Originally published in OOHNA Xpress on January 22, 2018
Work is a health promoting behavior. This is especially true for individuals experiencing mental health challenges.
How so? Work offers structure, routine, a sense of identity and purpose, social contact, financial security among other benefits that not even the best medical treatment program can provide. Early and safe Return to Work planning is critical to the recovery process, and the prevention of prolonged disability. Unfortunately, staying at work/returning to work is rarely prioritized as a treatment goal from the onset of illness.
The longer an individual is away from the workplace, the lower the chances of returning to work. That is why returning to work must be prioritized as a treatment goal from the beginning. Time and focus is of the essence.
Working to be healthy
Employers are increasingly aware of the importance of supporting employee mental health as a social and business imperative. Increased awareness of the issues and prevention efforts such as wellness programs and EFAP offerings are common. Despite the best efforts of the most conscientious employers, increasing numbers of individual employees are experiencing episodes of mental illness. And when this happens, many employers offer support, resources and benefits to assist the employee in the recovery of their health.
When it comes to issues like stress, anxiety and depression, that usually means treatment with a mental health care professional. And, traditionally, clinicians focus on symptom reduction – after all, they also want clients to feel better as fast as possible. Well-meaning clinicians often assume that clients need to feel significantly better before they can even approach the idea of return to work. The assumption is often that clients need to “get their life back” before they can approach return to work.
But, what if treatment as usual could actually make things worse?
Traditional therapy often fails to factor in how workplace realities impact the clinical picture. It can overlook the importance of focusing on context-specific intervention strategies as a means to restoring function, building resiliency and sustaining gains when individuals return to the stresses of work.
In the absence of work-focused interventions throughout treatment, clients may begin to feel better… right up to the moment when return to work is tabled. Then, familiar and new symptoms can arise – often with increased intensity. This exacerbation of symptoms in response to return to work discussions can make clients feel like they have taken one step forward and two steps back. Clients and clinicians alike can be convinced that more time away from work is needed.
If the anticipatory anxiety of return to work is not normalized and addressed from the start of treatment, it may solidify any negative associations clients have about their mental wellbeing and being back at work.
We never want to create a scenario in which work is seen as a barrier to wellness. (“I’ll be fine if as long as I don’t have to be at work!”) Work is a health-promoting behavior we aim to resume in order to support full recovery.
Finding treatment solutions
Common mental health conditions such as anxiety and depression are both chronic and episodic. Most often, people can continue to manage symptoms and function at work with varying degrees of difficulty. Right up until they can’t.
So, what is it that enables an individual with a mental health condition to face the prospect of work on a Wednesday but not the following Friday? What is it that turned a manageable disorder into a disability? An effective treatment plan has to assess and address the symptoms as well as the context in which they occur. After all, if workplace factors precipitated disability, left unaddressed they’ll very likely do it again.
This isn’t to suggest that it takes a toxic work environment to lead to symptom exacerbation or disability. An employee with social anxiety, for example, typically fears being evaluated. This can make them very vulnerable and prone to having a difficult time managing symptoms when it comes to performance appraisal time.
So, what if instead of strictly placing the focus on reducing their anxiety, they were taught to recognize the importance of preparation – with strategies such as “coaching up” and providing your manager with some ways in which you would like to receive feedback. (For example, sandwiching critical feedback with positive feedback.)
Really, therapy conducted outside the context of work is as likely to result in a successful return to work as passing your driver’s test without ever having got behind the wheel of a car.
Evidence-based CBT interventions, such as BEACON, must be tailored to the needs and circumstances of the individual in the context of home and work realities. It aims to support the integration of existing workplace resources and employer expertise to support timely, safe and sustainable return to work.
Because the best outcome is a healthy, thriving team that feels like they can tackle any challenges that come their way.