Recovery and Return to Work is an important part of a holistic PTSD Plan. Return to Work for an worker who has suffered PTSD can involve careful balancing of the needs of the worker and the needs of the workplace/Employer. The Employer has a duty to accommodate, which means that you are required to “identify and change any rules, practices, expectations or procedures to meet the needs of employees so that they can perform to the best of their potential. This right to equality must be balanced with the employer’s right to run a productive workplace.”1 This section will provide you:

  • Return to Work Considerations for a PTSD Plan.
  • Tips for accommodating a worker suffering from PTSD.
Legislative Requirements

Workplace Safety and Insurance Act (WSIA)

The WSIA is monitored and enforced by the Workplace Safety and Insurance Board. It establishes a system which ensures that workers are compensated for work-related injuries and occupational diseases. Participating employers, in return, are given immunity from civil suits for worker injury/disablement. The purpose of the WSIA is to accomplish the following in a financially responsible and accountable manner:

  • Promotion of health and safety in workplaces.
  • Ensuring wherever possible the successful return to work of employees following work-related injuries or occupational illnesses.
  • To facilitate re-entry into the labour market of workers and spouses of deceased workers.
  • To provide compensation and other benefits to workers and to the survivors of deceased workers.

The employer has the duty to modify the work or the workplace to accommodate the needs of the workers to the extent of undue hardship. The employer must re-employ the injured worker if they have worked continuously for the employer for one year and the employer normally employs 20 or more workers. If possible, and the worker is medically able to perform the essential duties of the job they must be returned to their pre-injury position. If the worker is unable to perform essential duties of their job, but is able to work they must be offered work appropriate to their functional abilities within the terms set out in the Act s. 40(1-2) and s. 41 (5-6)

Ontario Human Rights Code (OHRC)

The OHRC is the overarching legislation that requires employers to accommodate employees who are seeking accommodation due to disability up to the point of undue hardship.

Accessibility for Ontarians with Disabilities Act (AODA)

This legislation establishes mandatory accessibility standards in order to achieve accessibility for all people with disabilities by removing and preventing barriers for people with respect to goods, services, facilities, accommodation, employment, buildings and structures. The AODA adopts the broad definition of disability found in the OHRC. Specific to accommodation of a worker this standard applies to those who employ workers and offer accommodation. (Section 3)

Return to Work Considerations for a Prevention Plan

It may seem strange to include recovery and return to work in your PTSD Prevention Planning process, however there are some benefits to understanding more about this process and including it in the overall plan development. While some may argue that Recovery and Return to Work is outside of the scope of a Prevention Plan is it an important aspect of being prepared to support a worker and help them stay at work, recover and return to work. This program reviews a holistic health and safety management approach and therefore includes recovery and return to work.

The Institute for Work and Health did a comprehensive systematic review on the most effective workplace-based return to work practices in 2007 and identified 7 Principles for Return to Work. This review found that workplace based return to work interventions can have positive impacts on duration and costs of work disability2. Another study done by the Occupational Health and Safety Agency for Healthcare in British Columbia, Best Practices for Return to Work/Stay at Work Interventions for Workers with Medical Conditions highlighted similar principles. The majority of interventions in this systematic review focused on the individuals and the researchers highlighted the need to study more workplace based interventions. There is a belief that more effective workplace based interventions could improve the length of time the worker is away from work and support positive outcomes for the workers who are still working.

The principles outlined below come from both of these systematic reviews and provide a good starting place to establish your recovery and return to work portion of your PTSD plan. For each of the items you may want to review how your organization currently approaches return to work and identify if there are opportunities to include some or all of these practices. The 7 Principles for Return to Work state:

1. The workplace needs to have a strong commitment to health and safety which is demonstrated by the behaviours of the workplace parties.

  • This is demonstrated by Sr. Leadership invest in resources and time to promote safety and coordinate Return to Work; labour support for safety policies and return to work programming, commitment to safety issues is the norm across the organization.
  • This includes have a clear, detailed and well-communicated organizational workplace mental health policy that supports the Return to Work and Stay at Work process. This includes many of the items already covered when you are Just Getting Started.

2. The employer makes an offer of modified work to the injured/ill workers so they can return early and safely to work activities suitable to their abilities.

  • The literature highlights that work accommodations are an integral part of the return to work process and the context of their implementation determines their effectiveness.
  • See Tips for Accommodating a Worker who is Suffering from PTSD.

3. Those planning return to work need to ensure that the plan supports the returning worker without disadvantaging co-workers and supervisors.

  • The systematic reviewed highlights that the Return to Work process is a “socially fragile process.” To reduce resentment towards the returning work, steps must be taken to anticipate and address concerns that Co-workers and Supervisors have to ensure better outcomes. This can include education and encouraging cooperation with the process.
  • Offering training on PTSD and other mental health conditions is important. Raising awareness can address issues around stigma about mental health conditions and facilitate Return to Work.
  • Of importance, disclosure needs to remain in the hands of the worker. Regardless of disclosure evidence suggests that reducing stigma and silence around PTSD can facilitate successful accommodation and Return to Work.

