Text adapted from: "Disability and insurance claims in primary care," in Psychiatry in primary care by Ash Bender (CAMH, 2019).
Return to Work
Patient readiness is the key factor in return to work. It can be affected by a patient’s expectation of failure. A good approach to finding out whether patients are ready is to ask them about the positive and negative aspects of returning to work and about perceived barriers (Franche & Krause, 2002). Ask:
- “Is there anything good about going back to work?”
- “What are you afraid of?” “What may happen if you return to work?”
- “Do you foresee any barriers?”
If suitably accommodated work is not available, then retraining or rehabilitation to re-enter the workforce in another role may be an option. Make direct inquiries with the patient, insurer and employer if return-to-work supports are not apparent.
Supports for returning to work
Various programs can provide financial assistance or specialized services:
- Not-for-profit employment agencies:
-Skills development programs
-Employment centres
- Federally funded programs:
- Canada Pension Plan
- Provincially funded programs:
-Workers’ Compensation
-Employment Insurance
-Social assistance
-Disability support programs - Insurance-funded programs:
-Return-to-work co-ordination
-Driving desensitization (for people struggling with driving anxiety as a passenger or driver)
-Work hardening (also called “work conditioning,” which involves rehabilitation to prepare people for return to work) - employer-based programs:
-Employee assistance programs
-Human resources
Common barriers to returning to work
Early identification of medical and non-medical barriers to return to work can avoid prolonged disability or unemployment. Common barriers include:
- Poor treatment adherence
- Medication side-effects
- Physical comorbidities
- Avoidance due to stigma
- Outstanding insurance claim disputes
- Lack of suitable work
- Inadequate home and employer supports
- Unresolved work conflict
- Travel limitations.
Steps toward returning to work
Preparing for return to work should occur from the beginning of the person’s leave from work. It often requires additional information from the employer to develop a return-to-work plan. Insurers may offer return-to-work coordination to facilitate the process. Preparing for return to work involves the following components:
Understanding the person’s current work position, including:
- Physical and psychological demands
- Responsibilities
- Current conflict
- Safety-sensitive duties
- Management support
Determining whether suitable work accommodation is available and the length of time the person will need it.
- Consider hours (e.g., four hours per day for one month due to fatigue)
- Frequency
- Shifts
- Duties (e.g., no machine operation due to poor concentration)
- Transfer to different site
Determining whether additional supports are available in the workplace, including:
- Human resources
- Employee assistance programs
- Insurance coverage for continued psychological treatment
- Encouraging mediation to address disputed terms or grievances
Initiating the Process of Return to Work
Return to work should proceed in the following sequence:
- referral to return-to-work coordinator
- onsite job visit by the employee before the return-to-work date
- gradual return to the workplace if the person is still symptomatic
- gradual increase in hours and/or responsibilities
- retraining if accommodated work is not available
Helping Your Patient Stay in the Workplace
Once your patient has returned to work, use the following strategies to help the person stay there:
- Regularly monitor for re-emerging symptoms and side-effects
- Help your patient enhance problem-solving skills
- Encourage active coping