Return to Work
Resources
for Workers

In this topic we provide some illustrative case studies of return-to-work scenarios written by Suzie Moehrke and Dr Megan Woods from the University of Tasmania.  

The first case study details the fictional case of Ashley, an early childhood educator who has been experiencing depression, taken leave and is now returning to work. The case study presents the details of her mental health situation, how it is impacting her at the time of her return to work, and how her RTW plan addresses and accommodates her support needs.  

We also provide 3 additional case studies which feature different mental health situations, support needs and job requirements. So you might find it useful to review them and see what additional insights and ideas they might give you about the support you could find beneficial.  

Case Study: Ashley - Early Childhood Educator

Ashely is an early childhood educator and works at a large education centre in the centre of town. She has always wanted to work with young children and support their development, and us currently completing a university qualification in early childhood education by studying part time. Ashely is a kind bubbly person who gets along with all the other educators at the centre and all of the parents. She work primarily in the room for 2-3 year olds. Her day to day work usually involves  

• Caring for a group of up to 5 children  
• Providing assistance with their eating, dressing, nap times and play   
• Writing the programs of activities for the children in her care  
• Setting up and coordinating activities for the children  
• Working with other team members to identify and develop care plans to address the particular needs of specific children.  
• Communicating with parents about any specific needs their children have that day, or anything which has occurred which parents need to know. This includes notifying parents about incidents or accidents for which their child needed first aid, and advice about home care for any injuries.  

Ashley has recently broken up with her boyfriend. They had brought a house together and she is now going through the stress of a property settlement. She initially presented well at work and put on a happy face, but at home has often felt low and tired after a long day of supporting the families and colleagues in her workplace. She is not attending her gym after work anymore as she now favours jumping straight into bed after work. She also spends most of her weekends in her pyjamas and has started to use alcohol to help her sleep.  

As time goes on her workdays become harder and harder. The noise from the children and demands from the parents irritate her and make her snappy. She is also often forgetful and is annoyed with herself that the strain of dealing with her ex-partner and the property settlement is taking so much out of her. She has started taking days off here and there, but then finds it harder to cope when she returns to work. Her supervisor has noticed the changes in Ashley’s demeanour and asks if Ashley needs any support. Ashely confides she is not coping well with her breakup and her supervisor recommend she take some leave.   

While on leave Ashley’s GP diagnoses depression and prescribes medication to support her recovery while she works with a counsellor to process her feelings about her breakup. It concerns Ashley that she will going back to work being medicated and she does not want the staff or parents to know. She consults her doctor, reporting that she is  

• Still experiencing low energy and moodiness  
• Groggy when she wakes up - due to her medication - but usually feeling alert by 10am  
• going to the gym again but only able to go in the evenings when its quieter and there are few other people around      
• spending one-on-one time with friends and family but avoiding being in group settings as she feels like the ‘odd one out’ dealing with a breakup and depression when everyone around her seems to be happy  
• able to work on her university study but feels frustrated that it is taking longer to read the material and write her assessments than it usually does.     

Her doctor reassures her she can return to work even if she is not 100% herself again, that she is safe to work with children. They agree Ashley should initially return to work    

• Working half days to manage her energy levels  
• Start work after 10am when she feels alert and more confident to work with the children  
• Work primarily on writing and updating the care plans for the children in the 2-3 year olds room so she can self-pace her work and work in a quieter location such as the staff room or office area of the centre
• Work directly with the children during times when there is less ambient noise, such as meal and nap times

Case Study: Simon - Managing Director

Simon is 45 years old, a married father of four and the managing director of a residential aged care facility. Simon is a funny, kind, and generous person and is the most popular member of the leadership team. His staff know he is there to support them in every way possible, and that his number one priority is ensuring the best care possible for the residents. Simon’s role primarily focuses on working closely with the executive management team to implement strategies which enhance patient care and medical practice in the facility. This requires a lot of  

• Consultation with staff in all areas and at all levels   
• Operational understanding of all care situations and scenarios 
• Contant review and interpretation of care standards

• Learning about and applying into practice new developments in clinical practice and patient care   
• Real time processing of information about how care is being provided, issues that arise, and impacts on patient care and clinical practice  

Eight weeks ago, Simon suddenly lost his father to a heart attack. His father showed no risk factors and there was no family history of heart failure. Simon took a week off work to arrange and attend the funeral, and then came back to work immediately afterwards.  

Upon his return, everyone could see a change. He was angry and tired, his eyes were black from lack of sleep and his face was pale. He would anxiously tell anyone who would listen that he never saw it [the heart attack] coming.

Over the next few weeks, Simon’s grief and shock around his father’s death manifested into irritated outbursts and he became known for slamming doors and critical comments. His staff began to avoid him if they can, fearful of what may happen next. Simon still looked pale and exhausted, but was also often poorly dressed.  

A kind co-worker and friend who was also a doctor that Simon trusted and respected, suggested some time off work to process the death of his father. Simon was angry at the thought, but recognised deep down that he could not keep going this way. Ashamed of his own behaviour, he knew it was the right thing to do. The friend also provided the name of a psychologist to help him process the feelings he was experiencing. With the support of his friend, Simon contacted the executive team and advised them he would be taking an extended break to recover from the death of his father.  

