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Negotiating Safety: Facilitation of Return to Work for Individuals Employed in High-Risk Occupations

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Abstract

Purpose

Return-to-work (RTW) after absence due to a mental illness is a largely understudied area, especially in industries already struggling with retention like those posing unique and high risks for public or personal safety (i.e., pilots, police officers, and health professionals), otherwise known as safety-sensitive sectors. The goal of this paper is to examine how RTW coordinators work with individuals who took a leave of absence for mental illness in safety-sensitive occupations and navigate the RTW process.

Methods

Qualitative methodology was utilized to explore the experiences of 47 RTW coordinators who had worked with individuals employed in safety-sensitive industries. The participants were recruited across Canada using convenience sampling to participate in semi-structured interviews. The interviews were transcribed, anonymized, uploaded to NVIVO 11, and coded using inductive thematic analysis.

Results

Our analysis shows that despite the presumed rigidity of occupational health and safety standards for safety-sensitive positions, the notion of “safety” becomes ambiguous in navigating RTW processes, and concerns about safety are often interpreted as the potential risk workers may pose to themselves, other individuals, or the workplace image. Institutional constraints of safety-sensitive jobs shape the ability of RTW coordinators to advocate on behalf of the workers, ultimately placing the workers at a disadvantage by prioritizing safety concerns for organizations over employees’ needs.

Conclusion

It is important to consider how to protect workers in safety-sensitive occupations during the RTW process after absence due to a mental illness to ensure effective integration to the workplace.

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References

  1. Johnston DA, Harvey SB, Glozier N, Calvo RA, Christensen H, Deady M. The relationship between depression symptoms, absenteeism and presenteeism. J Affect Disord. 2019;256:536–40. https://doi.org/10.1016/j.jad.2019.06.041.

    Article  CAS  PubMed  Google Scholar 

  2. Dyrbye LN, Shanafelt TD, Johnson PO, Johnson LA, Satele D, West CP. A cross-sectional study exploring the relationship between burnout, absenteeism, and job performance among American nurses. BMC Nurs. 2019;18(1):57. https://doi.org/10.1186/s12912-019-0382-7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Headversity. The cost of neglected employee mental health? $80 billion and counting. headversity. [Online]. Available: https://headversity.com/the-cost-of-neglected-employee-mental-health-80-billion-and-counting/

  4. The Human Resources Professional Association, Mental health in the workplace. HRPA. [Online]. Available: https://www.hrpa.ca/hr-insights/mental-health-week/

  5. Edgelow M, Harrison L, Miceli M, Cramm H. Occupational therapy return to work interventions for persons with trauma and stress-related mental health conditions: a scoping review. Work Read Mass. 2020;65(4):821–36. https://doi.org/10.3233/WOR-203134.

    Article  Google Scholar 

  6. Tarro L, Llauradó E, Ulldemolins G, Hermoso P, Solà R. Effectiveness of workplace interventions for improving absenteeism, productivity, and work ability of employees: A systematic review and meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2020;17(6):1901. https://doi.org/10.3390/ijerph17061901.

    Article  PubMed  PubMed Central  Google Scholar 

  7. O’Brien-Pallas L, Murphy GT, Shamian J, Li X, Hayes LJ. Impact and determinants of nurse turnover: a pan-Canadian study. J Nurs Manag. 2010;18(8):1073–86. https://doi.org/10.1111/j.1365-2834.2010.01167.x.

    Article  PubMed  Google Scholar 

  8. Garcia M. Recruiting and training for critical jobs threaten airline growth. Can technology help?. Forbes. [Online]. Available: https://www.forbes.com/sites/marisagarcia/2018/08/22/recruiting-and-training-for-critical-jobs-threaten-airline-growth-can-technology-help/

  9. Thomas J. Study on causes and effects of employee turnover in construction industry. Int J Sci Res 2013;4(5).

  10. Scruggs L, Zimmermann C. Implementation of the human right to social security around the world: a preliminary empirical assessment of national social protection laws. 2011. [Online]. Available: https://ideas.repec.org/zimm/present/szsl.pdf

  11. Pennings F, Secunda PM. Towards the development of governance principles for the administration of social protection benefits: comparative lessons from Dutch and American Experiences. Rochester, NY, Feb. 11, 2015. [Online]. Available: https://papers.ssrn.com/abstract=2563828

  12. Rudner S. Understanding sick day entitlement. Available: https://www.hrreporter.com/opinion/canadian-hr-law/understanding-sick-day-entitlement/330155

  13. Heymann SJ, Gerecke M, Chaussard M. Paid health and family leave: the Canadian experience in the global context. Can J Public Health Rev Can Santé Publique. 2010;101(Suppl 1):S9–15. https://doi.org/10.1007/BF03403840.

