Title: Facilitating the return to work of NHS staff with common mental health disorders: a feasibility study
Funder: Department of Health and Social Care

Abstract: Design: A mixed methods study to develop & test the feasibility of an intervention to improve return to work (RTW) in NHS staff who go on sick leave with a common mental health disorder (CMHD). Method: The study is divided into 4 phases. Phase 1 gathers evidence by a systematic review & establishes care as usual (CAU). Phase 2 aims to develop an intervention & data collection tools by an iterative process involving stakeholders & patient and public representatives. Phase 3 aims to test the feasibility & acceptability of the intervention in the NHS & to assess for contamination if the main trial were to be an individually RCT. Phase 4 finalises the manualised intervention & makes recommendations on the best study design for a future trial. We will carry out phase 3 in 6 OH departments. At 4 study centres study participants will be assigned either to see an OH nurse who has been trained as a case-manager & receive the intervention or to see an OH nurse who has not been trained as a case-manager & will receive CAU. At the other 2 centres participants will receive CAU.This design allows us to test for feasibility & to assess the risk of contamination if an individually RCT were undertaken. Setting: 6 OH departments delivering services to different types of NHS Trusts. Target population: NHS staff who have recently been issued with a fit note which includes a CMHD. Inclusion criteria: Staff with a CMHD with/without an associated physical disorder, who have been off sick for > 7 days & < 90 days. Exclusion criteria: Staff with a psychotic disorder, addiction or dementia. Staff under investigation for misconduct or in the process of disciplinary action. Health technologies being assessed: Standardised case management delivered by OH nurses following training. This is likely to include identifying barriers to RTW (problem-solving, motivational interviewing, peer-support networking, work-focused CBT, optimisation of clinical treatment, goal setting. Graded, written RTW plan with workplace adjustments, based on discussion between participants & their manager & shared with the participants’ healthcare professionals. Timed reviews. Outcomes: Feasibility-Rates of uptake among those eligible to participate; frequency & nature of protocol violations; completeness of data collection; average consultation times compared to normal & average number of follow-ups per case; extra line manager and human resource time per consultation. Fidelity of the case-manager training. Acceptability- Qualitative findings of the acceptability of the intervention to participants, HR, line managers & case manager. Reasons for not completing the intervention & any adverse effects. Measurements of costs: Costs of delivering the package of interventions including OH nurse time, participants and manager time & cost of training OH nurses in case management. Manual development: Complete specification of the intervention & standard operating procedures for different settings. A manual for training the case-managers. Sample size With a sample size of 60 we will be able to estimate a participation rate of 80% to within a 95% confidence interval of +/- 10%. We have allowed for 84 participants., so we are confident that we will have a good precision around the participation and completion rates.

Lay abstract: Background Workers in the NHS are more likely to develop mild to moderate anxiety and depression (known as common mental health disorders or CMHD) than the general working population. Absenteeism is costly to the NHS, and for the individual. It is associated with poor health-related quality of life, reduced probability of eventual return to work (RTW) & social isolation. The value of early & pro-active rehabilitation of NHS staff on sick leave with CMHD is recognised, but there have not been any controlled trials in the UK to test suitable interventions to assist workers sick-listed with CMHD return to work. We know from previous studies that clinical assessment and treatment of sick-listed workers alone does not result in early RTW. This is best achieved by combining clinical treatment of the workers with adjustments being made to the workplace to facilitate their return. A recent study suggests that a healthcare-trained case-manager is ideally placed to assess sick-listed workers and to liaise with the managers to assess which workplace adjustments can be accommodated to enable the worker to RTW. Aims 1) To develop an intervention which we think will aid NHS staff who go on sick leave with CMHD to return to work. 2) To assess the effectiveness of an educational program to train occupational health (OH) nurses in case-management 3) To assess if the proposed intervention is acceptable to sick-listed staff, NHS managers and the nurses who deliver the intervention. In addition, we will assess if it is feasible to deliver the intervention in an NHS setting. 4) To assess if it would be possible to run a randomised controlled trial to formally test the intervention. 5) To produce a detailed description of the intervention & of the training program for OH nurses. Design and methods We will search the scientific literature for evidence of what individual interventions have improved RTW in workers sick-listed with CMHD. Together with workers who have had episodes of sick leave due to CMHD, NHS OH departments and NHS human resources/manager representatives will use this evidence to design an intervention that is likely to be effective and feasible to use in the NHS. The intervention is likely to combine clinical treatment, goal setting, workplace adjustments and a step-wise written RTW plan. We will train OH nurses to be the case managers, they will deliver the intervention in four NHS Trusts across the UK. We will include acute & non-acute Trusts and invite workers who are newly sick-listed with CMHD to take part. We will collect data on 84 workers (28 who will receive the intervention & 56 who will not) over a 12-month period. From these data we will assess if it would be feasible to evaluate the intervention in the NHS by a randomised controlled trial. We want to make sure that the intervention, including the training of case managers is acceptable to staff who are on sick leave with CMHD, NHS managers, and the OH nurses who will deliver the intervention. To this end, we will interview these groups of staff on their experiences of and opinions on the intervention. We will estimate the cost of the intervention. We will produce a report recommending whether it would be feasible to run a randomised control to test the clinical and cost-effectiveness of the intervention. We will also produce details of the intervention, together with the necessary questionnaires, data collection tools and training manuals for a future trial.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH