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Return to Work After Hospitalization for Mental Health Treatment

Find information on returning to work

From the desk of Sarah Small, M.S., CRC, Consultant – Cognitive/Neurological Team


At JAN we frequently receive questions about returning to work when an employee has been out on leave due to a mental health impairment. Often times these questions come when an employer receives a note clearing the individual to return to work after being out for some time or hospitalized to receive in-patient care to treat symptoms.

Employers will call with concerns about whether the employee is truly ready to return to work. Sometimes the employer will have witnessed an incident at work that resulted in the employee taking leave. Other times it might simply be concerns related to the knowledge of the diagnosis and hospitalization. This is a hard topic and there are no definite answers.

When these questions arise we will suggest relying on the medical documentation that has been provided and trusting that if the medical provider has released the employee to return to work then the employee must have been deemed ready.

The employer might seek clarification as to if there are any accommodations needed for the employee’s return. There may or may not be accommodations needed, but having the conversation ahead of time will hopefully help to facilitate a smooth transition.
What about situations where an incident occurred violating conduct rules, which led to the employee going out on medical leave? Must the employer completely disregard the incident? According to the EEOC, employers may hold all employees to the same performance and conduct standards. Therefore, an employer would not have to disregard or excuse the employee from any disciplinary action, but might discuss with the employee if there are any accommodations that may help prevent future violations or help to improve performance.

With that being said, here are a few practical tips:

  • Consider what you know. Look at the situation objectively and try to avoid any biases or stigma that may come with the notion of a mental health impairment. No two people with any diagnosis are the same.
  • Rely on the medical documentation that has been provided. Follow up with the employee or provider if clarification or additional information is needed.
  • Talk about accommodations leading up to the employee’s return. While there is nothing that requires it, doing so can help to ensure implementation of the accommodation on the day of return. If the employee expresses that there are no accommodations needed, there may not be. However, be open to discussing accommodations if the employee feels they may be needed after being back in the work environment.
  • Keep the line of communication open. If both the employer and employee openly communicate as they move through the transition it will hopefully allow things to go as smoothly as possible.

The EEOC provides the following example in its Enforcement Guidance: Disability- Related Inquiries and Medical Examinations of Employees under the ADA:

As the result of problems he was having with his medication, an employee with a known psychiatric disability threatened several of his co-workers and was disciplined. Shortly thereafter, he was hospitalized for six weeks for treatment related to the condition. Two days after his release, the employee returns to work with a note from his doctor indicating only that he is "cleared to return to work." Because the employer has a reasonable belief, based on objective evidence, that the employee will pose a direct threat due to a medical condition, it may ask the employee for additional documentation regarding his medication(s) or treatment or request that he submit to a medical examination.

Additional Examples:

An employee was on leave for 12 weeks while attending an in-patient therapy program for depression. Approaching the end of the program the employee’s spouse contacted the employer to notify the employer of a return to work date. The employer requested a note from the doctor releasing the employee to return to work and providing information about any accommodations needed for the return. The employee submitted the note clearing her to return and asking if she could work part time for the first 2 weeks to transition back into the workplace. The employer was able to provide the accommodation without any hardship and worked with the employee to determine what hours she would be in the office during those 2 weeks.

An employee with PTSD was meeting with his supervisor regarding performance. The employee was experiencing increased anxiety with the upcoming anniversary of the traumatic event. The employee had not shared the increased anxiety with the employer and performance was suffering. The employer started to discuss with the employee that they would be implementing a performance improvement plan (PIP). The employee became overwhelmed and stormed out of the meeting. Later that day, the employee informed the employer that he was having a hard time due to a medical condition and needed to take leave to attend a treatment program. The employer put the PIP on hold and implemented the leave as an accommodation. Upon the employee’s return to work, the employer requested documentation and reinstated the PIP to accurately assess performance.

An employee with a mental health impairment was having increased symptoms and started an altercation with a coworker. The employee was seen shoving the coworker before the altercation was broken up by other employees. Due to concerns of safety and violation of the conduct policy, the employer asked the employee to leave for the day. According to company policy, that type of violation would result in termination. The employee told the employer that he felt the incident occurred due to his disability and heightened symptoms. Due to the nature of conduct and no prior disclosure or request for accommodation, the employer chose to continue with the termination.

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