Returning to work after brain injury after brain injury

After making a degree of recovery from brain injury, you may feel that you are ready to return to work. However, the effects of brain injury can bring many changes to different aspects of life, including employment. You may find that you can no longer do the job that you once did in the same way, or that you can no longer do it safely.

This does not mean that you are no longer able to work, but that you may require adaptations to be made to the workplace to accommodate for your needs. Alternatively, you might find that a different role altogether is more suitable.

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Returning to a previous job

When returning to work it is nearly always better to return to a job that you know well rather than to try a new job. Familiarity of the role, colleagues and the working environment can all be helpful, although you may find that some aspects of the job require adjusting to accommodate for any new needs.

You do not have to disclose or give details of your brain injury to your employer, but you might find it useful to do so. Under the Equality Act 2010, employers have a legal duty to make reasonable adjustments to the workplace for a disabled employee, so having an open discussion about how your brain injury has affected your work performance can help to identify ways in which useful adaptations can be made. For more information on this topic, see Headway’s factsheets Brain injury - a guide for employers and A guide to the Equality Act 2010 (PDF).

You may wish to initiate a discussion on this by requesting a ‘return to work interview’, which can take place prior to formally returning to a job. Below are some ideas that you could consider discussing with your employer in a return to work interview:

  • Returning to work gradually; for example, starting at three mornings a week or even working from home to start off with
  • Returning with shorter hours
  • Taking more breaks through the day
  • Returning with less workload
  • Taking up a different role

You can also ask for regular meetings with your employer to discuss whether the adaptations are helping or whether you need further support to be arranged.

Finding a new job

If you are considering finding a new job after brain injury, it would be a good idea to start off by seeking advice and support from your local Jobcentre Plus. There are different advisors available at Jobcentres who can offer information about the options of returning to work with a disability.

Disability employment advisors (DEAs)

Some Jobcentres have Disability employment advisors (DEAs) who can offer specific advice about returning to work with a disability. However, the number of Jobcentres offering the DEA service has reduced over time, so it is a good idea to make contact with your local Jobcentre Plus first to find out whether they have a DEA available.

Work coaches

Work coaches can be accessed by individuals who receive the new welfare benefit Universal Credit, which is available in some parts of the country as a replacement to Income-related Employment and Support Allowance. They are non-specialist advisors who can offer support with preparing for returning to work.

DEAs and work coaches carry out an ‘employment assessment’. This can help with identifying what kind of employment will be suitable considering your skills, abilities, previous employment and interests. These are important factors to consider when deciding on what kind of job you apply for. Upon completion of the assessment, the DEA or work coach can recommend suitable jobs or offer advice on schemes that can facilitate a return to work. Below are listed some returning to work schemes that you might wish to discuss with a DEA or a work coach:

Access to work

This is a governmental scheme that offers financial support with returning to work with a disability. The grant can be used to cover the cost of making adaptations to the workplace, such as if you need specialist equipment or require a more accessible environment. The scheme is available across the UK, although it differs slightly in Northern Ireland. There are also certain eligibility criteria, such as if you are in receipt of certain benefits. For more information, visit www.gov.uk/access-to-work/overview. For information on Access to work in Northern Ireland, visit www.nidirect.gov.uk/access-to-work-practical-help-at-work.

Vocational rehabilitation

This is a multidisciplinary service that often consists of health professionals (such as occupational therapists and physiotherapists) and employment services. Vocational rehabilitation is not a service in its own right, but an extension of NHS rehabilitation services. You can therefore make contact with your local NHS brain injury rehabilitation team to find out if they can offer vocational rehabilitation to help you with accessing suitable employment advisors.

Work Clubs

These are local community led clubs that can provide support to anyone unemployed with finding work and developing work-related skills. You can find details of your local Work Club by checking your local council website. Work Programme If you have been on Jobseeker’s allowance for more than three months or if you are in the Work-related activity group of Employment and Support Allowance, you might be able to partake in a Work Programme. This is a scheme that can offer work experience and training for up to two years. For more information, speak to your local Jobcentre Plus. Work trials Undertaking a work trial allows you to try a job for up to 30 days on a voluntary basis without any employment related benefits being affected. You will need to discuss this option with the Jobcentre as there are some conditions attached, such as the number of hours a week that the job is offered.

Disability Confident

Employers who make a commitment to supporting disabled employees within the workplace can be identified by the Government’s Disability Confident symbol. The presence of this symbol means that there is a likelihood that the employer will be willing to discuss how your brain injury affects your ability to work.

