Psychiatry case study (from ‘Specialties in Practitioner Performance Advice cases’)

Insight report resource

Psychiatry and return to work action plan case study: Multiple episodes of mental ill-health where previous support to return to work has been insufficient

This is a composite case study with some facts altered to protect confidentiality.

Read full Insights publication ‘Specialties in Practitioner Performance Advice cases: Key themes and use of our services’.

Features of the case

Over a two-year period, a specialty doctor in psychiatry had four episodes of sickness absence due to mental ill-health. The psychiatrist reported to the trust that they were accessing ongoing support from their GP and a therapist, but shortly prior to the most recent episode had reported they were unable to cope.

No serious clinical concerns had ever been raised about the psychiatrist’s clinical performance, though a record audit had highlighted some issues with their consultation notes and clinic letters. The psychiatrist was seen as an important member of the team, though colleagues had noticed in recent times they had become withdrawn.

How did Advice respond?

The trust contacted the Advice service after the first two sickness absences. They were advised to refer to local policies as well as to the relevant guidance in Maintaining High Professional Standards in the Modern NHS (MHPS) to determine a fair and proportionate way forward. The trust was also asked to signpost the psychiatrist to the various independent support services available to them, including occupational health.

During the fourth sickness episode the trust again contacted the Advice service. In addition to the continued involvement of occupational health, the Case Adviser also suggested that the trust may wish to request a Professional Support and Remediation (PSR) action plan from the Advice service, to support the doctor’s reintegration into clinical practice following a prolonged absence.

What action did the trust take?

The psychiatrist was referred to occupational health after the third sickness episode. The psychiatrist was said to be accessing support, firstly through their GP and latterly with a therapist.

Subsequently, the trust requested a PSR action plan with the objectives of supporting the doctor’s continued mental health wellbeing; improving the doctor’s record keeping; and rebuilding positive and constructive working relationships with colleagues. The Advice service created an action plan which accommodated the psychiatrist’s phased return to work. The plan stipulated a requirement for the trust and psychiatrist to agree a job plan which took into account their health and wellbeing. The action plan set out various professional activities for the psychiatrist to complete and had regular review points for the psychiatrist to discuss progress with the trust. The Advice service also provided a security plan and guidance to further support the doctor’s health and wellbeing.

What was the outcome?

With the support provided by the action plan and security plan, in addition to continued health and wellbeing support, the doctor made positive progress in meeting their objectives.

At the conclusion of the action plan the doctor had satisfied the agreed objectives and was able to return to the full scope of their clinical practice.

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