Returning to work after a perinatal mental illness: A guide from an Occupational Therapist
For many people the transition to parenthood is a time of fear and excitement, uncertainty, happiness, and anxiety. Similar emotions are experienced by people returning to work or education after maternity leave. But feelings of stress, anxiety and guilt about being away from their baby at this crucial time is often heightened in people who’ve experienced a perinatal mental illness.
Their confidence and sense of identity can be affected by having to juggle previous and new roles, including:
Parent
Partner
Worker/employee
Student
Homemaker
Daughter/son/sibling
Friend
The importance and meaning of these roles shift when people return to work or education after having a baby. But everyone’s experience will be different. For people whose work or student role was an important part of their identity, returning to work or study can be positive. They may see the transition as an opportunity to reconnect with that part of themselves, and with other people. Others feel guilty about leaving their baby, especially if they’ve struggled to bond with them. They may lack confidence to do things they previously managed or enjoyed and question their ability whether at work or college, or at home.
Struggling to establish new routines and manage the demands of everyday life as a new parent is also common. However perinatal mental health illness can significantly affect a person’s ability to organise their time and ensure a good balance of parenting, self-care, and leisure activities. This is amplified when people return to work or study and can feel overwhelming for people who’ve experienced perinatal mental illness.
Information for parents and employers if parent is under a perinatal mental health team.
The NHS long-term plan extended perinatal mental health services for mothers and birthing people who need ongoing support from 12 to 24 months (NHS England, 2019). This change recognises that people who’ve experienced perinatal mental health problems are at risk of a relapse in their mental health when returning to work, which can occur during this period of change.
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If you are under a perinatal mental health team when you are due to return to work, you can ask for a referral to your perinatal Occupational Therapist.
Perinatal Occupational Therapists are part of the perinatal multi-disciplinary team and work alongside the other professions in the perinatal team including psychologists, nursery nurses, community psychiatric nurses, psychiatrists, peer support workers and pharmacists.
Occupational therapists provide practical support to help people experiencing perinatal mental health problems carry out the daily activities – occupations - that are important to them, their infants and families. Occupational therapists support the activities and routines people do themselves, and those they do with their infants – ‘co-occupations' - including the following:
· Self-care: getting washed and dressed, eating and sleeping, creating healthy routines
· Productivity: shopping, cleaning, preparing meals, managing study or work tasks
· Leisure: finding time to exercise, pursue personal interests and meet up with friends
· Parenting: feeding, changing and playing with the baby
Perinatal Occupational Therapists can support you in your return to work in a number of ways. These include:
· Helping you to explore your identity and role transition as you move from full-time parent to worker.
· Helping you to create a work/life balance which enables you to do the things that are important to you
· Supporting you with practical preparations and problem-solving practical issues (budgeting, time management)
· Supporting you in making an informed decision on whether to tell your employer about your mental health issues
· Exploring reasonable adjustments at work to support your mental health and wellbeing.
· Helping you to create a ‘return to work mental wellbeing plan’
· Supporting you with meetings with your employer.
Your Occupational Therapist may see you individually and/or in a group setting. Group settings provide an opportunity for peer support and to know you are not alone in how you are feeling. It also enables groups members to share ideas and hear other people’s perspectives.
Know your rights.
You are not obliged to tell employers that you have had a perinatal mental health illness, and you may be reluctant for fear of being judged. But disclosure means support and reasonable adjustments can be identified and put in place.
The Equalities Act (2010) means it’s unlawful to discriminate against someone because they are pregnant or have a pregnancy-related illness. The protection against discrimination lasts for a specific period which starts when someone becomes pregnant and ends when they finish maternity leave or return to work if this is sooner. If someone is treated unfavourably after this time, they could still be protected against discrimination because of their sex.
Under the Equalities Act people can request reasonable adjustments at work if they can demonstrate that their mental health problem is a disability: When a mental health condition becomes a disability - GOV.UK (www.gov.uk)
Reasonable Adjustments Include:
· Extended phased return, which may include use of accrued annual leave
· Flexible working arrangements
· Changes to work location, hours and duties
· Time off for appointments
· Access to a workplace buddy or peer support
· Access to workplace wellbeing support, coaching or mentoring.
