Since being in work is good for people’s
health and wellbeing, then a key measure of the success of a
clinical intervention is whether a patient is able to return to
work, education or training. Regaining occupational function,
meaning that your patient is able to seek work, return to work
following sickness absence or to regain productivity at work should
therefore be an explicit goal in the patient’s care plan. If
regaining occupational function is an explicit goal, then this
provides a basis for useful discussions about the process of
starting or returning to work or education, the challenges that may
arise over time and the practical steps that can be taken to
overcome any barriers. It also allows progress to be
monitored and increases the chances of identifying when
interventions are not working and a new course of action can be
agreed.
How long should people with mental
health problems be off work?
It is difficult to predict how long a person
who develops a depressive or anxiety disorder should be off
work. We know that many people with these disorders make a
slow recovery, whilst for others they are transient. People
often quote a natural recovery rate of only 20% for depression and
5% for anxiety disorders and the majority of people need support to
achieve recovery from these common mental health problems.
Importantly, what we do know is that the longer a person is off
work, the less likely they are to return to work. For people
who are off sick from work owing to mental health problems for six
months the chances of them returning to work within two years is
small, with only about 10% achieving this. This is similar to
the rates of return for those who go off work owing to back
pain.
It is important that peoples mental health
problems receive early recognition and intervention. Two
things are important to remember:
- People do not have to be entirely symptom
free to remain in or return to work
successfully.
- It is not enough just to provide early and
effective treatment; efforts to assist the patient back to work
should be carried out at the same time.
For those people who develop mental health
problems whilst in work it is important to try and help them keep
their job. Clinicians working in primary care play a key role in
this and should, in addition to providing access to medication and
psychological therapies, work with the patient at an early stage on
a return to work plan. For those working in Secondary care it
is important to discover among new patients referred to the clinics
and community teams or admitted to inpatient units whether they are
in work and liaise with their GP and employers. They may also
need to be linked in to the local vocational scheme and given
appropriate benefits advice.
Many people with long term mental health
problems, particularly those with a diagnosis of psychosis, will
not be in work and may not have worked for many years, if
ever. These people can and do work, but may need greater
support to find them suitable employment. For these groups
there is ample evidence that well organised supported employment
schemes can be successful in helping them find jobs.
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Evidence for effective
schemes to support people into work
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