    Article  Google Scholar 

  14. Durand M-J, Nastasia I, Coutu M-F, Bernier M. Practices of return-to-work coordinators working in large organizations. J Occup Rehabil. 2017;27(1):137–47. https://doi.org/10.1007/s10926-016-9640-7.

    Article  PubMed  Google Scholar 

  15. MacEachen E, McDonald E, Neiterman E, McKnight E, Malachowski C, Crouch M, et al. Return to work for mental ill-health: a scoping review exploring the impact and role of return-to-work coordinators. J Occup Rehabil. 2020;30(3):455–65. https://doi.org/10.1007/s10926-020-09873-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Dol M, Varatharajan S, Neiterman E, McKnight E, Crouch M, McDonald E, et al. Systematic review of the impact on return to work of return-to-work coordinators. J Occup Rehabil. 2021;31(4):675–98. https://doi.org/10.1007/s10926-021-09975-6.

    Article  CAS  PubMed  Google Scholar 

  17. Kuretzky B, McMillan W. The legal landscape for Canadian employers one year after legalization of cannabis,” Littler Mendelson P.C. 2019. Available: https://www.littler.com/publication-press/publication/legal-landscape-canadian-employers-one-year-after-legalization

  18. Swotinsky R. Opioids and safety-sensitive work. J Occup Environ Med. 2014;56(11): e133. https://doi.org/10.1097/JOM.0000000000000295.

    Article  PubMed  Google Scholar 

  19. Hegmann KT, Weiss MS, Bowden K, Branco F, DuBrueler K, Els C, et al. ACOEM practice guidelines: opioids and safety-sensitive work. J Occup Environ Med. 2014;56(7):e46-53. https://doi.org/10.1097/JOM.0000000000000237.

    Article  PubMed  Google Scholar 

  20. Mthimkhulu V, van der Walt HD. Exploring the relevancy of random and scheduled alcohol breathalyser testing in high-risk jobs within safety-sensitive work settings. SA J Hum Resour Manag. 2021;19:a1632. https://doi.org/10.4102/sajhrm.v19i0.1632.

    Article  Google Scholar 

  21. Els C, Jackson T, Tsuyuki R, Aidoo H, Wyatt G, Sowah D. Impact of cannabis use on road traffic collisions and safety at work: systematic review and meta-analysis. Can J Addict 2019;10(1):8–15. [Online]. Available: https://journals-lww-com.proxy.lib.uwaterloo.ca/cja/abstract/2019/03000/impact_of_cannabis_use_on_road_traffic_collisions.3.aspx

  22. Barger LK, Lockley SW, Rajaratnam SMW, Landrigan CP. Neurobehavioral, health, and safety consequences associated with shift work in safety-sensitive professions. Curr Neurol Neurosci Rep. 2009;9(2):155–64. https://doi.org/10.1007/s11910-009-0024-7.

    Article  PubMed  Google Scholar 

  23. Samimi K, Sepehr P, Jabbari M, Erfani Fard M, Rezapour S. Assessing safety culture and its relationship with mental load and job stress in the national gas company. Arch Occup Health. 2021;5(4):1101–8. https://doi.org/10.18502/aoh.v5i4.7978.

    Article  Google Scholar 

  24. Soomro S, Yanos PT. Predictors of mental health stigma among police officers: the role of trauma and PTSD. J Police Crim Psychol. 2019;34(2):175–83. https://doi.org/10.1007/s11896-018-9285-x.

    Article  Google Scholar 

  25. Edwards A-M, Kotera Y. Mental health in the UK police force: a qualitative investigation into the stigma with mental illness. Int J Ment Health Addict. 2021;19(4):1116–34. https://doi.org/10.1007/s11469-019-00214-x.

