Appendix 4.J – CMD (severe work stress) vignette

Situation

Chloe, a 45-year-old office worker, felt that her job was so demanding that she could no longer cope. As the company expanded and without notice, the nature of her work changed rapidly. She was unable to adapt, which in turn deteriorated the working relationship with her colleagues.

She consulted her treating physician who identified work overload and ambiguity in her role within the company. The doctor recommended cognitive-behavioral therapy (CBT) to better understand her thoughts and beliefs about her new work reality. In addition, he completed and signed a work stoppage form for a period of eight weeks.

Actions/actors by RTW stages

1. Time off and recovery period

Chloe informs her immediate supervisor of her absence by e-mail, mentioning the intense stress she is experiencing at work.
The person responsible for absence management calls her to explain the general process of RTW in their company and agrees that her immediate supervisor can contact her if necessary. She asks if she can disclose her adjustment difficulties to her immediate supervisor, without disclosing her specific health issues, so that he can plan appropriate work accommodations. Since Chloe was concerned about the new work tasks and her co-workers’ reaction to her time off, she decided to disclose her functional limitations (e.g., anxiety, difficulty concentrating), but without disclosing the relationship issues with her co-workers. With Chloe’s agreement, the person responsible for managing absences shared this information with her immediate supervisor.
Chloe begins CBT, as recommended by her attending physician, and mentions to the psychologist the strained relationships with her co-workers. The psychologist recommends that she discuss this with her immediate supervisor when the opportunity arises and teaches her conflict resolution strategies for reconnecting with her colleagues.

2. Initial communication with the worker by the workplace

In the following weeks, Chloe’s immediate supervisor calls to check on her. He provided social support without pressuring her or asking her about her rehabilitation and return to work. The immediate supervisor ended the call by asking if he could call her back to follow up. Chloe agreed and together they agreed on a frequency of calls.
During the follow-up phone call, Chloe informed her immediate supervisor that she had seen her treating physician again and that he had signed off on her for an additional four weeks. At this point, he listens to her and invites her to share her concerns about work. She discusses her workload and fails to mention the tense climate with her colleagues, believing that she could deal with this situation with the strategies proposed by the psychologist. Her immediate supervisor ends the call by reassuring her of her place in the company/team.

3. Assessment of the worker (work capacity) and his/her work (job demands)

Before the end of the work stoppage, her immediate supervisor contacted Chloe to check on her and ask about her possible RTW. Chloe shares with him that she is feeling better, although some anxiety symptoms persist.
Chloe informs him that her doctor recommends a gradual return.
The psychologist also agreed, given that she taught him strategies for resolving conflicts with his colleagues.

4. Development of the RTW plan with workplace accommodations

The gradual return is started at the rate of 2 days per week for the first two weeks. In addition, the immediate superior reorganizes the tasks within the team in order to reduce Chloé’s workload.

5. Resuming work (day 1)

Chloe receives the usual information from human resources, as well as their support and availability to help her in the weeks to come.
Chloe meets with her immediate supervisor and there is a discussion about the finer details of the team’s operation.
Chloe returns to her post and initiates a first contact with her colleagues, by applying the recommendations of her psychologist, but they remain cold towards her, because they do not appreciate the redistribution of the tasks which was imposed to them.

6. Follow-up of the RTW (in the following weeks)

During the first week of the RTW, Chloé realized that her co-workers still did not address her as they used to. This creates a feeling of devaluation and an increase in anxiety, even though she likes working in a team and is satisfied with the work arrangements that have been implemented.
The immediate supervisor checks in with Chloe regularly on her progress at work.
A month after returning to work, Chloe finally shares this reality with her colleagues. The immediate superior does not know what to do with this information and is reluctant to share it with his employer, in a context where he must demonstrate his expertise in restructuring the company.

Learning Elements

Chloe’s case management strengths:

Initial communication with the worker by the absence manager – this is a particularly important step in CMT cases, as the risk of prolonged disability is high.
Obtaining Chloe’s consent from the absence manager to disclose some information about her functional limitations.
The immediate superior’s contact with the worker, even before the beginning of the rehabilitation, as well as his follow-up (social support).
CBT, which encourages reflection on one’s work life and the recovery of one’s abilities.
The collaboration of the RTW actors: person responsible for managing absences, immediate supervisor, worker, attending physician.
Gradual return to work with accommodation at work.

Weaknesses in Chloe’s case management:

Lack of communication within the company about their new reality.
Lack of clarification of Chloe’s work situation with her co-workers. It is always useful to ask the worker about the state of his or her work relationship, which could have changed the RTW plan. In this way, the person responsible for absences, the immediate supervisor and the union representative could have worked together and planned an information meeting with the co-workers.
Failure by the person responsible for absence management (or other person in the human resources department, if applicable) to involve the union representative and the psychologist with the other players in developing the RTW plan. The implementation of concerted action within the company would have allowed the immediate superior to benefit from the knowledge/expertise of the other players involved and to better accompany Chloé during the RTW.

Comments

It may be useful for the employer to offer follow-up training on CMT to the organization’s immediate supervisors to help them better manage such situations.

Sometimes CMD cases are more complex. Here are two examples:

When the immediate supervisor is the cause of anxiety and chronic stress, it is appropriate to designate another actor in the RTW process. In any case, it is important to maintain contact with the absent employee during the recovery period, as well as to use the union representative. If the worker prefers that his or her immediate supervisor not contact him or her, check to see if he or she would like someone else on his or her team to stay in contact with him or her – (Table 4-11 ─ HR counselor or person responsible for absences)
When symptoms of depression are also present, it is sometimes necessary, for the well-being of the worker, for therapy to begin before the first contact with the workplace. However, it is important that the worker does not feel “forgotten” by the workplace; it is simply a matter of finding the “right moment” to offer support while respecting the worker’s capacities and needs.

A personal information management plan is desired when it comes to disclosure of worker health issues, especially for workers with CMD (Corbière, Villotti, Toth, & Waghorn, 2014).

Reference:
Corbière, M., Villotti, P., Toth, K., & Waghorn, G. (2014). La divulgation du trouble mental et les mesures d’accommodements de travail : deux facteurs du maintien en emploi des personnes aux prises avec un trouble mental grave. L’Encéphale, 40(S2), S91-S102.