what they may be able to do as they
make progress or adjust to their condition
• ensure that the employee is aware of the sickness absence and
disability policies
At the end of each conversation with the employee, the return-to work coordinator should agree on when the next follow-up contact
will be.
If the employee is too unwell to be contacted directly, the return-to work coordinator should explore if there is someone else, such as a
family member or friend, who can keep in touch on their behalf until
the employee is well enough for direct contact.
Managing return to work
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. They should pro actively seek support and
resources for managing an employee’s return to work from relevant
sources (e.g. human resources and occupational health professionals, Chamber of Commerce, unions).
With written consent from the employee, the return-to-work
coordinator should also contact the employee’s healthcare provider.
This allows for a two-way flow of information and increases the
coordination of support for return to work. The return-to-work
coordinator can highlight any factors that might have a bearing on
the employee’s return to work that may be relevant for the healthcare
provider to know. In addition, the healthcare provider can clarify
for the return-to-work coordinator any advice they may have to
assist in an employee’s return to work. However, the return-to-work
coordinator should be aware that if the employee does not wish them
to contact their healthcare provider that is their right.
If the return-to-work coordinator is concerned that an employee is
not yet ready to return to work, they should ask the employee to
provide a report from a healthcare provider stating that they are ready
to work. When the employee is back at work, the return-to-work
coordinator should conduct a return-to-work interview or discussion.

4. The role of supervisors
Information and training
The organisation should provide information to supervisors on how
they can support an employee who is off work or returning to work
after sick leave due to a mental health problem, including:
• their responsibilities for managing the attendance and return to
work of employees with a mental health problem
• the importance of good people management skills, including
effective communication, rather than being knowledgeable about
the employee’s mental health problem
• the organisation’s policy on return to work and how to put this
into practice
• that successful return to work is linked to support from
managers, the degree of control over work flexibility, the demands
placed on them at work, the clarity of their role within the
organisation, and their relationships at work
• the important role the employee plays in their own return-towork process
• what organisational resources might be available for workplace
adjustments
• how to introduce workplace adjustments and monitor the
return-to-work process
• the factors that make it difficult to return to work and how
they can minimise their impact
• what entitlements are available (e.g. family, sick and annual
leave) for employees with a mental health problem
• their legal responsibilities, such as those under the Disability
Discrimination Act
• understanding that it is their role to assist the employee to get
the help they may need, but not to diagnose mental health
problems or to provide counselling
• recognising the limitations of a supervisor’s responsibility
towards an employee with a mental health problem
Supervisors also need to know how to communicate with employees
on sick leave due to a mental health problem. Good communication
requires:
• being sensitive to and understanding the individual and their
context
• managing the expectations of an employee returning to work
• knowing how to have sensitive conversations with employees,
including how to handle those that do not go as planned
Mental health training for supervisors should include opportunities
to practice new skills during the training, and remind supervisors that
they too are employees who can expect help to return to work if they
experience a mental health problem.
WHAT RETURN TO WORK CONVERSATIONS SHOULD COVER
during return-to-work discussions, the return-to-work
coordinator should:
• discuss the return-to-work expectations of the employee by
clearly explaining policies regarding sick days, time off and
other matters related to employee well-being
• explain any changes in the employee’s role, responsibilities
and work practices that have occurred during their absence
• focus on the employee’s abilities and their capacity to carry
out their work, rather than on their limitations
• focus their discussions with the employee on the problems
they experience in the workplace and what actions can be
taken to address them, rather than on details of the mental
health problem
• find out how the employee’s symptoms and treatment
impact on their work and think about how this impact can
be reduced
• discuss with the employee whether any adjustments need
to be made to ease their return to work, while being honest
about the adjustments they can make and those they can’t by
explaining that some organisational factors are out of their
control
• make sure the employee understands the effect of any
adjustments on their pay and other entitlements (e.g. effects
of reduced hours or alternative work)
• discuss the employee’s right to confidentiality and reach an
agreement on when it would be appropriate to contact a
doctor or family member if they become unwell at work.
4. 5. Communicating about mental health problems in
the workplace
The supervisor should demonstrate and encourage awareness,
understanding and openness in relation to the issues of stress and
mental health problems in the workplace. They should acknowledge
the impact the employee’s mental health problem has on the
employee, while making the individual feel that they are a valued
employee in the organization.
Managing return to work
If the supervisor is also the return-to-work coordinator, they should
refer to the recommendations in the section ‘The role of the return-to work coordinator’. Below are guidelines for supervisors irrespective of
whether or not they are the return-to-work coordinator.
During return-to-work discussions, the supervisor should:
• discuss signs and symptoms of any relapse with the employee and
ask how they feel these are best dealt with
• sensitively deliver unwelcome news about their absence or
position in the workplace
• not make promises to the employee that they cannot keep
The supervisor should also be aware that if the employee does not
wish them to contact their healthcare provider that is their right.

