Facilitators and Barriers to Mental Health Leaves and Return to Work Among Canadian Teachers

Abstract

In our qualitative study, we interviewed 45 Canadian teachers about mental health issues, taking a leave of absence, and their subsequent return to work. We found that doctors, supportive principals, supportive colleagues, supportive human resource departments, supportive school boards, and the teaching unions were facilitators for taking a leave, while stigma, unsupportive administration, preparation, and the process of taking a leave were barriers. In returning to work, principals and administrators, and preparation to return were cited as barriers, while colleagues, principals and administrators, doctors, unions and a change in work were facilitators. We interpret these findings through a synthesized framework combining Allegro and Veerman's theory of sickness absence and D’Amato and Zijsrtra's theory of work resumption, highlighting individual, organizational, and societal factors shaping leave and return decisions. With the high cost of teacher absences and critical staffing shortages, we discuss the impacts of these facilitators and barriers and make recommendations for practice for a healthy teaching workforce.

Introduction

The prevalence of mental health issues is a growing concern both in Canada and internationally. While one in five Canadians experiences a mental health issue or illness annually, ¹ teachers appear to be particularly susceptible to experiencing mental health issues as compared to other occupations.^2,3 Prior to the COVID-19 pandemic, Canadian teachers reported low levels of wellbeing and resilience and significant compassion fatigue and emotional exhaustion. ⁴ The pandemic exacerbated existing stress within the teaching profession, leading to increased workloads, feelings of fatigue, isolation, and concern about students. ⁵ Canadian teachers experienced heightened levels of stress and anxiety during the pandemic, with significant declines in wellbeing.^6–9 Moreover, the pandemic saw increases in the rate at which teachers considered early retirement or resignation. ⁸

High levels of stress among teachers have been shown to result in increased absenteeism and illness.^10,11 Molestsane et al. ¹² found that teachers use sick days and short-term absences to cope with work stress. These research findings appear to reflect the everyday reality within Canadian schools. Canadian media have reported on the increased sick leave usage among teachers. ¹³ Staffing challenges due to absences topped the list of principals’ concerns. ¹⁴ Headlines about teacher staffing and teacher shortages are common in Canadian media outlets^14–16 and teacher shortages appear to be a global trend. ¹⁷

Leaves of Absence for Mental Health Issues and Subsequent Return to Work

Despite the existing teacher shortages and the knowledge that teachers use sick days and take leaves of absence due to mental health issues, there is a paucity of literature that addresses teachers’ leaves of absence for mental health reasons and subsequent return to work. International studies shed light on factors influencing leaves of absence for mental health reasons among teachers. For example, higher frequencies of psychiatric sick leave were found among Spanish secondary teachers who were divorced/separated, consumed alcohol, were substitute teachers, and had job dissatisfaction. ¹⁸ Burnout symptoms were associated with longer sick leaves among Brazilian teachers. ¹⁹ Student dissatisfaction was linked to teacher stress and subsequent sick leaves among Finnish secondary school teachers. ²⁰ A Spanish study found that more women teachers took leaves for psychiatric reasons than their male counterparts; in fact, none of the men in the study had taken such a leave. ²¹ In a recent study of 31 Brazilian teachers returning from mental health-related leave, most did not wish to return, not only because of their illness, but also because the teaching environment and work itself were the initial cause of their distress. ²²

In a previous study, we found a considerable number of Canadian teachers took a leave for mental health reasons; these teachers were predominantly women and stigma surrounding taking the leave and fears about job performance were primary concerns. ²³ We also found 49% of teachers retreated, took sick days or vacation, and almost 40% of teachers had taken a formal leave of absence due to mental health concerns. ²⁴ In addition, a supportive family/partner, financial coverage, and a supportive union representative were the top facilitators to taking a leave of absence for mental health issues, while concern for the impact the leave would have on students and unsupportive supervisors were the most frequently cited barriers. ²⁴

These leaves of absence come at a high cost. Timp et al. ²⁵ recently examined over 200,000 cases of sickness absence in the Dutch workforce and found that employees in the education sector tend to take longer mental health-related absences than those in other sectors. Financially, taking a leave for mental health issues has been estimated to be about double the cost of taking a leave for a physical issue. ²⁶ In addition, student achievement has been shown to decrease when a teacher is absent and there is a temporary substitute teacher in their place.^27,28 Despite the economic and academic burdens of mental illness, there is limited literature on teachers returning to work after a leave of absence and how teachers can facilitate a successful return to work, particularly after a leave for mental health concerns.

