Sustainable return to work for individuals with common mental disorders:

Building on available resources

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Scientific interpretation

When an employee/worker with a common mental disorder (CMD) returns to work after a period of absence, his or her continued employment – or sustainable return to work (SRTW) – is an important issue at both the individual and organizational levels. A comprehensive understanding of the various concerns relating to CMDs and the conditions which positively impact a return to work are fundamental to the achievement of a SRTW.

To meet this goal, we analyzed the Nielsen et al. study published in 2018. The study’s authors describe a SRTW and provide a framework to facilitate the return to work after an absence for employees/workers with a CMD. The authors identify five levels of resources that can impact a SRTW. They approach these different levels holistically; they consider both workplace resources and those available outside the workplace in a non-occupational, non-professional setting or context.

Expert adviser

Marie-Michelle GOUIN, Assistant Professor, Human Resources Management, Université de Sherbrooke

Authors

Rachèle HÉBERT, Researcher, Université de Sherbrooke

JOSÉE CHARBONNEAU, Research assistant, Université de Sherbrooke

PATRICE DANEAU, Research assistant, Université de Sherbrooke

This initiative was made possible through a collaboration with the Université de Sherbrooke.

WHAT DO WE MEAN BY:

Common mental disorder

Common mental disorder (CMD) is synonymous with transient mental disorder. It is normally used to refer to individuals with anxiety, depression or adjustment disorders – some of the most common mental health disorders found in the workforce. In the work place, CMD is generally referred to when affected individuals have an “employment relationship”, such as that of employee/worker, with an organization. Upon their return to work, these individuals can usually go back to their previous job.

Return to work

An employee/worker is considered ‘back to work’ (RTW) when he or she returns to work following an absence from it due to an injury or common mental disorder. The longer the absence from work, the more difficult the return to work can be.

Resources

In the article analyzed, resources are defined as “any element perceived by the individual as likely to help him achieve his objectives”[1]

An individual may recognize and identify available resources but not necessarily use them. This implies that the value or usefulness of a resource can only be determined by the individual who is in a position to use it. It is the individual who chooses to mobilize available resources or not.

In the work place, resources can be used by employees to undertake their tasks and achieve objectives. The availability and use of resources can affect both their productivity and health.

Complete reference

Nielsen, K., Yarker, J., Munir, F., & Bültmann, U. (2018). IGLOO: An integrated framework for sustainable return to work in workers with common mental disorders. Work & Stress, DOI: 10.1080/02678373.2018.1438536

Methodology

Theoretical and conceptual framework for return to work

1.Theoretical framework for resource conservation

Inspired by resource conservation theory (Hobfoll, 1989)[2]

  • The accumulation and conservation of resources is a natural incentive for achieving an objective.
  • A lack of resources to cope with work demands will compel employees to exhaust their own resources, and can lead to a relapse among employees with CMD.

 

 2. Conceptual framework based on occupational health psychology

The pre-existing IGLOO model defines practical interventions to promote the health and well-being of employees/workers (Nielsen et al., 2017)[3]

The authors made two adjustments to the IGLOO model:

a) Inclusion of the non-professional context that enables access to different resources.
b) Consideration of an organization’s overall scope and environment.

WHAT DO THE RESULTS OF THE STUDY TELL US?

Five levels of resources for a sustainable return to work

The proposed framework, which is designed to facilitate a SRTW, outlines the integration of resources on five levels: 1) Individual, 2) Group, 3) Leadership, 4) Organisation and 5) Overarching context. It is from these five levels that the acronym IGLOO is formed.

The identification of resources favourable to a SRTW can make it easier for SRTW stakeholders to mobilize resources.

The IGLOO framework can be used to:

  • Support and assist employees/workers with CMD.
  • Encourage discussion between organizational stakeholders, such as employees/workers, collaborators, managers/administrators and directors, and with healthcare professionals.
  • Facilitate collaboration between interested stakeholders.
  • Raise awareness of the role each level (from the individual to the global) plays in a SRTW. For example, a national investment in mental health prevention can support employees/workers with CMD but cannot address an actual or perceived lack of support in the workplace.

The IGLOO framework forms the basis for an intersectoral consideration of SRTW. It outlines how available resources at different levels can interact with each other and serve as a basis for the development of targeted interventions.

The following table outlines in detail the five levels of resources. It distinguishes resources in the workplace from those in a non-professional setting or context.

 

Level

Resources

Example of how resources are used or applied

INDIVIDUAL

Work environment

The cognitive and behavioural work responses of employees/workers with CMD may influence SRTW.

The risk of relapse during a RTW may be reduced if an employee manages to balance work demands and available resources.

  • Promote self-sufficiency
  • Facilitate job crafting
  • Provide informational support
  • Refer the employee/worker to programs which and specialists who can help him or her develop personal resources (eg, employee assistance programs, clinical specialists)

Non-professional context

Psychological factors specific to the individual can lead to behaviours that favour his or her SRTW.

  • Maintain a healthy lifestyle
  • Nurture positive self-esteem

GROUP

Work environment

The sense of belonging to a group is conducive to a SRTW.

