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
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-----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
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