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According to the Ministry of Health (2002), a mental illness is any significant behavioral or psychological syndrome characterized by the presence of distressing symptoms of significant impairment of functioning. Return to work is a vital social indicator of recovery and rehabilitation that leads to improved health outcomes and quality of life. However evidence suggests that those with some mental illness or mental health problems who return to work still have some symptoms of problems that may affect their work and well being. An occupational environment is inherently full of various kinds stressors that exert a high level of psychological strain on the employees. So in this scenario it is integral that the organization has designed a protocol on how to handle the reintegration of such employees, since they will need ongoing support from the organization in order to feel comfortable coming back to work without having to sacrifice on their wellbeing.
A qualitative study allow researchers to understand behaviours, perspectives, feelings, and experiences in depth, quality and complexity of a situation through a holistic framework (Holloway and Wheeler 2002). Some qualitative studies have been conducted in the past that aid in understanding the aspects of this topic that has already been covered or the areas that are important and should be focused upon even further. Psychological issues can cause disruptions to an individual’s behaviours, emotions, or thoughts that may last weeks, months or even years. Mental health issues in occupational settings are one of the prime causes for work absence. Research in the field of occupational rehabilitation and mental health has highlighted the importance of a collaborative process involving the management in the return to work process.
There are studies that talk about reintegration of employees in the workplace after absence however there are very few studies that talk about absence due to mental health reasons. ( IRSST) The study they devised to develop the program for supporting return to work following an absence for mental health reasons comprised of several components that laid the groundwork for a theroretical model, a logical model and an operational model. They placed importance on welcoming back or reintegrating the returning employees ad on supporting them in their work. It involved implementing reassurance practices during their sick leave and allowing the employees to make modifications in their work, that would make their return more successful and smooth. They research revealed that the success of this depend upon a climate of trust and respect, effective communication and collaboration among the all the stakeholders involved in the return to work.
Mental ill-health is one of the most common reasons of short and long-term sickness absence, affecting one in six employees in the UK (Council for Work and Health, 2014). However, studies have shown that the return to work process falls short too often with up to 20% of returning employees experiencing relapse or subsequently leaving work (Norder et al, 2017).It is extremely important that there is early intervention to support the employees to get back to work and make sure that they stay at work. However in the current scenario they are unsure of how to handle employees who are facing mental sickness. The line managers are often the first point of contact when employees are unwell as well as when they return. So it is integral that all the line managers are equipped with skills and knowledge to support the returning employees.
How do organisations effectively re-integrate employees that have been away from their work due to the occurrence of mental health problems.
The aim of this qualitative study is to explore how organisations can re-integrate employees that have returned to work following mental health issues.
- To help design a protocol for the organization
- To understand more about the individual experiences of recovery and deciding to go back to work
- To discover what expectations these employees have from their organisations, that will support their re-integration
According to Parahoo (2006), The design selected should be the best suited to achieve an answer to the proposed research question. Qualitative research is a subjective approach to describe life experiences and attach meanings to them (Burns and Grove 2009). There are four common approaches within qualitative research, phenomenology, grounded theory, ethnography, and historiography . A phenomenological approach will be used within this qualitative research.
This research design will include two types of data collection methods –
- Individual Interviews – These interviews will be semi structured, and are best suited to reveal Individual thoughts and perspectives of the participants. It produces detailed contextual information and is valuable when researching sensitive and complex behaviours. These interview will be looked at in terms of a purposeful conversation. The questions will be open ended, there will be non directive and neutral questions. If a sensitive topic has to be addressed then there will be ‘funneling ‘of those questions , this means that there is always a build up and the sensitive question is never asked at the start of the interview.
- Focus groups – This also entails structures interviews however they are group interviews. These are moderated by a group leader and are used to collect data on a particular topic. The pattern of the interview will be the same as individual interviews, however the responses will be collective. One of the challenges in conducting focus group interviews is to gather all the data correctly, since often multiple people speak and it may overlap. This is why audio or video recording of the group sessions should be considered. After which the data will be transcribed.
