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

Developing and putting in place ‘reasonable adjustments’

GPs have an important role in ensuring people with mental ill health have the appropriate working conditions.

GPs are a trusted source of advice for patients and also for employers. They therefore play an important role in ensuring that the right changes are made to working conditions to enable employees to continue to be in work and reduce the chances of an employee having to be absent from work due to sickness.

The Equality Act 2010 replaces the Disability Discrimination Act 1995 and 2005, and began to be implemented from October 2010. It means that employers and service providers have to make reasonable changes to ensure that people with a disability are not disadvantaged substantially compared with non-disabled people.

The types of ‘reasonable adjustment’ that can support people with mental health problems stay productive at work are changes that are relatively easy and inexpensive to put in place with some thought and preparation. It is also worth reminding your patients that many people without a disability or without a mental health problem need to make changes to their work patterns and conditions. Some people need more flexible working conditions because they have caring responsibilities, others with long term or fluctuating health conditions also need to make changes to the way they work.

A key theme running through Realising Ambitions, the Perkins review of employment support, in the testimonies of users of mental health services is the importance of support from members of the community mental health team. These professionals can help build self-esteem and confidence and help to reinforce the message that it may take time to find the right adjustments and for these to make a difference. You may want to review the reasonable adjustment agreement after a set time to see if further changes need to be made. You might also have to help your patient, and the employer, to be persistent and tenacious in finding and making the changes that make the positive difference.

Access to Work is a valuable, but underused, Department for Work and Pensions (DWP) scheme designed to financially assist employers with costs beyond that of reasonable adjustments, helping to produce a more efficient support system in the workplace.

Some suggestions for ‘reasonable adjustments’ are:

  • Allowing a person who found that the stress of a formal interview exacerbated his mental health condition to, instead, work (unpaid) to assess his suitability for the job.
  • Allowing a person who had difficulty travelling in crowded trains to start early and finish early in order to avoid the rush hour.
  • Relieving an administrator of the expectation that he relieve the receptionist during her lunch break because he found this contact with the public aggravated his mental health condition.
  • Changing usual shift patterns to allow a longer period of night shifts (rather than the usual one week) because changing the schedule of his medication in the transfer from day to night shifts was problematic.
  • Arranging for someone who became very drowsy after her monthly medication to take a day off and make up the hours elsewhere.
  • Appointing a ‘buddy’ or ‘mentor’ – someone on a similar grade and outside the usual management structure – to show the new employee the ropes and help them settle in to the workplace.
  • Enabling a person to arrange their hours to permit them to attend a weekly therapy session.
  • Permitting someone to take ten minutes out of the office when he became particularly anxious
  • Ensuring that a manager who found the pressure of large meetings very difficult, arrange her diary so that she had at least 15 minutes between meetings.
  • Providing written instructions for someone who was very anxious about forgetting to do things that were expected of him.
  • Gradual return to work after periods of sickness absence.
  • The possibility of working from home, reduction in hours or relief from some responsibilities to prevent the person having to take time off sick during fluctuations in their condition.
  • Allowing someone who became particularly paranoid at times to call a friend/support worker for support and reassurance.
  • Arranging for someone who found the distractions of an open-plan office detracted from her work performance to have her desk in a quieter area.
  • Enabling a person to arrange their annual leave to allow regularly spaced breaks throughout the year.
  • Creating the possibility of part-time working and job-share arrangements for someone who was unable to work full time.

Links to resources:


This section of the website explains the term ‘reasonable adjustment’ and includes links to specific guides for line managers which may be useful when working with employers. This page on the website includes the link to the publication ‘We can work it out’. This is a line manager’s guide to reasonable adjustments for mental illness.

This is the link to the Cabinet Office publication called ‘Small change, big difference’ which was produced with Rethink.

This guide is for employees and includes examples of adjustments that Rethink has identified from its work based on experiences of people with a mental health condition.

What’s reasonable?

Mental illness and disability law in your GP practice

This guide was produced by Rethink and the Royal College of General Practitioners and looks at what ‘reasonable adjustments’ can be made in GP surgeries.


This is an initiative to tackle stigma and discrimination surrounding mental health issues in England. The campaign aims to create a society where people who experience mental health problems enjoy the same rights and opportunities as other people. The website has links specifically for employers. The line manager’s resource is a practical guide to managing and supporting people with mental health problems in the workplace.

Examples of reasonable adjustments’. This part of the website includes useful examples of changes to work and work patterns.

Employers’ Forum on Disability

Employers' Forum on Disability is an employers' organisation focused on disability as it affects business. The forum includes employers from multinational corporations, Small and Medium sized Enterprises and the public sector.

‘Non-visible disabilities line manager guide’ includes extensive examples of ‘reasonable adjustments’.

This 'Tailored adjustment agreement' template is intended to be a living record of reasonable adjustments agreed between a disabled employee and their line manager.

The purpose of this agreement is to:

  • Ensure that both parties, the individual and the employer, have an accurate record of what has been agreed.
  • Minimise the need to re-negotiate reasonable adjustments every time the employee changes jobs, is re-located or assigned a new manager within the organisation.
  • Provide employees and their line managers with the basis for discussions about reasonable adjustments at future meetings.

This is a live document and should be reviewed regularly by both the employee and manager and amended as appropriate.

Realising ambitions: Better employment support for people with a mental health condition

Rachel Perkins, Paul Farmer and Paul Litchfield

Department for Work and Pensions, December 2009

This review was commissioned by the Secretary of State for Work and Pensions to look at mental health and employment and to identify how Government could help people with mental health conditions fulfil their employment ambitions. Chapter 4 includes examples of ‘reasonable adjustments’ that have enabled people with a mental health condition to prosper at work.


This booklet ‘Flexible working and work-life balance’ includes examples of flexible working such as term time working, job shares and changes to shift and rota patterns. It includes advice for employees on how to apply for flexible working. The booklet includes examples of flexible working from situations such as returning to work after maternity leave which might be useful in discussions with your employees, especially where you or they have limited experience or knowledge of mental ill-health.


The Mental health in the workplace: an employer's guide’ includes a section on supporting employees to stay in the workplace.

The Staying in employment’ booklet by Alison Cobb and Kaaren Cruse is written primarily for people who experience mental distress, or are living with a mental health diagnosis. It includes sections on making changes to the workplace such as the work environment or working practice. It also includes information and advice on getting support for putting the adjustments needed in place which may be useful for employers when discussing and agreeing reasonable adjustments with your patients and also with employers.

Chartered institute of Personnel and Development (CIPD)

Stress and mental health at work factsheet, September 2010

This comprehensive factsheet also includes a short section on adjustments at work.

Work Life

The health conditions part of the website includes a link to an American publication called ‘Working with MS’. This includes tips and techniques for developing adjustments or accommodations or different job duties. There is a five point plan to help identify the tasks and activities that your patient can do and those which s/he may experience difficulties with and how best to negotiate for the adjustments needed.

National Access to Work Team, Jobcentre Plus
DWP scheme designed to financially assist employers with costs beyond that of reasonable adjustments.

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