Brown et al. ²⁹ found that mental disorders among Scottish teachers often led to ill-health retirement but could potentially be prevented through part-time work or redeployment. In Brazil, Silva-Macaia and Fischer ³⁰ highlighted the role of school administration in supporting teachers returning from mental health leave. They stressed the need to address stigma and to improve working conditions in order to ensure successful work resumption. Nygren et al. ³¹ reported that reflective peer support sessions facilitated return to work for Swedish teachers experiencing stress-induced exhaustion disorder. In our previous research, ³² we found that despite taking mental health leave, nearly 80% of teachers returned to their original positions. Supportive colleagues were the main facilitators, while lack of workplace accommodations and unsupportive supervisors were the most common barriers. Unions provided the highest level of return-to-work support, outperforming school boards, principals, or supervisors. ³²

Therefore, while some literature recognizes the significant impact of mental health issues among teachers and the subsequent leaves of absence, there remains a gap in understanding the facilitators and barriers to taking leave and returning to work within the teaching profession. Addressing these gaps is crucial for supporting teacher wellbeing and ensuring a sustainable workforce in education. While we have previously looked at these facilitators and barriers in our quantitative research,^24,32 the present article uses qualitative data to delve deeper into facilitators and barriers of teachers’ leaves of absence for mental health and their subsequent return to work.

Theoretical Framework

We conceptualized leaves of absence and return to work by synthesizing Allegro and Veerman's ³³ theory of determinants for sickness absence with D’Amato and Zijsrtra's ³⁴ theory of work resumption. This perspective allows us to theorize why workers take leaves of absence and return to work and provides a lens to interpret the results of our study so that we can provide practical recommendations for the teaching profession and educational systems. Allegro and Veerman ³³ outline three key factors influencing sickness absence decisions: micro (individual-specific), macro (societal), and meso (organizational/professional) factors. Workers are influenced by these three factors when considering taking a leave of absence, such as living situations and health (micro), legal entitlements and labor laws (macro), and working conditions and supervisor support (meso). D’Amato and Zijsrtra ³⁴ combine Ajzen and Fishbein's ³⁵ Theory of Reasoned Action and Leiter et al.'s ³⁶ research on perceptions of organizational commitment, to propose a model of successful return to work. According to D’Amato and Zijsrtra, ³⁴ positive self-appraisals of health and the ability to work, as well as positive perceptions of the organization, are all required for a successful return to work. Conversely, negative perceptions of any of these diminish return-to-work success. Our synthesized framework underscores the multifaceted nature of mental health-related leaves and successful work resumption, noting how many factors play into teachers taking a leave of absence and returning to work.

Purpose of the Study

Recognizing the gaps in the literature and utilizing our theoretical framework, the purpose of our study was to explore the experiences and stories of teachers with mental health issues who took a leave of absence and returned to work, with particular attention to the facilitators and barriers they encountered during both phases. Thus, the study questions were:

• For teachers with mental health issues, what are the facilitators and barriers to taking a leave of absence from work?

• For teachers with mental health issues, what are the facilitators and barriers to returning to work after a leave of absence?

Methods

Recruitment

We obtained ethical approval from all participating institutions and conducted an online survey from November 2020 to May 2021 to learn more about Canadian teachers taking leaves of absence for mental health issues and their subsequent return to work.^24,32 We recruited participants for the survey on social media with the assistance of our partners, the Canadian Teachers’ Federation (CTF/CFE) and the Ontario Secondary School Teachers’ Federation (OSSTF). In addition, we commissioned a sample from an online survey market research company. In order to learn more about the detailed experiences, opinions, and personal stories of teachers, we followed up with qualitative semistructured interviews.^37,38 At the end of the survey, we asked respondents whether they would volunteer to participate in a follow-up interview. Due to time and financial constraints, 45 teachers were contacted for follow-up interviews. To ensure a wide variety of responses, we used purposive sampling to select a diverse group of interviewees based on the responses to demographic survey questions. ³⁷ Our inclusion criteria for interviews sought to balance geographical locations across Canada, including urban and rural areas, grades taught (elementary and secondary), age, gender, visible minorities, those who have taken a leave and those who had not, contract status (permanent or supply/occasional teachers), and various career stages (early/middle/late). Interviewees provided their informed consent to participate.

