Returning to Work

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Upwards of 80% of those who were not working when they accessed the service return to work, including some who had been not working due to mental illness for a number of years.

PH differs from Occupational Health

At PH we are not an Occupational Health service.

However we recognise that not all patients who are off work due to illness may have access to Occupational Health. PH clinicians can often discuss with the practitioner-patient the timing of the return to work and the return to work plan from the patient’s perspective. This could include consideration of what to tell colleagues about your illness, making arrangements for attending ongoing therapy appointments or how you might deal with any triggers in the workplace that may affect your mental wellbeing.

The role of Occupational Health is to view the return to work and associated plan from both patient’s and employer’s perspective, including considering any reasonable adjustments that may be required that will enable you to continue in your role.

When to ask for an independent Occupational Health review

Sometimes it may be helpful to get an independent Occupation Health review. This is particularly useful if your organisation/employer does not have access to its own service. The review can provide advice  around your fitness to return and the timing of that return, for example if:

• Your organisation/employer is encouraging you to come back before you feel ready.
• You may want to go back before your organisation/employer or even your PH clinician thinks you are ready.

Your organisation/employer may agree to fund this Occupational Health review. For GPs on the Performers List this may be funded by the local area team.

What will be taken into consideration when deciding if you are ready to return to work?

If you have been off work due to a mental health issue, the most important thing that you, your PH clinician and your organisation/employer will need to consider is that you are now recovered enough to pick up some, or all of your duties and that it will be safe for you and your patients to do so.

There will be consideration of:

• Presenting illness/ cause for time off and the response to treatment
• Any workplace triggers (e.g. Partnership or team difficulties or pending issues)
• Full understanding of roles, duties in roles and weekly timetable (to inform phased return)
• Liaison with Occupational Health or any other health professionals involved with your care to gather information about your fitness to return
• Anything to learn from a previous experience of return to work plan. Did it go smoothly or not?
• Any previous episodes of sickness absence.
• The aim is to help the practitioner-patient to think about a suitable phased return to work plan (if necessary) and over what period. Sometimes it can be helpful to add in additional duties/roles gradually with on call/duty sessions usually the last thing to add in.

Timing of return

• This should be neither too soon, which would decrease the chance of success if the doctor patient is not sufficiently recovered, nor too long off work.
• The longer a clinician is away from the workplace due to ill health the greater the likelihood of losing confidence in their ability to manage their role. Time off also allows increased time for rumination and worry whilst off sick.

Value of activity scheduling

• Following a long period of sick leave it can sometimes be helpful to start back on a part-time basis, building up to full-time work.
• Many patients find it useful to start building up a full time (9am to 5pm) schedule of non-work activities prior to return to work to build up stamina, a sense of mastery and to improve self-confidence
• Remember to include a mixture of productive and enjoyable activities (which can be rated out of 10 in a diary for productivity and enjoyment)
• Start with one activity per day and build up gradually.

Top Tip: Good to include some activities which will be feasible to continue alongside work for replenishment and relaxation once back at work

Psychological aspects pre return to work

One of the most common issues for a clinician returning to work after a lengthy absence can be psychological aspects associated with being back in the workplace.

• It is very common to experience a marked increase in anxiety once the decision has been made to agree a return to work date.
• This anticipatory anxiety follows a typical curve increasing in the days preceding the return and then easing once back in the workplace and getting on with daily tasks.
• Rehearsal is also helpful. Consider how you might answer questions from colleagues about reasons for absence (e.g. on return after an inpatient detoxification from alcohol or drugs)
• You may choose to share different levels of information with your senior colleagues and supervisors, than you do with your practice or hospital team and with your patients.
• The aim is for the practitioner-patient to share enough information to have appropriate support on return to work and to maintain the trust of their close colleagues, whilst reserving the right to privacy about your clinical details.