Thesis Critical factors in the return-to-work process. Perspectives of individuals with mental health problems, vocational rehabilitation professionals and employers, is authored by occupational therapist Susann Porter, who is currently taking a doctorate in the subject of health sciences, specialising in mental health. Her thesis is based on studies conducted of people with mental health problems, professionals working in vocational rehabilitation and employers.
Two of the studies are based on the same original study, in which 61 persons participated. The participants were diagnosed with either depression or bipolar disorder and were on sick leave and unemployed. They were randomly divided into two different groups assigned different types of initiatives. About half underwent the traditional phased method where the individual is initially treated for their symptoms and then assessed and trained to develop the ability for work in different phases, often involving different forms of subsidised work. The other half of the group was allowed to participate in a recently developed method, Individual Enabling and Support (IES), specially formulated for people with depression and involving e.g. motivational, cognitive and time-use strategies to suit the target group. The method implies that an occupational specialist works in an alliance with the participant, all based on the individual’s own wishes in terms of the objective of regular work. The intervention integrates care and treatment with seeking employment. The person does not need to be symptom-free, and the focus is on interests, former experience and the willingness to work. The support is not time-limited and continues once the participant has been employed. It also covers the employer.
The study lasted 12 months, during which time the participants were subject to the two different initiatives. All the participants, including those in the IES group, had experience of phased rehabilitation, but this was before the study started. Of the 61 participants who were included in the study, 16 participants were interviewed after receiving the interventions for 12 months, eight from each group.
Feeling of hope and power during rehabilitation
“Their experience was clear and unanimous. Several factors proved crucial for a successful return to work. Having the feeling of hope and power during rehabilitation. The professionals' attitude, that they were positive and believed that the individual could return to proper work, that they focused on the individual and combined health and care services with work-oriented initiatives. These critical factors were part of the IES method, but were mainly lacking in the phased rehabilitation, where the participants often described the opposite experience,” says Susann Porter.
The negative experiences of the participants with the phased rehabilitation were reinforced after interviews conducted with various professionals working in vocational rehabilitation (22 professionals).
“They confirm the experiences of the individuals, that they themselves lack sufficient knowledge of mental illness and that there are gaps in the collaboration between the individual, the professionals and the employers with the phased rehabilitation. People claim that they believe individuals with mental health problem are capable of working, but in almost all cases, they mean subsidised work. Such claims can send conflicting signals to the actual individual and even to employers,” says Susann Porter.
Shortcomings with phased rehabilitation
The shortcomings with phased rehabilitation also emerged after interviews of 24 employers. The results show that employers want to support their workers but lack knowledge of mental illness and need support from other professions when workers suffer mental health problems, support they request but which is often lacking with the traditional method.
“The different sections of the thesis support each other, which is encouraging. Although we need more studies of IES, the results in my thesis are clear. The factors experienced as critical by the individual participants for returning to work are lacking in major parts of the phased rehabilitation, where the focus is on reductions, limitations and subsidised work. To ask people with mental health problems to believe in their own ability to work when the professionals – by focusing on reductions and using subsidised work – send signals that they do not have this belief is asking too much. This has to change,” continues Susann Porter.
Susann Porter questions why this is often the case for persons with mental health problems trying to return to work. Why is this phased rehabilitation used so diligently, instead of methods such as IES that can demonstrate much better results?
“Perhaps the decision-makers themselves lack knowledge of mental illness and therefore don’t know what is required to help individuals return to work. This is an area that needs further study – what skills do Swedish professional politicians have regarding mental health problems, and what are their views on the ability of this group to work?
Susann Porter is already doing her best to study this issue locally. She will soon be presenting her results to Lund psychiatric board and has independently both invited politicians involved in the field and been invited to discuss mental health issues. She has also written debate articles in Dagens Medicin.
“It’s important for researchers and decision-makers to increase their collaboration on these issues, so that research in the field can progress and research results can be communicated to the general public,” says Susann Porter.