According to the World Health Organization, mental health is describedas: “a state of well-being in which every individual realizes hisor her own potential, can cope with the normal stress of life, canwork productively and fruitfully, and is able to make acontribution to his or her community.” But the World HealthOrganization’s definition applies only to part of thepopulation.

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At any given time, one-in-five American adults suffers with amental health condition that impacts their daily lives. Stress,anxiety and depression are among the most prevalent for injuredworkers. Left untreated they can render a seemingly straightforwardclaim nearly unmanageable, resulting in poor outcomes andexorbitant costs.

Increasingly, many in our industry are recognizing the need toproactively do all we can to address this critical issue. We mustopenly discuss and gain a deep understanding of a subject thatuntil now has been taboo.

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Four prominent workers’ compensation experts helped us advancethe conversation on mental health in the workers’ comp systemduring a recent webinar. They were:

• Bryon Bass, senior vice president fordisability, absence and compliance at Sedgwick
• Denise Zoe Algire, director of managed careand disability for Albertsons Companies
• Maggie Alvarez-Miller, director of businessand product development at Aptus Risk Solutions
• Brian Downs, vice president of quality andprovider relations at the Workers’ Compensation Trust

Why it matters

Mental health conditions are the most expensive healthchallenges in the nation, behind cancer and heart disease. They arethe leading cause of disabilities in high-income countries,accounting for one third of new disability claims in westerncountries. These claims are growing by 10% annually.

In addition to the direct costs to employers are indirectexpenses, such as lost productivity, absenteeism and presenteeism.Combined with substance abuse, mental health disorders costemployers between $80 and $100 billion in these indirect costs.

In the workers’ comp system, mental health conditions have asignificant impact on claim duration. As we heard from ourspeakers, these workers typically have poor coping skills and relyon treating physicians to help them find the pain generator,leading to overutilization of treatments and medications.

More than 50% of injured workers experience clinically-relateddepressive symptoms at some point, especially during the firstmonth after the injury. In addition to the injured worker himself,family members are three times more likely to be hospitalized threemonths after the person’s injury. Many speculate that thedistraction of a family member leads the injured worker to engagein unsafe behaviors.

Related: New research shows impact of underlying conditionson workers’ compensation claims

(Photo: Shutterstock)

Mental health problems can affect any employee at any time andthe reasons they develop are varied. Genetics, adverse childhoodexperiences and environmental stimuli may be the cause.

The stress of having an occupational injury can be a trigger foranxiety or depression. These issues can develop unexpectedly andtypically result in a creeping catastrophic claim.

One of our speakers relayed the story of a claim that seemed ontrack for an easy resolution, only to go off the rails a year afterthe injury. The injured worker in this case was a counselor who hadlost an eye after been stabbed with a pen by a client. Despite hisphysical recovery, the injured worker began to struggle emotionallywhen he finally realized that for the rest of his life he would beblind in one eye. Because his mental health concerns were raisedone year after the injury, there were some questions about whetherhe might be trying to game the system.

Such stories are more commonplace than many realize. They pointout the importance of staying in constant contact with the injuredworker to detect risk factors for mental health challenges.

Challenges

Mental health conditions — also called biopsychosocial orbehavioral health — often surprise the person himself. Depressioncan develop over time and the person is not clued in until he findshimself struggling. As one speaker explained, the once clear anddistinct lines of coping, confidence and perspective start tobecome blurred.

In a workers’ comp claim, it can become the 800-pound elephantin the room that nobody wants to touch, talk about or address.Organizations willing to look at and address these issues can seequicker recoveries. But there are several obstacles to beovercome.

Stigma and social prejudice is one of the biggest challenges.People who do realize they have a problem are often hesitant tocome forward, fearing negative reactions from their co-workers andothers.

(Photo: Shutterstock)

Depictions of people suffering from behavioral health issues inmass media are often negative, but are believed by the generalpublic. Many people incorrectly think mental health conditionsrender a person incompetent and dangerous; that all such conditionsare alike and severe; and that treatment causes more harm thangood.

As we learned in the webinar, treatment does work and manypeople with mental health conditions do recover and lead healthy,productive lives. Avoiding the use of negative words or actions canhelp erase the stigma.

Cultural differences also affect the ability to identify andaddress mental health challenges. The perception of pain variesamong cultures, for example. In the Hispanic community, the culturemandates being stoic and often avoiding medications that couldhelp.

