Psychological problems are a serious and rising public well being concern (World Burden of Illness, 2022) and the primary cause of illness absence and work incapacity pension in most high-income international locations (Blomgren and Perhoniemi, 2022).
Administration ought to embrace a holistic evidence-based method, which includes a vary of quality-of-life targets, together with returning to work through stigma-free facilitatory contact between worker and employer (Eder et al, 2023).
Nonetheless, in lots of international locations, such care is fragmented and erratically distributed, with lengthy waits for specialist providers and unclear skilled tasks, making the transition again to work particularly troublesome (Alonso et al, 2018; Evans et al, 2018; Hetemaa et al, 2021).
Collaborative care fashions intention to enhance this through coordinated efforts between major, occupational, and specialised care suppliers. Nonetheless, implementation is difficult because of its complexity and few research have qualitatively examined this course of from the angle of specialized psychological well being care.
This examine, set in Finland, aimed to discover the obstacles 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’ data, 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 really work collectively to assist folks return to work. This one dives into the fact.
Strategies
Seventeen members, 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 have been examined, utilizing the High quality Implementation Framework (QIF) and the Consolidated Framework for Implementation Analysis (CFIR).
5 analytical steps have been undertaken, knowledgeable by grounded principle:
- Publish-interview classes: analysing views of their regional contexts;
- Systematic deductive coding: of transcribed texts, based on the primary domains of the CFIR;
- Inductive derivation: carried out by thematic evaluation;
- Thematic identification: throughout CFIR domains;
- Eliciting dynamic mechanisms: underlying collaborative care fashions, figuring out facilitators and obstacles.
Whose voice is lacking? This examine explored clinicians’ views on care collaboration, however not the sufferers/employees it was meant to assist.
Outcomes
The examine recognized three most important themes and 6 key elements, concerning the facilitators and obstacles to collaborative care fashions.
The three most important themes have been:
- The scope and limits of cooperation within the new referral mannequin: What was the innovation? Uncertainty emerged in regards to 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 concerning the roles and tasks between psychiatric providers and OHS, created a barrier to collaborative functioning.
- Measurement of goal group smaller than anticipated: Though many employees have been thought to profit from the collaborative referral system, only some referrals really occurred. The variety of eligible sufferers was additionally unclear, and thus precise adoption and utilization have been adversely affected.
- Significance of stigma within the return-to-work course of: Reviews of self-stigma and societal stigma occurred each for remedy and onward referral in relation to psychological well being problems across the office. This represented a serious barrier to profitable collaborative care supply at each stage.
Six supporting elements have been recognized:
- Shared perception within the mannequin: Most professionals agreed the collaborative mannequin was useful and would enhance outcomes. Of observe, whereas beliefs eschewed the medical mannequin for a extra holistic consideration of the worker — priorities have been considerably centered on occupational and employer prerogatives, quite than the worker, reminiscent of, “pointless lengthy sick leaves [which] could possibly be prevented. [and] returning to work might then be doable earlier, as an illustration.”
- Want for clear roles: clearly defining roles and scopes of follow enhanced practitioners’ skill to collaborate.
- System and timing points: E-referral delays because of IT system issues, and healthcare reforms made implementation tougher. Higher infrastructure cohesion and robustness would enhance collaboration.
- Blended views on OHS readiness: Some professionals questioned if OHS had enough and particular coaching or sources for focused psychological well being help.
- Unaddressed elements affecting return to work: Necessary points like stigma, versatile work choices, and employer attitudes weren’t absolutely addressed by the mannequin of collaborative care provision. Intra- and interpersonal variables have been summarised aptly in a single quote: “…a few of these recovering people could endure from intense emotions of disgrace…failure, inadequacy, and disappointment with themselves for having to take break day work because of this sort of sickness. It could be simpler if they’d a damaged leg […]This challenge demonstrates] how vital it’s […] {that a} supervisor has a optimistic angle in the direction of [the] worker when returning to work [and] the chance to rearrange work circumstances in a manner that gives flexibility”.
