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I have been watching this thread with great interest. I am an RMN studying for OH Degree and my day to day role is to case manage the RTW of those who have had or still have mental ill health (depression, anxiety, bi-polar etc.,) The company I work for, specialise in mental health rehabilitation - providing treatment of CBT (from accredited therapists) plus rehabilitation from staff like myself. We are unique in the private sector with our service and are setting the bench mark for similar services. Our experience is that a RTW after mental illness works best when the reintegration programme is between 8 - 12 weeks duration. This is because the first 3-4 weeks is spent regaining self esteem, confidence and learning to trust. Plus these initial few weeks enable any residual cognitive distortion to arise and be addressed by the therapist who continues to support the RTW until the individual is working over 16 hours per week (or longer as required) The biggest problem we have by far is adjusting the mindset of the employers, traditional 4 week RTW plan. We can readily evidence the relapse when this type of plan is put in place, thus undoing all the effort of the individual in treatment and causing the revolving door syndrome. When the RTW plan fails - the patient is harder to pick up again due to loss of faith in themselves and their workplace. We advise that during the first 3 -4 weeks, retraining and reconnection with the business occurs, then responsible duties are gradually reintroduced. Our patients usually need planned exposure to the workplace prior to any discussion about RTW programmes. i.e. visiting the HR or OH for coffee/chat is very helpful in dispelling anxiety and maintaining or remaking the connection with work. There are still employers out there that do not encourage this! Another problem we have, is the employer not wanting the employee back unless 100% fit. This takes up a lot of our time as we explain that without the exposure to the working environment, full recovery is unlikely to occur and so a graded return to work is needed, despite some residual symptoms. Most recently the issue of liability insurance is being raised as a barrier to any RTW and my initial research indicates that this is an actual barrier and needs the GP/OHP and employer/insurer to work together to sort it out. 12 weeks sounds like a long time, but most of our patients are doing over 20 hours of valued work by week 6-8 and the last few weeks are monitored for sustained stability as hours increase to full time or maximum ability. We try to persuade employers to wait until this point before adjusting contracts of employment. This is in line with DDA, that a reasonable RTW programme should be provided. As we understand it, it is not reasonable to adjust someone's contract of employment during a RTW or after only a brief period. Our success rate of RTW is over 60% (2006 stats) and this is on cases of absence duration of over 6 months - many of several years and several of recurrent absences - all of which have remained employed during their absence. I would be interested in hearing feedback from others in the list; we want to raise the profile of mental ill health and RTW and can only do this with the support other professionals. Thanks for listening Chris -----Original Message----- From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Jean Greening-Jackson (Occupational Health) Sent: 13 February 2008 14:24 To: [log in to unmask] Subject: Re: [OCC-HEALTH] rehabilitation programmes I was interested in knowing what others did myself, especially those who plan returns for each individual. We couldn't do that on such a large number of employees, but I do sometimes work on a rehab programme PRIOR to a phased return. Our four week plan is employer/union agreed, and paid at full pay throughout, hence it's time limit. I will continue to watch this thread. As ever, I learn a great deal from others! -----Original Message----- From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Wayne Llewellyn Sent: 13 February 2008 10:06 To: [log in to unmask] Subject: Re: [OCC-HEALTH] rehabilitation programmes Ms Livock, How the devil are you? I hope the new post is treating you well. Jeans' phased rtw guidelines are an excellent general model and obviously based on research regarding chronic type conditions. The physiological background is that chronics tend to have energy system breakdown due to central changes (ie. In the brain). So, even if the injury itself has recovered pathologically there will be a graded short burst return to activity required. This involves not only the work itself but the days proceedings. These include the whole work day procedure as alluded to in jeans' attachment. One thing that we often do is change the start-time to avoid rush hour which often proves to reduce unnecessary trauma at the outset. I don't have any up-to-date research on this but will have a search to see what's out there. Regards, Wayne Llewellyn Clinical Director Premier Therapy, 6-9 Timber Street, London, EC1Y 0TQ t: 020 7687 7600 e: [log in to unmask] w: www.premiertherapy.co.uk Please don't print this e-mail unless you really need to. "This message and any attachments are solely for the intended recipient and may contain confidential or privileged information. If you are not the intended recipient, any disclosure, copying, use, or distribution of the information included in this message and any attachments is prohibited. If you have received this communication in error, please notify us by reply e-mail and immediately and permanently delete this message and any attachments. Thank you" Premier Health & Sport Therapy Limited. Registered in England no. 3376266. Registered Office: 6-9 Timber Street, London EC1Y 0TQ. -----Original Message----- From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Jacqui Livock Sent: 12 February 2008 15:57 To: [log in to unmask] Subject: [OCC-HEALTH] rehabilitation programmes Hi I am canvessing opinions and looking at what others do in relation to phased return to work (RTW) programmes and also if there is any research as to the "most successful" programmes. I know this will vary from OHN to OHN. I know RTW programmes are tailored to the individual and the organisation (and managers decide work hours) but my question is this.... Do you recommend people return on reduced hours EVERY DAY and build the hours at work each week or do you recommend A DAY ON/A DAY OFF type of programme. If you have tried both...which did you prefer/which did the employee/employer prefer? which was the most successful? Jacqui ~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~ Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html FORTHCOMING CONFERENCES AND EDUCATIONAL EVENTS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH OCCUPATIONAL HEALTH JOBS http://OHJobs.drmaze.net OCCUPATIONAL HEALTH NURSING EDUCATION http://www.aohne.org.uk ~~~~~~~~~~~~~~~ Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html FORTHCOMING CONFERENCES AND EDUCATIONAL EVENTS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH OCCUPATIONAL HEALTH JOBS http://OHJobs.drmaze.net OCCUPATIONAL HEALTH NURSING EDUCATION http://www.aohne.org.uk