Gabrielle Lis

The most common barriers to RTW are "psychosocial". Getting to know them makes it possible to overcome them.

“Psychosocial” is a word that gets used a lot in the disability management field and, while it can be daunting for the uninitiated, it means exactly what you’d expect – the combination of “psychological” and “social” (or interpersonal) factors that impact on a person’s ability to recover from injury or illness and return to work.

Understanding that psychosocial factors play a role in determining when and how someone gets back into their normal routine is NOT the same as believing that the person’s health problem is “all in their head”. But anyone who’s worked in the RTW or rehab field for even a few months realises that medical issues are not the be-all and end-all of recovery.

Taking psychosocial factors into account enables you to embrace – and begin to direct – the human drama of rehabilitation and return to work. People are, after all, people, and when they’re treated as such – rather than as numbers, or quotas or problems to solve – results tend to be better.

Psychosocial barriers erected in the workplace are the ones that can cause the most trouble.

RTW roadblocks can include issues surrounding relationships with management colleagues in the workplace as well as external factors impacting upon the environment at the workplace.

Does the injured worker have a sense that they are blamed by others for their own injury? Is the employer's return to work policy a supportive - or dismissive - one, and what has been the influence of the WorkCover system on the employee? Has being involved with the system left them with feeling like they have little control over their own recovery and return to work process? Do they feel like the workplace is happy to see them return and that fellow staff members are glad to have them back?

These questions can all throw up problems which, when encountered, make it harder for employees to return to their workplace. Return to work is more successful when employees feel supported. This becomes even more important when their condition is long term or complex.

Other psychosocial barriers it pays to be aware of include:

  • Beliefs about pain and illness.

Pain can have many complex effects on a person's life. Studies have indicated that people generally cope well with pain for about three weeks, but then it begins to have a range of negative impacts. Ongoing pain can be worrying, debilitating, and leave the person uncertain about their future.

Understanding pain, and understanding that more often than not it is not something to be feared, is necessary if injuries are to be addressed and return to work taken up as soon as is appropriate (often much before a "complete" recovery).

  • Motivation/expectation.

These barriers relate to, for example, the impact of an employee's own stress levels on the way they are likely to deal with their pain. Knowledge is power. An employee who has spoken with both their employer and a medical practitioner (ideally together) and who feels assured that returning to work will in fact be beneficial to their health as opposed to detrimental, and that the workplace would like to see them return, is armed with the tools they need to take more control over their own rehabilitation and are thus likely to have better outcomes.

Relationships really are key. Poor relationships and workplace conflicts build up over time: those that existed prior to the injury can create RTW difficulties months down the track.

Employers can look out for, and ask their employees how they're feeling about, some of the following other psychosocial factors which will play a role in recovery and return to work:

  • Recovery expectations. Positive recovery expectations are associated with positive health outcomes and realistic expectations of outcome.
  • Fear avoidance beliefs/behaviours. Fear of pain can result in the avoidance of situations where pain may be induced, ie return to work even under modified duties. However, pain does not necessarily mean re-injury, and avoiding pain may even delay recovery.
  • Pain-related fear leads to increased perceived disability, deconditioning and decreased functional performance.
  • Passive coping and feelings of helplessness, which are associated with reduced motivation.
  • Catostrophising. Negative expectations about recovery can sometimes become self-fulfilling prophecies. However, with the proper support, it is possible to develop realistic, optimistic expectations.

Active coping and self efficiency are the two most positive ingredients in an injured individual in return to work and will fend of psychosocial barriers.

Friendly (and not so friendly) relationships in the workplace, beliefs about work and pain and the level of support a person receives from their family can all facilitate or impede recovery. When people are fearful, distressed, or blame their employer they are less likely to return to work. Try to understand the issues affecting the employee and help to resolve them.

This proactive involvement can be an effective strategy for improving return to work outcomes.

Published 05 October, 2009 | Updated 18 July, 2022