Data Collection

The interviews were conducted by Zoom at a time of the participants' choosing. Interview data were anonymized. All identifying features were removed, and all data in this article are presented by labeling responses with an assigned alphabetic code. Interviews were conducted between November 2021 and July 2022 and were audio recorded, with the participants’ consent. While the interviews addressed a variety of topics regarding mental health, this article focuses on the portion of the interview about leaves of absence for mental health issues and subsequent return to work. Teachers were asked probing questions such as, but not limited to, “Can you describe the process of negotiating your leave?”, “How accommodating do you find your workplace is towards requests for leaves of absence?”, “Can you describe the arrangements for your return to work?”, and “What role did your manager/supervisor play in your return to work?”.

Participants

Forty-five teachers from across Canada participated in our interviews about teacher mental health, leaves of absence, and return to work. The majority of teachers identified as female (n = 33), while 12 identified as male. In terms of grade level, 27 worked as high school teachers (grades 9-12) while 18 were elementary school teachers (kindergarten to grade 8). Almost half considered themselves late-career teachers (n = 22), the next greatest number were mid-career teachers (n = 15), and fewest were early-career teachers (n = 7). Twenty-six of the participants were currently on a leave of absence from work for a mental health issue.

Data Analysis

The interview data were transcribed and sorted by interview question, enabling us to compare identified topics while organizing the data into relevant themes. ³⁹ We took a collaborative approach to analyze the data, with multiple researchers contributing to the interpretation as a form of analytical triangulation. This approach enhances the credibility of the findings by incorporating diverse perspectives and minimizing individual bias through collective analysis. ⁴⁰ We also used dialogic engagement to discuss and critically reflect on emerging themes and challenge our assumptions. ³⁸ Each interview was individually read and reviewed by two researchers, who each used open-ended coding to sort the data, looking for similarities and differences.^41,42 Subsequently, the researchers met to compare coding, to create categories and subcategories, and ultimately to cluster data in order to identify emerging themes.^38,42 For example, many teachers noted difficulties when dealing with the principal or vice-principal as a barrier to taking a leave of absence. Upon discussion, these two categories were collapsed into the theme of “administration” as a barrier.

Results

Below, we present the facilitators and barriers for teachers to take mental health leaves of absence and for their return to work. We illustrate these themes using quotations from the raw data.

Leaves of Absence for Mental Health Issues: Facilitators and Barriers

The most commonly cited facilitators for teachers taking a leave of absence were all related to social support: effectively supportive doctors, principals, colleagues, human resources/school board, and the unions. Supportive doctors were the most commonly mentioned facilitator. Primary care providers were often catalysts in the decision to take a leave. They helped with the process; for example, Teacher II stated, “I was able to get in to my physician, and he just said, ‘Look, you need to you need to stop, you can't, you can't go back, you have to give yourself a chance to rest and heal and get through this.’” Teacher S also explained that their doctor suggested coping strategies and offered to complete any paperwork required for a leave.

Supportive principals were valuable facilitators of taking a leave. Sometimes, as Teacher K noted, it was the principal who nudged the teacher to take the leave: “When I was really struggling, he suggested that perhaps I should just take the rest of the calendar year off.” Or as Teacher P stated, it was the principal who encouraged them to go to their doctor: “You’re going to go to your doctor, and you’re going to get them to write you a letter for mental health reasons; you need to be on medical leave.” Teachers who felt that their principals were supportive were very thankful and appreciative of this support; as Teacher H stated, “I have the best boss.”

Teachers felt that supportive colleagues were facilitators who made taking a leave easier by helping them not to feel judged. Teacher CC explained, “We all know each other; we know…people have their breaking points, and people tend to be pretty supportive that way.”

