Recovery at work support tools - Rapid Review

By Shannon Gray, Rachel Osborne, Michael Di Donato and Alex Collie.

Executive summary

This rapid review identified a large number of available tools that may be used to support recovery at work and return to work for those at risk of or suffering mental distress. It summarises each tools’ availability, complexity, target audience, the type of mental distress targeted and the stage of mental distress at which the tool provides support. It also provides a high-level description of the format and objective of the tool.

Tools varied in their target audience; however, the majority were targeted to multiple users or employers. There were 11 resources developed for multiple users, including the individual, employer, general practitioner, other healthcare provider, colleague, union/worker representative and insurer/case manager. Fifteen tools were targeted specifically to the employer, including managers, supervisors, human resources, occupational health and safety leaders, and return to work coordinators, among others. Two of these targeted small business owners. Only one tool was identified specifically for healthcare providers (general practitioners). There were two targeted to the individual, and another two with guidelines for case managers.

Only a small number of tools had been evaluated, however were generally found to have a positive impact on the individual and employer. Furthermore, many resources included links to additional resources, with the most commonly linked being HeadsUp and returntowork.net.au resources. Key themes identified throughout a large number of the tools to enable recovery at work or return to work included the following:

• Reduce the stigma surrounding mental health in the workplace
• Develop a mental health policy for the workplace and maintain support and resources for individuals potentially experiencing mental distress
• Recognise the early warning signs of mental distress
• Address the causes of any mental distress (where possible)
• Work collaboratively with the individual, employer, healthcare provider and case manager (where applicable) to support recovery at work or return to work
• Stay connected when an individual is absent and maintain communication once back at work
• When planning recovery at work or return to work, take the following into consideration:
  • Flexible working arrangements
  • Workplace modifications
  • Review job expectations
  • Set realistic goals and list duties/tasks
  • Barriers and facilitators to return to work
  • Maintain confidentiality and trust

Overview

Background

The World Health Organisation defines mental health as a “state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community”.  It is fundamental to exhibit mental health in order to think, emote, interact with each other, earn a living and enjoy life. Thus, the promotion of mental health is of vital concern to individuals, communities and society. Common mental illnesses include anxiety disorders, depression, bipolar affective disorder, post-traumatic stress disorder, schizophrenia, and dementia, among others. Mental illness may significantly interfere with an individual’s cognitive, emotional or social abilities.  However the impact of such mental distress is not limited to the individual, with depression and anxiety disorders estimated to cost the global economy US$1 trillion per year due to lost productivity.

There is a strong relationship between good work and good physical and mental health, with engagement in work an important determinant of health. Previous literature has demonstrated this to be a two-way relationship, with a negative working environment or unemployment potentially leading to physical and mental health problems. There is substantial evidence that returning to work or remaining at work during recovery following injury or illness is an important component of rehabilitation, and is an important marker of functional recovery.

Increasingly, employers are considered to have a responsibility to create a mentally healthy workplace, which is open to individuals’ needs, and is one where employees are happy to attend and feel supported by their manager and peers. Furthermore in Australia, employers have legal obligations to support individuals suffering mental distress to either continue work or return to work³. While the role of employers is critical, there are also ways in which those suffering mental distress may be managed, such as by general practitioners or insurance case managers, to encourage and facilitate return to work or recovery at work.

Rationale

The State Insurance Regulatory Authority (SIRA) in New South Wales (NSW) has prioritised initiatives relating to guiding and supporting mental health and wellness, and is a funding partner in the NSW Governments’ Mentally Healthy Workplaces (MHW) strategy 2018 – 22. SIRA is the lead on the recovery at work stream within the strategy. Following feedback from stakeholders, SIRA has prioritised  work focussed on providing individuals and employers with practical, easy to use recovery at work tools.To support SIRA’s work a rapid review of the literature and existing Recovery at Work tools and frameworks was requested from the Insurance Work and Health Group at Monash University. SIRA requested that the tools and frameworks included in the review provide information on (1) secondary prevention, that is identifying individuals experiencing early signs of mental distress and supporting them to remain at work whilst recovering, and (2) tertiary prevention, which aims to reduce the impact of the mental illness by supporting return to work.

Objectives

The aim of this rapid review was to identify existing tools and frameworks that are designed to support people keeping in touch with the workplace when absent from work and experiencing mental distress, or encourage and enable recovery at work and return to work by those experiencing mental distress. The scope specifically includes tools and frameworks that may be used without need for further refinement. Furthermore, where available this review sought to describe the effectiveness of these tools and frameworks, with respect to duration of work disability, compensation and healthcare costs, or quality of life, noting that it is beyond the scope of this review to formally evaluate effectiveness.

Specifically, we sought to find tools and frameworks that assisted:

• Individuals to actively engage in recovery at work or return to work when recovering from or symptomatic of mental distress
• Employers to manage recovery at work or return to work for individuals who are experiencing mental distress
• Service providers in their role in working with individuals recovering from or symptomatic of mental distress to stay at work or return to work

Note: Except when referring to a specific mental illness, we have used the term ‘mental distress’ throughout the review to capture all types of mental health issues, including but not limited to: stress, depression, anxiety, symptoms of depression or anxiety, post-traumatic stress disorder, adjustment disorder, bipolar disorder and schizophrenia.

