Uncover the psychological needs your employee may have in the workplace after their brain injury.

On returning to work

Has the injury affected the way the person is able to deal with change?

Most people follow some degree of a daily routine. A routine provides structure and helps us to accomplish our goals and reduce anxiety. A change to this can temporarily fluster anyone.

We all have a differing ability to cope with changes that are beyond our control. Some find regular change invigorating, others find the change and the psychological adjustment they have to make to it distracting and time consuming. When they struggle to deal with change, this can cause an employee to worry and this is likely to affect their performance.

A routine is especially important for someone with a brain injury, as having repetition helps them to relearn lost skills or find new ways of working with their injury. A brain injury can affect cognitive functions that relate to organisational skills. These include not only the way a person plans tasks for the day but also how they order their thoughts.

Generally, the more routine a brain injured person has, the better. A routine means that they don’t have to think about a new way of doing something and allows them to focus on a particular task.

A brain injury can also make it difficult for someone to switch between different tasks. If the employee’s role involves a lot of different types of tasks that may change at short notice, you should try and make this as easy as possible for them.

You may want to prepare a list of steps that need to be taken to complete tasks and put this in the employee’s diary. It is also useful to have regular meetings with the employee to check that they are making progress and are not overwhelmed.

What are the psychological effects of their brain injury, and what do they need to help with this?

The psychological consequences of a brain injury can be difficult to separate from the physical effects. The difficulties an employee may have will vary depending on the nature and severity of their injury.

A brain injured employee may suffer from the following:

  • Changes in their emotional responses
  • Changes in behaviour and personality
  • Low mood and depression

Their physical injury will have caused many of these changes. As it may have changed who ‘they’ are, this also has an enormous psychological impact. They will no longer feel the same and may struggle to understand what has happened. They may come to discover that they can never do something that was very important to them before their injury. Depression is common in those who have suffered brain injuries.

They may also suffer anxieties in relation to how they came to suffer their brain injury. For example, if they were injured in a car accident they may be very anxious about travelling by car.

Given the very long period of adjustment that is likely to be needed, and the changes that need to be made in their life, they are likely to need long term psychological support. You may want to consider funding counselling or vocational therapy to help the employee adapt to returning to work.

Have they developed any dependencies following their injury? If so, how should you deal with this?

A brain injury may cause an employee to become more dependent. Whether a dependency manifests itself in substance abuse or is emotional in nature, it will impact on the employee’s recovery. It can also negatively impact on the employee’s performance, behaviour and safety at work.

Emotional dependence can stem from feeling powerless and having a lack of self-esteem. You may find that an employee is more dependent upon their colleagues and lacks confidence. You should try to support the employee as much as possible and provide positive encouragement so that they can progress.

The employee may turn to alcohol or another substance as another way to cope with the consequences of their injury. Both depression and substance misuse are common. If the employee has previously suffered with substance abuse then there is a higher chance they will return to this after their injury. Alcohol and drug dependency after a brain injury can increase the risk of a seizure and sustaining a further injury.

As with any other employee who suffers from a substance dependency, you will have to strike a balance between providing support and taking appropriate action. If substance misuse occurs at work you should consider your obligations both to the employee and their colleagues, and how you can move forward. It is important to take specialist advice on your legal obligations from an employment lawyer.

Throughout employment

Are there areas of work that are causing particular frustration?

Recovery from a brain injury is a long process that can be very frustrating.

The employee is likely to see more rapid improvement at the start of their rehabilitation. However, as time goes by and in the longer term, this will slow down and can be inconsistent. An employee is likely to be eager to return to as many activities as possible. It’s common for someone with a brain injury to suffer frustration about their inability to do things they did before, or at the pace at which progress can be achieved.

For example, the employee may find they cannot work as quickly, or that they forget things easily. The employee may feel that they are not understood at work, especially if they have communication problems. It’s important that they feel they can talk to someone about this frustration.

A brain injury also makes it harder to manage frustration. Ensuring that your workplace is open and supportive will go a long way to addressing these feelings. You can reinforce to the injured person that you appreciate that relearning skills may be a slow process and that they can talk to you or others if they are concerned. You may also be able to provide equipment to help them with a particular difficulty, such as a memory aid.

Can the work environment be changed to reduce the brain injured employee’s anxiety?

It is important to think about how you can improve your workplace to bring out the best in your employees. Such changes may not carry a significant cost and can make a huge difference to employees who in turn are likely to be more productive.

Any employee who suffers anxiety may find it difficult to set and meet deadlines, participate in meetings, deal with change, or maintain relations with colleagues, and they are often reluctant to attend social events.

Anxiety is a disproportionate feeling of nervousness and unease about a situation, which is often worse if there is an uncertain outcome. It is common for an employee to feel significant anxiety after their brain injury.

