The return date is usually set before anyone feels ready for it. An email from HR asks for something in writing, a meeting is pencilled in for the first Monday back, and the person at the centre of it is still sleeping badly and rehearsing that meeting at 3am. Nobody in this is being unreasonable. Everybody simply wants a doctor to say what is safe.
The real question is plainer than the paperwork makes it look. Are you well enough to go back, to which parts of the job, and with what changes? That is the kind of fitness to work report mental health problems actually call for, and it is a different document from a note that says yes or no.
If you are at immediate risk of harming yourself or someone else, call 999 or go to A&E. For urgent mental health help, call NHS 111 and choose the mental health option, or call Samaritans free on 116 123, any hour.
What does a fitness to work report for mental health look at?
I start with the illness, in order. When it began, what tipped it over, and what has shifted since. Sleep, appetite, concentration and the mornings tell me more than a symptom checklist does, because they decide whether someone gets through a working day. I am comparing you with your own baseline, not with anyone else's.
Then I ask about the job, and I mean the job rather than the title. I usually ask people to walk me through an ordinary Tuesday. The hours, the commute, whether you work alone, how many people you deal with face to face, and how much of the day carries real consequences if a detail slips. Driving, machinery, handling money and responsibility for vulnerable people all change what I can safely write.
Concentration and stamina come next, because that is where a return quietly fails. Can you read a long document and still hold it at the end? How long before you are spent? What happens at 3pm? When this comes up in consultation, people often say they felt fine at home and came apart in the second week back. The reason is usually stamina, not mood.
The piece most people miss is the second layer. Sometimes work caused the illness: a workload that never eased, a conflict, an incident. Sometimes work is simply where something else became visible, such as money worries, a relationship ending, caring for a parent, grief, or drinking that has crept up. I ask about these calmly, because they change what a sensible return looks like. A report that ignores them tends to be wrong within a month.
I also check that nothing physical is being missed. Thyroid problems, low iron, broken sleep from snoring with pauses in breathing, and the side effects of treatment can all look like a mental health problem, or sit alongside one. If something needs testing, I say so and arrange it. Where treatment affects alertness, that matters for anyone who drives or makes safety decisions at work, and it goes into the opinion.
I ask directly about thoughts of self harm. It is a plain question asked in a plain way, and it shapes the timing more than anything else in the assessment.
Throughout, I am observing as well as listening: the pace of speech, whether attention holds for half an hour, whether a thread can be dropped and picked up again. In the report, what you tell me is recorded as your account, what I see is recorded as my observation, and my opinion is kept separate from both. That separation is what makes the report useful to an employer. It is also why I do not take sides in a workplace dispute.
The opinion usually lands in one of three places: fit for your usual duties, fit with adjustments, or not yet fit, with a date to look again. Adjustments I commonly suggest include a phased return over several weeks, changed hours, a temporary break from the most demanding tasks, a quieter place to work, time for appointments, and a named person to check in with. I describe what would help clinically. Whether a particular adjustment is reasonable for the business is the employer's decision, and the report says so.
Do I need a letter or a reasonable adjustments report?
It depends on what the employer needs to decide. A short letter answers a narrow question: whether you are fit to return, or fit with one simple change. A fit to work or capability letter of 1 to 2 pages is £250.
Where the employer wants to know what to change and for how long, an employment or reasonable adjustments report is usually the right document, at £495. Where the questions are wider, for example after a long absence, in a role with safety critical duties, or when an employer has sent a detailed list of questions, the comprehensive workplace or occupational report is £750. If your employer has an occupational health service, my report sits alongside theirs rather than replacing it. Every figure is on our medical report fees page.
Reports are usually ready 48 to 72 hours after the assessment, once all records and instructions are in. A priority 24 hour service is available for 25 per cent more, subject to the diary. Letters and reports are provided where clinically appropriate after assessment.
When should you see a doctor sooner?
Some things should not wait for a report or a meeting. Contact us, your NHS GP or the crisis lines above sooner if:
- you have thoughts of harming yourself, or you no longer feel safe
- sleep has fallen to a few hours a night for more than a week
- you are drinking more to get through the evenings
- panic on work mornings is stopping you leaving the house
- a change in treatment leaves you drowsy and you drive or use machinery for work
For the assessment itself, bring what you have: a job description, any occupational health letters, recent fit notes, the dates of your absence, details of your treatment and who is involved in it, and your employer's questions if they have written them down. A written list of questions makes the report answer what was actually asked. If the absence itself still needs documenting, my piece on sick notes for mental health covers that step first.
How do we approach this at Clinique Alpa?
You call, tell us what your employer has asked for, and we book a face to face assessment at 466 Green Lanes in Palmers Green, with time to go through the history properly. The report comes to you. With your consent, a summary goes to your NHS GP, because this is private care alongside the NHS and never a replacement for it.
If you are not ready to go back, that is what the report states, with a date to look again. That answer is as legitimate as any other.
This is an independent clinical opinion. It cannot be written to a required conclusion and does not guarantee the outcome of any claim, application, exemption or hearing.
Written by Dr Mitesh Parmar, MBBS MRCGP, Principal GP and Clinical Director at Clinique Alpa, 466 Green Lanes, Palmers Green, London N13 5PA. This article is general information, not personal medical advice. In an emergency call 999. For NHS advice call 111 or visit nhs.uk.