10/06/2015
Why mental health matters in workers’ compensation systems.
It didn’t take long for Dr. Renee-Louise Franche to raise eyebrows at Paradigm Outcomes’ sixth annual Innovation Symposium during her presentation on the relationship between mental health and workers’ compensation. She displayed a graph that showed how mental health issues had a dramatic effect on claims duration for physical injuries. Case in point: after 10 weeks, only 20% of claimants were still on benefits with just physical issues. But add mental issues to the claim? After 10 weeks, 100% of claimants were still on benefits. Even after 50 weeks, the claims were still in the 70% range.
“This is simply mind-blowing,” Dr. Franche said. “Add mental issues to physical problems and it becomes so hard for people to get back to work. Its impact on the duration of claims cannot be ignored.”
A self-described researcher and clinician who loves both people and data, she challenged workers’ compensation boards to aim for a specific list of goals. To do good, do no harm, respect people’s “autonomy” by not always telling them what to do, and finally, be fair. A careful consideration of evidence is one way of respecting these principles, she added.
“Why is mental health picked up so late in the game?” she said. “Physical issues like a back injury can often lead to depression.”
She pointed out that mental health conditions are common in both the general population and in workers. The one-year prevalence of mental disorders in North America ranges from 12% to 26%. For workers in the U.S., the prevalence of depression is anywhere from 7% to 16%. In Canada, there’s a 10% prevalence of at least one mental health condition. Depression, though, was identified in particular. “Depression is the most costly mental health condition in North America,” Dr. Franche said.
There were even more startling facts about why mental health matters in workers’ compensation. It’s the leading cause of disability in high-income countries, accounting for one third of new disability claims in western countries. It’s also more frequent in young adults, and workers with mental health conditions are also more likely to retire earlier.
There are also troubling “spillover effects” in both the workplace and for families of affected workers. “At work, there is some initial support, but then it’s followed by a growing disillusion from their employer, as well as a negative impact on co-workers,” Dr. Franche said. Families also come into play. Family members of workers are 31% more likely to be hospitalized after a worker’s injury than in the three months preceding the injury.
“There is a six-month crystallization of mental and physical health symptoms, and for return-to-work outcomes,” Dr. Franche said. “So it’s important to act early!” She pointed out seven principles for return-to-work (RTW) intervention:
These interventions reduce absenteeism. Workers with musculoskeletal conditions were nearly twice as likely to have lasting return-to-work results than those with usual care. Plus it improves health outcomes and is cost effective. However, the same effects weren’t observed for mental health conditions.
“There needs to be better access to clinical treatment for those who need it,” Dr. Franche said. “There must be work-focused clinical interventions, plus the facilitation of navigation of multiple systems, including WCBs.” She added that improved processes lead to improved fairness, which in turn improved RTW outcomes. Companies must create a better sense of perceived justice to gain shorter duration of disability. That means equity, equality, respect and sensitivity, with accurate, clear and timely information.
Dr. Franche concluded with a warning and a challenge. “We can’t remain complacent about mental health. Step out of your comfort zone!”
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