4. Supervisors are trained in work disability prevention and are included in the return to work planning.

  • Supervisors are important to the success of the Return to Work program because they are closest to the worker and they can manage the immediate return to work environment. This means that that in the case of PTSD, Supervisors and Managers need to understand how to accommodate a Worker suffering from PTSD which may involve training and education.
  • It may be important to train the Supervisor on how they can assist the Worker when they return to work specifically how to listen to the Worker’s limitations, helping identify tasks which may be challenging, evaluating the effectiveness of the interventions and the environment.
  • The literature highlights the need for the application of a systematic, structured and coordinated Return to Work process and plan and indicates that having this in place optimizes and improves return to work outcomes.
  • Involving the Supervisor or Manager in the Return to Work process also helps them feel more equipped to accommodate the Worker when they come back to work.

5. The Employer makes early and considerate contact with the injured/ill Worker.

  • The literature suggests that early contact is core to successful Return to Work programs, but it should consider the workers specific situation. This contact should be made by the immediate Supervisor and focus on the Workers well-being and mental health.
  • The Supervisor may want to refer back to Important Messaging for Workers about What to Expect which provides tips on how to communicate with workers who have experienced traumatic events, including reminding them that:
    • No one who sees a traumatic event is untouched by it.
    • It is normal to feel sadness, grief and anger about what happened and what you saw.
    • It is natural to feel anxious about your safety or the safety of those who are important to you.
    • They should acknowledge your feelings, it will help you move forward more quickly.
    • Everyone have different needs and different ways of coping. This is normal.
    • It is healthy to reach out for, and accept help if you need it.
  • The literature highlights that for this to be successful the workplace environment should be characterized by a shared sense of goodwill and confidence.

6. There is a person in the workplace who is responsible for coordinating Return to Work. This person can help provide an individualized plan that focuses on the workers initial and ongoing needs.

  • It is important that the person coordinating return to work has clear mandates and feel empowered to be flexible with creating different work accommodations.
  • Assisting the injured Worker remain or return to work while they recover while also ensuring that the workers return to work date is sensible, flexible and safe for the Worker.
  • Help the Worker return to the workplace post injury.
  • Connect and consult with the injured worker, treating Health Professional, and WSIB representative and make sure that every understands what to expect and what is expected of them.
  • Monitor the Workers progress towards returning to work.
  • Take steps to prevent further injury/illness.
  • Help resolve issues or disputes related to the return to work.

7. Employers and Healthcare Providers communicate with each other about the workplace demands, as needed, and with the worker consent.

  • The literature highlights the importance of the workplace facilitating access to evidence based treatment.
  • Healthcare Providers can play a significant role in the Return to Work process as the injured Worker is often looking to them for advice and guidance on how to Return to Work.
  • It is important that all of the players understand the workers job and the ability to accommodate.
  • Permission must be provided from the Worker for this type of contact to take place and the type of contact will vary based on individual circumstances and Healthcare Providers.
Tips for Accommodating a Worker who is Suffering from PTSD

This section is designed to provide you some tips on how to accommodate workers who have PTSD. Research has found that PTSD does have an impact on impaired occupational functioning, particularly as it relates to reduced productivity, presenteeism and absenteeism. This is not an exhaustive list of accommodations, there may be other ideas or options you may wish to use.

Questions to Consider when Accommodating Work

When considering how to accommodate a worker you may what to identify the specific circumstances related to that worker, some questions include:

  • What is the worker experiencing (signs and symptoms) and what are the limitations?
  • How will these limitations impact the work that the worker needs to do?
  • Are there specific job tasks that will be problematic as a result of these limitations?
  • What accommodations can help address or eliminate these limitations?
  • Has the worker been asked about possible accommodations, can they help identify specifically how the organization can assist?
  • In order to facilitate a successful return to work what training should be provided to the leadership team, supervisor or other workers who work with worker?
  • Is the worker currently receiving care or treatment and if so are they continuing to follow a treatment plan (if this is known)?

Potential Individual Accommodations

There are a range of treatment options for Workers suffering from PTSD. All treatment options should be in line with emerging best practices that are known to be effective and delivered by individuals trained in addressing PTSD including psychologists and psychiatrists. These potential individual accommodations can be used to support workers so that they can stay at work or return to work.