Other teachers felt that supportive human resources departments or school board administrators were facilitators in taking a leave. Teacher Y reported, “I had a very, very understanding superintendent. So, to ask for time off was very easy.” Teachers also consulted with school board employees (“the school board has two people on staff that they call ‘Wellness Specialists,’” Teacher B) or human resources staff. They suggested services and resources, including Employee Assistance Programs (EAP). These resources were useful: “It was definitely helpful…the EAP was great” (Teacher II).

Teachers interviewed also felt that the unions were facilitators in taking a leave. The unions provided support for the process; as Teacher TT stated, “I did everything through the union. So it was very easily done. Basically, the union told me what I needed [for my leave].” Union personnel also provided affective support, often being a person who just listens when a teacher was at their most vulnerable: “We had a really great union rep there … I dissolved into tears and I kept crying” (Teacher NN). Finally, leave entitlements were a less cited facilitator; as Teacher YY said, “We do have this great benefits plan. My salary was topped up to 90 percent  …  not many professionals have[that].”

Four main barriers emerged from the interviews for teachers taking a leave of absence for mental health issues: stigma, the process, unsupportive administration, and preparation. Stigma was the most cited barrier to taking a leave of absence. Teachers were concerned about how they would be perceived by administrators, colleagues, and parents; for instance, “You look like a failure. You can’t handle it?” (Teacher S); “there's a huge stigma around a leave of absence … as a sign of weakness and a sign of laziness” (Teacher KK); “I was trying to figure out what I was going to say to parents” (Teacher PP). Teacher UU noted that while medical information is private, “there's definitely a stigma and the information gets around, even if you don’t tell everybody.” One teacher acknowledged that the stigma may only be perceived, and that stigma may be internal: “Sometimes the pressure not to take a leave of absence comes from the individual themselves” (Teacher AAA). Teacher OO also concurred, feeling internal stigma, stating, “I’m someone who cares about optics.” A number of teachers also spoke negatively about teacher attendance tracking policies and systems, and how teachers felt stigmatized and penalized for using their sick days. They felt that taking a leave of absence would be viewed in the same way as abusing their sick days: as one teacher stated bluntly, “I’m not an abuser of sick days.” (Teacher TT).

The process of requesting and obtaining a leave was a barrier for some teachers. As Teacher QQ explained, “The logistics behind taking the leave and having to contact HR is just a lot of hassle … making that process a lot smoother and easier, would relieve the stress and probably allow that staff member to feel better about taking the leave.” There was a sense of frustration about what was perceived as a complex process to deal with when unwell: “They need to adjust their process to accept mental health as a disability … and not make it difficult for people to ask for a leave of absence” (Teacher SS). For some teachers, the process was too much to handle, so retiring or changing career was an easier option: “I might as well just retire. I don't want to fight the game anymore” (Teacher AA) and “I was thinking I would leave the profession because that was easier” (Teacher LL).

While supportive principals and school board administrators were viewed as facilitators for taking a leave for some teachers, unsupportive administration in general was viewed as a barrier for others. Many teachers told personal stories about specific principals or school board administrators not supporting them in various aspects of their jobs, which then often led to conflict, and then to teachers not feeling supported when taking a leave of absence. For example, Teacher P stated, “The vice-principal said I wasn’t allowed to go [on leave] … and basically I said, screw that.” Teacher OO felt that their principal's attempt at being supportive backfired and made the situation worse: “He always … dismissed it by ‘Oh, you're doing great, you're doing such a good job, keep up the good work.’ Toxic positivity.” Teacher O reflected, “They [administrators] don’t want to be unsupportive. They just don’t know how to be supportive.”

The preparation required to take a leave was also a barrier for teachers. Teaching is unique in that there is an expectation to prepare work when sick or away for a substitute teacher; as Teacher YY explained, “Teaching is a different profession in that way too, right? You have to have someone fill in.” This was a significant barrier to taking a leave for some teachers: “In terms of transitioning, because the thing is, when you stop teaching like that … you still have to prepare lessons and stuff.” (Teacher II). For some teachers, it was easier just to remain unwell at work and finish the academic year than to take a leave; as Teacher QQ said, “How is this going to work? No, I’m just going to stay and do this.”

