Mental illness accounts for up to one third of workplace disability claims in Canada, costing over $33 billion annually. People with mental illnesses have the right to participate fully in community life, including employment, with appropriate supports and accommodations. Returning to work after a mental illness requires consideration of symptoms, treatment, workplace supports, flexibility, and open communication between the employee and employer. Stigma remains a significant barrier, but with education and awareness, performance and loyalty of employees with mental illnesses can be comparable or better than others. Resources are available to help navigate returning to work.

1. Returning to Work?
Things to Consider
Evelyn Sparks, B.A, B.Sc.OT, MBA, OT Reg. (Ont.)
Acting Vice President, Professional Practice

2. Statistics
Mental illness-related disability claims (short-term
and long-term) account for up to one third of the
workplace claims, equaling approximately 70%
workplace costs and translating to 33 billion dollars
to the Canadian economy on an annual basis
(Sroujian, 2003).

3. Disability Rights
People living with mental health problems and illnesses
must not only be able to access the services and supports
they need to assist in their journey of recovery, but must
have the opportunity to be active citizens and to
participate fully in community life, as employers, workers,
students, volunteers, teachers, caregivers, and parents.
(Mental Health Commission of Canada, 2009).

4. Disability Rights
Mental illness is a disability which is explicitly recognized
under the Canadian Human Rights Act. Section 25 of the
Act defines disability as including “any previous or existing
mental or physical disability…” The Act prohibits
discrimination in employment on the basis of a
disability or on the basis of a perceived disability and
requires accommodation.
Canadian Human Rights Act.

5. Return to Work after Mental Illness

6. Time Away from Work
• May occur gradually due to accommodations,
decreased ability to the job due to symptoms of
illness
• May occur suddenly when it no longer becomes
possible to work, possibly due to hospitalization

7. Signs of Mental Illness
Look for changes and patterns. We all have off days.
Clues:
• Confused thinking;
• Difficulty in completing tasks
• Decreased tolerance of routine
• Emotional outbursts or withdrawal
• Heightened anxieties, fears, anger or suspicion; blaming
others.
• Loss of interest in preferred work
• Feedback from others, “you are not yourself!”

8. And Still More Signs
• Denial of obvious problems and a strong
resistance to offers of help,
• Dramatic, persistent changes in eating or
sleeping habits,
• substance abuse,
• thinking or talking about suicide or self-harm.
“How does mental illness interfere with work performance?”, Centre for Psychiatric
Rehabilitation, http://www.bu.edu/cpr/reasaccom/employ-func.html#howrecog

9. Possible Impact of Illness on Work
Performance
Essential Psychological Factors Needed for Work
(Fischler et Al.)
• Cognition
• Pace
• Persistence
• Conscientiousness and Motivation
• Interpersonal Functioning
• Stress Tolerance
• Job Specific Requirements (typing speed, people skills etc.)

10. Supporting Work
The primary goal is to continue work or to return as
soon as possible to work with appropriate
supports.

11. Are You Ready?
• Consult with your physician and care team
• Consult with Occupational Health
Judge for yourself:
• Symptoms are coming under control
• Sufficient energy to get through the day
• Daily routines are in place
• There is a return to work plan

12. Which Work?
• One thing to consider is that your previous work
might not be the best going forward
• Some workplaces are difficult and lacking
support
• Some work does not “fit” and therefore creates
stress
• Some work is difficult to re-enter gradually

13. Strategies for a Successful Return
http://www.gwlcentreformentalhealth.com

14. Employee Issues Impacting Return
to Work
• Symptom Management
• Level of shame related to leave
• Level of fear of negative judgment
• Perceived level of support in the workplace
• Current stress/frustration tolerance
• Coping strategies with interpersonal conflicts
• Level of interest/satisfaction with work prior to leave
• Recovery expectations

15. Environmental Issues
• Supervisory support (crucial)
• Organizational culture/ willingness and ability to
accommodate
• Co-worker perceptions of mental health leaves
• Prior relationship with employer/co-workers
• Physical environment (lighting, noise level etc.)
• Degree of control over work/work schedule (night shifts
may no longer be possible.)
• Communication between worker, insurance company,
employer and health professionals.

16. Supporting Recovery
Programs that address workforce needs may
include:
• Facilitated access to professional advice (EAP,
Occ Health);
• Flexible work scheduling practices;
• Union representation and consultation in
addressing needs where available.

