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Sheena Harrison

Return-to-work policies for workers with mental illness require sensitivity

August 17, 2014 - 6:00am



Return-to-work policies for employees with mental illness such as depression or anxiety should include flexible scheduling and communication with employees to understand accommodations they need while recovering from such conditions.

Experts say employers often make the mistake of not talking with employees about their mental health needs when they return from leave, which can make it difficult for employees to reintegrate into the workplace and perpetuate stigmas about mental illness.

“The employer should look at the employee individually on a case-by-case basis and not think about stereotypes or misconceptions” about mental health, said Melanie Whetzel, senior consultant for the cognitive neurological team at the Job Accommodation Network in Morgantown, West Virginia.

The network is part of the U.S. Department of Labor's Office of Disability Employment Policy.

Managers often are reluctant to discuss mental health concerns with employees because they are unsure of what to say or have mistaken beliefs about people with mental illness, Ms. Whetzel said.

Lack of communication or alienation of workers with mental health concerns can make it difficult for employees to talk with managers about their need for mental health treatment, time they may need for leave and strategies to help them get back to work when they are feeling better, she said.

“If the employer's more understanding and open ... then the employees are a little bit more open and willing to disclose” their mental health status, Ms. Whetzel said.

Fear about how managers and co-workers might react can cause some employees to stay away from work longer than recommended by their doctors, said Kristin Tugman, assistant vice president of health and productivity for Unum Group in Portland, Maine.

“When you think about the stigma that still exists from a mental health perspective, a lot of employees are just nervous about what are (their) co-workers going to think,” Ms. Tugman said.

Companies can take several steps to support employees coming back from leave after behavioral health treatment, experts say.

First, employers should provide flexible scheduling for employees who are returning to work. Similar to physical disabilities, an employee with behavioral health concerns may not feel ready to jump into their usual work routine as soon as they return from leave, said Terri L. Rhodes, San Diego-based executive director of the Disability Management Employer Coalition.

Such accommodations could include allowing an employee to work part-time temporarily and gradually increasing their hours, or allowing an employee to work from home temporarily if the office is overwhelming, sources say.

“You're allowing them to both physically and mentally get their stamina back around performing their regular work activities, and I think that has been more successful than just bringing somebody in cold turkey,” Ms. Rhodes said.

However, employers should not keep employees off the job if an employee and his or her doctor feel a worker is ready to return full-time, Ms. Whetzel said.

Having the employee stay home can prevent him or her from receiving support from work friends and colleagues, earning full income to pay medical bills, or having a daily structure and purpose — all of which are important to mental health recovery, Ms. Whetzel said.

While privacy concerns prevent employers from prying into an employer's health condition, managers can ask employees how to accommodate mental health concerns that employees or their doctors identify.

“Open communication is very important,” Ms. Whetzel said. “The employee's likely to know what their disability is, understand what their limitations are and know what would work best for them in terms of accommodations that would be effective.”

Communication has played an important role in Hennepin County, Minnesota, where the county government implemented a behavioral health return-to-work program in 2009 that reduced disability leave times for the county's nearly 8,000 employees

The program has included having an on-site case manager working with employees who are having mental health problems to help them get treatment and ease them back into the workplace.

“We wanted to make sure that if somebody was having problems with their kids or their spouse ... or they were dealing with other kinds of stressors, that we didn't have to call it clinical depression. It's just (that) you're having difficulties in a part of your life,” said Jim Ramnaraine, coordinator for the county's Americans with Disabilities Act administration program, on how the county worked to reduce stigmas about mental illness through its program.

Companies should train managers so they appropriately assist employees who are dealing with mental health concerns, Ms. Rhodes said.

“Once supervisors and managers understand or have the tools that they need to help somebody, then the return to work can be more successful,” she said.

It also can be helpful to prepare employees for ways to respond to well-meaning co-workers who are curious about their absence — a scenario that can be stressful for workers who don't want to reveal a mental illness, Ms. Tugman said.

“You might say something like, "I was out under a doctor's care. I'm doing much better now. Thanks for asking,'” Ms. Tugman said. “Just arming somebody with that level of preparation might get them over the hump and willing to actually try that return to work.”

But employers should not imply that an employee has a mental illness if the employee has not confirmed that information with them, Ms. Batiste said.

If a worker is exhibiting signs of trouble but won't discuss whether they have a condition, she said employers can address the issue in terms of whether the worker is exhibiting performance problems.

For instance, a supervisor could say, “We've noticed this about your performance (and) we need it to improve. How can we help you?” Ms. Batiste said.

“If they address it that way, it gives the employee a chance to say, "Well, I've been having some problems with depression and I'm having difficulty concentrating,'” she said.

Employers also should remain in touch with employees who are out on leave for mental illness or other concerns, Ms. Tugman said. While such discussions should avoid pressuring the person to come back to work, showing an interest in their recovery can provide motivation for the worker to get better.

“It's not about diagnosis; it's really just about showing concern,” Ms. Tugman said of reaching out, which includes sending a card or making a brief phone call. “If an employer can ensure that they maintain that connection with the employee, you're much more likely to have that employee feel willing to attempt to return.”

 



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