For some teachers the barriers of administration and preparation overlapped. A number of teachers shared experiences about being asked by administrators to do teaching work while on leave, such as report cards, lesson planning, or contacting parents. This caused significant distress for teachers. For example, Teacher SS shared, “She wanted me to make phone calls to parents while I'm on a medical leave, because report cards were coming. Well, I was coming back as a volunteer.” Teacher O similarly said, “‘Of course, we value people's mental health.’ Yeah, they value it until you actually take it and they still want you to lesson plan from home even though you're on stress leave.”

Other less frequently cited barriers to taking a leave of absence for mental health issues included the impact the leave would have on colleagues (“the extra workload that it [a leave] puts on colleagues,” Teacher LL) and precarious employment and future impact for teachers on a longer term occasional contract (“I’m working for hard to get these references … the rest of my career is on the line,” Teacher M).

Return to Work After a Leave of Absence for Mental Health Issues: Facilitators and Barriers

Many of the return-to-work facilitators were the same as the leaves of absence facilitators, as social supports again emerged as key facilitators to return to work among interviewees. Supportive colleagues were the most frequently mentioned of the facilitators. Feeling welcomed back to work among supportive colleagues was encouraging and appreciated by teachers who took a leave: “My colleagues were supportive, they were really good …’we’re happy you are back’” (Teacher V). Some teachers had a close circle of colleagues or a close confidant who helped them in their work resumption. For instance, Teacher W explained, “I found a mentor … and she stuck with me like glue.”

The human resources department or school board administration also facilitated a successful return to work for several teachers. For example, Teacher YY explained, “The human resources people … have really tried to work with me … to put forth a good return-to-work plan.” Within schools, a number of teachers also mentioned that the school principal was a facilitator in return to work. “They really welcomed [me] back,” (Teacher DD) one teacher explained, and another said, “[I found] my administrators to be very supportive … they were aware of my situation.” (Teacher UU). Small changes, such as timetabling, that were within a principal's prerogative were appreciated by teachers, and teachers felt these changes were integral for a successful return to work.

Doctors were another facilitator mentioned by teachers to return to work. Not only were doctors helpful for return-to-work plans and accommodations (“My doctor was also very supportive [for the return-to-work package]… so it was very specific for the accommodations meeting,” Teacher TT), they were often viewed as champions for the teachers. Teacher Y explained, “My doctor … she tried to advocate for me.”

The unions were also viewed as facilitators in the return to work after a leave of absence. The affective support was valued as “someone in your corner” (Teacher V) and as an advocate: “The union was support. She would have gone to fight for me” (Teacher BB). Union resources, such as counseling services, were also valued by teachers; as Teacher OO said, “Through our union we have counselling … that was the best thing ever.”

A change in work was also a facilitator for teachers returning to work after a leave of absence. These changes could be a part of a formal return-to-work plan, such as a gradual return. Teacher NN explained that they realized, “Maybe I can start back part time … so we started creating a plan to come back to work.” Alternatively, teachers applied for other jobs within the school or board to facilitate return to work. As Teacher O stated, gradual reentry did not suit them: “I went right back in … but I changed jobs.”

Our interview data revealed that a successful return to work was hindered by two key barriers: administrative barriers and preparation barriers. A lack of administrative support was by far the most commonly cited barrier to work resumption, which can be subdivided into three types of administrative barriers. First, a number of teachers cited a lack of administrative affective support as a barrier to returning to work. Teachers wanted to feel welcomed and valued by the administration team. As Teacher W explained, “I needed some hand holding.” Those teachers who experienced a lack of enthusiasm for their return to work felt distressed by the lack of support. Teacher V said, “Not even the principal or vice principal welcomed me back or anything. It's very lonely. It's very isolating.”

The lack of plans for a successful return was the second cited administrative barrier for return to work. Many teachers returned to the same classroom situation, which was the cause, or partially the cause, of their leave of absence, and thus, returning to the same situation was troubling and very stressful. According to Teacher PP, “Nothing was discussed in terms of what would be set up for me when I came back to make it better.” In fact, sometimes teachers felt that the situation they were returning to was worse and that they were being penalized for having taken a leave; for example, Teacher B explains that “She [the principal] gave me a ton of courses that do raise my anxiety and everything probably on purpose.”

