Is returning to work important for mental health? A new possibility for intervention.

Depression, anxiety disorders and burnout syndrome are among the most common causes of absence from the workplace and, in the most severe cases, permanent incapacity for work. The loss of work has a negative impact on one's mental health status, the possibility of recovery and the perception of one's psychophysical well-being. Clinical interventions including pharmacological treatment (where deemed necessary), psychotherapy and reinforcement of the individual's skills can reduce the negative impact of the psychological disorder and progressively improve the ability to carry out work effectively. According to experts, reintegration into work allows, for example, to

1. increase the sense of efficacy and gratification
2. decrease feelings of exhaustion and cynicism typical of depression (Maslach et Leiter, 2016);
3. provide stability and a programme of daily activities (Lagerveld et al, 2012);
4. maintain financial security and a good level of social integration (Moore et al, 2017).

In cases where disability becomes permanent, on the other hand, rehabilitation efforts tend to decline with a negative impact on the individual's quality of life and the social and health costs borne by the community. In this regard, a semi-standardised, patient-oriented intervention of about 80 hours has recently been presented (Behrens-Wittenberg et and Wedegaertner, 2021) and seems to be prospectively very effective. The procedure consists of 3 phases.

Phase 1: Stabilising the mental health status of the patient, ensuring continuity and quality of treatment and support, including bureaucratic support. Coaching can be helpful in assessing and reinforcing the skills, abilities and competences needed for recovery. These steps should be calibrated according to the mental stability of the individuals and their personal priorities.

Phase 2a: If the patient's previous job position is available, it is preferable to opt for reintegration in the same place of employment. The intervention requires a reconnaissance of the workplace to check for possible criticalities to be examined together with the employer and the patient, in order to define strategies to limit the impact on the state of health.

Phase 2b: If no place of employment is available, lateral thinking is used to create new job prospects by enhancing the skills and abilities required by the available jobs. In this phase the individual should be supported both in the preparation/training phase and in the drafting of application documents and the subsequent selection phase.

Phase 3: The phase of re-employment and/or starting a new activity is supported by specialised staff until the end of the intervention. It is important to make the individual feel that he/she is able to cope with the new social and work challenges and that the psychologist is always available to support him/her and to enhance the skills needed to interact in the new environment.

Although the intervention has limitations and can be further improved, it is a useful tool to improve work capacity and in general the biopsychosocial well-being of the individual, which is the main core business to be achieved.

Bibliography

Behrens-Wittenberg E and Wedegaertner F (2021) A Return-to-Work Intervention for Prematurely Retired Depression or Anxiety Disorder Patients. Front. Psychiatry 12:662158. doi: 10.3389/fpsyt.2021.662158

Lagerveld SE, Blonk RW, Brenninkmeijer V, Wijngaards-de Meij L, Schaufeli WB. Work-focused treatment of common mental disorders and return to work: a comparative outcome study. J Occup Health Psychol. (2012) 17:220–34. doi: 10.1037/a0027049

Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. (2016) 15:103–11. doi: 10.1002/wps.20311

Moore THM, Kapur N, Hawton K, Richards A, Metcalfe C, Gunnell D. Interventions to reduce the impact of unemployment and economic hardship on mental health in the general population: a systematic review. Psychol Med. (2017) 47:1062–84. doi: 10.1017/S0033291716002944