Planning and providing rehabilitation-focused treatment
- What is the treatment plan?
- Who is the treatment provider?
- How long will treatment be required?
Planning for a return to work should begin early and remain rehabilitation-focused. Ideally, both treatment and planning for a return to work are done concurrently, provided there are no barriers. The role of primary care providers in planning treatment includes:
- educating the patient about diagnosis, treatments and recovery
- identifying potential barriers to recovery
- clarifying duties and workplace supports
- discussing return to work from the beginning
- encouraging active coping
- asking the insurer about additional rehabilitation resources
- referring early if the patient has severe symptoms or total disability.
Supporting Patients While They are Off Work
Drawing on behavioural activation, encourage healthy activity to limit entrenchment in the “sick role.” Encourage patients to:
- maintain self-care and home routines
- engage in cardiovascular exercise at least three times per week
- schedule regular activities with a support network
- participate in physiotherapy or other active treatments
- maintain good sleep hygiene
- pursue pleasurable activities
Use Rehabilitation-Focused Approaches
Rehabilitation often begins with establishing the goal of full recovery and return to work. This involves educating the patient about the diagnosis and treatment rationale, and setting expectations for adherence. Identifying the patient’s perceived barriers to recovery and return to work can also inform treatment planning and potential non-medical obstacles. Monitoring for passive coping, such as “relaxing,” and for maladaptive coping, such as substance use, should be a routine part of follow-up.
Medications with abuse potential (e.g., narcotics and benzodiazepines) or impairing side-effects (sedating and cognitive) should be avoided unless they are necessary. If progress does not occur as expected, refer the patient for psychiatric consultation, interdisciplinary outpatient programs and evidence-based psychotherapy (e.g., cognitive-behavioural therapy).
The Role of Specialists in Treatment
As part of a rehabilitation plan, insurers will often cover fees for private treatment providers, such as psychologists or occupational therapists. Specialized insurer-funded services are often used if disability becomes prolonged or if there are barriers to accessing publicly funded treatment.
It is important to choose capable and qualified specialists (listed below) who will be able to both focus treatment on achieving recovery and return to work and provide adequate documentation. For this purpose, an insurer may request an independent medical examination.
- Cognitive-behavioural therapy
- Interpersonal therapy.
- Behavioural activation
- Exposure-based therapy
- Progressive Goal Attainment Program (PGAP)
- Confirm diagnosis
- Establish degree of impairment
- Stabilize severe symptoms
- Refer to hospital-based programs
- Recommend returning to work
- Monitor after return to work
- When is return to work expected?
- What is the patient’s prognosis for returning to work in his or her previous or modified position?
There are several prognostic indicators for a return to work after mental health disability. In determining prognosis, you must consider various factors, including clinical, psychosocial and workplace factors (Dorian & Bender, 2010). Below are some of the most important factors in determining prognosis.
- Clinical factors
- Premorbid functioning
- Severity of symptoms
- Duration of disability
- Psychosocial factors
- Financial needs
- Pending litigation
- Support at home
- Workplace factors
- Job satisfaction
- Duration with employer
- Employer relationship/support
When considering the factors related to prognosis, remember that the chances of return to work quickly decrease with time and are unlikely after one year. Often, non-clinical factors are more important than clinical factors, and disability may be avoided if suitably accommodated work is available. Common non-medical barriers to return to work include changes in home caregiving roles and employer inflexibility with the return to work plan.