In this episode of Headspace for the Workplace, I sit down with Dr. Mark Salzer, Professor and Chair of the Department of Rehabilitation Sciences at Temple University, and one of the country's foremost researchers on participation for people with serious mental illnesses and autistic adults. Mark's work focuses on what people are actually doing in their lives, work, school, dating, parenting, voting, volunteering, and what structural and environmental factors support or block their ability to participate fully. His research on how effort itself can become a barrier to participation is particularly relevant to the return-to-work context.
The episode opens with a framing I use with employers regularly: the wouldn't, couldn't, shouldn't trap. After a suicide attempt, psychiatric hospitalization, or serious mental health crisis, well-meaning managers and HR professionals often arrive at a quiet set of assumptions: this person probably wouldn't want the pressure of their old role, probably couldn't handle the stress, probably shouldn't come back just yet. These assumptions feel protective. They are often the opposite. They replace the employee's own assessment of their readiness with the manager's discomfort, and they create exactly the kind of low-expectation environment that research shows delays recovery rather than supporting it.
I share my own experience in this episode: returning to work after losing my brother Carson to suicide, with no FMLA leave left, and having to negotiate a return that was made possible not by policy but by colleagues who met me with dignity. Mark builds on that with two takeaways that are both simple and evidence-rooted: maintain hope that the person can return to the success level that got them hired in the first place, and make the return a collaborative, action-oriented partnership rather than a top-down accommodation process.
Why This Matters in the Workplace
The Wouldn't, Couldn't, Shouldn't Trap Is Common and Costly
Most managers who fall into the wouldn't, couldn't, shouldn't trap are not acting with malice. They are acting with discomfort. Mental health crises, unlike physical injuries, do not come with a physical therapist's clearance letter, a lifting restriction, or a straightforward return-to-work protocol. The vagueness produces anxiety in managers, and that anxiety gets translated into lowered expectations that feel protective but function as barriers. The research is clear: low expectations produce low outcomes. When a manager assumes an employee cannot return to their previous performance level, they stop creating the conditions that would allow that return to happen.
What the Research Shows About Participation and Recovery
• Participation in meaningful activity, including paid work, is itself a health intervention for people with serious mental illnesses
• People with mental health challenges are among the most discriminated-against populations in society, with levels of prejudice and misunderstanding that do not reflect the actual abilities and capacities of the individuals involved
• Mental health issues affect up to 20% of the population, meaning that in any organization of meaningful size, employees with lived mental health experience are already present and contributing
• Effort itself can become a participation barrier when the cognitive and emotional load of re-engaging with a role feels overwhelming, even when the person has both the desire and the underlying capability to return
• A manager's assumption about what an employee can handle becomes a self-fulfilling prophecy in both directions: high expectations combined with genuine support produce better outcomes than low expectations combined with avoidance
Why Action-Orientation Matters More Than Insight
One of the most important practical insights in this episode is the distinction between a therapeutic conversation and a return-to-work conversation. Managers are not therapists. They do not need to understand the nature of the crisis, the diagnosis, the treatment, or the psychological dynamics at play. What they need is a simple, repeatable action-oriented framework: I want you here. I want you to be successful. I want us to be successful together. What can we do? That question, asked with genuine intent and followed with creative, flexible problem-solving, is more powerful than any amount of clinical understanding.
In this episode, we’ll answer:
How should an employer support an employee returning to work after a suicide attempt or psychiatric hospitalization?
What are the most common mistakes managers make when an employee returns from mental health leave?
Can someone return to full performance after a serious mental health crisis?
What is an action-oriented return-to-work conversation for mental health leave?
Why is participation in work important for mental health recovery?
Two Tactical Takeaways from This Episode
Tactical Takeaway #1: Maintain Hope That the Person Can Return to the Success Level That Got Them Hired
Mark's first takeaway is an explicit challenge to the low-expectation trap. The skills, competencies, and capabilities that made someone an excellent hire do not evaporate during a mental health crisis. They may be temporarily inaccessible, disrupted by the crisis and its aftermath. But they are still there. And the employer's job is to maintain the belief that those capabilities can be reclaimed, while actively creating the conditions that make reclaiming them possible.
