Psychological issues are a serious and rising public well being concern (International Burden of Illness, 2022) and the primary purpose of illness absence and work incapacity pension in most high-income nations (Blomgren and Perhoniemi, 2022).
Administration ought to embody a holistic evidence-based strategy, which includes a vary of quality-of-life objectives, together with returning to work through stigma-free facilitatory contact between worker and employer (Eder et al, 2023).
Nevertheless, in lots of nations, such care is fragmented and erratically distributed, with lengthy waits for specialist providers and unclear skilled obligations, making the transition again to work particularly troublesome (Alonso et al, 2018; Evans et al, 2018; Hetemaa et al, 2021).
Collaborative care fashions goal to enhance this through coordinated efforts between main, occupational, and specialised care suppliers. Nevertheless, implementation is difficult because of its complexity and few research have qualitatively examined this course of from the attitude of specialized psychological well being care.
This examine, set in Finland, aimed to discover the limitations and facilitators in implementing a brand new referral mannequin that connects specialised psychological well being care with occupational well being providers (OHS) to assist sufferers return to work earlier. To the authors’ information, that is the primary examine to evaluate such a mannequin throughout totally different well being care sectors.
Few research have explored how psychiatric and occupational groups truly work collectively to assist folks return to work. This one dives into the truth.
Strategies
Seventeen contributors, comprised of the builders of a referral mannequin and the psychiatrists and OHS physicians delivering it between 2021 and 2023 in Finland, consented to finish semi-structured group and particular person interviews.
Interprofessional collaboration dynamics had been examined, utilizing the High quality Implementation Framework (QIF) and the Consolidated Framework for Implementation Analysis (CFIR).
5 analytical steps had been undertaken, knowledgeable by grounded concept:
- Submit-interview periods: analysing views of their regional contexts;
- Systematic deductive coding: of transcribed texts, in keeping with the primary domains of the CFIR;
- Inductive derivation: performed by thematic evaluation;
- Thematic identification: throughout CFIR domains;
- Eliciting dynamic mechanisms: underlying collaborative care fashions, figuring out facilitators and limitations.
Whose voice is lacking? This examine explored clinicians’ views on care collaboration, however not the sufferers/staff it was meant to assist.
Outcomes
The examine recognized three predominant themes and 6 key elements, relating to the facilitators and limitations to collaborative care fashions.
The three predominant themes had been:
- The scope and bounds of cooperation within the new referral mannequin: What was the innovation? Uncertainty emerged concerning the mannequin, with particular person practitioners unclear about what it persistently included. Some noticed it as simply an e-referral, others anticipated broader cooperation, together with with employers. This ambiguity relating to the roles and obligations between psychiatric providers and OHS, created a barrier to collaborative functioning.
- Measurement of goal group smaller than anticipated: Though many staff had been thought to learn from the collaborative referral system, only some referrals truly occurred. The variety of eligible sufferers was additionally unclear, and thus precise adoption and utilization had been adversely affected.
- Significance of stigma within the return-to-work course of: Experiences of self-stigma and societal stigma occurred each for therapy and onward referral in relation to psychological well being issues across the office. This represented a serious barrier to profitable collaborative care supply at each stage.
Six supporting elements had been recognized:
- Shared perception within the mannequin: Most professionals agreed the collaborative mannequin was useful and would enhance outcomes. Of be aware, whereas beliefs eschewed the medical mannequin for a extra holistic consideration of the worker — priorities had been considerably targeted on occupational and employer prerogatives, fairly than the worker, resembling, “pointless lengthy sick leaves [which] might be averted. [and] returning to work may then be doable earlier, as an example.”
- Want for clear roles: clearly defining roles and scopes of apply enhanced practitioners’ potential to collaborate.
- System and timing points: E-referral delays because of IT system issues, and healthcare reforms made implementation more durable. Larger infrastructure cohesion and robustness would enhance collaboration.
- Combined views on OHS readiness: Some professionals questioned if OHS had satisfactory and particular coaching or assets for focused psychological well being assist.
- Unaddressed elements affecting return to work: Essential points like stigma, versatile work choices, and employer attitudes weren’t totally addressed by the mannequin of collaborative care provision. Intra- and interpersonal variables had been summarised aptly in a single quote: “…a few of these recovering people might endure from intense emotions of disgrace…failure, inadequacy, and disappointment with themselves for having to take break day work because of any such sickness. It will be simpler if they’d a damaged leg […]This undertaking demonstrates] how vital it’s […] {that a} supervisor has a constructive perspective in direction of [the] worker when returning to work [and] the chance to rearrange work situations in a manner that gives flexibility”.
- Exhausting to estimate what number of sufferers qualify: an absence of collated or stratified demographic knowledge on which kinds of sufferers fitted the referral standards, restricted the applicability and generalisability of this collaborative mannequin.
General, the examine did determine some facilitators that supported implementation. There additionally seemed to be belief in those that developed the mannequin, contributing to its acceptance and implementation. Regardless of this, the brand new referral system confronted confusion, sensible challenges, and deeper social challenges that restricted its effectiveness.
Referral pathways flounder when obligations aren’t clear. This analysis reveals the infrastructure and coaching gaps we have to repair.
Conclusion
The examine highlighted the rising international occupational challenges posed by psychological well being issues, impacting people’ potential to work, resulting in extended illness absences and diminished high quality of life. A brand new referral mannequin was developed in Finland, aiming to boost collaboration between psychiatric providers and occupational well being providers (OHS) to facilitate earlier return to work for sufferers with psychological well being situations.
