Dan Jolivet described the importance of return-to-work programs for employees with behavioral health and substance abuse disorders in his first post along with two key elements associated with program success: a holistic approach and the services of a return-to-work consultant. In Jolivet’s second post, we consider the importance of stay-at-work services and program metrics.
The Third Element: A Focus on Stay-at-Work Services
Return-to-work (RTW) professionals recognize that a significant percentage of the employees with whom they work could have been helped prior to going out on leave. This early intervention could have either avoided the employee leaving the workplace or minimized the length of time out of work. That kind of early intervention is the focus of stay-at-work (SAW) programs.
Early intervention requires a different focus to identify appropriate employees. SAW programs primarily rely on referrals from the employer (either through the human resources department or the employee’s supervisor) or the employee themselves. RTW consultants located onsite with employees can also identify potential referrals through their observations of workers doing their jobs or through onsite discussions.
Denial, Shame, Stigma and Ignorance
In my experience, SAW programs face two significant barriers in helping workers dealing with behavioral health conditions.
First, employees generally conceal their problems from their employers, because of denial (the belief the problem isn’t severe enough to require help), shame (the feeling that the problem represents a flaw in them as a person), or stigma (the fear that others will treat them differently if they acknowledge their problems). Employers can address these impediments to obtaining support through communication, educational promotions, and anti-stigma campaigns, all of which have the additional benefit of increasing employee utilization of other employer-offered benefits, including EAP.
The second barrier SAW programs face is ignorance. Few people think of individuals with behavioral health conditions as appropriate for these programs, because they don’t know that most people diagnosed with mental health and substance use problems recover. Or they don’t realize that appropriate accommodations exist for them.
Education from the SAW provider for front-line employees, managers and HR contacts is essential. A close partnership between the RTW consultant and the employer (particularly involving the human resources department) can help overcome this obstacle.
The Fourth Element: Measurable Results
The final ingredient found in a successful RTW program is outcome tracking and reporting. Anecdotal evidence such as success stories and case studies present the human side of RTW and SAW programs, but financial leaders want to understand the impact these programs make to the company’s day-to-day business.
Results should include a variety of statistics that are meaningful to the employer and allow them to compare their outcomes to their own historical results and industry benchmarks. Metrics that are commonly reported by month, quarter or year include the number of cases initiated and completed, participation rates, success rates, and return-on-investment estimates. Employers may want to see these broken out by demographic variables (age of the employee, employee tenure, union status) or diagnostic categories. Success rates and ROI estimates are also related to reduced leave incidence (short-term disability leaves per 100 employees), reduced duration of individual leaves, reduced average leave duration, and lost days avoided.
In addition to demonstrating the success of the program, these metrics also allow the employer and their vendor to identify trends and opportunities to improve the program. A spike in workers compensation claims related to PTSD, for example, can lead to research that identifies potential causes and interventions for improvement.
Successful RTW and stay-at-work programs are always evolving based on the needs of the employer, changes in their workforce, and developments in the field related to behavioral health and disability.
Other Elements to Consider in Return-to-Work Programs
While the four elements I described are central to a successful RTW program, two other elements can enhance success.
First, a generous reasonable accommodation expense (RAE) benefit can make the difference between a successful RTW plan and an unsuccessful one. Although accommodative equipment is usually not key to helping a person with a behavioral health condition return to work (or stay at work), the RAE benefit may be used to pay for the RTW consultant’s services.[i]
The process of returning people to work often requires frequent contact from the RTW consultant over the course of months – particularly for employees with severe or complex conditions – as well as support such as accompanying the employee to medical appointments or meeting with the employee at the worksite. Most employers don’t include funds for these services in their budgets. That may delay (or prevent) appropriate services from being provided to the employee while funding is identified. A substantial RAE benefit can expedite service delivery and ensure that early intervention happens in the beginning stages of the employee’s condition.
Second, although accommodative equipment is less frequently required with employees who have behavioral health conditions, such equipment is needed occasionally. A successful RTW program will have written policies and procedures regarding equipment ordering and delivery. This is particularly important for those employees with complex comorbid (behavioral and physical health) conditions for whom equipment may be needed to address a physical problem that impacts the employee’s mental health.
Finally, I think it’s important to note that a successful RTW program is customized to the employee’s needs. This requires a team that is innovative, creative and passionate. Luckily, my experience suggests most people who work in the field of disability rehabilitation and RTW services fit that description perfectly.
Innovative RTW programs benefit both employers and their employees. Employers can benefit in their ability to meet their productivity or service delivery goals, which, in turn, may provide financial returns. But, as importantly, employees with behavioral health conditions can maintain all the benefits that come from employment. This is not just about a paycheck, but the social engagement of a job, the sense of purpose and fulfillment that comes from doing meaningful work, and the happiness, confidence and self-esteem that many of us derive from our occupations. And that is a key to our country’s recovery from the long epidemic of diseases of despair.
 I use the term “behavioral health” as an umbrella term, encompassing both mental health (psychiatric) and substance use (alcohol & drug) issues and conditions, but there isn’t clear consensus in the field and some people use “mental health” as the overarching term. I also use the term “addiction” as synonymous with problematic substance use conditions.
 Note that legal issues that are relevant to return-to-work programs, such as FMLA, ADA, OSHA standards and state workers compensation statutes are outside the scope of this article. Interested readers should consult appropriate legal resources with respect to compliance with those and other regulatory requirements.
 These employees are also often the ones identified as utilizing a disproportionate level of medical and pharmaceutical benefits, as well as repeated sick leaves, workers compensation leaves, and disability leaves. They may be well known to their employer’s HR Department because of their complex needs, and a side benefit of working with a return-to-work consultant is that the consultant may become the primary point of contact for the employee, thus relieving the HR Department of some of the difficulties associated with helping these employees navigate their complex health needs.
 Accommodative equipment is by no means rare when it comes to behavioral health conditions. People with limitations in their ability to concentrate, for example, may be helped by noise-canceling headsets; people with exaggerated startle responses following a trauma may benefit from cubicle doors to prevent coworkers from walking into their workspace without warning; people recovering from addiction may use mobile apps designed to support better control of their emotions; and so on.