Simon’s psychologist diagnosed him with anxiety and depression. A recovery action plan was created to help him manage his intrusive thoughts about his father’s death, process his grief and restore his sense of self. After 5 weeks off work, he decided he would like to go back. At this time, Simon was  

• Able to concentrate for short periods of up to an hour,  
• Still experiencing occasional intrusive thoughts about his father and his father’s death  
• Experiencing difficulties focusing and concentrating  
• Feeling concerned about ‘missing things’ when making decisions or processing information  

Simon found he was calmest and best able to function when he could focus on one thing at a time, work quietly without distractions or interruptions, and work at his own pace.  

Simon and his psychologist determined together that he was capable of: 

• Working one day a week, with the aim of increasing his work days over a three-month period to five days a week.  
• Working in quiet locations with minimal noise around him  

and agreed Simon would meet fortnightly with his psychologist to access ongoing support, review how his return to work was going, and determine when he was able to increase the number of days he was working.  

Case Study: Mia - Midwife

Mia is a recently graduated midwife and is excited to start work at the large regional hospital in her hometown. She is 26 years old, and although not yet a mother herself, is absolutely thrilled to be supporting families at this important time and welcoming new life into the world. On her first day she meets her colleagues, who are a mix of older and younger staff. She feels a great sense of excitement and relief to be learning from such an experienced collection of knowledgeable people.   

In her first week, she is taken to task by a senior midwife named Marge for not filling in discharge paperwork properly of a mother and baby who left the ward. Mia tries to explain she would ensure she would not make that mistake again, but Marge walks out of the room. Over the next few weeks, Mia finds herself constantly working the same shift as Marge, and Marge always finds something to criticize her about. Mia starts to feel anxious about doing her job and coming to work each day. She dreads having to face Marge and find out what she has done wrong this time. Week after week Marge does not let up, nit picking at every decision Mia makes. One day Mia overhears Marge telling other midwifes in the staff room how useless she is, that she is not to be trusted as a midwife. Mia is devastated and heads home early with a stomachache.  

The constant stress from working with Marge and hearing those words, make Mia now doubt her own judgement. She finds herself constantly sweating and shaking when on shift, doubting every decision she makes. Mia is now making small mistakes due to the stress she is feeling, giving more fuel to Marge’s fire.   

After only nine weeks in her new role, Mia arrives at work but cannot walk through the hospital door. She vomits into the roadside gutter and heads for home. She receives a call from a senior staff member later that morning to find out where she is. Mia bursts into tears explaining she would have to resign due to her incompetence as a midwife. The senior colleague reassures Mia, suggesting she take the week off and come to work next week to discuss the situation. The staff member reassures her they will arrange a time and a location for the meeting that is private and on a different floor away from other staff.   

Preparing for the meeting with a supportive friend, Mia decides she wants to ask in the meeting   

• Whether there have been other instances of Marge bullying other staff   
• What the hospital can do to help her feel psychologically safe and supported.  
• Whether her roster can be changed so she never be rostered with Marge again.  
• That other staff not be told she was taking leave after such a short period at work due to the anxiety she was feeling working with Marge.  

Her friend suggest she also ask whether she can be allocated a mentor who Mia trusts to give her good guidance and rebuild her confidence as a midwife.   

Case Study: Ben - Paramedic

Ben is a paramedic in a small regional city. He is the fun young fit larrikin of the team and loves music festivals and rock climbing with his fiercely competitive twin brother.  He has just brought his own house and lives on his own. Close to 30 years old, he is at the peak of his physical fitness and his professional game, doing well on every level. 

Two weeks into the winter roster, he faces another gruelling rotation. He never has a moment to spare in his 12-hour shift and barely has time to eat.  It has been the same for over 12 months now. They are always short staffed, and it feels like there are not enough ambulances or paramedics to cover the work. Ben is normally able to cope well with the demands of the job, but the call outs, paperwork and stress are feeling relentless. Ben is experiencing constant headaches, is fatigued and seems to contract every illness going around. He is eating less and losing weight. He feels stuck in a lose-lose situation: either he gives his patients the care and attention he wants to but feel depleted and wrung out, or he pulls back and invest less energy in his job, but then feels like he is letting down his patients and himself.   

After coming down with yet another virus, Ben visits his GP and they discuss together how frequently Ben is getting ill. His GP expresses concern that Ben has become burned out, which has depleted his immunity, energy levels and general resilience. He recommends Ben takes two weeks of sick leave. Two weeks later, Ben returns to the GP. He has recovered from his virus but admits the break has made him realise he feels defeated by his job situation. He still loves being a paramedic and helping patients but cannot stand the pressure or the responsibility of paramedic work right now. He is concerned that he will return to the same demands and pressure he was experiencing before, and he will keep getting sick. He is now wondering if he might have to change careers.  

At his GP’s suggestion, Ben arranges a meeting with his supervisor. They are sympathetic and ask Ben what help he needs. Ben knows he cannot quit as he still needs money to live and pay his mortgage and decides to stay working full time. He informs his supervisor he wants to:  

• continue working full time  
• stay with his work unit as he does not want to lose the connection and camaraderie of working with his friends in the paramedic service. 
• reduce his responsibilities and take a break from being ‘on the road’, and is open to working in an administrative role or in the radio dispatch centre if a role is available.