Method

We conducted a rapid literature review of both local and international academic and grey literature for tools, frameworks, and clinical practice guidelines designed to support recovery at work and return to work for those with symptomatic mental distress, or recovering from mental distress. For the purposes of this review, a tool was considered as anything that could be used by the target user to assist or guide recovery at work or return to work of individuals at risk of or suffering mental distress. Note also that a tool may be within a more extensive document. As the focus was on usable, end-user tools, clinical or pharmacological interventions were not included. As a rapid review, the search process was not exhaustive. Rather, academic and grey literature searches were targeted based on the review objectives.

Search strategy

We searched for grey literature using the internet search engine Google, and within webpages or existing tools for links to other tools or frameworks. We supplemented this search with a targeted literature search in the academic database, PubMed. The academic search sought descriptions and evaluations of existing tools. Keywords used for both grey and academic literature searches can be found in Appendix 1.

Data extraction

Feedback gathered by SIRA indicated a need to source tools and frameworks that were end-user friendly, in that they were easily accessible, easy to understand and implement, and required minimal time commitment.   Each tool was therefore assessed for its accessibility, complexity, and language used. These ratings were formulated based on judgements of the research team and not a scientific method for determining which rating each tool was given, but was arrived at by the consensus of two authors. Criteria for these assessments are described below in tables 1 through 3. Information from identified tools was extracted as per the below categories and transcribed into data extraction tables (Appendices 2 and 3), with each tool presented individually. These data were then summarised into results by the end user(s) and by whether they had been evaluated. Note that access to the tools that were evaluated (found in academic literature) was not possible and hence, these tools could not be rated, therefore, comments were provided under each heading.

Target

Type of mental distress

In some instances, the type of advice provided in the tools was specific to particular mental illnesses. Therefore, we have described whether each tool was designed to be applied to any type of mental distress, or whether the tool was developed with particular mental illnesses in mind.

target audiences

Each tool provided varying types of information and tips, depending on the target audience. Therefore, we found it important to highlight whether the target audience included multiple parties (e.g. employer and individual) or whether it was targeted to a particular stakeholder (e.g. employer). The classifications included employer, individual, general practitioner, other healthcare provider, insurer/case manager, small business owner(s), colleague, and union/worker representative.

NOTE: In the context of this review, ‘employer’ refers to supervisors, managers, return to work coordinators, human resource professionals and occupational health and safety professionals, or specific roles within an organisation, such as the individual’s supervisor.

Description

The description component of Appendices 2 and 3 gives a high-level overview of the format in which the tool is presented, important features that it contains, and its objective.

Return to work assistance

The return to work assistance column (‘RTW’) in Appendix 2 provides a binary yes/no response as to whether the tool provides tips or templates for how to discuss and plan for the individual’s recovery at or return to work.

Stage of mental distress

The stage of mental distress (‘Stage’) component of Appendices 2 and 3 gives an indication of what stage of mental distress the tool targets. For example, whether the tool targets prevention of mental distress, management of mental distress, return to work support for those off work due to mental distress, or a combination of these.

Accessibility

We characterised the accessibility of the tools into three distinct groups. The ratings varied based on the ease of access and whether personal or organisational information was required for access or whether there was a cost or significant time commitment to use the tool (e.g. by attending workshops). Table 1 provides an overview of ratings.

Table 1: Description of accessibility ratings

Complexity

To describe the complexity of the tool we used a rating system whereby tools were classified as concise and straightforward, or whether there was a moderate or extensive time required to read it, view it, be involved in it, or a combination. See table 2 for rating classifications.

Table 2: Description of complexity ratings

Language

Table 3: Description of language ratings

Research findings

The tools and frameworks identified were most commonly web-based or accessed online. A summary of findings is presented below. Further details on each tool are provided in Appendix 2. We categorised tools by type of user and by whether they had been evaluated.

Multi-user tools

Eleven tools provided information to multiple end-users. Most were readily accessible with no sign up or cost involved, with all of these providing downloadable, printable resources. One resource that sought to provide workplaces with tools to prevent mental distress and tools to manage individuals with mental distress, however, involved interactive workshops at a cost.

Individual

There were only two tools identified that specifically catered to the individual with mental distress. These were both easily accessible and easily understood, concise tools, however the toolkit from the Black Dog Institute required provision of personal and organisational details.

Employer

The majority of tools were targeted at employers (n=15). These tools varied in their accessibility and complexity; however most tools provided online or downloadable fact sheets or brochures. Some organisations provided resources that involved videos, templates, case studies, training sessions and workshops. All tools were designed to support recovery at work or return to work, while also supporting an inclusive and supportive work environment that promoted good mental health.