Another aspect of the research design is the approach of reflexivity in the study. This is an attitude embodied in the researcher, that his/her position in the research will influence the angle of the study , the methods used and results or findings ( Malterud, 2001)
Reflexivity is hence the process of becoming self-aware in order to provide an impartial analysis. The researcher then makes a conscious effort to examine their own thoughts and preconceptions, there is a critical reflection of one’s own biases.
Homogeneity of the sample will be maintained in terms of the experiences the participants share, that will be in common to what the research wants to explore. Half the sample will be facing individual interviews (employees) and the other half of the sample will be put together in a focus group (line managers). The total strength of the sample will be not more than 6-8 participants.
The sample will be coming from three sources.
- Employees who have returned to work following mental health problems.
- Employees who are currently on leave because of mental health issues, who are considering to return to work after recovery.
- The employee line managers of different organizations who have experience in dealing with the task of supporting employees that have returned to work after battling any mental health problem.
Ethical procedures of recruitment and consent will be strictly adhered to.
The interviews and focus groups will be arranged in places familiar and comfortable to the participants.
- Interviews with the employees will take place in the house of the participants, with his/ her permission at a time convenient to them.
- Focus groups with the line managers will take place outside in some place rented out for that day, having a quiet atmosphere in a strictly professional manner. A date and time will be chosen for the focus group meeting, based on the suggestion of the participants.
It is important to state the recruitment procedure before the interview process is discussed in further detail.
The human resource department of the organisation will be contacted and all permissions and formalities will be sorted out. Then they will send out requests in the form of calls or emails asking employees who are or had been on a leave due to mental health issues to take part in the qualitative study. There will be no direct communication at this stage in order to maintain confidentiality of the employees who would fall under this umbrella. The decision to be a part of the study will be complete voluntary. Once the participants accept the request they will be contacted and further details regarding the date and time of the individual interviews will be discussed.
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The employee line managers will also be directly contacted by the Human resources department, requesting them to take part in the focus group, when agreed upon details on the focus group meeting will then be discussed with the.
As stated previously, a qualitative study is intended for this research, in order to do so there will be open ended, semi- structured and detailed individual and group interviews. This allows that participants to openly discuss their views and experiences, which might get inhibited if they are subjected to closed ended or extremely structured interviews. The interviews will be face to face and this helps in observing non verbal behavior and the researcher to seek clarification of some detail if necessary. An approximate duration of the interviews may be decided however it will depend on the participants to decide the direction and length of the interviews. All the interviews will be recorded either through audio or video with prior permission of the participants after which each individual interview will be transcribed for analysis. Follow up interviews may be conducted based on the results of the first set of interviews. All the participants will be made aware of their right to withdraw from the research at any time.
The NVivo software program that organises written data will be used in order to manage collected data. The data will be coded and connections between different categories and themes will be used to further the understanding of process of reintegration of the target population into the organisation once they return to work. That will help in designing a protocol for the organisation.
Every research presents a variety of ethical and moral issues which has to be addressed prior to commencing the data collection, in order to protect all the participants from any potential harm. The study will only start once the ethical approval has been received from the research ethics committee.
- All the participants will be informed about the approximate time they will have to dedicate towards the study, and interviews will be arranged according to the schedule of the participants.
- There will be voluntary participation, nobody will be forced to take part in the research. Hence, there will be no obligation to take part. Participants can withdraw at any time.
- The permission of the various departments of the organization in question will be taken, during the time of recruitment and when deemed necessary for other things, as the study is being conducted for the benefit of the organization .
- Prior permission to audio or video record will be taken from all the participants. Once transcribed the data will be stored in confidential folders that only the researcher will have access to.
- Privacy and confidentiality will be maintained at all times. No identifiable information will be printed or recorded in the study. However If it seems that someone is at risk of direct harm, confidentiality may be broken.
- There will be no harm of any kind inflicted on the participants. Psychological status of the participants will be monitored at every step to ensure the comfort of the participant.
- It will be insured that all participants have given their informed consent before carrying out any interview. All participants will have an option of withdrawing from the study at any time without any repercussions.