The practical implication is this: when you see a change in performance, the story you tell yourself about that change matters enormously. The easy story is bad actor, deliberate disengagement, or permanent impairment. The more accurate and more useful story is this person is struggling, their underlying capabilities are intact, and with the right support they can get back to where they were. Telling yourself that story does not guarantee the outcome. But telling yourself the opposite story almost guarantees a worse one.
WHY IT WORKS
The expectation effect in human performance is well documented: people rise or fall to meet the expectations of the people who have authority over them. A manager who communicates, through words and actions, that they believe in an employee's ability to return to full performance is actively contributing to that outcome. A manager who communicates, even subtly, that they doubt it is actively working against it. Mark's call to hope is not sentimentality. It is evidence-based leadership.
Tactical Takeaway #2: Work With People to Make Their Successful Return a Reality
Mark's second takeaway redefines the return-to-work conversation as a partnership rather than a process. The employer's role is not to administer an accommodation, hand down a modified duty list, or wait for the all-clear from a medical provider. It is to sit alongside the employee, listen to what they need, brainstorm solutions together, and co-create a plan that honors both the employee's dignity and the legitimate requirements of the role.
The conversation itself has a simple, repeatable script: I am here. I want to support you. I want this to be successful. I want you to remain with us and be as successful as you were before, or more successful. What can we do? That question, genuine and open, invites collaboration. It signals that the employer sees the employee as an asset, not a liability. It removes the burden of advocacy from someone who may be exhausted and fragile. And it keeps the conversation action-oriented rather than clinical, which protects both parties from conversations that neither is equipped to have.
WHY IT WORKS
When people co-create a plan rather than receiving one, two things happen. First, the plan is more likely to actually work because it reflects the employee's real needs, which the employer would otherwise have to guess at. Second, the employee's sense of agency is preserved, which is itself a recovery factor. Mark's framework also explicitly names the limits: be flexible and creative as much as possible, but recognize that sometimes the timing is not right, and support the person's dignity even in naming that together. The goal is always the person's best outcome, not the employer's comfort.
about DR. MARK SALZER
Mark Salzer, Ph.D. is a psychologist and Professor of Social and Behavioral Sciences in the College of Public Health at Temple University. He is also the Director of a federally-funded research and training center on independent living and participation of adults with psychiatric disabilities (www.tucollaborative.org).
Dr. Salzer and his colleagues conduct research that raise awareness about the importance of participation, such as work, going to school, leisure, faith, volunteering, and time with family and friends, as critical to health. They also test the effectiveness of interventions aimed at enhancing participation. He actively partners with people with lived experience of mental health challenges, their family members, providers, and policymakers.
SHOW NOTES
Temple University Collaborative on Community Inclusion
Relevant article(s) and resources
Salzer, M.S. & Baron, R.C. (2016). Well Together – A blueprint for community inclusion: fundamental concepts, theoretical frameworks and evidence. Published by Wellways Australia Limited, Melbourne, Australia. Available at https://tucollaborative.org/inclusion-foundations/well-together-a-blueprint-for-community-inclusion-fundamental-concepts-theoretical-frameworks-and-evidence/
Salzer, M.S. & Burns-Lynch, B. (2016). Peer Facilitated Community Inclusion Toolkit. Philadelphia, PA: Temple University Collaborative on Community Inclusion for Individuals with Psychiatric Disabilities. Available at http://www.tucollaborative.org/wp-content/uploads/Peer-facilitated-community-inclusion-ACCESSIBLE.pdf
Salzer, M.S. (2024). Building On Recovery: Embracing Community Inclusion in Mental Health Policies and Services. Community Mental Health Journal, 60, 1571-1578. https://doi.org/10.1007/s10597-024-01309-z.
Salzer, M.S. (2021). Community Inclusion and Social Determinants: From Opportunity to Health. Psychiatric Services, 72(7), 836-839. doi.org/10.1176/appi.ps.202000394
Snethen, G., Thomas, E., Jeffries, V., & Salzer, M.S. (2021). Welcoming places: Perspectives of individuals with mental illnesses. American Journal of Orthopsychiatry, 91(1), 76–85. https://doi.org/10.1037/ort0000519.