Return To Work, Take Two

“What should I tell people when I go back to work?” “I just want to be treated normally by my co-workers.” “I’m worried I’ll get fired.” “How will I handle the judgment from my colleagues?”  These are just some of the concerns I heard from the amazing people in partial hospitalization who were preparing to graduate, then return to work.  I return to work in a couple of days.  I’m nervous.

Going back to work after a vacation can be hard.  You may feel overwhelmed by an overload of e-mails; you may feel behind on certain projects or tasks; you may feel anxious about getting up early and battling traffic to get to work on time.  When a person is going back to work after extended time off because of a mental illness, add to that:

• Worry over how to respond when you inevitably get questions like “Are you feeling better?”, “What happened?” and “Are you okay”?
• Fear of being judged or treated differently by people that know or suspect you have been absent due to a mental health struggle, because mental illness can still be so very stigmatizing
• Concern that you are not ready, as “healing” from a metal health crisis is not linear, nor finite like some physical illnesses may be
• Anxiety with being triggered, as job stress can be an initial trigger or at least part of the causal equation for many mental health crises

In partial-hospitalization, there were graduates on most days, since we all started the program at different times.  When preparing to graduate, the facilitator typically asked about readiness, concerns moving forward, and supports in place.  By far, the number one concern that was shared by those who gradated before me?  Returning to work.

The first time I had to take an extended amount of time off of work, it was due to suicidal urges, hospitalization, and then a partial-hospitalization step-down program.  While being deeply depressed and barely able to shower or take care of myself, I still had to take the necessary steps to ensure my life would be waiting for me when I recovered.  I was expected to navigate the system of applying for short-term disability, communicate with managers at work, and create a plan for successful management of new diagnoses while also worrying about how in the hell I was going to return to my new “normal” life soon.  After I finished partial-hospitalization, I had an appointment with my individual therapist who wanted me to bring my husband, Duece, along to debrief this mental health crisis, and develop a safety plan for preventing a full crisis in the future.  What actually happened was that I escalated into a full panic in her office, crying so hard that my words could barely be understood when trying to communicate my ever-growing anxiety with returning to work; I begged for more time off work; I stripped off as much clothing as was socially acceptable so I didn’t add passing out to the list of things my body was experiencing.  I was given ice cubes to hold on my forehead and told to focus on slowing my breathing to calm down.  While this is happening, my therapist is calmly talking to Duece explaining what is going on with me, why I am getting so upset, so hot, so panicky, like she had seen it a hundred times before.  I love my therapist, but I’m not going to lie, my emotions were so heightened that I wanted to scream at her for making my struggle in that moment feel so “normal” and trivial. The end of this story is that I went back to work, it was hard, and then it was fine.

This time around, I feel more confident with returning to work.  I think to myself, I’ve done this before. Most people I work with know more about my mental health struggles now, which makes me feel better and worse at the same time.  Mental illness is misunderstood.  People don’t know what to say, or how to act.  The reality is, all I want is to be treated the same as before, given the same amount of responsibility with the same expectations, and to be shown compassion, support, and respect, as you would with anyone returning from an extended time off of work due to illness.  Even though I’m feeling more ready, and even a little excited with returning to work this time around, I can still sense that oncoming spike in anxiety.  One of the most effective skills I have learned when preparing for an upcoming anxiety-inducing situation is coping ahead.  To cope ahead, I consider the situation and the specific events or situations that could be the most difficult, then develop a plan for effectively coping.

Here are some recommendations that have worked for me, and may work for you when getting ready to return to work or other responsibilities:

• Be vulnerable (to your comfort level) with a trusted colleague(s) or manager by sharing something about your experience.  This will start a support system for you at work.
• A day or two before returning to work, start looking through e-mails or work material to minimize that overwhelming feeling of being behind.
• Imagine a day at work, and imagine it going well.  This helps me get back into “work” mode before actually returning to work.  Remember all of your favorite parts of your job.  For me, I miss the one-on-one time with my patients and chatting with my co-workers.
• Then imagine what could happen if it doesn’t go as well as you had hoped.  What was it that went wrong in your imagination?  Try to develop a realistic plan for managing those unwanted events or emotions.  You may want to imagine your day at work again, and imagine coping effectively with the difficult situations that arise.
• Take care of yourself.  Make sure to get plenty of sleep the night before your return.  If you are someone who has trouble with sleep, consider getting back on your “work” sleep schedule before your return.  Maybe plan a little extra “you” time to take care of yourself during that first week or two back.
• Lastly, ask for help when you need it.  Ask someone in your support system to help you with laundry or grocery shopping or whatever could make your transition more manageable.

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Do you have other ideas for coping ahead with return to work?  What has worked for you?  Please share your ideas and experiences in the comments.  Together, we can help each other find success in the important areas of our lives and continue building that life worth living.