Signs and SymptomsWhat this could look like at workImpact on job tasksPotential Accommodations

Intrusive Memories

  • Reduced concentration
  • Difficulty managing time and tasks
  • Increased errors in work
  • Difficulty completing complex tasks
  • Reduced organizational skills

  • Difficulty completing tasks with deadlines, time pressures or high expectations
  • Inability to complete tasks in which error rate is impacted by reduced concentration
  • Inability to complete complex tasks or multi-task


  • Reduce distractions in the workplace
    • Sound proofed areas
    • Use of white noise
    • Soothing music
    • Uninterrupted work time

  • Manage completion of work
    • Flexible scheduling
    • Breaking large projects into smaller chunks, with easily achievable goals
    • Provide memory aids such as schedulers, organizers, use of auditory or written cues
    • Weekly meetings with supervisor or mentor to assist with determining goals, reminding of important deadlines, create daily to do lists

  • Restrict tasks with immediate risk for injury if concentration lapses


Avoidance

  • Social Withdrawal, irritability
  • Relationship problems
  • Difficulty maintaining close relationships
  • Feelings of guilt, depression or worry
  • Social Withdrawal, irritability
  • Relationship problems
  • Difficulty maintaining close relationships
  • Feelings of guilt, depression or worry

  • Reduced motivation and productivity

  • Increased stress, emotional outbursts

  • Interpersonal difficulties with customers, supervisors and co-workers

  • Decreased ability to deal with conflict or other emotionally charged events

  • Reduced capacity to cope with stressful situations

  • Encourage use of stress management techniques
  • Allow support animals
  • Allow telephone calls to doctors or others for needed support
  • Use a mentor or supervisor to alert employee if behaviour is becoming unprofessional or inappropriate
  • Encourage the worker to walk away from frustrating situations and confrontations
  • Provide awareness training to supervisors and co-workers
  • Provide partitions or closed doors to allow for privacy
  • Assign supervisor or mentor to be available to answer employees questions
  • Allow for a flexible work environment – scheduling, breaks, leaves for counseling, work from home
  • may not be able to complete tasks with frequent customer contact

Hyper-arousal

  • Excessive fatigue
  • Exaggerated startle response
  • Hypervigilance
  • Increase in self-medication practices

  • Reduced concentration, activity and productivity
  • Allow for flexible start time
  • Provide a place for the employee to sleep during breaks if needed
  • Allow the worker to work one consistent schedule
  • Allow for a flexible work environment
  • Provide goal-oriented workload
  • Identify and remove environmental triggers such as particular smells, or noises
  • Allow a support animal
  • Allow for breaks and provide a place where the worker feels comfortable to use relaxation techniques or contact a support person

Supportive Management Techniques

When you are planning how to manage recovery and return to work for your workers, it is important that you are support the managers and supervisors so that they can utilize effective techniques which help keep the worker on track to recovery. Below are a list of tips that may help supervisors and managers implement an individual return to work plan:

  • Be prepared to provide day to day guidance and feedback, focused on tasks.
  • Provide written and verbal instructions.
  • Provide positive praise and reinforcement.
  • Recognize when the worker is experiencing hyper-arousal symptoms, stress or withdraw and provide support and remind them of mechanisms they can use such as utilizing quiet space, strategies to deal with conflict.
  • Establish long term and short term goals, breaking down complex tasks.
  • Provide clear expectations of responsibilities and outline the consequences of not meeting those performance standards.
  • Plan how to evaluate the effectiveness of the accommodations.
Implementing Best Practices in Return to Work

Assessing your Program:

When evaluating your return to work program, some key metrics to monitor are a decrease in both short and long term disability related to PTSD and mental health injury, an increased utilization in the employee assistance program (EAP) and an increase in benefits for psychological support.  Indirect metrics may include improved job satisfaction, reduced turnover in important operational roles, reduced stigma related to modified duties, and reduced employee complaints. In addition to outlined return to work practices and modifications, voluntary assessments should be completed to address barriers to recovery and return to work for workers with PTSD.

Family Engagement:

Broader family and community members should also be engaged to support recovery and return to work. This will allow for a quicker return to work and help the first responder move back into their routine. Moreover, engagement with friends and families of workers who are suffering from PTSD increases awareness to PTSD, reduces the stigma, and allows for a community of support. Some examples of how friends and/or family are engaged include:

  • Open houses, BBQ, family night and other social events, which also provide information about PTSD
  • Providing family-based peer support that allows family members and caregivers to speak to others who have had similar experiences, in an effort to support themselves and their loved one through recovery.
  • Offering and funding for time-limited family counselling if required. This can be made available by the employer as part of an insurance benefits package, though an EAP or under circumstances which it is deemed necessary for the well-being and recovery of the worker and their family.
WSIB and Return to Work

The Workplace Safety and Insurance Board provides return to work services for Ontario Workplaces. Information about this process can be found on the WSIB site.

Visit WSIB Site

1. Canadian Human Rights Commission, 2016
2. Occupational Health and Safety Agency for Healthcare in BC, 2016. Institute for Work and Health, 2007.