The positive experience of having worked as a team member can facilitate a SRTW for an employee/worker with CMD.

Co-workers and colleagues are more likely and more willing to support and assist a RTW employee/worker if they have a good, previously-established working relationship with him or her.

Some factors relating to a work group, such as interpersonal conflicts, can negatively influence a SRTW.

  • Prioritize the stability of group members
  • Leverage support from successful SRTW collaborators (eg, provide information on how to manage symptoms and work load)
  • Reintegrate, the employee/worker into his or her former position so he or she returns to a familiar work environment
  • Prepare the employee’s RTW by counselling and engaging co-workers/colleagues and other group members (eg, information, education, dispelling prejudices)
  • Inform group members of the returning employee’s abilities to resolve any applicable conflicts that preceded the work stoppage
  • Lighten group work loads (eg, have the returning employee work in a supernumerary position during the RTW period, keep his or her replacement on staff so the work loads of co-workers/colleagues do not increase)
  • Whenever possible, use supernumerary employees to reduce any impacts on the work load of other group members

Non-professional context

Support from family and friends can facilitate a SRTW.

Access to a positive non-occupational social network can contribute to a SRTW for an employee/worker with CMD.

  • Assist the employee/worker with household tasks and child caring responsibilities
  • Advise how to manage CMD in a non-working environment or non-professional setting

LEADERSHIP

Work environment

Managers/administrators play a key role in structuring the work of, and making the necessary accommodations for, an employee/worker in a RTW program.

Inclusive, supportive and personalized management is conducive to helping an employee with CMD undertake a SRTW.

  • Listen and offer support
  • Adopt a personalized approach to manage the productivity of individual employees/workers
  • Ensure there is efficient and effective communication with the employee/worker and his or her co-workers/colleagues during and after a RTW.
  • Assume responsibility for the return-to-work process. For example, participate in the development and implementation of an RTW plan, ensure it respects the employee’s/worker’s needs and capabilities, and actively contribute to conflict resolution
  • Allay the fears and concerns of an employee in a RTW program and his or her co-workers/colleagues

Non-professional context

The expertise of healthcare specialists, such as family doctors, psychiatrists and psychologists, can positively affect a SRTW.

Depending on overall circumstances, healthcare providers may determine the timing of a RTW.

Having positive relationships with healthcare specialists can be of benefit to a SRTW.

  • Based on available information, ensure the employee/worker receives appropriate follow-up care, including medical and/or professional support. For example, monitor the employee’s progress in terms of professional capabilities and propose alternatives programs, if improvement is needed
  • Regular communication with healthcare providers can favourable a RTW employee and his or her SRTW.
  • Establish and maintain solid relations with key healthcare providers

ORGANIZATION

Work environment

Internal policies and human resources management practices are critical to a RTW program for employees/workers with a CMD.

Organizations in which work is designed, structured and managed to facilitate a RTW are best positioned to ensure a SRTW.

Healthcare specialists with a solid understanding of CMD, such as family doctors, psychiatrists and psychologists, can provide critical internal resources (eg, advice, preventive measures).

  • Provide procedures that take into account adjusted career opportunities for returning employees/workers (eg, longer-term or lateral career progression). Instead of advancing to a managerial position, for example, a returning worker may develop skills to become an expert in his or her chosen field.
  • Implement measures such as flex time and part-time work or allow employees to work from home or remotely
  • Consider CMD issues and appropriate work practices in performance evaluation procedures
  • Train RTW employees/workers with a CMD and their co-workers/colleagues so they can structure work demands and recognize and manage CMD symptoms in the workplace.
    • Training can improve individual capabilities, such as self-efficiency and job crafting
  • Offer stress management training at work
  • RTW practices should recognize the individual capacities of employees with CMD and acknowledge that these capabilities will change over time (eg, allow a gradual return to work, if possible)

Non-professional context

Employees/workers with a CMD who have access to specialized and community-funded resources, such as charitable organizations, are more likely to have a SRTW.

  • Access information and advice from charitable organizations and use it to raise awareness about CMD among friends and colleagues.
  • Verify access to a 24/7 employee assistance hotline.

OVERALL CONTEXT

Work environment

Employees with a CMD who live and work in countries where cultural and socio-legal frameworks support or encourage organizations to implement RTW management policies and programs are more likely to have a SRTW.

Differences and disparities between countries must be considered at the legislative, political and insurance levels (eg, sick leave or critical illness benefits).

  • Employees/workers with CMD who reside in a country with generous social welfare benefits may not be overly concerned with a RTW, or the need to work and contribute to society. Attitudes such as these can prolong an absence from work and undermine a SRTW.
  • Return-to-work pressure may be strongest in a country with few social welfare benefits (eg, a lack of financial support). These factors may prompt a hasty return to work and undermine a SRTW.

Non-professional context

An organization whose managers/administrators are knowledgeable about CMD, and which offers appropriate support to employees/workers with CMD, is well positioned to implement a SRTW.

An employee’s financial commitments, such as a mortgage or rent, and family responsibilities, such as child or dependent care, can impact a SRTW.

