Table 3.
Examples of study quotes per theme
| Theme | Sub-theme | Example quote |
| Awareness of condition/illness and support needs | Disclosure of condition/illness | |
| Barriers: | ||
| Employees described depression as something else, due to cultural taboo linked to depression | “ . . . depression is tabooed, and nobody talks about depression . . . In turn, employees may disclose their depression as stress or something else . . . ” [61] (Author interpretation) | |
| Employees with ABIs or mental illness not always aware of residual limitations and work-related challenges | [TBI survivor] “The worker is not usually knowledgeable until they step back into the work site, or once they get there and discover they can’t do some part of their work” [59] | |
| [Employees with episodic disabilities, e.g., depression, anxiety] “More commonly with a mental health condition, you’ve got subtler things: meltdowns, chronic lateness, inability to concentrate, disruptive behaviour, not fulfilling commitments, or not showing up for work regularly . . . We label them as complex cases, we try to be as good as we can. When somebody’s perception of their ability doesn’t match the reality, then we have to take those very delicately” [48] | ||
| Facilitator: | ||
| Disclosure of mental illness led to better employer understanding and supportive action | “When Pat* did subsequently disclose his experience of mental illness, Shazza felt able to understand more fully and to offer support if required” (Author interpretation) [62] | |
| Access to information about employee | ||
| Barriers: | ||
| Employers omitted from disability support and RTW planning | [Employees with episodic disabilities, e.g., depression, anxiety] “At times, supervisors and workers were not included in discussions” (Author interpretation) [48] | |
| Lack of- or inadequate information from health professionals | [Employees with mental illness] “Employers also described a feeling of being “kept in the dark” when meeting with the different RTW services with regard to the employee’s rehabilitation. This made it difficult to provide adequate work accommodations” (Author interpretation) [45] | |
| Facilitators: | ||
| Obtained information from employee (e.g., by asking them to get it in writing from health professional, or asking them to communicate their support needs) | [Stroke survivor employees] “Sometimes you can get the patient on your side and you can say, “Look, when you see your physio next, or whoever, can you ask them, can they put anything in writing?” and sometimes the physios will do that” [53] | |
| Employers’ attitudes, knowledge, skills, and experience | Attitudes towards condition/illness and support needs | |
| Barriers: | ||
| Employer support depended on whether they saw mental illness as a workplace or personal issue | “Opportunities to support employees with depression are influenced by whether depression is understood as a private matter that should be managed in the private sphere or embraced as a workplace issue that involves the responsibility of the employer” (Author interpretation) [61] | |
| “ . . . absences pertaining to mental illness versus absences pertaining to relational conflicts, disciplinary measures or problems related to personal life . . . some workers were given more support and more time to recover and had access to additional sessions under the employee assistance program (EAP). Other workers received telephone calls putting them under greater pressure, and were questioned and challenged regarding their treatment and health status” (Author interpretation) [52] | ||
| Facilitator: | ||
| Employees with ABIs or mental illness considered valuable for organizations | [TBI survivor employees] “I would characterize us as compassionate, and try to see the value of the individual. We have a business to run, but its run by people, not machines” [59] | |
| “I have an employee who has gone through a lot in his life, and got CBT treatment for depression. Based on this experience, he has very good skills to cope with organizational changes and stress compared to my other employees. In this way, he is a resource” [45] | ||
| Knowledge, skills, and experience | ||
| Barriers: | ||
| Lack of knowledge about ABI or mental illness and its impact on employee’s work ability | [Stroke survivor employees] “Such knowledge was however asked for by the employers, as they felt uncertain about their levels of “medical” knowledge and how this affected their responsibility as an employer” (Author interpretation) [42] | |
| Lack of knowledge and skill regarding supportive strategies for RTW and work retention | “They did not know how best to support their employee, or the extent to which the mental health problem impacted on work ability, social context, and productivity” (Author interpretation) [31] | |
| [ABI survivor employees] “Patients and employers both noted that line managers’ lack of knowledge of sick leave, and company reorganization, were barriers to RTW” (Author interpretation) [13] | ||
