The Difficult Art of Returning to Work after Mental Health Problems

by David Gilbert

October 9, 2016

I said to my soul, be still and wait without hope
for hope would be hope for the wrong thing; wait without love
for love would be love of the wrong thing; there is yet faith
but the faith and the love are all in the waiting.
Wait without thought, for you are not ready for thought:
So the darkness shall be the light, and the stillness the dancing.
(T.S. Eliot)


The Wait

After a scary bout of mental illness, I was recovering. Thoughts turned to work, my supportive GP felt I could make a ‘phased return’ and my employers arranged for an occupational health assessment. Inevitably, as things took longer than I expected (typical NHS processes!), I started a whole new set of speculative anxieties in my head – after all, what's a head like mine to do when faced with nothing to fill itself with? 🙂

They call it ‘managing uncertainty’. I've always been rubbish at that. I usually create a drama, turn it into a crisis, cathart, get through it, get over it. Repeat. Now I was being asked to wait. Simply wait.

Monsters filled my head – my post would be downgraded. I wasn't up to being a Director. The role of Patient Director was doomed from the start. I was a failure. The problems – a ton of them, that had made me ill in the first place would not be solved. My employers were well-meaning and could send me flowers, but the reality would be different. They probably didn't like me. Such BS we fill ourselves with.

Knowing much was BS, I tried other tactics - planned voraciously. Made an action plan. I leaned on friends for support and advice (probably too many of them). I also went for long walks, picking up litter (my new localist activism) and wrote a ton of poetry.

What did I learn? That most of the worries were without foundation (plus ca change), and that some of the tactics helped (the walks, the plans, the poetry) and some didn't. The worries never really went away. I wasn't ‘distracted’ or cured of my obsessive thoughts, but on the whole, I allowed them to just be. And that was a step forward – I didn’t cut and run. I didn't allow the future or my thoughts about the future to bully me. I allowed myself to have mixed feelings without being overly swayed by the negative ones. I could be mixed in my head and still live and do things.

I did not resign. In the old days I might have done. I am proud that I stuck with it. And I am grateful to all those who helped me to do the uncertain, unexciting, boring and non-dramatic thing. In particular, my amazing wife, Susan.  I had broken a pattern – that anxiety about uncertainty does not have to convert to drama or crisis.

The meeting

Last week I stepped back in. I finally had a meeting with my employers, in the Sussex MSK Partnership. On the drive from London to Brighton, I was a weird mixture of anxiety and calmness – I was happy that at last I could make the move back, but of course nervous about the process. That was natural.

Again, I managed to contain my anxiety. But halfway around the M25 I was really tempted to just go home. But I breathed and tried to allow the overwhelming feeling to pass. It didn't go away, but retreated a bit. Maybe one can learn to be in the present, at the same time as the circling thoughts and difficult sensations. Maybe that's the point.

I turned on my Spotify playlist: Sparks ‘This Town ain't big enough for the both of us’ and laughed. Not right. Next up was ‘The Rising’ by The Boss. Better, I thought, and hit the re-play button.

At the meeting, they said we could reflect on the role, that the projects I wanted to drop I could drop (and were being covered by others) and that other issues would be dealt with as I had felt they needed to be. They welcomed me back warmly, we were specific in our plans about when I would be working where in the first few weeks. They were serious about accepting my concerns….. and I could not have wished for more.

Breaking Stigma

What has the Sussex MSK Partnership done so far that I feel is different and worthy?

Firstly, here is an organisation that has not yet got it right with the Patient Director role. It's the first role of its kind. How could it be perfect from the start? They know and I know that I was doing too much, had not had enough support and that this needs rectifying. We should have sorted it out earlier. But better late than never (though I wish I had not had to suffer for it!). I reckon many NHS organisations would not even get that far in their acknowledgement of circumstances and consequences.

Secondly, I feel fine about telling people I have suffered from anxiety and depression as a result of work pressures – I don't feel the stigma. How good is that? I know it is easier for me, because my previous problems were out in the open. But I have worried that this latest bout would make them rethink, that doubts might be expressed about my ability to hold down the job. None of this so far. Fingers crossed.

Thirdly, they have also listened to my doubts about the portfolio, and to my plans for rethinking how to do it (based on much more of a mentoring relationship with key folk, building capacity over directing activity-related programmes). They are continuing their commitment to risky innovation. It might not work out, but then again, it just might. This experiment may be worthwhile. There is a shed load of learning for the NHS whether we 'win' or 'lose' - others should take note.

They are not perfect. But then nor am I. Maybe it’ll work out after all. Watch this space.


The final word though, self-indulgently, is about me. I did a brave thing. I think driving around the M25 and not turning back, has allowed me to face a few demons that desired me to flee. I broke some habits. I stepped back into the place that had broken me. Temporarily, not forever. I have learned that I can go back, if I so choose.

I was calm, strong(ish) and constructive in the meeting. I was proud of the dignity I think I displayed – this is not a trait I usually associate with myself.

For all those who are about to do a courageous thing, I wish you calmness, strength and dignity.


(c) David Gilbert 2016

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4 comments on “The Difficult Art of Returning to Work after Mental Health Problems”

  1. Well Done , Perhaps I will do as well in meetings this week though I don't think so ,I need a support network and don't have any friends or family to rely on only in my voluntary work . I am 70 in just over a week and don't expect any cards or gifts . I am well known for my public voluntary work but its all meetings lasting about 2 hours all the rest of the time I am on my own in my flat . Oh well it might not be for much longer at 70

  2. Bravo! Linda Gask tweeyed this article. I have bipolar disorder and while my job has been freelance, my discharges from 7 hospitalizations were known in this small town where stigma is alive and well. Take care and best wishes, Dyane

  3. Hi David,
    Lovely to hear that you are being supported by your organisation to return to your role, I think many organisations could learn from that. Really interesting to hear about the role of Patient Director too - a refreshing approach to patient engagement!

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