Dr Geoffrey Waghorn is a Senior Scientist at the Queensland Centre for Mental Health Research and has written extensively about employment and severe mental illness.  When he shared his expertise with RTWM, he had some surprising news for employers: managing return to work for staff with psychiatric disabilities is pretty much "business as usual".

Why? Because people who have a psychiatric disability have a lot in common with people who don't. Dr Waghorn explained…

"You know what it turns out employers have to do for this group of people? Nothing other than good management. They don’t have to do anything different. The person themselves wants to be treated the same as any other worker. They don’t want any special treatment. However they don’t want any additional stress caused by bad management. So everything that good employers or good managers do to pay attention to their workers’ individual needs is all that’s required."

And to look at it from a slightly different angle, we all experience mental health difficulties at some point in our lives. According to Dr Waghorn, there are three broad categories of mental illness:

1. Very severe mental disorders that involve developmental changes in the brain that start at the beginning of life - things like schizophrenia, schizoaffective disorder, and bipolar affective disorder, which will affect around 2% of the population in their lifetime;
2. Mental disorders like anxiety and depression, which can be circumstance related - things like clinical anxiety, depression and post-traumatic stress syndrome, which will affect around 20% of the population in their lifetime; and
3. "Life ache" - things like stress, grief and relationship problems, which affect 100% of the population.

To varying degrees, each of these categories of mental illness impacts on a person's ability to work productively. While a lot of employers might be tempted to put individuals with severe mental disorders in the too hard basket, the fact is that in terms of managing return to work, there is a lot more in common between the three categories than you might think.

Dr Waghorn puts it like this: "If you’ve recently had a bereavement, if somebody close to you has died, it is very difficult to function for a couple of months. And mental disorders can be a bit like that. Some days you’re just in a complete fog and you don’t have any get up and go. And that doesn’t mean you’re not a good worker. It just means that you’re a good worker in a bad place."

Just as an employer doesn't need to know intimate details about an employee's experience of grief in order to provide effective management following bereavement, employers don't need to "swallow the textbook of psychiatry" in order to assist an employee with a psychiatric disability return to work.

"They don’t even need to know any psychiatric terms at all. They just need to know how that particular illness in that particular person manifests those work restrictions and those work strengths in that particular job."

Sound familiar? As always, effective RTW is about finding a fit between workplace environments and individuals - and flexible management achieves the best results. The emphasis should be on practical issues: things like breaks, duties and expectations about shift work and overtime. Employers do not have to go through this process alone. Federally funded initiatives such as the Job In Jeopardy program and the disability employment network service provide no-cost services aimed at finding and retaining employment for people with psychiatric disabilities.

"Employment consultants are available to actually visit the workplace and help train the person and reorganise their job, or redesign their job. Sometimes they offer things like wage subsidies. If their productivity is never going to be up to par, they can be paid pro rata on wages according to their productivity via the Supported Wage Scheme."

This approach also makes things easier for employees, who may be more comfortable communicating with their employer about their illness via a third party. There is a lot of stigma, misinformation and sometimes even fear associated with severe mental illnesses and this can make employees wary of disclosing their condition to their employer. However Dr Waghorn wants employers to recognise that they're probably already employing people with psychiatric conditions.

"We just don't realise how many of these people are already in our workplaces. When there's stigma out there, people apply for jobs and don't disclose these health conditions. They know they're going to be discriminated against."

The more people with severe mental illnesses there are in the workforce, however, the less likely stigma is. According to Dr Waghorn, while "...the psychiatric terms can trigger stigma, the presence of a person with one of those stigmatising disorders actually reduces stigma because when the workplace gets to know the person they no longer think of them as a disorder."

Like other ill or injured people, early return to work can have enormous therapeutic value for those with psychiatric disabilities. Dr Waghorn considers work to be "...a key health intervention for people with severe mental illness. Work is incredibly important. If you have a serious mental illness and go home and sit on your porch, you not only don’t learn to manage your mental illness in challenging situations, but you lose whatever skills you already had. You lose your confidence to talk to people, you lose your social skills, you lose your ability to coordinate tasks and work efficiently. You lose your ability to work to time pressure and keep yourself moving. You can very easily get demotivated and slovenly and have a low metabolic rate and that’s really bad for us, we know that.

“People who work feel the relief from stigma, because for once they’re regarded as a worker and not a mental health patient or a dole bludger. It’s not possible to escape that stigma without a valued role like employment. And not only does employment help you escape from stigma, it also gives you the opportunity to improve your mental skills and your physical skills and your strengths. Plus the social opportunities that come with work. So people can get their lives back through employment when they can’t any other way."

It is not only employees with psychiatric disabilities who benefit from participation in the workforce: the workforce benefits too. Individuals with severe mental disorders can be an enormous asset to an organisation. People with bipolar, for example, are often "…more creative, more energetic and better able to concentrate than people without the disorder." And because individuals with a severe mental illness can find it difficult to attain employment, they tend to be extremely well motivated once employed.

"The thing about having a severe mental illness is that once you’ve got a job and opportunity in something you like, you understand how damn hard it is to get that. And you value it highly. You actually spend your spare time thinking about how you can improve your work performance when you’re next at work. And I don't think too many people when they've just left school think like that!"

This isn’t to suggest that all news about employment and psychiatric disability is good news. A high-functioning individual with bipolar may sometimes take unexplained absences from work or seem bereft of motivation. A person with schizophrenia may have difficulties managing their illness for a time, and experience psychotic symptoms. And even when recovery is consistently well managed, it isn't always possible for someone with a serious mental disorder to return to work in the same position or vocation they had before first onset or relapse. According to Dr Waghorn, return to work outcomes vary considerably.

"I know architects that have gone back to their same job. I know other people who have had to change their career direction completely. So I suppose the best position to hold on that is, to not have a position. And to allow the possibility that the same job might be possible, but they might have to reduce the hours, they might have to change the mix of tasks a little, or they might have to retrain for something much different."

But again, this is "business as usual" for RTW. While the preferred option is always to get individuals back into the same job, within the same department and for the same employer as before illness or injury, it isn't always possible. That’s a fact of life.

Good management can, however, make a real difference. As Dr Waghorn noted, “Employers can help a lot. They can help identify a person’s strengths and match that to the right mix of duties.” For psychiatric disability the best results are achieved, as always, when employers, employees and health professionals collaborate for RTW.