Return to Work Plans Start on Day One
June 19, 2019
In recent speaking engagements, I have been asked a variant of the same question by multiple audience members: “When is it appropriate to start talking about return to work when someone goes on leave under disability or FMLA?” The answer is simple–in most behavioral health cases, the answer is: right away, on day one. But why? This may seem illogical if we predict a leave may last weeks or possibly even months.
As my wife would attest, in my personal life there are times when I am very planful and other times that I detest detailed planning. Sometimes the motto to live by is, life is what happens when you are busy making other plans; other times it more closely mirrors plan your work and then work your plan. Often there is logic in what gets planned and what does not; other times it seems rather random. Surely there is a time and place for both approaches.
The 12-step model of addiction management mirrors this dual approach in some respects. Proper planning is necessary for many aspects of sobriety (working the steps, having a sponsor, developing plans to keep busy etc.). However, there is also a focus on living day by day, taking things as they come, and focusing on being sober today and not all of next week. This also holds true with how we treat other behavioral health conditions. A treatment plan must be able to address current realities and incorporate longer-term goals.
When it comes to return to work discussions, we, as providers can too often focus on the current emotional state, and not on what needs to happen going forward. We may provide treatment to resolve the symptoms or treat the condition, but rarely is there an early/immediate plan delineated for improving functioning and return to work. So, to the question of “when do we start talking about return to work,” the answer is “the day they leave work.” Too often we see the work conversation avoided or deferred to a later date (and not days, but weeks or months later). When this happens, we are inadvertently deferring progress. We are missing opportunities to provide proper support and skills so that they can return to work. And quality of life, therefore, decreases.
Goal attainment is also a key concept here. Goals can only be met if they are worked toward and planned for. It is unreasonable to ask a patient about returning to work at the 11th hour and expect a positive outcome. Conversely, we can expect a positive outcome if we talked about return to work throughout treatment, planned for it, and worked on removing barriers. Even in cases where we are quite unsure about exactly when a patient can return to work, it is important to select a target date. This provides structure to the intervening time. For example, if we know that we have four weeks between now and the first day back at work, it allows us to set mini-goals at intervals within that month that will build up to the desired outcome. Even if returning to work does not happen after four weeks, the patient will be closer to the goal for having engaged in the process.
This does not mean that work is always going to be a primary focus of treatment early on. Clearly, some clinical situations warrant first addressing urgent clinical issues (as in the case of lengthy psychiatric hospitalization, severe addiction, significant safety concerns, etc.). The author would argue, however, that such instances are the exception and relatively rare. Even in such cases, there is an inherent sense of hope in discussing going back to work, as this implies functioning will improve, which further implies that the symptoms and negative emotional state will improve.
By focusing on return to work on day one, we have taken an active role helping to achieve positive functional outcomes. More important, however, is the underlying message that goes along with that: You can get back to normal, and I can help you get there.