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Occupational therapists

The guidance contained here was first published in 2004 and therefore makes no reference to the Fit Note. The majority of the guidance contained herein remains relevant, although readers will need to keep in mind the existence of the Fit Note in applying any potential recommendations.

Occupational therapists (OTs) have a comprehensive medical training covering both physical and psychological conditions, and are also skilled in analysing the practical consequences of illness or disability. The profession has a central role in resolving any residual issues following a period of illness and medical treatment, and also in advising employers about the needs of sick or disabled workers when they return to the work environment. OTs can also assist employees who are still at work but having difficulties due to illness or disability.

An OT will carry out a detailed assessment of the needs of the workplace and the abilities of the individual, and identify problems and potential solutions. Where appropriate the OT will provide an action plan and oversee its implementation.

An OT have provide specific advice in the following areas:

Risk assessment and risk monitoring

Once a risk assessment has been carried out, and agreement reached on action required, the OT can monitor progress and review the risks during work retention and rehabilitation programmes, which may involve the presence in the workplace of employees who are not “100 per cent fit”.

Retention programmes and absence management

OTs can assess problems both inside and outside the workplace and establish a retention or return to work plan with employer and employee.

Return to work programmes

Where an employee has been away from the workplace for a long period, and particularly where he or she has a acquired a long-term disability, the OT can advise on the practicality of a return to work, and the need for any modifications to the job role, the work environment, or the hours worked.

Environmental or worksite modifications

OTs are experienced in assessing what adaptations or specialist equipment may be required to assist an employee to perform his or her duties. Where necessary the OT will be able to provide a specification for use by architects or builders, and will be able to liaise with relevant staff and contractors to ensure the work is carried out satisfactorily.

Contacting an occupational therapist

Employers or employees wishing to contact an occupational therapist have a number of options. The availability of occupational therapists in the public sector to assist with employment issues is quite limited because of high demand for their services, and referral routes vary. In some cases the Disablement Employment Adviser based at the local Jobcentre Plus will be able to refer directly to an Occupational Therapist, or give practical advice on local contact routes. This may be the best route to follow initially.

Occupational therapists employed by the local authority social services department can usually be contacted through the local social services office, and an initial enquiry by telephone should be sufficient to establish whether they would be able to assist with employment issues.

Contacting occupational therapists working in the NHS is often more difficult, but one of the following routes should be followed:

An increasing number of occupational therapists work outside the statutory sector, either independently or employed by private companies. The main point of contact for such occupational therapists is a branch of the College of Occupational Therapists, Occupational Therapists in Independent Practice, (OTIP). OTIP can be contacted via their website,, or through their helpline, 0800 389 4873

Case studies

Case study 1

A farm worker had his leg amputated below the knee following an accident at work. As a result, the local HSE inspector identified a number of health and safety concerns. Both employer and employee were very distressed by this accident, since they had been friends for many years. They could not see how to make the farm “safe” for the worker as an amputee. An occupational therapist was able to carry out a detailed risk assessment, which identified the main risks as:

With the assistance of grants from the Access to Work scheme for a suitable mobile lift, changes in working patterns, and work trials supervised by the occupational therapist, the employee was able to return to fulltime work.

Case study 2

A fireman was injured in a car accident. One of his muscles was permanently damaged and it was decided that he was therefore unable to carry out all his duties. He was signed off work pending complex surgery to the affected area. Activity and task analysis by the occupational therapist identified that the particular weakness did not in fact prevent him from carrying out any actions that could be necessary in the course of his work, and it was agreed by the consultant that the proposed surgery was unnecessary. The employer agreed to thorough work trials and after successful completion of these the fireman returned to fulltime work.

Case study 3

An experienced engineer had been off sick for three months with stress, anxiety, and depression. At the point of referral to the local occupational therapy service he had been having some counselling with limited success. Assessment by an occupational therapist identified that the client found it difficult to cope with anxiety and stress at work, and to “switch off” at the end of the working day. The occupational therapist worked with him to develop his coping strategies, including a set of “coping cards” which he used on his return to work. The occupational therapist also encouraged him to develop interests and hobbies outside work. Finally the occupational therapist negotiated some adjustments in working patterns between the client and his employer, and oversaw progress during a successful phased return to fulltime work.

Case study 4

A young woman was diagnosed with a manic-depressive disorder while she was an undergraduate at university. Despite several hospital admissions, she remained unable to return to university or any form of employment and became increasingly depressed. The occupational therapist worked with her over several months to stabilise and gradually increase her activity levels while maintaining structure and balance in her daily routines. As she became more able to manage her own condition, her confidence levels increased. After a period of voluntary work, she was able to progress to part-time paid employment, and then to return to full-time study at university.

Updated 2010-10-09