Sometimes simple changes to the work environment can help to put an employee at ease. Firstly, you should talk to the employee to try to understand what is causing the employee to feel anxious. Having an open and honest work culture will help create an environment where an employee feels comfortable to talk about this.

Changes that may help:

  • Using a flexible working policy
  • Having a quiet working room available
  • Having a buddy system for the employee

How do you recognise that your brain injured employee may have depression?

Depression is common following a personal loss or drastic change and can affect any employee. It is particularly common following a brain injury.

Depression leads to a range of symptoms such as low mood to, in more extreme situations, suicidal thoughts. This can make it hard for an employee to cope with work tasks and can make them irritable or withdrawn. It may be that someone who works closely with the employee will notice the symptoms of depression first. With an open and supportive workplace, they should share their suspicions with a manager to ensure that as much can be done as possible to help the employee.

The employee should be encouraged to seek medical advice and may need to be referred to an occupational health practitioner if there is any possibility that they have depression, given the seriousness of the condition. The occupational health practitioner may recommend treatment and will consider if the employee is well enough to work, as well as suggesting what adjustments may be needed to enable the employee to continue or return to work.

Having a daily routine and recognising the employee’s achievements and contributions will help to support their return to work after the brain injury.

Specific triggers

Does your brain injured employee need extra support at specific times, such as on significant anniversaries?

A brain injury can cause long term physical, cognitive, emotional and behavioural problems. These problems can be worse at times of stress or when memories of the trauma are triggered. You may find that an employee has particular difficulty at these times, such as on the anniversary of their injury. This may also occur when they come across reminders of abilities or anything else they have lost because of the injury.

You should try and support your employee as much as possible. It may be that you need to provide additional support during difficult times, for example by allowing an employee to work more flexibly.

A supportive work environment enables all of your employees to achieve their best. It is helpful to provide an ‘open door’ policy, and for managers to meet each employee regularly to consider their progress and address and any needs they have.

Our work location is moving; how should I support our brain injured employee?

A change in work location will create a number of significant changes for your employees.  For example, it is likely that their journey to work, personal work area and team structure will all be affected.

A change in work environment can be difficult for anyone, let alone someone with a brain injury. You may wish to have a meeting with the employee to discuss the upcoming changes and any concerns they have about it. You can then reassure them and help the employee to plan for the change. By having open communication about the change, you should help to make it as smooth a transition as possible.

You need to ensure that the new work location is physically accessible to them, bearing in mind any mobility difficulties they have. You should also consider what adjustments can be made to make the transition as easy as possible. It may be best that they work flexibly during the period of the move to the new location, perhaps working from home some of the time to minimise disruption and provide some continuity.

If the employee is particularly anxious about the move, you could consider giving them a tour of the new office before you move to help alleviate their nerves.

How can changes in personnel or team structure be managed so that they cause the least disruption for a brain injured employee?

It is almost inevitable that at some point you will need to restructure your organisation. Any change in management or team structure will be an uncertain and disruptive time for your staff. If an employee has a brain injury, they may find this situation harder to handle.

Following a brain injury, it is common to experience anxiety at times of change. The injured person may be worried about a new member of staff joining their team, or someone who they are close to leaving. Whatever the situation, it will need to be carefully managed.

If your brain injured employee’s line manager is changing, then a period of transition involving both supervisors should help ease any concerns and make the change easier.

If a new member of staff is joining the team, you may need to provide additional training about brain injuries as part of their induction. Of course, it is the employee’s decision about what to share about their own injury. You can, however, encourage them to be open so that others can appreciate their particular needs and so that they can be supported in the best way.

If a close colleague of your brain injured employee is leaving, you should reassure them that there are other people in your organisation who are there to support them. You may want to ensure they have plenty of support available at the time of the change, until they develop new connections with others.

After the changes have been implemented, you should have regular meetings with your employee to ensure the new team structure is working and that the employee doesn’t have any concerns.



Covid-19 update: Business as usual
at Bolt Burdon Kemp

Bolt Burdon Kemp continues to remain very much open for business. We are passionate about achieving life-changing results for our clients, providing excellent client care and ensuring you receive the support you need.

We continue to progress our clients’ existing cases and support new clients with their cases.

All of our wonderful people are successfully working from home. We have re-opened our office so that those who need to work in the office are able to do so, in a socially distanced and safe manner. 

Our strategy of working in teams continues to ensure there is always someone for you to talk to. We are using telephone and video-conferencing very effectively. A number of multi-million pound cases have settled since the virus outbreak, using these facilities.

We are determined more than ever that the wheels of justice will keep on turning.

Contact us on 020 7288 4800 or info@boltburdonkemp.co.uk and one of our team will get in touch with you.

Read more from Managing Partner, Jonathan Wheeler