Referring psychiatric patients to occupational health services for earlier return to work - a qualitative implementation study of barriers and facilitators.

Background: Mental disorders are a major public health challenge, and their prevalence is globally increasing. They substantially affect work ability, quality of life, and the number of years of disability. A new model for referring psychiatric patients to occupational health services (OHS) aims to improve the continuity of care and to promote the early return to work (RTW) of workers with diagnosed mental health conditions. The purpose of this qualitative implementation study was to identify the facilitators of and barriers to implementing the new model.

Methods: We used the Quality Implementation Framework and the Consolidated Framework for Implementation Research (CFIR) as theoretical frameworks. We interviewed the developers of the model and the psychiatrists and occupational health physicians who deliver it. We invited forty participants to join the study, 17 of whom consented. We conducted nine semi-structured group and individual interviews. Data analysis consisted of analysing the sessions, systematically coding the transcribed texts according to the main domains of CFIR, thematic analysis, and identifying the overarching themes and context-related mechanisms.

Results: We identified three overarching themes crucially related to the implementation of the model: uncertainty about the scope and boundaries of the cooperation in the model, ambiguity about the size of the target group, and the existing sociocultural and self-stigma related to mental illness. Shared belief in the importance and the positive effects of the model and trust in the developers were the main facilitators of the implementation of the model. The main barriers were the limited availability of the e-referral system between the psychiatrists and OHS, uncertainty regarding the number of eligible patients, and the low number of actual referrals during implementation.

Conclusion: Collaborative models in mental health care should accommodate various stakeholders from different sectors involved in the treatment and rehabilitation of workers with diagnosed mental health conditions. Helping health care workers contact possible cooperation partners and knowing how to address important individual, workplace-related and sociocultural factors such as stigma may strengthen collaboration between different sectors and stakeholders in mental health care. Future studies should focus on the multi-actor feasibility of the new collaborative models and include the patients' perspective.