- All the findings and results will be authentic, all experiences portrayed in the interviews will only be considered and included in the final report.
“The purpose of data analysis is to organize, provide structure to, and elicit meaning from research data” (Polit and beck 2008).
A Thematic Qualitative approach will be adopted in this study. The NVivo is a qualitative data analysis software , this will be used to manage data. Enabling flexibility in coding and rapid access to the data.
Data analysis is going to take place on the side of data collection as when the interviews (Individual and group) are conducted , the data gathered is organized and interpreted to give some meaning to it.
The interviews verbatim will be transcribed and then the analysis of the transcripts will be carried out using Interpretative Phenomenological Analysis (IPA) which was developed by Jonathan Smith and colleagues .
IPA tries to understand in depth how an individual experiences a phenomenon from their own subjective perception within a distinct context and is concerned with ways in which individuals interpret or make sense of what they experience and attach meanings to their life events (Smith et al., 2009)
It emphasizes three philosophies –
- Ideographic – Where there is focus on a person’s subjective lived experience of a particular phenomenon
- Phenomenological – Where there is an emphasis on how people attach themselves to the world they live in and how they connect with it.
- Hermeneutics – where the subjective experiences are interpreted from language and text.
Analysis will be conducted one transcript at a time and will involve several steps (Smith et al., 2012)
- Immersion in the data – The transcript will be read over and over again before coding starts.
- Initial understanding of the data – All the patters in the data will be identified , for example the similarities an the differences.
- Identifying descriptive aspects of the data- Every descriptive detail of people, events , things etc will be identified.
- Identifying linguistic aspects of the data – The use of language like metaphors, pauses tone , emotion etc will be identified.
- Conceptual interpretation of the meaning – Based on the previous steps a meaning will be generated, this meaning has to undergo speculation to dwell even deeper and understand all it’s layers.
Themes will start to develop from initial notations of every individual transcript. After identification of various themes, these will be clustered together under various thematic categories , for example all the themes that show some kind of contradiction will get clustered under the thematic catergory of polarization.
In this manner themes have to be identified for every individual participant of the group, however all the subordinate themes of every participant should be accounted for. This is very important in order to reach a level of Gestalt .A level of clarity or insight when all the data can be viewed as one , espousing a clear meaning or interpretation. In this manner when one transcript is analysed and the thematic categories are identified, the subordinate theme should be kept in mind while analyzing the next transcript, however without allowing the previous analysis to bias this.
IMPLICATIONS FOR THE FUTURE RESEARCH
As well as being unlawful , the biggest barrier to recovery for an individual with mental illness is to battle discrimination. Even after return to work following their recovery stages these people are still discriminated against by their fellow employees and superiors. A concrete protocol to carry out reintegration and the establishment of a supportive working environment is extremely necessary in order for a successful reintegration of the workers who are coming back to to office following their absence due to mental sickness.
There are several steps that may be suggested to facilitate a better reintegration These also serve as suggestions for future research as this topic has not been much dwelled upon , as a taboo still exists on mental illnesses and people fail to recognise the seriousness of it.
It is extremely important that the line managers remain in contact with the employees , right from the early stages of absence. It should be made sure that the employee feels valued.
It is integral to maintain contact throughout the absence as that imporves the likelihood of returning to work. It reduces anxiety, fosters a sense of belonging and maybe easier for the employee to return to work if he/ she is updated about the ongoing work.
Incase the line managers may have strained relationships with the employee in question then the collegues should be there to extend their support and concern towards them.
It might be difficult to handle employees who have returned after absence because they may be out of touch with the ongoing work , and might be still recovering from their illness. So in this case the managers should have specific competencies specific to deal with this kind of a situation , even training to develop the competencies should be provided.
The line managers should have a proper return to work conversation to with the employee to understand all the needs of the person. The manager should come up with a short term work plan so that the employees do not feel too much of work pressure when they return. The workload should increase based on how well the employee is handling the strain. Informal meetings should be organised just to check up on how the employee is doing , just to reduce the stress and anxiety.
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