Most workplace mental health referrals can be managed through occupational health assessment.
Some cases, however, become more difficult because the clinical picture is unclear, absence becomes prolonged, medical opinions differ or important employment decisions need to be made.
Employers may be trying to understand whether an employee is fit for work, whether a return to work is realistic, what adjustments are reasonable or whether further medical evidence is needed.
In many cases, employers are under pressure to make decisions without complete clarity.
At Workforce Wellbeing, our consultant occupational physicians provide independent advice to help employers understand the relationship between mental health and work. Where additional specialist opinion is required, we can provide access to independent psychiatric assessment through our in-house Consultant Psychiatrist, who is embedded within our clinical leadership team.
This allows seamless escalation from occupational health assessment to specialist psychiatric opinion within a coordinated physician-led service.
A case may become more complex where there is:
These situations often require a structured, evidence-based approach so that decisions are fair, proportionate and defensible.
Employers do not usually describe a case as “complex” at the start.
They may simply be seeing an absence that is continuing longer than expected, unclear return-to-work timescales, inconsistent advice from different sources or uncertainty about what support is appropriate.
In some cases, the employee may appear keen to return but remains clinically fragile. In others, performance, attendance or workplace relationships may have deteriorated over time.
The challenge is often not a lack of concern. It is knowing what the available information means and what a reasonable next step should be.
Occupational health helps employers understand how health affects work and how work may be affecting health.
In complex mental health cases, occupational health can help by reviewing the available information, identifying gaps in evidence, assessing work-related functional impact and advising on fitness for work, adjustments or return-to-work planning.
The aim is not to replace the role of the employer, GP, treating clinician or psychiatrist. The aim is to provide independent workplace-focused medical advice that helps employers manage difficult situations safely and fairly.
For wider workplace mental health referrals, see our Occupational Health Support for Mental Health at Work service.
Sometimes occupational health assessment alone may not provide sufficient clarity.
Independent psychiatric assessment may be helpful where there is diagnostic uncertainty, conflicting medical opinion, complex trauma or PTSD-related symptoms, concern about risk, prolonged absence or uncertainty regarding future work capacity.
Workforce Wellbeing can provide access to independent psychiatric assessment through our in-house Consultant Psychiatrist, who is embedded within our clinical leadership team.
This can support occupational health advice in complex or finely balanced cases.
For further information, see our Independent Psychiatric Assessment for Employers and Occupational Health Providers page.
Complex mental health cases often involve difficult questions about fitness for work.
For example, an employer may need to know whether the employee can return to their full role, whether a phased return is appropriate, whether restrictions are needed or whether further recovery is required before work can be considered.
Occupational health advice can help clarify:
In safety-critical or high-responsibility roles, these decisions may require particular care.
Some complex cases sit at the boundary between health, performance, capability and employment decision-making.
Occupational health does not make employment decisions. However, it can provide medical advice that helps employers understand whether health is likely to be affecting attendance, performance or ability to sustain work.
This can be particularly important where:
Clear occupational health advice can support fair and defensible decision-making while maintaining appropriate boundaries between medical advice and management responsibility.
Some complex mental health cases involve overlap with neurodivergent traits.
An employee may initially present with stress, anxiety, burnout or performance concerns when the underlying issue is related to ADHD, autism, dyslexia or executive functioning difficulties. Equally, neurodivergent employees may develop anxiety, low mood or exhaustion when workplace barriers remain unrecognised for prolonged periods.
Where neurodiversity appears relevant, Workforce Wellbeing can also provide specialist Neurodiversity Workplace Needs Assessments focused on workplace barriers and practical adjustments.
A case may be complex where there is prolonged absence, unclear diagnosis, conflicting medical evidence, uncertain prognosis, safety-critical duties, capability concerns or overlap between mental health and neurodiversity.
