Moving Minds, a psychological management and rehabilitation service, responds to Keith Bushnell's recent article on mental health and workplace absence.
Delayed return to work has been an on-going challenge for many years. Mr Bushnell rightly draws attention to the problems associated with prolonged absence for work in his article Cracking the mental health problem.
As he correctly states those away from work for six months or more are unlikely ever to return to work. A key factor is the six month absence from work.
The origin of this six month break from work is interesting and goes back a long way, to the National Insurance Act 0f 1911 in fact.
This Act was designed "to put ourselves.... on a level with Germany" in the provision of social welfare. One of its stated benefits was that workmen contributing to the scheme would have 26 weeks paid sick leave.
This was an entirely reasonable length of time in 1911 when women spent up to ten days in a nursing home after delivery and fractures of a femur were routinely treated for three months in bed on traction.
In 2013 six months sick leave is not always appropriate, but the six month period seems to have acquired sanctity over time.
In practice this interval acts as a protected period which is effectively immune from any useful therapeutic interventions. The recent rebranding of "sick certificates" to "Fitness for work" notes does not seem to have led to any significant behaviour change on the part of those who issue these notes.
Irrespective of the original medical cause of the work absence during the six months down-time a number of harmful secondary behaviours may become entrenched, which make a normative return to work increasingly less likely.
There is also the psychological fact that it only takes 28 days for a new habit to be established, i.e. to not smoke or doing physical exercise.
There has been some published work to determine how long a person should take to recover from significant medical and surgical conditions.
The below research carried out by the DWP in 2001 (Box 1) shows the length of absence from work in weeks in those with no other disabilities, who are under 60 years and not engaged in heavy manual work after.
| Condition | Average length of absence |
| an open hernia repair | up to three weeks |
| an open appendicectomy | up to three weeks |
| gall bladder removal | up to five weeks |
| hysterectomy | up to seven weeks |
| Angioplasty | up to four weeks |
| heart attack | up to six weeks |
| coronary artery bypasses grafting | up to eight weeks |
It is striking how short the period of fitness to return to work is, often being six weeks or less. The corollary is that there is limited evidence that "lesser" or "less significant" diseases or procedures will need longer absences from work.
