Critical factors in the return-to-work process. Perspectives of individuals with mental health problems, vocational rehabilitation professionals, and employers.

Introduction: Mental health problems are a major concern among todays working age population. This is experienced by individuals as personal suffering and a loss of income, and by society overall as a financial burden regarding sick leave, healthcare costs and a loss of productivity of individuals outside the labour market. When an individual is in the return-to-work (RTW) process, they often need support from both vocational rehabilitation professionals and employers. Insufficent support can present a barrier for a successful RTWoutcome. Aims: Study I: To explore which factors are of critical importance for individuals with affective disorders in their RTW-process, and to explore the impact of two vocational approaches, Traditional Vocational Rehabilitation (TVR), and Individual Enabling and Support (IES), on the service users’ experiences of the RTW-process. Study II: To evaluate the effect of the IES and TVR approaches on empowerment and depression severity after 12months of intervention. Study III: To explore the mental health literacy of vocational rehabilitation professionals and their perceptions of employers in the RTW-process. Study IV: To examine employers’ beliefs, knowledge and strategies used in providing support to employees with mental health problems. Methods: Studies I and II were based on the same parallel randomized controlled trial (RCT) (n=61) of individuals with affective disorders participating in either TVR or IES. Study I was a qualitative study using content analysis. Participants (n=16), purposely sampled from the RCT, had undergone TVR (n=8) or IES (n=8) interventions over the preceding 12-months. Study II was a quantitative study including all 61 RCT participants (TVR n=28 and IES n=33). Studies III and IV both applied the grounded theory methodology, with Study III including (n=22) vocational rehabilitation professionals, and Study IV (n=24) employers. Results: In Study I three themes of importance in the RTW-process emerged: To experience hope and power, Professionals positive attitudes, belief and behaviour, and Employing a holistic persepctive and integrating health and vocational service. In Study II a statistically significant difference was found between TVR and IES where the IES participants showed an increase in empowerment and a decrease of depression which was not seen among the TVR participants. In Study III three categories emerged regarding the vocational rehabilitation professionals: Holding a position of power in the RTW-process, Viewing and believing in individuals’ work ability plays a central role, and Recognizing employer’s role as a key factor for realizing employment. In Study IV, two categories emerged: Comprehending mental health problems is complex, and Lacking established conditions to support work. Conclusion: From the perspective of individuals with affective disorders the results highligted the importance of the IES approach i.e. having an Employment Specialist working together with the individual in a person-centered manner, and integrating vocational services with health services towards the goal of competitive employment. When doing so, the result showed increased empowerment and decreased depression. It is therefore critical to increase the mental health literacy among both vocational rehabilitation professionals and employers. Such knowledge may strengthen collaboration between them and close time and service gaps that exist among welfare organisations involved in the RTW-process.