The final administrative barrier to a successful return to work was administrative nagging. Some teachers discussed how their principal was frequently asking them while on leave when they would be returning to work, which was quite distressing for teachers. Teacher WW explained their situation: “He [the principal] had been very aggressive. My mother-in-law worked at the school, and rather than contacting HR to navigate the process through the proper channels, he was sending messages home with my mother-in-law. ‘Can you ask when she's coming back? We need to know.’” This scenario was not unique as some other teachers felt hounded by principals about a return date: “She needed to know when I was going back to work … it was too early to decide” (Teacher V). The other element of administrative nagging that was mentioned as a barrier to return to work was the constant paperwork required by human resources and insurance policies. Constantly feeling as if they had to prove they were mentally unwell was difficult: “Every two weeks I had to confirm that I was still ill and I needed to continue [to be] on leave … I found that process difficult to manage” (Teacher BB).

The final cited barrier to returning to work was the preparation required to return to work, particularly in the middle of the school year. Teacher Z had planned a return to work after Christmas but still had to do marking over the holidays before their official return: “The person [occasional teacher] who had done the contract for me left me a class set of marking … I still had to do it when I got back. She left it there and was like, ‘Get it ahead of time.’” Report cards were frequently mentioned in discussions about leaves of absence, and questions around whose responsibility they were for completion were common. Upon return to work, Teacher P said, “I was expected to write report card comments for kids I had never met.” A gradual return, while a facilitator for work resumption for some, ended up being a barrier for others as it meant more work upon return. Teacher OO explained, “I had to prep for her [the substitute] every day anyway, so they might as well have returned full-time.”

Discussion

Teachers who are experiencing mental health issues and who take a leave of absence need to be able to recuperate with the goal of successful work resumption. This underscores the core purpose of our study: to identify the barriers and facilitators of taking the time off needed to recover from mental health issues and examine the facilitators and barriers to a healthy return to work. Research from around the world has shown a clear connection between teachers’ mental health challenges and their use of sick leave or extended absences.^{10–12,19,20,22,25} Building on this body of work, our study offers a Canadian lens and highlights critical factors that support or hinder the process of taking a leave for mental health issues and resuming work.

Returning to our synthesized theoretical framework, which provides a lens to explore and interpret our results using micro, meso, and macro factors, ³³ it is evident that these factors did influence teachers in taking a leave of absence, both as barriers and facilitators. In terms of work resumption, elements of the organization were frequently mentioned as well as the importance of primary care, supporting D’Amato and Zijsrtra's ³⁴ theory that negative and positive perceptions of the organization, as well as teachers’ health, both impact return to work. At the micro-level, personal situations such as family circumstances, living situations, and financial situations were infrequently mentioned as barriers or facilitators to taking a leave for mental health issues. However, for occasional or supply teachers, their personal employment circumstance was a barrier to taking a leave as they did not want to impact their chances for permanent employment. A stigma of taking a leave was the most cited barrier to taking a leave. Stigma could be viewed as a macro factor because the stigma of mental health issues is a larger social issue. Stigma could also be regarded as a micro-level factor, as fear of a stigma of taking a leave and how one is viewed could be personal perception. Teachers in our study did not want to be perceived as bad teachers, and it was noted that perhaps some of the stigma comes from the teachers themselves. These findings align with the literature that notes stigma is associated with mental health issues among teachers, ⁵ and our previous findings that stigma remains a significant barrier for teachers taking a mental health leave ²³

We found that doctors were facilitators and important social and medical supports when taking a leave at both the micro- and macro-levels. Doctors both encouraged teachers to take a leave when medically needed (micro) and supported teachers in completing all the paperwork necessary for taking and navigating the process for continuing the leave (macro). Doctors were seen as key affective supports and advocates during return to work, particularly in advising on accommodations and helping develop return-to-work plans. This highlights the critical role of primary care in supporting teacher mental health and is a significant finding of our study. The role doctors play in supporting teacher mental health, leaves of absence, and return to work has not been previously explored or found in the literature or our previous work, yet doctors were the most cited facilitator for taking a leave. This finding also emphasizes the importance of access to primary care, which is a well-documented phenomenon in Canada as millions of Canadians, 1 in 5, do not have access to a family doctor or nurse practitioner. ⁴³