Occupational therapists can support you to access further advice and support if required (Citizen’s advice, Working Families, ACAS)
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If your employee is under a perinatal mental health team when they return to work, they may ask their perinatal Occupational Therapist to support them in their transition from full-time parent to employee.
Perinatal Occupational Therapists can support your employee return to work in a number of ways. These include:
· Supporting your employee in making an informed decision on whether to tell you about their mental health issues
· Exploring reasonable adjustments at work to support your employee’s mental health and wellbeing.
· Helping your employee to create a ‘return to work mental wellbeing plan’
· Supporting your employee with return to work meetings with you.
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Employees are not obliged to tell employers that they have had a perinatal mental health illness, and your employee may be reluctant to tell you for fear of being judged. But disclosure means support and reasonable adjustments can be identified and put in place.
The Equalities Act (2010) means it’s unlawful to discriminate against someone because they are pregnant or have a pregnancy-related illness. The protection against discrimination lasts for a specific period which starts when someone becomes pregnant and ends when they finish maternity leave or return to work if this is sooner. If someone is treated unfavourably after this time, they could still be protected against discrimination because of their sex.
Under the Equalities Act people can request reasonable adjustments at work if they can demonstrate that their mental health problem is a disability: When a mental health condition becomes a disability - GOV.UK (www.gov.uk)
Reasonable adjustments include:
· Extended phased return, which may include use of accrued annual leave
· Flexible working arrangements
· Changes to work location, hours and duties
· Time off for appointments
· Access to a workplace buddy or peer support
· Access to workplace wellbeing support, coaching or mentoring.
Occupational therapists can support your employee to access further advice and support if required (Citizen’s advice, Working Families, ACAS).
Information if the parent is not under a perinatal mental health team.
If you have experienced a perinatal mental health illness the transition back into work can be a challenging time. It’s important to think and plan ahead about how to manage this transition. For example:
· Finding childcare you can trust
· Sleepless nights and how to manage these
· Costs and expenses
· Breastfeeding/chestfeeding and expressing at work
· Not feeling confident in work clothes
· How to be organised
· Managing excitement vs guilt
You may also want to consider…
• Flexible working request which could mean a change of location, part or full working from home (hybrid working)
• Use of annual leave/emergency leave (childcare problems)
• Consideration of graded return to work – might consider using A/L to shorten the week
• When and where you could breastfeed/expressing at work
• Any specific tech you might need (especially if working from home)
• Time off for appts
• Consider a change of role
• Staggered start and end times to work with childcare
• Re-training or inductions into the work place
• Requesting a buddy/coaching/mentoring to help with confidence building
Advice for a parent returning to work.
Be patient with yourself - Take time to settle in, ease into projects. It’s a big adjustment period!
Build trust in childcare - Start childcare 2 week prior to work if possible – you will feel more at ease
Set clear boundaries with yourself and your team - Make working schedule clear, turning off after work, don’t take on too much, set priorities
Open and honest/Advocate for your and your child’s needs – If you need to leave early for childcare, ask don’t assume they won’t accommodate
Other options – if work isn’t suiting you are there other roles?
Use annual leave, have a graded start to work, shorter week, ease back in
If you are breastfeeding, express – employers must find space and allow time for this
Find team support – are there other working mothers? Guilt is huge but also common – sharing this can help
Make time for you - Put lunch in calendar, have a weekly activity for yourself, wake up an hour before baby to have time to yourself
Focus on positives – Think about all the things you like about work, the work, the people, rewarding?
Use Keeping in touch days – helps to ease back in and keep up to date with any changes
Be kind to yourself, it’s a challenging time.
Additional Resources
• https://maternityaction.org.uk/advice/maternity-and-parental-rights-for-self-employed-parents/
• https://pregnantthenscrewed.com/
• https://www.mind.org.uk/information-support/legal-rights/discrimination-at-work/overview/