 

Reasonable adjustments
The supervisor should make reasonable adjustments for the employee
in the workplace that 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.
When making reasonable adjustments, the supervisor should be
flexible and treat each case individually, but on a fair and consistent
basis. They should avoid making stereotypical assumptions about
the capabilities of employees with a mental health problem. The
supervisor should also make sure that any side effects of treatment the
employee experiences are considered against their job requirements.
This is particularly crucial in jobs where there are health and
safety risks. These adjustments should be regularly reviewed by the
supervisor.
The supervisor should support the employee to access treatments
by allowing the person time off work to attend appointments and
should investigate other workplace supports that may be available
to the employee, such as an Employee Assistance Program (EAP),
rehabilitation services or a local employment service.
Managing the returning workplace environment
The supervisor should be realistic about workloads and be aware that
some people will wish to prove themselves and may offer to take on
too much. Instead, the supervisor should set achievable goals that
make the employee feel that they are making progress. To make the
employee’s first weeks back as low-stress as possible, the supervisor
should make sure the employee doesn’t return to an impossible
in-tray, thousands of emails or a usurped workspace. The supervisor
should watch out for hostile reactions to the employee’s return to
work and promptly stamp out any hurtful gossip or bullying.
The supervisor should take the time to have frequent informal chats
so there is an opportunity to discuss progress and problems without
a formal (and possibly intimidating) session. However, the supervisor
should ensure that the employee does not feel that their work or
behaviour is being overly monitored or scrutinised, or that they
feel like a nuisance for creating extra work for the supervisor. The
supervisor should ensure that any concerns raised by the employee are
investigated and dealt with quickly.
The supervisor should continue to support the employee’s return to
work well beyond the initial return. However, the supervisor should
avoid fostering a dependent relationship with an employee with a
mental health problem through providing excessive support. They
should reassure the employee that they understand medical and
personal boundaries and will respect them.
Supervisors should work with healthcare and rehabilitation providers
to support employees with mental health problems, and identify
physical and psychological factors in the work environment that can
be adjusted to accommodate an early, safe and sustainable return to
work.
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. In the case of relapse after return
to work, the supervisor should not make any assumptions about
whether or not the employee is able to continue working.
If a disciplinary process is required for the employee, the supervisor
should have a range of options available for this process, such as
counselling, referral to an occupational health specialist etc., as well as
the more usual system of warnings.
If the organisation does not have a return-to-work policy, the
supervisor should suggest that they have one.
6.Having a return-to-work plan
Development
A clear written return-to-work plan should be developed by the
return-to-work coordinator in discussion with the employee. The organisation should ensure the employee is actively involved
in the development of the return-to-work plan, and that it is agreed to
by everyone affected by the plan.
The return-to-work plan should be flexible and adjustable to allow for
changes in the employee’s mental health or workplace circumstances,
and should last for a sufficient time period to allow the employee
to recover. When agreeing on a return-to-work plan, the supervisor
should always be clear on the duration of any amended duties or
supports. In most cases, these measures will be temporary.
The return-to-work plan should be constantly monitored to ensure
that tasks and hours remain appropriate and sufficient supports and
resources remain available. The supervisor should take steps to keep
everyone informed and make sure the plan is respected.

WHAT A RETURN TO WORK PLAN SHOULD CONSIST OF.
• the approximate date of the employee’s return to work

• the time period of the plan

• the roles and responsibilities of all involved in the plan

• a description of suitable duties for the employee

• any reasonable adjustments that assist the employee to remain
at work and remain well (e.g. return to a modified work
role or system, or alternative working hours, whether on a
temporary or permanent basis)

• information about any impact of adjustments on terms and
conditions of employment (i.e. on leave, superannuation,
other employment benefits)

• any advice received from healthcare providers, human
resources etc.

• strategies to handle stress, particularly around workplace
activities that may trigger this for the employee, such as short
deadlines, early meetings or workplace conflict

• the process of ensuring the plan is put into practice

• the process by which the plan will be reviewed, including
review dates and by whom

• signatures of agreement – employee, supervisor etc.
What the returning employee can do
The employee should talk to their supervisor and raise any concerns
they might have about their return to work. They should also
negotiate with their supervisor about reasonable adjustments to assist
with their mental health problem.
The employee should learn the symptoms and triggers of their mental
health problem. They should understand that mental health problems
are sometimes unpredictable, and that their impact on both cognitive
and interpersonal functioning may make work a challenge. The
employee should identify perceived barriers and prioritise solutions
for a safe and early return to work.
The employee should discuss with their return-to-work coordinator
about how to approach their return to work and manage their mental
health problem in the workplace. When talking to their return-towork coordinator about returning to work, the employee should
discuss:
• what their tasks and responsibilities will be
• any work activities that may trigger stress and what helps to
reduce or manage this stress
• how much they can disclose to work colleagues
• barriers to a safe and early return to work
• any specific needs they have (e.g. time off to attend appointments,
inability to do the job in the same way as before becoming
unwell)
The employee should discuss with a healthcare professional about
how to approach their return to work and manage their mental
health problem in the workplace. This should include discussion
of any adjustments to their work that may be needed on a
temporary or permanent basis and how any medication side effects
may affect their work. During a return-to-work assessment by a
healthcare professional, the employee should be aware that it is their
responsibility to report any participation and activity limitations that
are a result of their mental health problem and which may affect their
work. The employee should continue to keep their doctor or treating
health professional informed during the return-to-work process.
The employee should 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.
What colleagues can do
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.

 

what trade union representatives can do.

This section applies only in situations where the employee is a trade union member.
The trade union representative should:

• encourage the employee to co-operate with their employer on a return-to-work plan and use the
opportunity offered by a return-to-work interview to ask for help with work-related problems
• reassure the employee that details about their mental health problem cannot be given to others
without their consent
• encourage the employee to talk to their doctor about going back to work and about any side effects
of medication that may affect their safety or performance at work
• encourage the employee to talk to their doctor about any adjustments to their work that may be needed on a temporary or permanent basis
What family and friends can do

Family and friends should:

• provide practical support to allow the employee to return to work (e.g. childcare, transport,
household tasks)
• support the employee in meeting their obligations under the return-to-work plan
• leave the decision about when to return to work to the employee and their health care professional
• not give negative messages to the employee about their ability to return to work
• positively acknowledge success in return to work
• be aware of early signs of relapse and how these may impact on work performance.
Family and friends should also be aware that positive emotional 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.

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