Alternative options to returning to work

If you do not quite feel ready to return to work and want to discover new skills or strengths before returning, there are a number of alternative options that you might wish to consider:

Practical strategies when preparing to return to work

Seeking support

It is important to choose a job that is right for you; even though you will likely know best about your personal skills, interests and experience, it can be very useful to seek advice and support from family, close friends and professional services. This can be particularly helpful if you experience memory issues, difficulties with making decisions or reduced self-awareness as a result of your brain injury. Remember that accepting help from others is a sign of strength, not weakness, and the right support can make a successful return to work much easier.

Only return when you’re ready

One of the most common problems brain injury survivors face when returning to work is that they return too soon because they do not realise how the effects of their brain injury will impact on their work performance. This is a particular problem when a good physical recovery has been made, as people often assume that cognitive abilities have also recovered. Returning to work often reveals the full extent of difficulties after brain injury, and returning too soon can damage confidence if performance doesn't meet expectations.

Performance doesn’t meet expectations

It is advisable to avoid making major decisions and becoming involved in stressful situations until you feel you are ready. This is especially the case in jobs with high levels of stress and pressure and where margins for error are small. Mistakes made because of the brain injury could damage your confidence and hinder recovery. Be honest with yourself, prepare as much as possible and don’t try to rush your recovery. Remember, try not to take on overtime, shift work or new responsibilities until you feel ready.

Be positive, but realistic

The attitude you have towards returning to work after brain injury is very important. Research has shown that the following factors are particularly influential:

  • Willingness to accept and act on honest feedback from others
  • Realistic awareness and insight
  • Willingness to use strategies to help with these problems
  • Willingness to tell others what you need

Thinking positively does not just mean saying, “I will go back to work”, but rather it means carefully considering and planning the best options. It means asking yourself, “what can I do?”, “what am I going to have difficulty with?” and “how do I manage the problems?”

There is a balance to be found between positivity and realism. Unrealistic expectations can lead to disappointment and loss of self-esteem, and it is very important to think carefully about the effects of the brain injury and their impact on your abilities. However, it is equally important to be positive and committed in the path you choose to follow.

Communicate with your employer

You do not have a legal duty to disclose your brain injury to an employer and they are not allowed to ask questions about your health unless it is directly related to the job requirements. However, you should always disclose information related to your health if it may put yourself or other people at risk. The following suggestions can help to ensure that you are keeping communication open with your employer:

  • Make sure you keep in fairly regular contact with your employer while you are away. You might wish to ask a family member or a friend to do this for you if it is difficult to keep contact yourself.
  • Make sure you understand your sick pay entitlement and do not be afraid of discussing this with your employer
  • Provide your employer with information about brain injury, such as other Headway publications. Of particular relevance is the Headway factsheet Adaptations to the workplace - a guide for employers.
  • If you have a DEA or a relevant healthcare professional, ask if they would be willing to talk to your employer
  • Be honest with your employer about your abilities. If you are unsure about your ability to complete a task, tell them.
  • Make sure your employer is aware of any legal issues, such as if you have been told that you cannot drive due to an increased risk of epilepsy. This may also mean that you need to take other precautions at work.

Communicate with your colleagues

Again, it is up to you whether you tell colleagues about your brain injury and its effects. If you are returning to your previous job then they will know you have been away, so it can be better to tell them something about the situation. Don’t feel that you have to share anything you aren’t comfortable with, but it will help people to understand and make some allowances if you are as honest as possible. The following suggestions are worth considering:

  • Discuss with your employer whether you want your colleagues to know about your brain injury and any resulting disabilities. You are within your rights to ask for others not to be informed.
  • Keep in touch with friends at work while you are away in order to keep them informed about the situation. If you wish, ask them to keep other colleagues up-to-date and to discretely let them know of some of the difficulties you may experience when you return.
  • If starting a new job, you might like to arrange to visit your new colleagues before you formally start. It might be possible to arrange an induction process where you can discuss the situation and make sure people are aware in advance of any special arrangements.

Practice a structured home programme

It is important to be as prepared as possible before returning to work. An effective way of doing this is to follow a programme to assess and develop the skills that will be required. The aim is to be able to mimic a working week, so try to follow your programme throughout regular working hours. Try to do this for at least two weeks before returning to work.

