“Dis-able bodied” or “dis-able minded”: stakeholders’ return-to-work experiences compared between physical and mental health conditions

Figures & data

Table 1. Legal financial and RTW responsibilities of workplace actors in the Netherlands and Denmark.

	The Netherlands	Denmark
Financial responsibility	Employers pay for the first 2 year of sickness absence, at least 70% of wages per year with a maximum of 170% over 2 years	Employers pay for the first 30 days of sickness absence, thereafter municipalities pay a reimbursement for up to 1 year
RTW responsibility	Within 1 week: notification of sickness absence at OHP/service (employer) Within 6 weeks: problem analysis (declaration of the functional (in)capacities of the employee) (OHP) Within 8 weeks: RTW plan (employer and employee) Every 6 weeks: follow-up meetings (employer and employee) After 46–52 weeks: first year evaluation (employer and employee) After 87–91 weeks: final evaluation (employer and employee) After 93 weeks: employee applies for disability benefit at Employment Insurance Agency	Within 4 weeks: sickness absence interview (employer and employee) Within 5 weeks: notification of sickness absence at the municipality (employer) After 8 weeks: RTW plan (on employee’s request) (employer and employee) Possibility attest (declaration of the functional (in)capacities of the employee) (first page: employer and employee, second page: general physician) Employer is allowed to ask medical certificate and statement of duration
Sanctions	For employer: third year of sick pay, paying disability benefit of partially disabled workers for max. 10 years	For employer: no sanctions
	For employee: being withhold wage payment, denied access to disability benefit after 2 years	For employee: being withhold wage payment from employer or sickness benefit from municipality
Employment protection	Generally no dismissals possible	Possibility to dismiss

For NL: Gatekeeper Improvement Act (2002), Extended Compulsory Sick Pay Act (2004), Work and Income according to Capacity Act (2006); for DK: Sickness Benefit Act (2010).

Table 2. Overview of sickness absence cases and interviewees.

Case	Employee characteristics Gender, age, position	Health condition P: physical, M: mental	Interviewees^a^,^b
The Netherlands
NL-1	Woman, 35–40, nurse	P: neurological disorder	SE/SV/HR^1/OHP^2/MA^3
NL-2	Man, 35–40, nutrition asst.	P: musculoskeletal disorder	SE/SV/HR^1/OHP^2/MA^3
NL-3	Woman, 40–45, nurse	P: cancer	SE/SV/HR/OHP^2/MA^3
NL-4	Woman, 35–40, nurse	M: common mental disorder	SE/SV/HR^4/OHP^2
NL-5	Woman, 40–45, nurse	M: common mental disorder	SE/SV/HR^4/OHP^2
NL-6	Woman, 55–60, nutrition asst.	P: musculoskeletal disorder	SE/SV/HR^5/VE^6/OP
NL-7	Woman, 30–35, nurse	M: common mental disorder	SE/SV/HR^5/SW
NL-8	Woman, 35–40, nurse	P: neurological disorder	SE/SV/HR/OHN^7
NL-9	Man, 55–60, nurse	P: neurological disorder	SE/SV/HR/VE^6/OHN^7
NL-10	Woman, 55–60, HR manager	P: hearing disorder	SE/SV/HR/VE^6
N/a	Additional interview		OHP
Denmark
DK-1	Woman, 35–40, nurse	M: common mental disorder	SE/SV
DK-2	Woman, 30–35, nurse	M: common mental disorder	SE/SV
DK-3	Woman, 25–30, nurse	P: pregnancy complication	SE/SV
DK-4	Woman, 55–60, nurse	P: cancer	SE/SV
DK-5	Woman, 30–35, medical sec.	P: bone fracture	SE/SV
DK-6	Woman, 30–35, nurse	M: common mental disorder	SE/SV
DK-7	Woman, 35–40, nurse asst.	P: gastrointestinal disorder	SE/SV
DK-8	Woman, 45–50, nurse	M: common mental disorder	SE/SV
DK-9	Woman, 55–60, nurse asst.	P: cancer	SE/SV
DK-10	Man, 40–45, nurse	M: common mental disorder	SE/SV
DK-11	Woman, 40–45, medical sec.	P: cancer	SE/SV
N/a	Additional interviews		HR (2)/UR (2)/SW

a Differences in the number of interviews per country are related to variations in national and organizational policies.

b Equal numbers imply that the same interviewee is involved in more cases. Explanation of abbreviations for interviewees in order of appearance: SE: sick-listed employee; SV: supervisor; HR: HR manager; OHP: occupational health physician; MA: mobility advisor; VE: vocational expert; OP: occupational physiotherapist; SW: social worker; OHN: occupational health nurse; UR: union representative.

Figure 1. Data coding structure.[33,43]

Table 3. Example of conflicting interpretations of work ability in a mental case in the Netherlands.

OHP Judgment of work ability in mental cases

99 percent of the mental health complaints that I come across are related to the private domain, and then I need to say, “the day has 24 hours, the week has 7 days, we have an employment contract for 24 hours, so you can come here [to work], it’s good for you, and you have plenty of hours left to solve your problems” (NL 1-5)

Employee, supervisor and HR manager Describing how the response of the OHP has delayed the RTW process

In the beginning it [the RTW] took much longer because of the OHP. I told him how I felt […] and then he said “[…] I hear that you only work 23 hours a week so you have enough time left to work on yourself, so I don’t see any problem why you can’t work” […] I felt like he cut the ground from under my feet (Employee NL-5) The involvement of the OHP in this case has […] delayed and impaired the process. […] Of course you want an employee to return to work as soon as possible, […] but in this case he gave such a blunt advise: “you have to return or else you’ll lose your job” (Supervisor NL-5) The OHP is very firm in his judgment of mental health problems […]. And that may backfire, so that employees don’t want to return to work (HR manager NL-4/5)

Table 4. Examples of the importance of RTW plans for both physically and mentally sick-listed employees in Denmark.

Physical cases	I wish I could have started up with some hours or less days […], but if the department has to function we have to be there all the time […]. They expect you to be here for a 100 percent (DK-7)	No RTW plan
	It [the meeting] always ended up with “do you think you can take some more hours now?” […] Instead of, when […] we made an agreement of “this is how it’s going to be”, then leave it [at that] rather than pushing all the time (DK-11)	Deviating from RTW plan
Mental cases	The one thing I was missing was an overview. […] Now, I have a plan on paper and I can say, “I’m not ready for this, this is what we planned”. […] [So] the main thing in getting back to work was making a structured [RTW] plan (DK-2)	No RTW plan
	I heard that they make a [RTW] plan and you follow it, and I didn’t have any. So from day one I was just on my own. […] I have taken the work tasks and divided them into red, yellow and green […] and then I wrote down how many hours I should work (DK-6)	No RTW plan
	I made a [RTW] plan with help from the outside, from the municipality. They helped me […] to make plans for about 14 days at a time […] and to really hold on to the plans that we were making. […] I didn’t have that the first time: […] I built up hours as well, but it was too fast (DK-10)	RTW plan not based on employee’s needs

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