01/10/2017
In the United States workforce, mental health issues such as depression and anxiety can have a dramatic influence on the duration of physical injury claims and return to work. Since psychosocial factors affect cases in varying degrees, it benefits case managers to be able to understand the impact, detect these conditions early on, and help guide cases to better outcomes.
Recently, psychologist and work disability prevention and occupational health consultant Renée-Louise Franche, Ph.D., R. Psych, and Paradigm Medical Director Steven Moskowitz, M.D., conducted a webinar on the effects that mental health has on workers’ compensation. Although most injuries start with a biomedical problem, a person’s psychological and social health impacts how they perceive illness, report their symptoms and respond to treatment. A poor outcome may actually be due to psychosocial issues, rather than just biomedical issues.
Dr. Franche provided a unique perspective on the topic, coming from WorkSafeBC, the British Columbia workers’ compensation system, which consists of one uniform jurisdiction and is more overt in their mental health coverage. Dr. Franche’s presentation highlighted the concept of “beyond coverage” and how can we get the most out of the biopsychosocial model. The featured presentation addressed five primary topics:
Mental health in workers’ compensation covers mood disorders, anxiety disorders and stress-related disorders. No matter the jurisdiction or claim, studies have shown that the presence of a mental health condition predicts a longer duration of work absence. According to WorkSafeBC statistics, injured workers who have psychological issues are four times more likely to continue to receive benefits over time as compared to the overall population of workers with physical injuries.
In Dr. Franche’s large cohort study of 600 claimants with workers’ compensation injuries, over 50% experienced depressive symptoms within 12 months post-injury. The number significantly reduced at the six-month mark, but those who struggled with depressive symptoms at this point continued to report symptoms at the twelve-month mark. This result indicates that intervention will have more of an impact when performed in the first six months post-injury to reduce “crystallization.”
Mental health conditions are substantially more challenging compared to physical conditions due to a lower comfort level of return-to-work partners, the difficulty of accessing evidence-based treatment, and underdeveloped restrictions and limitations, protocols and measures. These cases are also more complex and the silence of those suffering sometimes perpetuates stigma.
One way to break the silence of mental health issues is through early detection and intervention. Putting specific screening processes in place at the front of the claim will save time and hardship in the long run. Early detection can facilitate a targeted intervention to those who need it and prevent the effects of “crystallization.”
WorkSafeBC developed screening questions that have proved helpful in conquering the factors that prolong work disability. Screening is a continuous process and first contact is recommended within 21 days of the injury. While deceptively simple, these screening questions are not merely a checklist but the start to a conversation. Some of the questions included are:
These questions can help uncover potential concerns and roadblocks which affect return-to-work, such as:
There are a few key elements that serve as a guide for best practices in return-to-work interventions for workers with mental health conditions. One is the facilitation of navigation during the claim process, in which adjusters play a major role. Another is the facilitation of access to clinical interventions that are work-focused.
If these key elements are addressed, there is an improvement in perceived justice on the part of the injured worker, which is associated with improved return-to-work outcomes. These should be addressed in the first six months of the claim process.
While adjusters come from different jurisdictions and follow different processes, they will all likely find benefit from intervening and interacting with injured workers in a way that can address these crucial best practices.
In terms of navigating through the systems, the adjuster can act as the facilitator by explaining the processes, clarifying expectations and addressing any confusion. If mental health conditions are not compensable, adjusters can still assist in their treatment. One way is to cultivate a network of providers who focus on incorporating mental health elements in their treatment. Discussing community-based resources and treatment options are also important. Once again, communication is key; do not hesitate to reach out to return-to-work partners.
Return-to-work plans are not just about tasks, duties and hours– they are also about work conditions and cultures, which should be integrated into the RTW plan. Be on the lookout for high demand and low control work environments, which are associated with higher rates of relapse and failed return-to-work. Consider the work climate (e.g., is the climate respectful? discriminatory?). It is important to review with the worker ways to address any issues that appear to be barriers to RTW. Reformulate the plan in terms of ability versus disability and specify the workers’ ideal work conditions. The impact on outcomes can be significant. Studies show that when planned work conditions are met, there is a 24% lowered risk of an injured worker still having a mood or anxiety disorder 12 months later.
Mental health issues, if left unattended, can prolong work disability duration. Early identification and targeted interventions are key to mitigating the impact on return-to-work outcomes. For more details on this intriguing topic, listen to a replay of our September 2016 webinar, New Approaches to Mental Health in Workers’ Compensation. Stay tuned for upcoming topics in our quarterly webinar series.
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