How will issues be managed upon returning to work?

Every brain injured person is affected differently. Some people might be willing to speak openly about what happened to them and the ongoing difficulties they face, whereas others may want to hide the fact that they may have ongoing problems. Prior to the employee returning to work, the employer should have a conversation with the employee about what, if anything, they’d like to be shared, who with and in what format.

The benefit of colleagues knowing some information about the employee’s injury is that they will understand how they have changed and why they may behave in a different way. They will also have a chance to support the employee more effectively if they know more about what they are going through. However, employers need to be respectful of the injured person’s wishes and shouldn’t discuss confidential information about the employee with their colleagues without their explicit permission. The employee may not want to share sensitive information with colleagues, at least not straight away. Aside from sharing details about the injured person’s condition, employees may generally find training in awareness of the needs of those with disabilities and brain injuries useful.

Although the injured employee is entitled to their confidentiality, it is important that their colleagues understand what support they are likely to need when returning to work. Any communication about this must be relayed in a sensitive manner.

A good understanding of the needs of the people you work with is essential for a successful and happy team. As such, when new people join who will be working with the brain-injured employee, it will most likely be beneficial for them to have training on the effects of brain injury generally and on how their colleague has been affected, as it’s unlikely that they will have worked with someone who has a brain injury before. It will give them a better understanding of what the employee finds difficult and the likely reasons for this. More extensive training may be needed if the new employee will be working very closely with the brain-injured employee. If an employer has adapted some of their work practices because of the needs of a brain injured employee, then new employees will also need to know about this. Information on this could be included as part of an employer’s induction process.

Re-integrating with colleagues

A brain injury can make it more challenging for an employee to interact with their colleagues and explain their feelings. They could be self-conscious about their injury, and this may make them feel anxious about interacting with colleagues. It might be helpful for employers to consider ways to make the employee feel more comfortable around their colleagues when they return to work. This could take the form of informal 1:1 meetings with those that the employee works closely with. The employer may want to ask the employee if there is anything that they think would help them with re-integrating with their colleagues, and could seek to facilitate any suggestions. In any event, it is likely to take a little time for them to adjust.

Where personality change is present, this can be difficult to accept, particularly for colleagues who were close to the employee before their injury. They may find it difficult to deal with the change too and should be supported where necessary. If the employee is acting in a way to upset or cause distress to their colleagues, the employer will need to manage the situation carefully as all employees are entitled to a safe working environment. As stated in this guidance under the heading What adjustments can be made for emotional/psychological disability?, in situations where other employees are unhappy with the injured person’s behaviour, it is important to seek specialist employment law advice on management.

Has the way they work within a team changed?

There are many qualities that help make someone a good team player. These include reliability, having good communication skills, being able to listen and share ideas, and being co-operative and flexible. Unfortunately, many of these qualities can be impaired by a brain injury. This can make working in a team harder for a brain-injured employee who is returning to work.

For employees who are responsible for managing others, their management and leadership style may have changed. As long as this doesn’t cause difficulty, this may be something that can be adapted to. However, training may be required, and some skills may need to be relearned. It may be that they need to make a graduated return to their management position. The employee’s team members should be given training on the way that brain injuries can affect people, and the employer should make it clear that employees can raise their concerns if any issues arise.

If the brain-injured employee’s management is causing difficulty with the people in their team, employers will need to provide additional support to the manager and those in their team. Employers should talk openly with them to try and resolve any difficulties and make things better for the employee and their team. Team changes may need to be made where issues cannot be resolved. If role changes are being considered, employers may need to take specialist advice on their legal obligations from an employment lawyer or HR specialist.

We all have differing abilities to cope with change. Some people find change invigorating, whereas others might find it stressful and distracting. Some of the common ongoing symptoms following a brain injury can make it more likely for change to feel worrying, which can affect employee wellbeing and performance.

Physical work environment – Changes to the physical work environment could be particularly unsettling for an employee who has a brain injury. A change of physical location, for example, a warehouse relocation or an office move, is likely to be of major significance to an employee who has a brain injury. Their journey to work, personal work area and who they work closest to physically is all liable to change. Accessibility and suitability to their needs may be on their mind. In addition to the usual discussion with employees when there is such a major change, it may help brain-injured employees to have a separate meeting to go through the changes and any specific concerns they may have. Employers can take on board any concerns they may have and help them start to plan for the change. Adjustments may need to be made to make the transition as easy as possible. For example, it might work best for them to work flexibly during the period of the move to the new location to minimise disruption and provide some continuity. If the employee is particularly anxious about the move, employers could consider giving them a tour of the new work premises before the move. Open communication about the change can help make it as smooth a transition as possible.

Equipment – If an employer is introducing new devices or software, consideration will need to be given to whether this is likely to present any issues for the injured employee. There may be a requirement for all employees to receive training on how to use something new. Employers could also consider whether there are any device/software settings that can be applied to make them more user-friendly, for example using larger font size or activating voice-control. Adaptions may even be required to the software. The injured employee may require additional training and/or a step-by-step guide to using the device/software for future reference.

