Return-to-Work Programme: Supporting Employees After Long-Term Leave

Without a plan, returning to work after long-term leave can end in repeat absence or resignation. A step-by-step return-to-work programme guide for employers.

An employee may be away from work for weeks, sometimes months, because of a mental health difficulty, a serious illness, surgery, a workplace accident or bereavement. Then one day they come back, and all too often the first morning brings a card, a few words of "welcome back", and an environment that expects them to pick up exactly where they left off. Yet after a long absence, returning to work is a process full of both excitement and anxiety for the employee: "How will they receive me?", "Will I be able to work as I did before?", "Does everyone know what happened?" In this article I look at how you can support an employee after long-term leave, what a well-planned return-to-work programme should include, and how you can begin building one in your organisation.

Why Is Returning to Work a Process That Needs Planning?

A long period of leave is not simply an "absence"; it is a significant turning point in an employee's life. During their time away, the person may have been dealing both with a health problem and with the fear of losing their job, their income and their future. By the time they return, the work environment may have changed, new people may have joined the team, and processes may have been altered.

An unplanned return usually leads to one of three outcomes:

• Early burnout: Driven by a need to prove themselves, the employee takes on too much in the first weeks and soon begins to struggle again.
• Repeat leave: Symptoms return and the employee has to take sick leave once more.
• Leaving the job: An employee who feels excluded, stigmatised or inadequate chooses to resign.

All three outcomes are costly for both employee and employer. Losing an experienced employee means recruiting and training someone new and increasing the team's workload. An analysis in the United Kingdom reported that around 40% of the costs of staff leaving were attributable to mental health problems (Deloitte, 2022). This figure is specific to the UK, but it shows how important the link between mental health and staff turnover is.

The World Health Organization's 2022 guidelines on mental health at work also recommend return-to-work programmes that combine work-directed support with clinical care for employees who take leave because of mental health conditions. This recommendation is classed as "conditional", with a "low" certainty of evidence; in other words, the evidence is still limited, but experts recommend the approach (WHO, 2022).

What Do Employees Experience After Long-Term Leave?

The feelings and difficulties employees most often describe during the return process include the following:

• Anxiety and uncertainty: The question "Will I be able to perform as I used to?" can cause intense anxiety both before and after the return.
• Fear of stigma: Employees who have taken leave for mental health reasons in particular worry that colleagues will treat them differently. In a European survey, 50% of workers said they believed that disclosing a mental health problem would harm their career (EU-OSHA, 2022).
• Guilt: An employee who thinks they have added to the team's burden may feel guilty.
• Physical and cognitive capacity: The course of treatment, medication or a long period of inactivity can affect attention and energy levels.
• Adjusting to a changed environment: New managers, new software or changed duties can make the return even harder.

For employees returning after a workplace accident, going back to the place, the machine or the task involved in the accident can itself be a serious source of anxiety. People who experience post-traumatic stress symptoms alongside a musculoskeletal injury have been reported to have lower return-to-work rates (Lin et al., 2016; low to moderate quality evidence). For this reason it is important to consider the psychological dimension when someone returns after an accident. For more on this topic, see the article on psychological support after a workplace accident.

The Legal Framework

Under Article 15 of Turkey's Occupational Health and Safety Law No. 6331, the employer provides health surveillance according to the risks employees are exposed to. When an employee returns after a workplace accident, an occupational disease or repeated absences for health reasons, a medical examination is carried out if the employee requests it. Under Article 17 of the law, an employee who has had a workplace accident is given additional training before starting work again. Employers are also obliged to consider employees' suitability for the work in terms of health and safety when assigning tasks (Article 4).

These provisions highlight the role of the workplace physician and the occupational safety specialist during the return process. However, matters relating to leave entitlements, medical certificates, pay, changes of duties and the employment contract are governed by separate legal provisions. For definitive information on these matters, I recommend consulting an employment law specialist.

Health information is among the special categories of personal data. With whom, and to what extent, information about an employee's diagnosis, treatment or reason for leave is shared must be handled carefully, with the employee's consent and within the relevant legislation.

What Does a Good Return-to-Work Programme Include?

An effective return programme begins during the leave and continues for several months after the employee has come back. The key components are as follows.

1. Measured communication during leave

Cutting off contact with the employee completely during their leave is not healthy, and neither is constantly bothering them with work matters. Brief, warm contact at pre-agreed intervals lets the employee feel they have not been forgotten. The best approach is to decide the frequency and form of this contact together with the employee.

2. A pre-return meeting

One or two weeks before the return, a meeting can be held with the manager, HR and, if necessary, the workplace physician. This meeting covers the following:

• How the employee is feeling and what they expect from the return
• Which tasks they will start with in the first weeks
• Adjustments that may be needed (working hours, distribution of duties, breaks, workplace)
• What the team will and will not be told
• The flexibility needed for treatment and follow-up appointments

3. A phased return plan

Where possible, starting with shorter hours or a reduced workload in the first weeks allows the employee to build up their capacity step by step. The plan should be flexible and open to updating according to the employee's needs.

4. Reasonable adjustments

For employees with a mental health condition, reasonable adjustments in the work environment appear as a strong recommendation in the WHO guidelines on mental health at work (WHO, 2022). Flexible working hours, a quieter workspace, prioritising tasks and regular short feedback conversations are examples of such adjustments.

