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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

Regaining occupational function: a vital measure of clinical success


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:

  1. People do not have to be entirely symptom free to remain in or return to work successfully.
  2. 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

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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