17. Flexibility
• Flexibility at the start or end of work hours to
accommodate effects of medication or for medical
appointments.
• Part-time or split shifts
• More frequent breaks
• Graduated return to work
http:/www.gwlcentreformentalhealth.com

18. Flexibility, con’t
• Assigning minor task to other employees (balance
of work)
• Modifying the way instructions are given (i.e. written
instructions may help employee focus on tasks)
• Having brief weekly meeting (i.e. 10 mins) to deal
with issues before they become a problem.
http:/www.gwlcentreformentalhealth.com

19. Maintain Stamina
• Vary tasks throughout the day
• Take on some opportunities to learn new skills
• Request a self-paced workload
• Where possible do some of the work from home
• Consider job sharing/temporary shift to part-time
work
• Break up big tasks into smaller ones
www.gwlcentreformentalhealth.com

20. Employees Dealing with Stress
• Request clear expectations
• Ask for help from counselors or EAP
• Ask for constructive feedback and positive
reinforcement
• Take needed time for doctors appointments,
therapies
www.gwlcentreformentalhealth.com

21. Employee Support at Home
• Let loved ones know that returning to work may
cause fatigue and added stress. Let them know
how they can provide support.
• There are support groups for family, friends or
others to help them understand illness and how
to best help the individual recovering from
mental illness and to provide support for
careproviders.

22. Reluctance to Disclose
• Stigma
• Safety / employment security
• Privacy
• Toxic workplace
• Assumptions about impact on career progression

23. Whether to Disclose
Reasons to Disclose:
• Allows opportunities for accommodations
• Creates opportunity to educate and reduce stigma
• If the employee becomes unwell, work adjustments can
be made more quickly
• If there has been a prolonged absence the employee
may wish to share the reason with the supervisor /
colleagues

24. Whether to Disclose
Reasons Not to Disclose:
• Judgment, expertise, and actual performance
may be devalued
• Negative attitudes about mental illness
• Illness may not impact on your performance

25. Stigma and Employment
In a study by the Canadian Mental Health
Association, it was shown that employees with
mental health problems tend to be more loyal, have
an attendance rate comparable to other employees
without mental health problems and their
performance level is at about the same or above
those of other employees.

26. Impacts of Stigma
• Delays in seeking medical attention. One-fifth
will have significant mental illness, one-third of
those will seek help for it.
• Shame (“pull up your boots” mentality).
• Reluctance to take time off work from
employment with attendance management
systems.
• Pressure for early return as disability is invisible.

27. Self Stigmatization
People with mental illness often face a double
problem: symptoms of their mental illness and public
stigma
Brief Reports: Self-Stigma, Empowerment, and Perceived Legitimacy
of Discrimination AmongWomen With Mental Illness
Nicolas Rüsch, M.D., Klaus Lieb, M.D., Martin Bohus, M.D. and Patrick
W. Corrigan, Psy.D.
Psychiatr Serv 57:399-402, March

28. Self Stigmatization
• Review your strengths
• Be aware of your rights
• Make use of therapies
• Use the time for honest reflection
• Decide what parts of the problem are actually
yours and what parts are the environment
• Make a plan
• Celebrate successes

29. Resources Available
Mental Health Works http://www.mentalhealthworks.ca/
Mental Health Commission of Canada
http://www.mentalhealthcommission.ca/English/Pages/default.aspx
GWL Mental Health
http://www.gwlcentreformentalhealth.com/index.asp

30. References
Toward Recovery & Well-Being : A Frame Work for a Mental Health Strategy for Canada (2009). Mental Health Commission
of Canada. Retrieved on 10-11-2010 from http://www.mentalhealthcommission.ca/English/Pages/Strategy.aspx
Fishchler, G. Assessing Fitness-For-Duty and Return-To-Work Readiness for People with Mental Health Problems in the
Minnesota Career Development Association Newsletter, The MCDA Communique, summer 2000. Retrieved on 15-11-
2010 from http://www.psycheval.com/assessing_ffd_rtw.shtml
Fischler, G., Booth, N. Vocational Impact of Psychiatric Disorders, An Aspen Publication : Maryland, 2009.
Definition of the word ‘work’, Merriam-Webster Online Dictionnary (2010). Retrieved on 17-11-2010 from http://www.merriam-
webster.com/dictionary/work
Ross, J. Occupational Therapy and Vocational Rehabilitation, John Wiley & Sons Ltd : England, 2007.
Saint-Arnaud, L., Saint-Jean, M., & Damasse, J. (2006). Towards an enhanced understanding of factors involved in the
return-to-work process of employees absent due to mental health problems. Canadian Journal of Community Mental
Health, 25(2), 303-315.
Workplace strategies for mental health : Mental Health Facts and Figures. Retrieved on 10-11-2010 from :
http://www.gwlcentreformentalhealth.com/display.asp?lc=1&l1=2&d=2
Workplace strategies for mental health : Accomodations that work. Retrieved on 10-11-2010 from :
http://www.gwlcentreformentalhealth.com/display.asp?l1=182&l2=6&d=6
Evelyn Sparks, OT Reg. (Ont), Rosemarie Lidstone, OT Reg (Ont), Mood Disorders: Employment Issues and Dealing with
Stigma, November, 2011
Emily Deacon MSW, Claude Lurette, Recovery Is Possible, Stats Can Presentation, September, 2012.