  • A company or organization that facilitates open discussion about and has policies and programs in place to deal with CMD can reduce or diminish bias and prejudice about it. This makes it easier for employees/workers to seek help.
  • Mortgage or rent payments may incite an employee/worker with CMD to return to work. But an early return can lead to a relapse.

CLARIFICATION FROM OUR EXPERT

Develop and execute interdisciplinary and interjurisdictional strategies

Having knowledge of various stakeholder resources facilitates their strategic mobilization.

If a manager/administrator can assist an employee suffering from a CMD during a RTW program, the manager/ administrator can also:

  • Ensure co-workers/colleagues of a RTW employee/worker with a CMD have a solid understanding of his or her reality and of the RTW program in order to solicit their support for a SRTW
  • Assess mental workloads, and identify and implement accommodation measures that can facilitate a SRTW and serve as a pre-emptive tool for other CMDs
  • Consult with insurer to identify the resources available to the employee/worker during his or her absence from work and RTW.

 

To summarize, interdisciplinarity and follow-up measures undertaken during the absence from work and RTW maximize support for the employee/worker and best facilitate a SRTW.

 

Implement primary prevention measures

The impact on mental health of the psychosocial work environment is well documented. Some risk factors are linked to the development of CMD, such as:

  • high levels of psychological stress or pressure, eg, heavy workloads
  • low levels of awareness
  • the prevalence of harassment in the workplace.

 

If an intervention targeting these risk factors can prevent CMDs, then common mental disorders should be considered when managing a RTW in order to avoid a relapse and favour a SRTW.

RECOMMENDATION FROM OUR EXPERT

Develop a RTW policy and procedures

A workplace health and retention policy that supports employees/workers with clearly-defined, well-established and practical procedures provides a cohesive framework that reinforces organizational commitment to workplace well being.

Establishing and clearly defining RTW procedures:

  • fosters positive perceptions of organizational equity and fairness
  • explains individual employee’s/worker’s roles during a RTW
  • standardizes administrative practices for managing a RTW.

 

Equip managers/administrators with appropriate tools

Managers/administrators play an important role in supporting employees/workers during a RTW but are often poorly equipped and may have difficulty reconciling this role with their daily tasks (and high workloads).

Management support is essential:

  • to inform, assist and recognise managerial efforts in CMD prevention and RTW programs
  • to train managers so they develop the skills and acquire the understanding they need to assist and accommodate RTW employees/workers.

 

Four essentials activities for managers/administrators to ensure a SRTW:

  1. Communicate effectively with the employee/worker and all other stakeholders about the RTW
  2. Create and maintain a relationship of trust with the employee/worker and his or her co-workers/colleagues; implement conflict resolution management techniques, if necessary
  3. Identify and deploy RTW resources and procedures
  4. Monitor RTW progress, and that of the employee/worker, using specialized resources, such as ergonomy, as required.

 

Managers/administrators will be better prepared to:

  • inform and raise awareness among co-workers/colleagues about CMDs, the underlying symptoms and possible impacts on an employee’s/worker’s ability to perform and the overall return-to-work context
  • rigorously monitor RTW programs to ensure their sustainability (eg, openly discuss employees’ RTW preoccupations and resulting concerns and tensions, if any)

 

ATTENTION!

Workplace tensions or conflicts that began before an employee’s CMD-related absence may remain after he or she returns to work. In addition to CMD-related risk factors, it is necessary to take these tensions into account to facilitate a SRTW.

The redistribution of tasks during a RTW can generate dissatisfaction, worries and concerns among the returning employee’s co-workers and colleagues. It is important for managers to raise their awareness of return-to-work issues and involve them in RTW planning.

Complete document for the development of a recovery and return-to-work support and coaching approach targeting employees returning to work after a CMD-related absence from work:

Supporting a Return to Work after an Absence for a Mental Health Problem: Design, Implementation, and Evaluation of an Integrated Practices Program (Research Report: R-706).

To download a free copy of this document, click here

TO CITE THIS GLOBAL-WATCH SCIENTIFIC INTERPRETATION

Gouin, M.-M., Hébert, R., Charbonneau, J., Daneau, P. (2018). Sustainable return to work for individuals with common mental disorders: Building on available resources. Global-Watch Scientific Interpretation available at www.global-watch.com

TO CITE THE ORIGINAL ARTICLE BY THE AUTHORS OF THE STUDY

Nielsen, K., Yarker, J., Munir, F., & Bültmann, U. (2018). IGLOO: An integrated framework for sustainable return to work in workers with common mental disorders. Work & Stress, DOI: 10.1080/02678373.2018.1438536

Références

1. Definition used by Halbesleben, Neveu, Paustian-Underdahl and Westman (2014), p. 6.

2. Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44, 513–524.

3. Nielsen, K., Nielsen, M. B., Ogbonnaya, C., Känsälä, M., Saari, E. et Isaksson, K. (2017). Workplace resources to improve both employee well-being and performance: A systematic review and meta-analysis. Work & Stress, 31, 101–120.

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