Table 4.

Factors influencing employers’ support

Stakeholder /systems (based on the systems defined in the Sherbrooke Model [43])	Barriers			Facilitators
ABI literature only	Mental illness literature only	Across ABI and mental illness literature	ABI literature only	Mental illness literature only	Across ABI and mental illness literature
Employer		Considered depression to be employee’s private issue [52, 61] Support for RTW not considered worthwhile investment [61, 62] Large workloads, lack of autonomy, and time constraints hindered support to employee [47, 50, 57]	Lack of knowledge about ABI/mental illness and impact on work ability [31, 42] Lack of knowledge/skills for supportive strategies for RTW and retention (including dealing with unexpected issues) [31, 45-47, 50, 56, 57, 60, 62, 63]		Relevant knowledge about depression potentially facilitated planning of communication and workplace environments [61] Open, calm, and non-judgmental communication with employee [62]	Employees with ABI or mental illness still seen as valuable for organisation [13, 45, 54, 56, 59, 62] Employers’ previous experiences of ABI/mental illness from personal and work life [31, 46, 47, 57, 62] Knowledge and skills for increasing employees’ confidence [62, 63] Effective leadership skills [31, 59]
Employee with ABI or mental illness	Would not employ compensatory strategies to facilitate work participation [58]	Uncompromising with accommodations [50]	Did not disclose diagnosis or work-related challenges [48, 53, 61] Not aware of residual limitations or work-related challenges [31, 48, 58, 59] Too driven/highly motivated, could lead to pressure and stress, threaten or hinder RTW [13, 50, 53]	Communicated their limitations [13] Had retained necessary skills for work performance (e.g., team working) and good pre-injury job performance [13, 53, 58].	Disclosed diagnosis to employer [31, 43] Had certain personal qualities, e.g., resilience, good work ethic [43, 44, 61, 62] [Irvine]
Workplace	Organisational re-structuring limited or prevented availability of suitable, alternative job roles [13, 63, 64]	Employers not permitted to have information or be involved in supporting RTW of employee [31, 50] Senior management saw accommodations as being expensive, time-consuming and unbeneficial [48] Lack of defined roles/responsibilities across supervisors and OH staff, and pressure from superiors to control absences [52]	Potential or actual impact of accommodations on co-workers [31, 48, 53, 56, 61, 63] Accommodations not possible due to financial restrictions [59, 61, 63] Lack of HR support mean extra responsibility for employers [53, 56]		Advice from HR and OH staff on legal obligations, management of performance issues, and solutions to facilitate RTW [31, 50, 52, 62, 63].
Healthcare		Hindered contact between employer and employee, and provided insufficient support [43, 45]	Lack of-, or inadequate information about employee [42, 43, 45]	Information gained by requesting employee to obtain it in writing [53] Advice and information from health professionals regarding employee and aspects of RTW process [46, 53, 55, 59]
Insurance/legislative			Insurance agents applied pressure for RTW to happen quickly [46, 50]
Culture/politics	Family and friends put pressure on- or claimed time of ABI survivor employee [13]	Social workers applied pressure for RTW to happen quickly [61]			Support from Swedish Social Insurance Agency, social workers, or public employment services in improving employer confidence [45], and developing strategies to support employee [46]
Across different stakeholders in different systems (e.g., Human Resources and Occupational Health personnel, insurance agents, social worker, Swedish Social Insurance Agency)		Lack of communication across stakeholders [48, 50] Lack of defined stakeholder roles during RTW/retention [43, 47, 52]	Different stakeholders had different agendas, tried to impose decisions [46, 49, 50, 61] (specific examples given elsewhere in table)	Family supported re-setting of goals, or helped with work responsibilities of employee [13, 63]	Workplace links with local sources of mental health support [54, 62]	Employers supported through communications with other stakeholders in managing and planning RTW process [31, 45-47, 49, 51-53, 56, 59, 61-63] (specific examples given elsewhere in table)