With mental health now a leading driver of income protection claims, the role of vocational rehabilitation (VR) is coming into sharper focus. In the following exclusive, Vanessa Sallows, Claims and Clinical Development Director of Legal & General, explores why renewed government attention, including the Keep Britain Working review, the third government-commissioned report in 15 years and the first to highlight VR, could mark a turning point for the protection industry by helping more people stay in and return to work.
Mental health issues have reached record levels; they’re the leading cause of long-term absence, drive most work-related ill-health, and are the main factor behind economic inactivity. However, this doesn’t mean people are ‘cheating the system’ or ‘workshy’. Unfortunately, this kind of negative rhetoric is increasing, according to research, which risks a potential backslide into old ways, where people avoid speaking up and seeking the help they need.
New research from King’s College London shows that attitudes toward mental health have reverted to 2009 levels, despite improvements made up to 2019 through campaigns like Mind’s Time to Change, L&G’s Not A Red Card, and Stevenson/Farmer’s Thriving at Work.
At the same time, a recent BBC report highlighted that GPs rarely reject fit notes for mental health concerns, underscoring that their role should not be gatekeeping fitness for work. It also highlights a disconnect in the face of evidence that meaningful work benefits mental health.
So, faced with nearly two decades of progress – in terms of reducing stigma – potentially at risk, you might be forgiven for asking, what’s the reason to be cheerful?
In our opinion, that reason is the Keep Britain Working report. Because for the first time in at least 15 years of government-commissioned independent reviews, it focuses squarely on Vocational Rehabilitation (VR). And we know, through many years of Group Income Protection experience and outcomes data, that VR works. It proactively helps employees stay in work and return to work. Whatever the condition.
L&G’s data shows that the highest number of claims notifications we receive are related to mental health issues; nearly half (43%) of all notifications received in 2025.
However, due to proactive intervention with our care pathway and VR, only 14% of these mental health claims notifications went on to become a paid claim in 2025. That’s because of the VR support we provide, which gives employees the help they need at an early stage, thereby preventing downward spirals and unnecessarily prolonged absence.
Even where a paid claim does arise, our VR support ensures that around 9 in 10 are successfully supported to return to work within the first year of absence.
Case study – VR in action
To provide an example, one of our members, a service assistant for a TV company, was struggling with panic attacks whenever he needed to make a decision and was now on long-term sick leave. They had a history of anxiety and depression caused by bereavement in childhood. We referred them to our partner Onebright at the first review and they attended seven sessions of Cognitive Behavioural Therapy (CBT).
Following this, they were keen to return to work but also anxious about doing so. We followed up the CBT with a Vocational Rehabilitation review, which reinforced the plan to return to work. Support was provided to help calm the anxiety about returning and, in partnership with the member and their employer, our VR expert prepared a phased return to work plan.
Jonathan Moffitt, L&G’s Clinical Development Manager, adds: “Using vocationally focused CBT and guidance from a Vocational Clinical Specialist, we assisted the member in alleviating their mental health symptoms and restoring confidence in daily decision-making. The implementation of a structured return-to-work plan and consistent reassurance facilitated an efficient and sustainable return to employment and sooner than would have otherwise been the case.”
VR gets the recognition it deserves
As mentioned, one of the really great things about the Keep Britain Working review is that it calls out the value of VR, in terms of such expertise being central to its goals of helping more people stay in and return to work; crucially, in a way that’s sustainable for both the employer and the employee.
Previous government-commissioned independent reviews, while sharing similar goals – namely, the need to shift from reactive to proactive sickness absence management – didn’t place VR front and centre in their proposed solutions.
Back in 2011, Black and Frost’s Health at work – an independent review of sickness absence, leant more heavily on welfare reform.
This was followed, in 2019, by Health is everyone’s business: proposals to reduce ill health-related job loss, which placed more emphasis on the role of employers, but primarily in terms of making Occupational Health (OH) more accessible to SMEs.
At the time, L&G called for clarity on what the government meant by OH, because the language used in the consultations at the time suggested roles and responsibilities much more akin to VR. While the two disciplines can complement each other, they have different specialisms.
VR and OH: complementary, but different
OH is based on the medical model. It aims to ensure the health, safety and wellbeing of employees at work. Whilst OH may offer medical advice, treatment is not usually part of its remit. Rather, it focuses on health assessments, medical surveillance, workplace hazard assessments, ergonomic evaluations, plus guidance to employers on workplace health and safety regulations, plus their obligations under the Equality Act 2010.
VR, meanwhile, is based on the biopsychosocial (or ‘whole person’) model and is centred on providing dynamic treatment. It aims to help employees return to – and thrive in – the workplace, following illness or injury. It intervenes at an early stage in the absence, wherever appropriate, with the health benefits of gainful employment in mind.
No change without behavioural change
In short, with the government’s official recognition of the value of VR, there’s hope. Hope that this time around, all that valuable experience and expertise that we’ve built as an industry over the years, will now be utilised on a much wider scale to help support better health outcomes and stronger business returns for a much wider audience.
But attitudes to mental health are the foundation on which improvements are made. So, while we’re putting in place the right services and support, we shouldn’t lose sight of the ongoing attitudinal mental health challenge this country is facing.
Fortunately, there’s hope there, too. The King’s College London research also included some encouraging findings: over 96% of respondents felt that people with poor mental health have been ridiculed for far too long. And 80% of people believe that people with mental health challenges should have the same right to work as anyone else. While these perspectives may seem obvious, it is valuable to see them supported by a significant majority.