| [Employees with mental illness] “Intervention time was an issue that caused uncertainty. Employers did not know how to determine the necessary support period” [31] | ||
| Challenging dealing with situations arising during RTW process and beyond (e.g., recognising when employee unwell) | “Some employers observed no obvious effects from mental illness on how their employees performed their jobs, although some of those same employees reported experiencing negative effects. It seemed that the effects the employee noticed (for example not being as productive) were not always outwardly observable” (Author interpretation) [62] | |
| Facilitators: | ||
| Knowledge of depression facilitated communication with employee | “Knowledge of depression provides opportunities to take depressive symptoms into account in the communication with employees with depression. Accurate oral and written information is applied to meet depressive symptoms that make it difficult to remember and concentrate” (Author interpretation) [61] | |
| Benefitted from advice and information from health professionals | [TBI survivor employees] “They welcomed practical advice in planning a phased RTW (e.g. a RTW timetable), guidance about which work tasks to begin with and how to upgrade tasks, and advice on legal requirements regarding driving” (Author interpretation) [55] | |
| Previous experiences useful for understanding and handling RTW challenges | [Stroke survivor employees] “The participants described how they tried to use previous experiences from both work and private life to handle the challenges with which they were confronted. They emphasised the usefulness of having other experiences like supporting persons with other diagnoses and other difficulties in returning to work as well as one’s own experience of long-term sick leave. These insights contributed to increased awareness about the complexity in the process of RTW and the importance of having sufficient time” (Author interpretation) [46] | |
| [Employees with mental illness] “ . . . I have a lot of empathy for what she’s been through, and I’ve spoken to her about some of that from my own experiences at different times, I think that has definitely helped.” [57] | ||
| Work retention facilitated by employers being effective leaders and having links with local services | [Employees with mental illness] “Conflicts in the workplace were also cited as a potential cause of stress, and that conflicts needed to be dealt with quickly by the employer to prevent negative effects” (Author interpretation) [31] | |
| “Several social firms had links with local mental health services, liaising with services to support employees if their mental health became a cause for concern” (Author interpretation) [54] | ||
| Provision of work accommodations | (No sub-theme) | |
| Barriers: | ||
| Work accommodations not always possible due to impact on co-workers | [Employees with depression, adjustment disorder or anxiety] “Sometimes the doctor thinks, yes, it’s a good idea to make some small adjustments, but that’s not so easy because it affects co-workers . . . ” [43] | |
| Employers in small- and medium-sized organisations restricted by financial aspects of work accommodations | “With a smaller employer it is harder to offer light duty. Most of the time, a small business employer can’t wait for the worker to recover from a TBI injury. Recovery in those cases, from my experience, is often 6 to 12 months. In order for a small business to survive they can’t wait that long before filling that position” [59] | |
| [Employees with mental illness] “ . . . it’s right that they’re supported, but it’s just really hard. It has a big impact on other colleagues and a big impact on the business reputation and growth.” [56] | ||
| Employers in large organisations restricted by negative attitudes of senior management towards accommodations | [Employees with episodic disabilities, e.g., depression, anxiety] “ . . . HR participants and DMs reported that their efforts to build awareness, increase training, and provide accommodations for workers with episodic disabilities were seen by their senior management as expensive and time consuming and as not contributing to the bottom-line of the organization” (Author interpretation) [48] | |
| Lacked autonomy, time and availability to provide support for employees with mental illness | [Employees with mental illness] “ . . . supposed to be at the manager’s discretion but it’s not really, it’s . . . I can decide I want to apply discretion and then I have to send a bid with the case up to my senior managers for them to go “yes that’s ok.”’[57] | |
| [Employees with mental illness] “Several supervisors referred to their workload which was increasing continuously, with large teams to manage in a difficult work context marked by the lack of human and financial resources. They did not have time to follow up on absent workers and only dealt with the most urgent files” [52] | ||
| [Employees with mental illness] “We have a well written return-to-work policy and action plan for this; the problem is that we do not have the time to follow things through” [47] | ||