Strong leave entitlements were a macro-factor in considering taking a leave, with the financial coverage while on a leave being a facilitator. On the other hand, a macro factor that was a barrier to taking a leave of absence was the process of taking a leave. The logistics, paperwork, and documentation required for a leave were burdensome for teachers facing mental health issues. In some cases, the process was a deterrent to taking a leave, resulting in presenteeism (working when ill), retirement, or career change. With staffing shortages being reported at crisis levels,^15–17 teachers need to be able to take a leave to recover and return to work healthy, so teachers do not continue to work when they should be off work, resulting in a need to take a longer leave or losing teachers entirely from the profession. ²⁹

The other facilitators and barriers to taking a leave of absence were meso-level factors: changing work, principals, human resources/school board, colleagues, unions, and preparation. Changing work was found to be a facilitator in returning to work after a leave of absence for mental health issues. Clear processes to be able to change jobs, job roles, or reduce hours worked may be a way to keep teachers in the profession but still encourage a return to teaching. ²⁹ Supportive colleagues, principals, administrators, and unions were also elements of the organization that impacted a successful return to work, congruent with previous literature that found social supports positively impact teacher mental health.^44,45

Teachers value supportive principals and administrators throughout both the leave of absence and return-to-work processes. In our study, participants generally described their experiences with school leadership as either entirely positive or negative. Organizational barriers to returning to work were often administrative and principal-related, including lack of affective support, inadequate timetabling, poor communication and planning, and nagging while on leave. These issues contributed to negative perceptions of the organization and the return process, aligning with D’Amato and Zijlstra's framework. ³⁴ These findings also support Silva-Macaia and Fischer's ³⁰ study, which found the role of school-level administrators to be crucial in a successful work resumption. We agree with Silva-Macaia and Fischer ³⁰ that improved working conditions are needed for teachers to successfully return to work. Otherwise, as other research has noted, teachers are returning to the same environment and situation that caused some or all of the distress. ²² Some participants in our study noted that administrators expressed a desire to be supportive but lacked the knowledge or training to do so effectively. Both our current findings and previous quantitative work^24,32 highlight the need for training and clear procedures to help principals, administrators, and school board staff better support teachers with mental health challenges. When such supports and processes are in place and function smoothly, teachers view principals, administrators, and school boards as key facilitators in both taking leave and returning to work.

Colleagues and union personnel were key meso-level factors in both taking a leave and shaping positive organizational perceptions when returning to work after mental health leave. Teachers found that both their colleagues and their unions provided affective support, facilitating taking a leave and subsequently welcoming the teacher back to work, creating a sense that there is “someone in your corner” (Teacher V). These findings align with our previous research identifying supportive colleagues as the primary facilitator of return to work, ³² and with Nygren et al., ³¹ who emphasized the role of positive peer support in work resumption after a leave for stress exhaustion. Interestingly, teachers in our study also found that the impact on colleagues was a barrier to taking a leave, with teachers feeling that their absence would be a burden on their peers. Perhaps the feeling that teachers were a part of a team in a school and the resulting social networks could be both a positive and negative factor simultaneously. Unions also provided support to navigate the leave and return to work process, paperwork, advocating for return-to-work plans, and sharing existing supports, such as Employee Assistance Programs and counseling. Thus, like doctors, the unions were able to help teachers navigate macro factors of taking a leave of absence, aiding the process, and providing teachers with subsequent support for return to work, as we also found in our previous work. ²⁴

Finally, preparation was a meso-level factor that greatly impacted teachers taking a leave of absence and was also an organizational element that created a negative perception of the organization when returning to work. Unlike most professions, teachers have to prepare work for while they are absent. Questions about who was responsible for planning, report cards, and parent communication frequently arose, and these unknowns often led to friction between teachers and principals, resulting in both a barrier to taking a leave and resuming work. In many cases, the amount of perceived work required to take a leave resulted in teachers staying on the job and working when ill, resulting in presenteeism, known to negatively impact the quality of instruction. ²⁷ Conflict about whose responsibility preparation was also led to teachers taking more time off, thus returning to work later, often at the end of a term or the beginning of a new school year. This provides a possible explanation to Timp et al.'s ²⁵ finding that teachers take longer leaves for mental health issues than other professions. Clear delineations of job roles are needed when teachers take a leave and return to work during a school year, so that there are no surprises for the principal, teacher, or occasional teacher; however, the way teaching is structured, there may be no easy answers or plans. If a teacher needs to take an immediate leave before the end of term, can a replacement teacher who just started to complete report cards for students they just met? Is it even ethical to ask the new teacher to do so? But if they don’t, who will complete them?

