Disability: the fight for reasonable adjustments

by Louise Freeman

A recent BMA survey found that many doctors had to struggle harder than they thought for an accommodating workplace

Location: UK
Last reviewed: 30 November 2020
louise freeman

A medic experiencing mental ill-health may be considered a ‘disabled’ person under the Equality Act 2010 if his or her mental illness (considered as if without treatment) has a substantial, negative long-term effect on the ability to undertake normal day-to-day activities

There is no requirement for the disability to be consequent of a medical diagnosis, although some conditions, such as addiction, are specifically excluded from the act. You are still protected from disability discrimination if you have met the definition of disabled in the past and have now recovered.

As with any other disabled person, a doctor or medical student with mental health disability is entitled to consideration of reasonable adjustments to their work or study. Rethink Mental Illness provides examples of reasonable adjustments for mental health disabilities including changes to working hours or allowing time off for treatment, assessment or rehabilitation. For doctors, reasonable adjustments often include reduced on-call or night shifts or reducing clinical sessions.

At a recent meeting I heard the phrase: ‘Once reasonable adjustments are advised, it’s normally straightforward.’

That wasn't my experience. I encountered difficulty in agreeing suitable adjustments to my work in returning to my consultant role after sick leave with a bereavement reaction. I was asked by my employer, ‘what did you say to occupational health that they made this recommendation?’ regarding initial advice that night-time on call should be avoided for the first three months of my return. This exchange developed into a lengthy and acrimonious discussion with predictable effects on my mental health. The recommended reasonable adjustments were deemed not to be reasonable.

The return to work process eventually resulted in my contract being terminated. At the time, I felt as if my symptoms were dismissed and seen as being ‘self-reported’ owing to mental illness being an ‘invisible’ disability.

My own experiences happened more than a decade ago. So surely things have got better since?

Medics replying to the recent BMA disability survey echoed my own experiences of difficulty in having recommended ‘reasonable adjustments’ implemented. And when I asked the hundreds of (doctor and medical student) members of the Doctors' Support Network about their experiences of needing reasonable adjustments for mental ill-health, the results showed little improvement over time. There was no apparent correlation between career stage, or age as to whether medics had a positive or negative experience of reasonable adjustments.

It was clear from the responses that some employers still don’t understand their legal duties under the Equality Act, or how to apply them to mental health disability. One doctor simply said (about occupational health): ‘They don’t know what to offer for mental illness.’ Others spoke of policy not being followed, occupational health advice being ignored, and being placed in stressful work scenarios that exacerbated their issues.

One doctor commented that ‘reasonable adjustments are often seen by those in authority as a sign of weakness and inability to cope’.

On the other hand, those who had received reasonable adjustments described the mutual benefits for themselves and their employers: ‘Flexibility worked both ways – if able, they helped out when needed and had time off when needed. I was able to accommodate medical appointments around days off or at either end of shifts.’

Proactively addressing any potential barriers to work for medics with mental-health related disabilities makes obvious economic sense. When medical school costs £250,000 -- with far more expenditure to train a doctor to career-grade level -- failure to address mental-health related reasonable adjustments is hardly in the long-term interests of the NHS. In addition, there is no reason why suitable adjustments to work or study should not be considered before the Equality Act disability definition is met – requiring fewer resources rather than waiting to treat a more serious problem when the threshold is eventually reached. 

Access to reasonable adjustments for mental health disability should not be a 'postcode' lottery dependent on the variable practices of local organisations. The stigma of having had a mental illness, as well as being seen as demanding or needy, can create further barriers for individual medics. By raising awareness, we can (as a profession) improve support and challenge organisations to do better without relying on individuals to advocate their own adjustments, often at a time when they feel particularly vulnerable during recovery.

I hope the spotlight on mental-health disability in UK Disability History Month, and the focus on healthcare professionals' mental health and wellbeing during the pandemic, will result in substantial improvement in how we support each other in returning to work or study after mental ill health.

Louise Freeman is the co-chair of DSN (The Doctors' Support Network), a confidential peer support network for doctors and medical students with concerns about their mental health. A charity, founded in 1996, DSN aims to raise awareness, reduce stigma and influence the agenda regarding physician health. Dr Freeman is also a member of the BMA equality, diversity and inclusion advisory group.

A longer version of this article is published on the DSN blog