| Organisational restructuring during employee absence created challenges in providing support (e.g., ensuring appropriate work role) | (ABI survivor employee) “As a result of the reorganization, he was . . . placed in the administration department . . . Well, if there’s one job . . . he’s not good at, that’s administration” [13] | |
| (TBI survivor employee) “... we haven’t really had any vacant positions where we can use a handicapped person... the way our plant is structured, that could pose a problem for them.” [64] | ||
| Providing extra support was burdensome on employers | [Employees with mental illness] “If you delegate something to them, you got to hover over them to get it done [. . .] so it can place weight on you also” [60] | |
| Influence from stakeholders | Employees | |
| Barriers: | ||
| Employees hindered their own RTW through their attitudes and behaviours | [TBI survivor] “Carl reportedly did not attempt to compensate for his poor memory and he may have been unaware of some of his problems or the extent of them” (Author interpretation) [58] | |
| [ABI survivor employees] “Employers noted that if the patient was too driven, for example by the need to maintain financial security, the resulting stress might threaten successful RTW” (Author interpretation) [13] | ||
| Facilitators: | ||
| Employees with mental illness who retained working roles had certain qualities | “Employers often talked in terms of the qualities that their employee brought to their organisation, rather than benefits. These qualities included insight, respect (commanded for their views as service users with lived experience), knowledge and honesty around their mental illness, creativity, confidence, professionalism, trustworthiness, supportiveness, resilience and credibility” (Author interpretation) [62] | |
| Helpful when employees used lived experience of mental illness to enhance job performance | “John’s view is that Charlotte*’s experience of mental illness adds value to her work, in terms of her ability to engage, relate and validate people’s experiences, making her a better counsellor. As a result, she has a very high retention rate” (Author interpretation) [62] | |
| RTW of employees with ABIs facilitated by their retained pre-injury orientation and communication skills | “Patients and employers identified several factors facilitating RTW, such as the patient’s drive. Patients and employers agreed that good job performance prior to ABI facilitated RTW” (Author interpretation) [13] | |
| Other stakeholders (e.g., family, insurance agencies, health and social care professionals, employers and their superiors, Human Resources/Occupational | ||
| Health staff) | ||
| Barriers: | ||
| Lack of communication across stakeholders caused issues in RTW process, including lack of defined roles | [Employees with depression, adjustment disorder or anxiety] “Lack of clarity between the primary health care services and the OHS regarding the medical and RTW-support available could also add to conflicts and the risk of employees slipping through the net. Therefore, it was important to clarify roles and responsibilities through an open dialogue between the different stakeholders” (Author interpretation) [43] | |
| Employers’ supportive practices and RTW planning restricted when stakeholders try to enforce their different agendas | [Employees with depression] “ . . . employers’ supportive practices are challenged by the different agendas of the vocational rehabilitation stakeholders poisoning the opportunities to provide support” (Author interpretation) [61] | |
| Health professionals caused issues during the RTW process (e.g., made demands without understanding situation or job requirements) | [Employees with mental illness] “Employers also described often meeting with rehabilitation professionals who were demanding without any understanding for their situation and specific job requirements” (Author interpretation) [45] | |
| Family and friends put pressure on- or claimed time of employees | [ABI survivor employees] “Patients and employers mentioned pressures at the patient’s home or people claiming a patient’s time as barriers to RTW” (Author interpretation) [13] | |
| Facilitators: | ||
| Communication across stakeholders within and across organisations useful for planning and providing support for employees’ RTW | [Stroke survivor employees] “ . . . communication with the Swedish Social Insurance Agency was smooth and allowed for more concrete strategies to be developed to handle work demands and to identify appropriate work tasks in relation to the individuals’ actual resources” (Author interpretation) [46] | |
| Family support at home facilitated monitoring and adjustment of employees’ working roles and hours following ABIs | “Both patients and employers underlined the importance of support from the partner, whose observation of the patient’s functioning at home helped to reset goals during the RTW-process” (Author interpretation) [13] |