The Medical, Charity and Social models of disability are all flawed in the employment context, particularly for getting the newly disabled back into the workplace. These more ‘traditional’ models are being slowly replaced, but are newer models breaking exciting new ground or just labelling the good practice of trained, experienced Occupational Health (OH) practitioners?
The medical model sees disabled people as ill or sick. Disabled people must be ‘cured’ or ‘made better’. The only true experts are medical professionals who explain in general terms how disability ‘limits people’. They have things done for them, which ultimately leads to ‘disempowerment’ by those who ‘know best’.
The charity model portrays disabled people as worthy of pity. They are ‘brave’, ‘plucky characters’ who manage to be happy and to achieve. Control and power rests with well-meaning, able people who strive to bring about change for the benefit of the ‘afflicted’. The language used is similar to that of the medical model. Disabled people are ultimately expected to be grateful for what they receive and act as passive recipients.
The social model of disability is linked to the way society organises itself. Disabled people are seen as having needs, wants and aspirations. Passivity is replaced by a desire for equality. Disability is not seen as something invoking pity or in need of a cure. While this model is absolutely correct in terms of its aspirations, it is not realistic for organisations to adapt the workplace to accommodate the diversity of potential disabilities.
The academic OH community has been clear about the need to engage stakeholders, with a proactive stakeholder management role supported by clinical input. As far back as 2000, OH guidelines noted that “organisational and/or management strategies (generally involving…high stakeholder commitment to…encourage and support an early return to work) may reduce absenteeism and duration of work loss.”
Perhaps building on this need for a proactive stakeholder role is the biopsychosocial model. In this model, it is believed that biological, psychological and social factors may aggravate and perpetuate disability. It is based on the premise that the management of sickness and incapacity must address all the barriers to work in a cohesive approach. The strength of this model is that it provides a framework for disability and rehabilitation, contextualises the health condition, allows for interactions between the person and the environment and can be used on a wide range of conditions.
The Hanasaari model also has a strong focus on how the wider environment, including economic, social, and organisational factors among others can impact health. These affect the inner triangle of ‘man, work and health’, having a significant (although occasionally indirect) effect on workplace health. Organisational cultures and strategies may exert a stronger, more direct influence on workplace health.
Clinical input is only one part of the jigsaw and multiple stakeholders are required to support case management. Secondly, case focus from all stakeholders needs to be coordinated to ensure the diversity of employees’ needs are met. Finally, it is essential that funding is in place. The cost of workplace adjustments to accommodate disabled employees is not as much as people think, due to initiatives such as Access to Work, where support can be given to companies and disabled employees.
The benefits of a diverse workforce are significant – research has shown disabled staff to have low absenteeism rates and long tenures, and are described as loyal, reliable, and hardworking. Diversifying work settings leads to an overall positive work environment. So whichever model you follow – a successful return to work of a disabled employee is something all stakeholders must encourage and celebrate.