Returning to work after brain injury
There are many ways to approach returning to work after a brain injury and this factsheet provides some strategies that have been shown to enhance the potential for success.
It is important not to try to do everything alone. Accepting help from others is a sign of strength, not weakness, and the right support can make a successful return to work much easier.
Excellent sources of help include:
- Rehabilitation services, particularly specialist vocational rehabilitation
- Disability Employment Advisers (available at the local Jobcentre Plus)
- Occupational therapists
- Disability employment organisations
- Headway Groups and Branches
Disability Employment Advisers (DEAs) should be available to all, but the availability of other professional services varies across the UK. More information on these services and the programmes available from Jobcentre Plus can be found on the 'Returning to work help and support' page.
Remember, the support of family and friends is also invaluable and they may be able to help you to implement some of the suggestions in this factsheet.
Choose the right option
The most important aspect of returning to work is to choose the right option. Going back to full-time employment is not appropriate for everybody and it is important to have an enjoyable, healthy and balanced life in whatever way is most suitable for you.
Consider the following options:
- Return to your previous place of employment
- Start a new job, either full-time or part-time
- Enrol in vocational training or adult education
- Start your own business
- Find voluntary work
- Enjoy having the time to pursue other interests, such as hobbies or spending more time with family and friends
Return to your previous job if possible
If you have a job still open to you from before the injury then returning to it in some capacity is usually the best option. There are many advantages to returning to work with your previous employer. They already know you and value you and may be more likely to make allowances than someone who doesn't.
Discuss the following options:
- Returning gradually, for example, starting at three mornings a week or even working from home to start with
- Returning with shorter hours
- Taking more breaks
- Returning with less workload
- Taking up a different role at the organisation
Arrange a meeting with your employer and find out what the options and procedures are and how flexible can they be. Ask them to put everything in writing in case you forget, or take someone with you to help you remember.
Be positive, but realistic
The attitude you have towards returning to work is very important.
Research has shown that the following factors are particularly influential:
- Realistic awareness and insight
- Acceptance of disability and acceptance of self
- Willingness to use strategies to help with these problems
- Willingness to tell others what you need
- Willingness to accept and act on honest feedback from others
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 injury and their impact on your abilities. However, if you are realistic and sensible about things then it is equally important to be positive and committed in the path you choose to follow.
Communicate with your employer
Many people are unsure whether to tell a potential employer about the effects of their injury. It is up to you whether you declare it or not, unless you are asked about it directly on a job application form. However, if you do not declare it then it may be difficult to show that you should be covered by the Equality Act. You must always mention your disability if it might risk your own or other people's health and safety.
If you are honest about your abilities and limitations, then the employer will have no surprises if you then experience any problems. It may mean that they will be able to make reasonable adjustments if you require any additional support, which they will not be able to do if you don't tell them. It will also give you peace of mind because you won't feel like you're hiding anything.
Employers often do not understand the subtle, hidden effects of brain injury, as they will usually have had no experience or education on the subject.
The following suggestions should help them to understand the situation and allow them to make any necessary allowances:
- Keep your employer informed at all stages. Make sure you keep in fairly regular contact while you are away.
- Make sure you find out what your sick pay and annual leave entitlements are.
- Provide them with information about brain injury, such as Headway's publications.
- If you have a Disability Employment Adviser or healthcare professional, ask if they can help by talking to the employer.
- Be honest with your employer about your abilities. If you are unsure about your ability to complete a task, tell them.
- Make your employer aware of any legal issues, such as if you have been told you cannot drive due to increased risk of epilepsy. This may also mean you need to take other precautions at work.
Communicate with your colleagues
Again, it is up to you whether you tell colleagues about your injury and its effects. If you are returning to your previous job then they will know you have been away, so it is better to tell them something about the situation. Don't feel that you have to share anything you aren't comfortable with, as your business is your own, 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 colleagues to know about your brain injury and any resulting disabilities. You are within your rights to ask for others not to be informed. If you don't wish others to know then you can ask your employer to sign a confidentiality form in order to comply with the Data Protection Act.
- 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 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.
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 concentrating and filtering out unwanted distractions.
Also, jobs with very high levels of stress and demanding time deadlines may be unsuitable.
The following job characteristics may be helpful after brain injury:
- Having a sympathetic employer who will provide feedback, support and stability
- Interesting, so suiting a lowered tolerance for frustration
- Low stress and few time deadlines
- Requiring old familiar 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
However, while this is a useful guide, everyone is different and you shouldn't feel constrained if you are ready for something more challenging. In fact it is often the case that people who were high-functioning before injury can still perform well in demanding jobs as long as some adjustments and allowances are made.
It is also important that the workplace itself is suitable. Before attempting to return you 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 size companies who don't have an occupational health department may be able to get help with this from NHS Plus (see 'Useful Organisations'). It may also be necessary to carry out a risk assessment and more information on this can be obtained from the Health and Safety Executive (HSE) (see 'Returning to work - further information').
The Equality Act (2010) requires that employers make any reasonable adjustments necessary. Further information on this can be found in the Headway factsheet Adaptations to the Workplace - A Guide for Employers.
Use compensatory strategies and external aids
Many people use external memory aids, regardless of whether they have a brain injury or not. External memory aids are particularly important for people with memory problems as they limit the work the memory has to do. It is important to remember that this isn't cheating and using external aids will not prevent any natural improvement of
Some examples of external memory aids include:
- Diaries, filofaxes or datebooks
- To-do lists of the day's or week's tasks
- Mobile phones
- Computer applications, such as Outlook calendars
- Wall charts
- Tape recorders and Dictaphones
- Electronic organisers
- Sticky-backed notes
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 and Coping with Memory Problems after Brain Injury, and the booklets Memory Problems after Brain Injury and Managing Fatigue after Brain Injury.
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.
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.
- Practice 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 practice making the journey to and from work at the times you will need to do so.
- Ask if there are any work tasks you can do at home to help your employer.
Only return when you're ready
Finally, it is important to remember that the timing of your return is very important. People often try to return to work too early after a brain injury. This is a particular problem when a good physical recovery has been made, as people often assume that cognitive (thinking) abilities have also recovered. Returning to work often reveals the full extent of difficulties and returning too soon can damage confidence if 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 injury could damage your confidence and hinder recovery.
Be honest with yourself, don't try to rush your recovery and prepare as much as possible. Remember, try not to take on overtime, shift work or new responsibilities until you feel ready.
Work is an important part of most people's lives and returning after brain injury is a key part of many people's recovery. Depending on individual circumstances and the effects of the injury it can be very difficult, but with help and support and by following the suggestions on this factsheet many people can return successfully.
Many people need to make adjustments in order to achieve a healthy work/life balance and returning to employment is often not possible at all. Employment is not the only option and it is important to remember that deciding not to work can be an equally positive step. Leading a healthy and happy life is the most important thing.