    Article  Google Scholar 

  26. Stelnicki AM, Carleton RN, Reichert C. Nurses’ mental health and well-being: COVID-19 impacts. Can J Nurs Res Rev Can Rech En Sci Infirm. 2020;52(3):237–9. https://doi.org/10.1177/0844562120931623.

    Article  Google Scholar 

  27. Khan WAA, Conduit R, Kennedy GA, Abdullah Alslamah A, Ahmad Alsuwayeh M, Jackson ML. Sleep and mental health among paramedics from Australia and Saudi Arabia: a comparison study. Clocks Sleep. 2020;2(2):246–57. https://doi.org/10.3390/clockssleep2020019.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Petrie K, Smallwood N, Pascoe A, Willis K. Mental health symptoms and workplace challenges among Australian paramedics during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(2):1004. https://doi.org/10.3390/ijerph19021004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. MacEachen E, Neiterman E, Malachowski C, McKnight K, Crouch C. Roadblocks and alternate routes: practical strategies for managing mental health and return to work. Ontario: University of Waterloo; 2020. https://ellenmaceachen.ca/rtw-mental-health-guide/.

    Google Scholar 

  30. Igboanugo S, Bigelow PL, Mielke JG. Health outcomes of psychosocial stress within firefighters: a systematic review of the research landscape. J Occup Health. 2021;63(1):e12219. https://doi.org/10.1002/1348-9585.12219.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bell S, Palmer-Conn S, Kealey N. ‘Swinging the lead and working the head’ – An explanation as to why mental illness stigma is prevalent in policing. Police J. 2022;95(1):4–23. https://doi.org/10.1177/0032258X211049009.

    Article  Google Scholar 

  32. MacDermid JC, Lomotan M, Hu MA. Canadian career firefighters’ mental health impacts and priorities. Int J Environ Res Public Health. 2021;18(23):12666. https://doi.org/10.3390/ijerph182312666.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Johnson CC, Vega L, Kohalmi AL, Roth JC, Howell BR, Van Hasselt VB. Enhancing mental health treatment for the firefighter population: understanding fire culture, treatment barriers, practice implications, and research directions. Prof Psychol Res Pract. 2020;51(3):304–11. https://doi.org/10.1037/pro0000266.

    Article  Google Scholar 

  34. Bannatyne AJ, Jones C, Craig BM, Jones D, Forrest K. A systematic review of mental health interventions to reduce self-stigma in medical students and doctors. Front Med. 2023;10:1204274. https://doi.org/10.3389/fmed.2023.1204274.

    Article  Google Scholar 

  35. Karaffa KM, Koch JM. Stigma, pluralistic ignorance, and attitudes toward seeking mental health services among police officers. Crim Justice Behav. 2016;43(6):759–77. https://doi.org/10.1177/0093854815613103.

    Article  Google Scholar 

  36. Petrie K, Milligan-Saville J, Gayed A, Deady M, Phelps A, Dell L, et al. Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2018;53(9):897–909. https://doi.org/10.1007/s00127-018-1539-5.

    Article  PubMed  Google Scholar 

  37. Syed S, Ashwick R, Schlosser M, Jones R, Rowe S, Billings J. Global prevalence and risk factors for mental health problems in police personnel: a systematic review and meta-analysis. Occup Environ Med. 2020;77(11):737–47. https://doi.org/10.1136/oemed-2020-106498.

    Article  PubMed  Google Scholar 

  38. Obuobi-Donkor G, Oluwasina F, Nkire N, Agyapong VIO. A scoping review on the prevalence and determinants of post-traumatic stress disorder among military personnel and firefighters: implications for public policy and practice. Int J Environ Res Public Health. 2022;19(3):1565. https://doi.org/10.3390/ijerph19031565.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Saragih ID, Tonapa SI, Saragih IS, Advani S, Batubara SO, Suarilah I, et al. Global prevalence of mental health problems among healthcare workers during the Covid-19 pandemic: a systematic review and meta-analysis. Int J Nurs Stud. 2021;121: 104002. https://doi.org/10.1016/j.ijnurstu.2021.104002.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hara KW, Bjorngaard JH, Brage S, et al. Randomized controlled trial of adding telephone follow-up to an occupational rehabilitation program to increase work participation. J Occup Rehabil. 2018;28(2):265–78. https://doi.org/10.1007/s10926-017-9711-4.

