Kerry Foster wrote an excellent blog, Best Practice: Is Your Injured Worker With A Psych Injury Too Sick To Work?’, summarizing two compelling articles: ‘Is your patient too sick to work?’ by Dr.’s Gregory Couser and Gabrielle Melin of the Department of Psychiatry and Psychology at the Mayo Graduate School of Medicine Rochester; and ‘If Work Makes People with Mental Illness Sick, What Do Unemployment, Poverty, and Social Isolation Cause?’ by Joe Marrone and Ed Golowka from the Institute for Community Inclusion in Portland.  Foster and the authors of these articles have, in our opinion, hit the mark on the topic of staying off work due to psychological illness or difficulties.  We have been working with a population of individuals who are off work due to chronic mental and/or somatic health difficulties for many years and the trends we see are directly in line with what these authors are speaking of.

First of all, when we meet with clients for our initial assessment and we ask them what led up to their leave from work, they start off by listing the stressful events and/or the limiting symptoms, and then go on to say that when they met with their doctor, their doctor suggested that they take some time off work to recover.  In many cases, through going off work, the client has now eliminated from their life a key part of their identity or role in this world.  They have deleted the human interaction that may have accompanied their job, they have opened the door to possible financial pressures and isolation, and they have closed the door to productivity, financial contribution to the family, and maybe even a sense of accomplishment and purpose that they may have once obtained from their job.  They have also now entered the mindset that the difficulties they are facing and their work cannot co-exist, and that they must wait until they feel better in order to do their job.  The problems here are that with chronic conditions, the individual may in fact never feel completely better with symptoms at times persisting regardless of treatment. It is the case that until these individuals resume working and actually immerse themselves into their work environment again, they will never be able to learn how to allow their difficulties and their work to exist simultaneously.    Whether it was a decision made independently, or one made by their doctor, it is often one that can hinder a client’s recovery rather than encourage it.

The next problem that arises is that as people continue to sit at home waiting to feel better enough to return to work, the time keeps passing, the challenges continue to exist or become even worse, and the idea that they are disabled from doing their job gets further and further reinforced.  Often times, when we see clients who have been off work for two years or more, we are automatically faced with additional challenges in helping them Portrait of an upset businessman at desk in office. Businessmanget back to work, primarily because this notion and conditioned belief that their symptoms and work cannot co-exist has been carved into their minds.  The earlier clients are referred to us, the better results we see.  If we see clients at the point that they go off work, or even when they are still working but are having challenges, we can work with them to learn how to manage and cope with their difficulties in such a way that they do not have to give up a pivotal part of their life.  We can provide strategies to manage their difficulties while AT WORK, and can teach them how to address and deal with issues as they arise.  Furthermore, we can help them identify the value that their work brings to their life.   Even if someone does not go into work every day thinking I LOVE MY JOB, we can often still help them identify what it is about working that is meaningful to them – whether it is financial security, status, sense of accomplishment, financial contribution within the family, setting an example for their children, the ability to live a comfortable lifestyle, or the means to keep their family healthy – there is rarely an empty response.  From there, the client may notice that in being off work, they are moving away from that value rather than towards it, which is causing additional suffering to their already quite full plate of difficulties.

Early intervention is important, but is not always granted.  There are a number of reasons for this, but one that I will discuss is the issue of individuals needing to feel that they CAN open up early on and that they will be heard.  In order for early intervention to be possible, it is essential that the individual suffering feels that they have someone they can open up to as soon as they start to notice their struggles so that they can be dealt with immediately rather than allowing them to persist and likely bring on additional suffering.  Workplaces need to create open and inviting environments that make employees feel comfortable to speak up about their difficulties and to receive the support needed, rather than having to go off work to deal with things in the privacy of their own home.

At OHS we offer intervention services to individuals at any stage, whether they are still working and are struggling or whether they have gone off work and are looking for help to get back on track.  If you, or someone you know could use some support and guidance towards getting back to where you want to be, please do not hesitate to get in touch with us.  We are also able to provide educational programs to employers about mental health at work and about how to best support your employees if they approach you with challenges they are experiencing to lessen the risk of prolonged disability.

Kerry Foster’s full blog is available here: Best Practice: Is Your Injured Worker with a Psych Injury Too Sick to Work?



Crouser, Gregory, P. & Melin, Gabrielle, J. (2006). Is your patient too sick to work? Current Psychiatry 5(9):17-25.

Foster, Kerry. (2014, April). Best Practice: Is Your Injured Worker with a Psych Injury Too Sick to Work? Retrieved from

Marrone, Joe & Golowka, Ed. (2000). If Work Makes People with Mental Illness Sick, What Do Unemployment, Poverty, and Social Isolation Cause? Speaking Out (Psychiatric Rehabilitation Journal) 23(2): 187-193.

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