Suggestions for Future Research, Policy, and Practice

Our study is based on qualitative interviews, which allowed us to answer the research questions and explore the complexity and nuance of each teacher's unique story, situation, and circumstances surrounding their leave of absence for mental health reasons. Each experience was distinct and shaped by factors such as school context, personal history, and evolving classroom dynamics. This diversity enriches our understanding of how leaves and work resumption unfold for teachers in real-world settings. Our large sample of 45 participants enabled us to trace common themes while respecting the individual depth of each participant's account. We also realize that those teachers who agreed to participate in our interview may have a greater interest in the topic, which may result in a self-selection bias and possibly more extreme feelings and opinions on leaves and work resumption. Conversely, it is also possible that those still facing mental health challenges may not have the time or mental energy to participate in a follow-up interview. As we have also noted, teacher recruitment and attrition are serious issues in education.^16,17,29 It would be fruitful for future studies to target those teachers who did not return to work after a leave of absence to explore possible interventions for keeping teachers in the profession. In addition, our interviews focused only on the teachers’ point of view. As principals and administrators played key roles in determining whether teachers took leaves and whether they returned to work, hearing from administrators about their experiences of leading schools, teachers, and staff with mental health issues is a worthy future line of research. We know little about leaves and return to work from an administrator's perspective.

Finally, we encourage researchers, policymakers, and education practitioners to consider these findings when developing or evaluating programs to support teacher mental health. Future efforts should strengthen identified facilitators and reduce barriers such as:

• Implement antistigma campaigns to normalize mental health issues and leaves of absence for education workers;

• Promote positive school cultures to foster social support at work and create a sense of belonging and advocacy for mental health;

• Clarify work responsibilities before a leave of absence to define clear roles around tasks such as lesson planning, grading, and report cards;

• Provide organizational support for return-to-work plans, such as change of work, redistribution of workloads or purposeful timetabling, to help teachers successfully transition back to work;

• Create policies for occasional teachers to ensure they can take leave without fear of losing future employment opportunities; and

• Train principals about how to best support teacher mental health, leaves of absence, and successful work resumption.

Conclusion

The international literature demonstrates that teachers’ mental health issues are related to taking sick leave and leaves of absence.^{10–12,19,20,22,25} Teachers have reported significant declines in wellbeing since the pandemic.^8,9 This fact, compounded with teacher shortages ¹⁷ and with the financial and scholastic cost of teacher absences,^27,28 makes it more important than ever to improve teacher mental health. Not only does this require healthy workplaces and schools to keep teachers well and productive, but it also requires clear and supportive processes for taking leave when needed to recover from a mental health issue. To foster a successful return to work, a clear and supportive process is necessary as well. Our study adds a Canadian perspective to the global conversation on teacher mental health, leaves of absence, and return to work by providing rich qualitative data and the voices of teachers. We identified several key facilitators and barriers in this process, including stigma, primary care, processes, preparation, and social supports in school systems (colleagues, unions, principals, administrators, and school boards). Creating educational cultures, workplaces, and structures to overcome these barriers and enhance these facilitators are essential for fostering a sustainable and healthy teaching workforce.

Author Biographies

Kristen Ferguson is a professor of Education at the Schulich School of Education and the Dr. Elizabeth Thorn Chair in Literacy at Nipissing University. Her research interests include literacy education, teacher professional development, and teacher mental health, stress, and coping.

Melissa Corrente is an Ontario Certified Teacher, mother of 2 and a senior research associate at the University of Ottawa. She teaches part-time for the Schulich School of Education at Nipissing University. Her research interests include teacher mental health, healthcare worker burnout, and food literacy for children.

Ivy Lynn Bourgeault, is a professor in the School of Sociological and Anthropological Studies at the University of Ottawa and the University Research Chair in Gender, Diversity and the Professions. She leads the Canadian Health Workforce Network, the Empowering Women Leaders in Health initiative and co-leads the Team Primary Care: Training for Transformation project. Dr. Bourgeault has garnered an international reputation for her research on the health workforce, particularly from a gender lens.