Managing Return to Work after Mental Health Issues: A Systematic Review of the Managers’ Role

Background: Long-term work absences due to mental health conditions constitute a major public health concern in Europe. Despite extensive efforts in return to work (RTW) initiatives, 55% of workers experiencing mental health problems make unsuccessful attempts to RTW following long-term leave (Matrix Insight, 2013). This persistent challenge highlights the need to better understand the psychological and organizational factors that enable a sustainable RTW process. While research has traditionally conceptualized RTW as a binary outcome, recent perspectives emphasize it as a dynamic, temporal, and socially embedded process in which managers play a central role (Nielsen et al., 2018, 2023). Yet, empirical evidence on managers’ experiences, challenges, and concrete behaviors remains scattered across disciplines and underdeveloped compared to evidence that focused on employees. As a result, we still lack an integrated understanding of the role of managers in supporting employees’ RTW following mental-health-related absences.

Methods: To address these gaps, we conducted a systematic review examining the role of managers in employees’ RTW for mental health-related absences. Using a comprehensive set of keywords related to managers, RTW, and mental health, we searched Scopus, Web of Science, and PsycINFO for the title, abstract, and keywords fields of English-language peer-reviewed journal articles that used both qualitative and quantitative research designs. Of the 880 articles initially identified, 69 met the inclusion criteria after duplicate removal, relevance screening, and independent review by the first two authors.

Results: The integrative review reveals several key themes. First, perceived managerial support–emotional, practical, and relational–emerges as central in shaping employees’ reintegration trajectories. Second, managers themselves face significant strain as they navigate tensions between organizational constraints and employees’ individual needs. Third, we found a lack of knowledge, training, and practical tools, leaving managers ill-equipped to handle the complexities of RTW situations. Based on these insights and our systematic review, we propose an integrative framework outlining multilevel antecedents and consequences of managerial involvement in the RTW process. A critical evaluation of theoretical and methodological limitations is also discussed.

Conclusion: These findings integrate and enhance our understanding of the understudied role and lived experience of managers in RTW process for employees with mental health issues. The results highlight the importance of considering the insufficient tools, guidance, and training available to managers. This gap can create a vicious circle in which managers feel ill-equipped to support employees effectively, leading to increased uncertainty, stress, and potentially inappropriate behaviors. Future research could explore how targeted managerial training, organizational support systems, and structured RTW can improve managers’ support for sustainable RTW outcomes and societal well-being.