Two of these resources were targeted to small business owners. These tools, which were both readily accessible and straightforward, support small business owners to identify potential stressors, manage their own mental health and assist in planning stay at/return to work.

Service provider

Healthcare provider

Only one relevant resource was found for healthcare providers. This was specific to general practitioners treating individuals who were suffering a work-related mental health condition. This is conveniently presented in three formats: a detailed clinical guideline; a summarised clinical guideline and; a two-page fact sheet.

Case manager

Two related resources for insurers and case managers describe eight key action areas recommended to be implemented to ensure best practice in psychological claims management. The original, developed by SuperFriend, is applicable to all types of insurance claim. The other, a collaboration between SuperFriend and SafeWork Australia, has been tailored to Australian workers’ compensation systems.

Evaluated tools

We were not able to identify any formal evaluations of the tools and frameworks identified in the grey literature. This is not to say that evaluations of these tools do not exist, it is also possible that evaluations have not been made publically available and thus could not be identified during our search.

However, the academic literature searching did identify evaluations of some tools that appeared to be within scope. The first was an E-Health module titled Return@Work, which was implemented at a cost to employers in the Netherlands for workers suffering common mental disorders such as depression, anxiety, and somatization disorders. There were positive outcomes with respect to a return on investment, faster return to work, and improvement in the rate of remission of symptoms among those that used the tool compared to the control group. However, the tool itself could not be located.

The second targeted construction workers at risk of suicide, with a validation study finding the tool helped improve suicide and mental health awareness, help-seeking behaviours, and treatment engagement. An overview of the MATES in Construction program is available online, however full details requires attendance at training sessions. This tool is currently only available in Queensland, however; the training is now being trialled in other industries, such as MATES in mining.

The third was an intervention taught to primary care providers (e.g. general practitioners) to support workers with stress-related mental disorder or adjustment disorder to reduce sick leave and reduce chronicity of symptoms. Attendance at training sessions was required, and the tool was not able to show an improvement in sickness absence.

The fourth was a web-based decision-aid tool (READY) to help working Australians decide if they should disclose their mental health condition at work^.. Those in the intervention group had access to the tool for 2 weeks and followed up with twice, with positive impacts on mental health.

Common themes

A number of methods of management or support were consistent across the majority of the tools, regardless of the target audience. Additionally, many tools included links to further resources, with the most commonly linked being HeadsUp and returntowork.net.au resources. Table 4 provides an overview of common themes that were evident throughout the literature.

Table 4: Common methods of management or support

Limitations

Whilst every effort was made to search comprehensively, given the short timeframe, it is possible that some relevant material may not be included. This is not an exhaustive list of every available tool, framework or guideline available for the individual, the employer or service providers to support the recovery at or return to work of those experiencing mental distress, rather an overview of those available. Furthermore, evaluations for online resources could not be found, either due to them not having been evaluated, the evaluations not being made public, or the evaluations not showing up during the literature search.

Conclusion

This rapid review identified a large number of available resources to support different stakeholders to manage and support individuals suffering from mental distress to stay at work whilst recovering or return to work after a period of absence. Tools varied in their target audience, however the majority were targeted to the employer or to multiple parties. Very few of the online and downloadable tools, found through grey literature searching, were found to have been evaluated. However, a small number of tools had been evaluated and in general were found to positively affect the individual and employer. Many tools included links to further resources, with the most commonly linked being HeadsUp and returntowork.net.au resources. When all tools were considered there were a number of common themes and components.

Harvey et al (2014) noted that there is often a disconnect between mentally healthy workplaces as defined in academic literature, and the reality of what occurs in workplaces. Furthermore, evidence-informed strategies to assist workplaces to enhance their employees’ mental health and wellbeing are limited. This review has highlighted that whilst there are numerous resources available to support recovery at or return to work for individuals suffering mental distress, for a number of different end users, their effectiveness cannot be determined as they have not been evaluated. However, the consensus for a mentally healthy workplace uses a five-point overarching framework that is evident throughout the common themes identified across this review. These are to 1) design work to minimise harm; 2) build organisational resilience through good management; 3) enhance personal resilience; 4) promote and facilitate early help-seeking; and 5) support recovery and return to work. It is necessary, in future, to evaluate the identified tools to demonstrate their effectiveness.

Appendices

Appendix 1: Search strategies

Academic literature

[title] “mental” OR “mental distress” OR “mental disorder” OR “depression” OR “anxiety” OR “stress” OR “post-traumatic stress”

AND

[title/abstract] “recovery at work” OR “return to work” OR “stay at work” OR “reduce work absence”

AND

[title/abstract] “tool” OR “framework” OR “program” OR “programme” OR “intervention” OR “support” OR “plan” OR “template”

Grey literature

“mental” OR “mental health” OR “depression” OR “anxiety” OR “stress” OR “post-traumatic” OR “PTSD”

AND

“recovery at work” OR “return to work” OR “stay at work” OR “work absence”

AND

“tool” OR “framework” OR “intervention” OR “plan” OR “program” OR “support” OR “support tool”

Appendix 2: Grey literature