- Exhausting to estimate what number of sufferers qualify: an absence of collated or stratified demographic information on which kinds of sufferers fitted the referral standards, restricted the applicability and generalisability of this collaborative mannequin.
General, the examine did establish some facilitators that supported implementation. There additionally gave the impression 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 tasks 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 problems, impacting people’ skill to work, resulting in extended illness absences and decreased 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 circumstances.
The examine concluded that for collaborative fashions in psychological well being care to achieve success, they have to contain numerous stakeholders throughout totally different sectors. Addressing particular person, workplace-related, and sociocultural elements, together with stigma, is crucial to strengthen collaboration and enhance return to work outcomes for sufferers with psychological well being circumstances.
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 follow. The evaluation was longitudinal and mixed totally different analysis strategies, which helped strengthen the findings. Equally, three researchers every appeared on the information individually to verify the evaluation was honest and thorough.
Though solely 17 of the 40 invited folks participated, the group included almost half of these most concerned in creating and utilizing the mannequin, giving helpful 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 a neighborhood system, are extremely related for different areas within the nation. Nonetheless, generalising the findings exterior of Finland, particularly past Europe, could also be restricted because of variations in well being care techniques.
One limitation not recognized by the authors of the examine, is the conflicts of curiosity that could 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 take care of “employees with psychological well being difficulties”, priorities mentioned in service supply aligned “extra carefully with employers’ wants than staff’” – i.e. decreasing 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 regionally appointed by an employer themselves. This may cut back their incentive to advocate for infrastructural adjustments, or adjustments wanted by employees 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 tasks might 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 follow
Return to work within the context of psychological well being issue, shouldn’t be seen as a easy endpoint of restoration; it’s a strategy of adaptation, studying, and infrequently re-exposure to stressors.
Traditionally, proof demonstrates that psychological well being providers will be too centered on symptom discount (Secker 2003) and fewer on quality-of-life elements reminiscent of employment, whereas it’s more and more understood that people don’t at all times should 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 help to folks dwelling and dealing with psychological well being circumstances. Understanding the obstacles and facilitators highlighted on this examine will help enhance care supply, return-to-work help, and cooperation throughout sectors. Extra sources and higher techniques is likely to be wanted to trace sufferers and help joint psychological well being efforts. Belief within the mannequin and its builders helped, however issues like unclear targets, restricted e-referral techniques, and lack of concentrate on stigma made it tougher to make use of.
For the mannequin to work extra reliably, psychiatrists want extra help about when to refer sufferers and occupational well being providers (OHS) workers might have higher psychological well being coaching. All stakeholders, together with sufferers, employers, and healthcare suppliers ought to be knowledgeable about useful office adjustments and the way to cut back psychological well being stigma.
Extra analysis is required to grasp how this mannequin suits with current applications, what number of sufferers may benefit, and what sources are wanted to place it in place successfully.
As a psychologist working throughout 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 help, and this stage presents a crucial and delicate section in a single’s restoration. For a lot of, work is not only about employment; it signifies normalcy, id, and reintegration into society after a interval of isolation, sickness, or disconnection.
Reflecting on my medical follow, my function has prolonged past remedy rooms.
I’ve discovered myself partaking 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 practical, supportive, and individualised. I typically 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 setting and for them to enhance and lengthen, generalise the therapeutic work, particularly when the office may also be a website of stress, stigma, and vulnerability, significantly if employers lack psychological well being consciousness.
Due to this fact, a better emphasis on collaboration with employers, employment specialists, and psychological well being groups is crucial, not solely to facilitate entry to work for workers with psychological well being issues, 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 secure, 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 obstacles and facilitators. BMC Well being Serv Res 25, 109 (2025). https://doi.org/10.1186/s12913-025-12238-2
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