The examine concluded that for collaborative fashions in psychological well being care to achieve success, they have to contain varied stakeholders throughout totally different sectors. Addressing particular person, workplace-related, and sociocultural elements, together with stigma, is important to strengthen collaboration and enhance return to work outcomes for sufferers with psychological well being situations.
Psychiatrists, occupational well being providers and employers should work collectively to assist folks return to work safely and sustainably.
Strengths and limitations
This was the primary examine to look at how a brand new referral system for workers with psychological well being points was put into apply. The evaluation was longitudinal and mixed totally different analysis strategies, which helped strengthen the findings. Equally, three researchers every seemed on the knowledge individually to ensure the evaluation was truthful and thorough.
Though solely 17 of the 40 invited folks participated, the group included practically half of these most concerned in creating and utilizing the mannequin, giving useful insights into each the event and supply sides of the referral system. The examine additionally used each group and particular person interviews, to analyse the breadth and depth of pros’ expertise.
Since occupational well being providers (OHS) and psychiatric providers are organised equally throughout Finland, the findings from these professionals, designing a referral pathway in an area system, are extremely related for different areas within the nation. Nevertheless, generalising the findings exterior of Finland, particularly past Europe, could also be restricted because of variations in well being care programs.
One limitation not recognized by the authors of the examine, is the conflicts of curiosity that might come up by solely sampling the views and experiences of pros like builders, psychiatrists, and OHS medical doctors, however not sufferers. Though the collaborative referral system studied right here was focused at bettering look after “staff with psychological well being difficulties”, priorities mentioned in service supply aligned “extra carefully with employers’ wants than staff’” – i.e. lowering size of sick go away, accelerating return to work. You will need to acknowledge a possible battle of curiosity for OHS suppliers on this respect, as a result of in Finland (and in a lot of Europe) OHS are both contracted or domestically appointed by an employer themselves. This could cut back their incentive to advocate for infrastructural modifications, or modifications wanted by staff with psychological well being difficulties, the place these wants are at odds with these of the mutual employer.
Nonetheless, the examine highlights how vital collaboration is between psychological well being providers and the office, and the way higher understanding stigma, timing, and obligations may additional enhance return-to-work efforts.
Implementing a brand new mannequin is one factor — translating it into real-world affect throughout settings is one other.
Implications for apply
Return to work within the context of psychological well being problem, shouldn’t be seen as a easy endpoint of restoration; it’s a means of adaptation, studying, and infrequently re-exposure to stressors.
Traditionally, proof demonstrates that psychological well being providers will be too targeted on symptom discount (Secker 2003) and fewer on quality-of-life elements resembling employment, whereas it’s more and more understood that people don’t all the time must be symptom-free earlier than returning to work (Henderson et al., 2011).
On this context, this examine gives helpful recommendation for bettering collaboration and teamwork between psychological well being providers and occupational well being providers, in delivering assist to folks dwelling and dealing with psychological well being situations. Understanding the limitations and facilitators highlighted on this examine can assist enhance care supply, return-to-work assist, and cooperation throughout sectors. Extra assets and higher programs could be wanted to trace sufferers and assist joint psychological well being efforts. Belief within the mannequin and its builders helped, however issues like unclear objectives, restricted e-referral programs, and lack of deal with stigma made it more durable to make use of.
For the mannequin to work extra reliably, psychiatrists want extra assist about when to refer sufferers and occupational well being providers (OHS) employees may have higher psychological well being coaching. All stakeholders, together with sufferers, employers, and healthcare suppliers must be knowledgeable about useful office modifications and methods to cut back psychological well being stigma.
Extra analysis is required to know how this mannequin matches with current packages, what number of sufferers may benefit, and what assets are wanted to place it in place successfully.
As a psychologist working inside the Nationwide Well being Service, I’m struck by how vital early intervention and joint working are when people return to work after or whereas they’re accessing psychological well being assist, and this stage presents a vital and delicate part in a single’s restoration. For a lot of, work isn’t just about employment; it signifies normalcy, id, and reintegration into society after a interval of isolation, sickness, or disconnection.
Reflecting on my scientific apply, my function has prolonged past remedy rooms.
I’ve discovered myself participating in collaborative, systemic work which incorporates liaising with vocational providers, occupational well being groups, and employers to make sure that return-to-work plans are life like, supportive, and individualised. I usually use a spread of psychological frameworks like CBT to assist purchasers handle workplace-related anxiousness or construct confidence, however it’s equally vital for employers (and different suppliers) to construction their atmosphere and for them to enhance and prolong, generalise the therapeutic work, particularly when the office may also be a web site of stress, stigma, and vulnerability, significantly if employers lack psychological well being consciousness.
Subsequently, a better emphasis on collaboration with employers, employment specialists, and psychological well being groups is important, not solely to facilitate entry to work for workers with psychological well being considerations, however to make sure sustainability and stop additional psychological well being challenges arising.
Returning to work is about greater than being “higher.” It’s about feeling protected, understood, and supported — by everybody.
Assertion of Pursuits
None declared.
Hyperlinks
Major Paper
Henriksson, M., Tikka, C., Juvonen-Posti, P. et al. Referring psychiatric sufferers to occupational well being providers for earlier return to work – a qualitative implementation examine of limitations and facilitators. BMC Well being Serv Res 25, 109 (2025). https://doi.org/10.1186/s12913-025-12238-2
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