    Article  PubMed  Google Scholar 

  41. Saxvik A, Tornbom K, Petersson E, Hange D, Nejati S. Experiences of patients with common mental disorders concerning team-based primary care and a person-centered dialogue meeting: an intervention to promote return to work. PLoS ONE. 2022;17(7):e0271180. https://doi.org/10.1371/journal.pone.0271180.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Nicholas MK, Costa DSJ, Linton SJ, Main CJ, Shaw WS, Pearce G, et al. Implementation of early intervention protocol in Australia for ‘high risk’ injured workers is associated with fewer lost work days over 2 years than usual (stepped) care. J Occup Rehabil. 2020;30(1):93–104. https://doi.org/10.1007/s10926-019-09849-y.

    Article  CAS  PubMed  Google Scholar 

  43. Weiss AK, Quinn SM, Danley AL, Wiens KJ, Mehta JJ. Burnout and perceptions of stigma and help-seeking behavior among pediatric fellows. Pediatrics. 2021;148(4): e2021050393. https://doi.org/10.1542/peds.2021-050393.

    Article  PubMed  Google Scholar 

  44. QSR International. Release notes (NVivo 11 for Windows. [Online]. Available: https://techcenter.qsrinternational.com/Content/nv11/nv11_release_notes.htm

  45. Pomaki G. Return-to-Work strategies for employees with mental health conditions. Manulife, [Online] 2017. Available: http://events.snwebcastcenter.com/manulife/GBRS/Prod/Media/Mailing/PDF/ReturntoWorkStrategiesforEmployeesWithMentalHealthConditions.pdf

  46. Dewa CS, Loong D, Bonato S, Joosen MCW. The effectiveness of return-to-work interventions that incorporate work-focused problem-solving skills for workers with sickness absences related to mental disorders: a systematic literature review. BMJ Open. 2015;5(6): e007122. https://doi.org/10.1136/bmjopen-2014-007122.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Skivington K, Lifshen M, Mustard C. Implementing a collaborative return-to-work program: Lessons from a qualitative study in a large Canadian healthcare organization. Work Read Mass. 2016;55(3):613–24. https://doi.org/10.3233/WOR-162437.

    Article  Google Scholar 

  48. Turner T, Jenkins M. ‘Together in Work, but Alone at Heart’: insider perspectives on the mental health of British police officers. Polic J Policy Pract. 2019;13(2):147–56. https://doi.org/10.1093/police/pay016.

    Article  Google Scholar 

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Acknowledgements

We thank the Ontario Workplace Safety and Insurance Board grants program for their funding support. We also thank research assistants Sharanya Varatharajan, Teeyaa Nur, Erica McDonald, Megan Dol, Nada Dali and Emily Giau for their contributions to this research study.

Funding

Ontario Workplace Safety and Insurance Board, MACE2018, MACE2018, MACE2018

Author information

Authors and Affiliations

  1. School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

    Elena Neiterman, Ellen MacEachen, Ekaterina McKnight, Karolina Kaminska & Pam Hopwood

  2. Faculty of Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

    Meghan Kathleen Crouch

  3. Rehabilition Sciences Institute, University of Toronto, 500 University Avenue, Suite 160, Toronto, ON, M5G 2A2, Canada

    Cindy Malachowski

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  1. Elena Neiterman
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Contributions

Conceptualization: E.N. and E.M. Methodology: E.M., E.N. and C. M. Formal analysis and investigation: EK.M., E.N., E.M., C.M. and P.M. Writing - original draft preparation: E.N. and K.K. Writing - review and editing: All Authors. Funding acquisition: E.M., E.N. and C.M. Resources: E.M. WSIB (e.g. funder) Supervision: E.M.

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Correspondence to Elena Neiterman.

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Neiterman, E., MacEachen, E., McKnight, E. et al. Negotiating Safety: Facilitation of Return to Work for Individuals Employed in High-Risk Occupations. J Occup Rehabil (2024). https://doi.org/10.1007/s10926-024-10189-9

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