New tasks – A brain injury often makes learning new tasks more challenging. Both employee and employer can expect that introducing new tasks to the employee’s role will require an adjustment period. How long the employee will need depends upon the nature of the task being introduced and how the employee has been affected by their brain injury. For example, if they have difficulties with their memory, even a small change may be difficult for them to implement. In that situation, it may be helpful for the employee to be provided with tools to help them complete the task, such as a checklist to follow until they have learned how to do it. If the new task is quite complex, it might help if the task learning can be broken down into more manageable ‘chunks’.

Team changes/restructuring – Employees can feel anxious and uncertain when staff members leave or when new members of staff join. Management and/or team structure changes can be particularly unsettling. If an employee has a brain injury, they may find these kinds of situations harder to handle.

If a brain injured employee’s line manager is changing, then a period of transition involving both managers could make the change easier. If a new member of staff is joining the team, the employer may need to provide additional training about brain injuries as part of the new staff member’s induction. If a close colleague of the brain injured employee is leaving, the employer might be well advised to reassure them about the other people in the organisation who are there to support them, and to be available to provide additional support around the time of the change, until the injured employee has developed new working relationships and feels settled.

Work-related travel could involve anything from taking the bus to work, to driving between towns, to flying to another country. If a brain-injured employee needs to travel as part of their work, it is important that consideration is given to the type of travel involved and how this could affect the employee. If they have mobility difficulties, special arrangements may need to be made for travel with the operator. Employees should speak to their doctor in advance of any significant work-related travel to discuss what they need, if there would be any difficulties in travelling, and how these could be dealt with. Employers should speak to the employee to ensure that they are safe and happy to travel.

If an employee has an issue with their usual journey to and from their place of work following a brain injury, their employer should speak to them about whether they may be able to work more flexibly and travel outside of the busiest times. If the type of work allows for working from home, and this can be balanced with the requirements of this business, a regular working from home arrangement could also be considered.

Many people who have a brain injury have ongoing medication needs. Medication following brain injury is varied and could include anti-epilepsy medication if the employee has risk of seizures following their brain injury. Medication for anxiety or depression is also common following brain injury.

Some medications have known side effects that may prevent an employee from carrying out certain tasks, for example using heavy machinery if the medication is known to cause drowsiness or severe fatigue. It is important that employers are aware of any potential restrictions on work an employee may have as a result of their medication; this should be considered as part of the occupational health assessment before the return to work, although medications may be changed after an employee has returned to work. Some medications can take time to work and the employee may require additional adjustments or understanding whilst any changes in medication take effect or stabilise.

Employers should encourage the employee to advise them of any medication changes that may affect their ability to work. If the employee has concerns about a new medication or unexpected side-effects, they should seek advice from their doctor and let their employer know if changes to their work need to be considered.

If an employer notices that a change for the worse in a brain-injured employee’s behaviour or performance, the employer should meet with them to discuss what may be causing this. A new side-effect of an existing medication or a change in medication could be potential causes. If the employee and/or employer suspect that this may be the case, the employee should speak to their doctor as soon as possible so that the employer can be advised on whether changes to the employee’s work need to be considered.

Employees may need to take medication while they are at work. Medication can usually be taken without special arrangements being made; however, an employee may want privacy. If a private room cannot be accommodated, adding a privacy screen to a work area, or allowing an additional break for taking medication may be reasonable alternatives.

A brain injured employee may find it more difficult to follow conversations, particularly in noisy or crowded environments, and they may struggle to express themselves well in group conversations. The challenges of social interactions can be compounded when there are several groups chatting at an event, especially if some of those attending are strangers. It may also have become more difficult for the employee to interpret the more subtle aspects of communication, such as minor irritation, or cues that a conversation has reached an end.

These challenges may cause anxiety and could even be overwhelming to someone who has a brain injury. Employers can try to assist in social situations by introducing the injured employee to others and guiding conversations. Other employees who are aware of the employee’s difficulties may also adjust their communication style to be more inclusive to the injured person.

Social communication skills can be relearned, so employees may become more comfortable in these situations over time. However, they might continue to struggle, and they may not always wish to participate in events.

Post brain-injury fatigue can also impact on how well a brain-injured employee can cope with social events. They may wish to be more selective about the events they attend, or might plan to leave events after a set period of time.

It can benefit many employees to consider a range of social events, including those that do not focus on alcohol. This may assist a brain injured employee if their medication is affected by alcohol, and to avoid them having to deal with the challenges that can arise from inebriated colleagues/clients.

Has the way the injured person responds to alcohol changed?

For many, drinking alcohol is an integral part of work social and networking events. Alcohol is, however, a depressant which causes the brain to slow down. Following a brain injury, the brain can be more susceptible to the effects of alcohol; even a small amount of alcohol might negatively affect the brain injured employee. Their emotional responses may be disproportionately affected, and they may suffer further physical injury if they lose coordination. Alcohol can also magnify some of the cognitive problems caused by brain injury, such as difficulty with memory and concentration.

A significant date, like the anniversary of an accident that caused the brain injury, can be difficult to manage for brain-injured employees. The reminder of the accident/event may bring back distressing and upsetting memories resulting in an emotional response. They may also experience physical symptoms, such as increased fatigue and headaches. It is important for an employer and employee to discuss how they may like to deal with significant dates. There may be an agreement that they can work from home on significant dates or not work at all on the date in question. Alternatively, they may actually prefer to work to take their mind off the event.

A supportive work environment where employees feel empowered to discuss difficult things like how they would like to manage any significant dates, can assist brain-injured employees in maximising their potential.