Perceptions of medical providers or employers as authorityfigures can be a deterrent to recovery. Family dynamics can play arole, as some cultures rely on all family members to participatewhen an injured worker is recovering. Claims professionals andnurses need training to understand the cultural issues that may beat play in a claim, so they do not miss the opportunity to help theinjured worker.

Another hurdle to addressing psychosocial issues in the workers’comp system is the focus on compliance, regulations and legalmanagement. We are concerned about timelines and documentation,sometimes to the extent that we don’t think about potential mentalhealth challenges, even when there is clearly a non-medicalproblem.

Claims professionals are taught to get each claim to resolutionas quickly and easily as possible. Medical providers — especiallyspecialists — are accustomed to working from tests and imageswithin their own worlds, not on feelings and emotional well-being.Mental health issues, when they are present, do not jump off thepage. It takes understanding and processes, which have not been thenorm in the industry.

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Another challenge is the fact that the number of behavioralhealth specialists in the country is low, especially in theworkers’ comp system. Projections suggest that the demand willexceed the supply of such providers in the next decade. Ourspeakers explained that with time and commitment, organizations canpersuade these specialists to become involved.

Jurisdictions vary in terms of how or whether they allow mentalhealth-related claims to be covered by workers’ comp. Some statesallow for physical/mental claims, where the injury is said to causea mental health condition — such as depression.

Less common are mental/physical claims, where a mental stimulusleads to an injury. An example is workplace stress related to aheart attack.

“Mental/mental claims” mean a mental stimulus causes a mentalinjury. Even among states that allow for these claims, there iswide variation. It typically hinges on whether an “unusual andextraordinary” incident occurred that resulted in a mentaldisability. A number of states have or are considering coverage forpost-traumatic stress among first responders. The issue iscontroversial, as some argue that the nature of the job is itselfunusual and extraordinary, and these workers should not be givenbenefits. Others say extreme situations, such as a school shooting,is unusual enough to warrant coverage.

(Photo: Shutterstock)

What can employers do

Despite the challenges, there are actions employers and payersare successfully taking to identify and address psychosocialconditions.

For example, Albertsons has a pilot program to identify andintervene with injured workers at risk of mental health issues thatis showing promise. The workers are told about a voluntary,confidential pain screening questionnaire. Those who score high(i.e. are more at risk for delayed recoveries) are asked toparticipate in a cognitive behavioral health coaching program.

A team approach is used, with the claims examiner, nurse,treating physician and treating psychologist involved. The focus ison recovery and skill acquisition. A letter and packet ofinformation is given to the treating physician by a nurse whoeducates them about the program. The physician is then asked torefer the injured worker to the program, to reduce suspicion anddemonstrate the physician’s support.

Training and educating claims professionals is a tactic someorganizations are taking to better address psychosocial issuesamong injured workers. The Connecticut-based Workers’ CompensationTrust also holds educational sessions for its staff with nationallyknown experts as speakers. Articles and newsletters are sent tomembers to solicit their help in identifying at-risk injuredworkers.

Ongoing communicating with the injured worker is vital. Askinghow they are doing, whether they have spoken to their employer,when they see themselves returning to work are among the questionsthat can reveal underlying psychosocial issues. Nurse case managerscan also be a great source of information and intervention withat-risk injured workers.

Changing the workplace culture is something many employers andother organizations can do. Our environments highly influence ourmental health. With the increased stress to be more productive anddo more with less, it is important for employers to make theirworkplaces as stress-free as possible.

Providing the resources to allow employees to do their jobs andfeel valued within the organization helps create a sense ofcontrol, empowerment and belonging. Helping workers balance theirwork loads and lives also creates a more supportive environment, asdoes providing a safe and appealing work space. And being willingto openly discuss and provide support for those with mental healthconditions can ensure workers get the treatment they need as soonas possible.

As one speaker said, “By offering support from the employer, wecan reduce the duration and severity of mental health issues andenhance recovery. Realize employees with good mental health willperform better.”

Listen to the full webinar on this topichere.

Kimberly George is the senior vice president, seniorhealthcare advisor at Sedgwick. She can be reached at [email protected].

Mark Walls is the vice president, communications andstrategic analysis, at Safety National. He can be reachedat [email protected].

Views expressed here are the authors’ own. To listen tocomplete “Out Front Ideas” webinars, please visit: http://www.outfrontideas.com/archives/.