Some suggestions for a structured home programme are:

  • Practise working at a computer and concentrating for as long as you will need to at work
  • Try to get up and go to bed at the times you will need to when you go back to work
  • Practise being physically active for as long as you would need to at work. This can involve any activities you like, such as mowing the lawn, shopping, cleaning the house or exercising at the gym.
  • Practise activities that involve planning and organising, such as shopping, cooking a meal, organising a night out with friends, or arranging a holiday
  • Practise activities that make you concentrate, such as computer games, watching films, reading books or doing crosswords
  • Practise taking notes when using the telephone
  • Practise any physical activities that you will need to do
  • Practise your time management skills by sticking to appointment times
  • Practise making journeys on public transport if you can no longer drive. It is particularly useful to practise making the journey to and from work at the times you will need to do so.

Practical strategies within the workplace

Make sure the working environment and demands of the job are suitable

The effects of brain injury can make some working environments unsuitable. For example, busy, noisy, stressful office environments can be difficult to cope with if you have difficulty with concentrating and filtering out unwanted distractions. Jobs with very high levels of stress and demanding time deadlines may also be unsuitable. The following characteristics can be particularly useful in a job:

  • Having a sympathetic employer who will provide feedback, support and stability
  • Low stress and few deadlines
  • Requiring pre-existing knowledge and skills
  • Requiring one task to be completed at a time
  • Structure, routine and predictability
  • Local and possibly part-time if fatigue is a problem

It is also important that the workplace itself is suitable. Before attempting to return you may need to make sure your GP agrees and that you will be covered by your employer’s insurance. Your employer may need to do an occupational health assessment. Small and medium sized companies who don’t have an occupational health department may be able to get help with this from NHS Health at Work. For more information, visit www.nhshealthatwork.co.uk.

Use compensatory strategies and external aids

Many people use external memory aids, regardless of whether they have a brain injury or not. They can, however, be particularly useful for people with memory problems following brain injury, as they limit dependency on memory systems. It is important to remember that this isn’t cheating, and using external aids will not prevent any natural improvement of memory.
Some examples of memory aids include:

  • Diaries, filofaxes, datebooks or notebooks
  • To-do lists
  • Mobile phones
  • Watches
  • Calendars
  • Computer applications, such as calendars and alarms
  • Wall charts
  • Tape recorders and Dictaphones
  • Sticky-backed notes
  • Cameras

There are also many strategies that can help to compensate for problems. These will vary for different jobs and different people and it can be a matter of experimenting to find out what works for you. However, some advice can apply to most jobs. For example, remember that tasks become more manageable if broken down into small stages so that they are less overwhelming. Another example is to arrange to do particularly demanding tasks at times of the day when you are at your most alert.

You can find more information on the use of strategies and external aids in other Headway publications. Of particular relevance are the factsheets Difficulties with decision making after brain injury (PDF) and Coping with memory problems - practical strategies (PDF), and the booklets Memory problems after brain injury (PDF) and Managing fatigue after brain injury (PDF).

Arrange for careful monitoring and feedback

The effects of brain injury mean you may not always be able to accurately assess your own performance. Regular monitoring and feedback can help to identify and address problems as quickly as possible. Consider the following:

  • It can be a good idea to have somebody else to help you to monitor your progress, identify problems and provide feedback about strengths and weaknesses. It may be possible to have a colleague act as a ‘mentor’ for a while in order to do this.
  • Arrange regular review meetings with your employer in order to monitor your progress and pick up on any problems. Having another person present at review meetings (e.g. your DEA, occupational therapist, union representative or mentor) may be a good idea, especially when you first start back at work.
  • Remember, it is better to identify and sort out any problems as soon as they occur
  • Remember that sometimes problems can occur that are not due to your injury and are just a regular part of working life
  • Try to think of all feedback in a positive way, even if you have made mistakes
  • Treat mistakes and negative feedback as part of the learning process

Welfare benefits and returning to work

There are some welfare benefits that will carry on being paid if you return to work, while others will stop being paid once you start working. If you are on benefits and your employment circumstances change, you must inform the Jobcentre or the Department for Work and Pensions. Failure to notify a change in your circumstances can result in a civil penalty and you may be charged £50 as well as having to repay any benefits overpayments.

Online benefits calculators can sometimes help with identifying whether your benefits will be affected depending upon your employment circumstances. You can access benefit calculators from the following websites:

More information about benefits is available in the welfare benefits section.

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