The transitional period of returning to work after a prolonged period of sickness absence can be daunting for the employee AND their line manager - especially where the ill health revolved around a stress at work issue. Coming to terms with changes that have taken place during the employees absence and re-establishing team working practices will take effort and commitment from the manager and employee alike. Supportive and proactive interventions must be implemented to ensure a smooth transition back to the workplace.

The employees perspective

Returning to work following a long period of absence is daunting in itself, but with stress-related absence this is often so threatening that some individuals never make the transition back to full time employment. If the illness was brought about by stress at work or there are unresolved bullying or harassment issues, its likely that fear of a relapse, along with lack of confidence and low self-esteem, will inhibit rehabilitation. When work pressures only partially contributed to the illness, there may be a feeling of guilt on the part of the employee that he or she had let their fellow workers down and put unnecessary pressure on others in the run-up to their illness. Such anxieties may be groundless, but individuals feel very fragile following stress-related illnesses C with anxiety, depression and panic attacks being common symptoms of breakdown or burnout. A considerable amount of support and encouragement is required if a full recovery is to be both achieved and sustained.

The employers perspective

The long-term absence of an employee naturally puts pressure on an organisation, both in terms of the costs of covering the absence and also in maintaining the morale of team workers. Achieving the smooth return to work of an employee who has been absent for some time requires early steps to be taken to establish a non-threatening rapport with the individual, and this should be undertaken with care and sensitivity. It should be the responsibility of the line manager or personnel officer to keep in contact with the employee C as its important that the absent employee feels valued but not pressured into returning to work before they are completely recovered.

Once it has been established that an employee is well enough to return to work, its imperative that a phased return is planned. This should involve the employees GP, counsellor/coach, personnel officer or line manager, together with an external mediator if there are unresolved workplace issues that still need to be addressed. The phased return should include a short induction programme and any necessary retraining. Workloads at this stage should be carefully monitored C as too much too soon could result in a crisis of confidence and a relapse; while too small a workload can have the effect of making the employee feel superfluous.

Guidelines for rehabilitation back to work

Each case has to be judged on its merits, and in cases of return to work after several months of illness it will be important to work in conjunction with an occupational physician. The importance of this process cannot be overstated. Once an employee has highlighted that they have had a stress-related illness, positive action must be taken to remove the stressors and/or give adequate training and support to the individual to enable them to cope with the demands of their job

The normal work-related pressures should be removed, as far as is possible, for the initial return to work, and then gradually reapplied as the individual becomes fit enough to accommodate them as part of their normal everyday work. In some cases retraining may be appropriate, and this will depend on discussions with the individual, the job evaluation and skills analysis.

Ongoing appraisal needs to be a guided conversation, with the manager helping to review aspects of the job that may be difficult, and identifying areas where the individual is happy to initially return to begin work.

Key questions for consideration in ensuring successful rehabilitation of an employee back to work include:

? Has the individual been off work for the optimum recovery period? Individuals may return to work too soon and without having had enough time to rest and recover and to rebuild their self-esteem and confidence.

? What are the factors that caused the original problem, and who needs to assume responsibility?

? Is it appropriate that the individual returns to exactly the same role?

? Where the individuals role needs to be changed, has this been communicated clearly, i.e. are the manager and individual clear about roles, responsibilities and expectations?

? What working practices need to be in place to support the returned worker and what can management do to facilitate this?

? Has the individual been given any advice on burnout prevention? The value of this cannot be overstated, particularly in relation to key areas including sleep, hygiene, energy management (through nutrition), and graded physical exercise programmes.

? Have procedures been established for the regular review of the situation? Progress should be continually monitored with regular communication between the Occupational Health department, manager and the individual.

? Motivation C is the individual suited to the job? What do they want from their job?

Serious stress-related illness, and in particular burnout, are conditions from which it is difficult to make a complete recovery. There is, unfortunately, a high risk of relapse should either the employer or the employee not have learnt the necessary lessons. It is for this reason that the employer must monitor the employees return to work and be alert to the early warning signs of reoccurring personal stress or any inability to cope with given tasks. Regular appraisal will identify further training needs, and provide a discussion forum to enable both parties to raise issues that may be inhibiting a full return to work.

Having said this, it is only reasonable to accept that whilst the employer can provide the structure and support mechanism for an employee to return to work, they cannot guarantee that the employee will necessarily slot back successfully into the original position that they formerly occupied.