5. Regular follow-up meetings

Holding short, regular meetings between the manager and the employee during the first three months after the return helps potential difficulties to be noticed early. These meetings should be designed as support conversations, not performance reviews.

6. Coordination with clinical support

If the employee is continuing treatment, it is helpful to coordinate the return process with clinical care, with the employee's consent and within the bounds of confidentiality. For example, flexibility in working hours can be offered so that they can attend therapy sessions.

7. Needs that differ according to the reason for leave

Not every long period of leave creates the same needs. Although the basic structure of the programme is shared, some details vary with the reason for the leave:

• Leave for mental health reasons: Fear of stigma and confidentiality come to the fore. It matters that the employee has a say in what the team is told and that follow-up meetings are free of performance pressure.
• Surgery or long-term illness: Physical capacity, ergonomic adjustments and flexibility for follow-up appointments stand out. The workplace physician's recommendations serve as a guide.
• Workplace accident: Returning to the place and the task where the accident happened can trigger anxiety and avoidance. Additional training, gradual exposure and, where necessary, psychological support should be planned.
• Bereavement: The attention and energy of an employee who has lost a loved one may fluctuate for a long time. Allowing flexibility on special days and anniversaries is a humane form of support.
• Maternity and parental leave: Sleep patterns, caring responsibilities and the change of roles all affect the return. I have covered this topic separately in the article on returning from maternity leave.

This distinction helps you respond to each employee's needs without forcing them into a single mould. Even so, the person who knows best is always the employee themselves; rather than making assumptions, you need to ask.

The measure of a successful return is not how much work the employee gets done on the first day, but whether they are still well, and still in their job, six months later.

The Role of the Manager and the Team

The direct manager is the most critical figure in the return process. The manager's attitude determines whether the employee feels accepted or excluded. In the WHO guidelines on mental health at work, the recommendation with the strongest evidence is mental health training for managers (WHO, 2022). In one randomised controlled trial, after managers received four hours of mental health training, work-related sick leave in their teams fell by 18% compared with baseline (Milligan-Saville et al., 2017). This study was carried out in a single organisation and the results need to be replicated in other settings, but it shows how important the manager's role is.

Some practical suggestions for managers:

• Welcome the employee sincerely; saying "I hope you're feeling better" and "it's good to see you" is enough.
• Do not ask the reason for the leave; if the employee wants to share it, listen.
• Set realistic expectations and discuss them openly.
• Pass on to the team only the information the employee has given permission to share.
• Do not allow gossip or comments such as "they're not the same any more".
• Work together with HR and the workplace physician when necessary.

The attitude of colleagues also matters. Excessive attention and coldness can both make the employee uncomfortable. A natural and respectful welcome is often best. It is also important to recognise the effort of the colleagues who took on the work in the employee's absence; otherwise, accumulated tiredness can turn into an unspoken resentment towards the returning employee. It is also important for managers to know their own limits in this process, and the article on mental health training for managers may offer guidance here.

Suppose a planning specialist at a logistics company returns to work after taking three months' leave because of depression. Before the return, a short meeting is held with their manager and HR, and it is agreed that they will work half days for the first two weeks, that the heaviest reporting tasks will be temporarily given to a colleague, and that there will be a short weekly follow-up meeting. The team is told only that "they were on leave for health reasons and we are glad to have them back with us". At the end of three months, the employee moves to full-time work and takes on their workload gradually.

How to Get Started in Your Organisation

1. Needs analysis: Look at how many employees have taken long-term leave in the last two or three years, and at the rates of repeat leave and resignation after the leave. Check whether your current return practices rest on a written procedure. Where possible, hold anonymous feedback conversations with employees who have returned from leave.

2. Programme: Prepare a written return procedure covering communication during leave, the pre-return meeting, the phased return plan, reasonable adjustments, follow-up meetings and confidentiality rules. Train managers and the HR team in how to behave during this process. Where necessary, offer individual psychological support to the employee going through the return.

3. Measurement: Monitor, at three and six months after the return, whether the employee has stayed in work, whether they have taken further leave and how satisfied they are with the process. The monitoring indicators recommended by the ILO include absence, resignation and use of support services (ILO, 2026).

You can find the organisational support options for return-to-work programme design and manager training on the corporate services page.

Frequently Asked Questions

Can I ask an employee on mental health leave the reason for their leave?

Health information is a special category of personal data, and it is not appropriate to ask for details the employee does not wish to share. What you need to know as a manager is which adjustments the employee needs. For legal details, you can consult an employment law specialist.

How long should a phased return last?

The duration varies according to the person, the reason for leave and the nature of the work. It is generally planned for somewhere between a few weeks and a few months and is updated flexibly according to the employee's situation. What matters is that the plan is made together with the employee and reviewed regularly.

What is the workplace physician's role in the return process?

The workplace physician assesses the employee's suitability for the work in terms of health and safety and can make recommendations on the necessary adjustments. After a workplace accident, an occupational disease or repeated absences for health reasons, a medical examination is carried out if the employee requests it.

What should be done if the employee struggles again after returning?

This does not mean the process has failed. In the follow-up meeting, it is necessary to talk openly about the difficulties, update the plan and, if needed, make it easier for the employee to access clinical support. Recovery does not always move in a straight line.

• #return-to-work programme
• #human resources
• #mental health
• #reasonable adjustments

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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