Individual research recommendation details

Recommendation ID

NG146/3

Question

For people with common mental health conditions, what interventions are effective and cost effective in reducing long-term sickness absence and supporting return to work in the UK?

Any explanatory notes
(if applicable)

Why the committee made the recommendations
The committee discussed that musculoskeletal conditions and common mental health conditions are the most frequent causes of long-term sickness absence among employees. Evidence from a small number of non-UK studies in people with musculoskeletal conditions suggested that interventions to strengthen a person's physical and mental health, and to focus on reducing potential barriers in the workplace, may increase return-to-work rates.
Although the committee noted the limitations in the evidence, they agreed that for employers with occupational health access, it would be useful to have the option of arranging a therapeutic programme of graded activity or problem solving for employees who are absent for 4 or more weeks because of musculoskeletal conditions. Although the economic analysis focused only on changes in absenteeism, because of a lack of data on other outcomes, such as productivity, staff turnover and wellbeing, the committee noted that these types of interventions could be cost saving.
The committee discussed evidence which showed that the time people take to return to work after absence because of a musculoskeletal condition may be reduced if flexible adjustments are agreed between employee and employer, as part of a planned return-to-work process.
The committee heard from an occupational health expert and an expert from a mental health support service that it can be helpful for an impartial person (who may or may not be part of the organisation) to facilitate discussions between the employee and employer, to help agree adjustments that are acceptable to both. The committee noted that there may be a number of people who could fill this role, examples include people from occupational health services, occupational therapists and vocational rehabilitation consultants.
A study of people who had returned to work after absence related to mental health conditions showed a supportive monitoring and problem-solving intervention delivered over 3 months to be associated with a reduced risk of recurrent absence. Although the economic analysis only considered the impact on absenteeism, this intervention was estimated to be cost saving.
Although the evidence was limited, in that it was based on 1 low-quality study, the committee also heard from an expert who supports people with mental health conditions that have resulted in them being absent from work or struggling to remain in work. Their testimony described the use of individual support plans and supportive monitoring. Based on this evidence and their expertise, the committee noted that such interventions are considered to be good practice for people with long-term absence due to common mental health conditions.
The committee noted that although there are substantial limitations in the evidence on supporting people to return to work after absence due to musculoskeletal or mental health conditions, particularly the lack of UK-based studies, it is important to not discourage what is considered to be good practice.
The committee agreed that interventions for those with common mental health conditions should be a research priority. This group may experience recurrent and long-term sickness and there is a lack of evidence on supporting their return to work. The committee recognised that reasons why a person may take sickness absence may be complex. They therefore agreed that research studies should aim to capture the context of the sickness absence and the preferences of participants in supporting them to return to work, alongside data on whether they have been able to return to work (see research recommendation 3 and research recommendation 4).

How the recommendations might affect practice
The recommendations made in this area reflect good practice but some may currently be more accessible to people working in larger organisations. For example, organisations may buy in occupational health services that provide access to physiotherapy, counselling or ergonomic assessment of worksites.
Not all organisations have access to such services, particularly micro-, small- and medium-sized organisations. But they may be able to access them with minimal resource implications, for example by being part of a local or sector association that subscribes to these services.
There may be resource implications if everyone returning to work after absences of 4 or more weeks because of a common mental health condition is offered a 3‑month programme of structured support.
Economic modelling indicated that such an approach could be cost saving. The committee considered that these interventions could offer value for money and in the long run could reduce their costs. In the model these were achieved through savings associated with reduced absenteeism. The committee were mindful of other potential benefits not captured in the model, such as increased productivity as a result of early or sustained return to work and reductions in the costs associated with staff turnover.
Implementing the recommendations may need resource input initially, but over time may result in a reduction in the costs of sickness absence and improved productivity.
Full details of the evidence and the committee's discussion are in evidence review C: facilitating return to work from long-term sickness absence.

Source guidance details

Comes from guidance

Workplace health: long-term sickness absence and capability to work

Number

NG146

Date issued

November 2019

Other details