Why Mental Health Matters in Workers’ Compensation Systems

At the 2015 Paradigm Innovation Symposium, Renée-Louise Franche, PhD, RPsych, Clinical Psychologist and Consultant in Work Disability Prevention and Occupational Health, presented a session discussing why mental health issues are so important in workers’ compensation.

Mental health issues in injured workers can no longer be ignored. These conditions are increasingly being recognized as potential risk factors for prolonged duration of work absences, and even for no return to work within the context of workers’ compensation.

Why mental health matters in work disability prevention?

• 1-year prevalence of mental disorders in North America ranges from 12-26%. For depression this is 4-7%.
• Worldwide, mental health conditions are the leading cause of disability in high-income countries, accounting for one-third of new disability claims in Western countries.
• Mental health-related disability is more frequent in young adults.
• Workers with mental health conditions have earlier retirements than those without.
• Studies show that mental health issues have a significant impact on claim duration.
• Another study showed that, within the first 12 months post injury, over 50% of workers experienced clinically-relative depressive symptoms at some point during their claim.  This is highest during the first month following the accident.
• There is a significant spillover effect to the families of injured workers. Family members of injured workers are three times more likely to be hospitalized three months after the injury than three months before the injury. It is speculated that the distraction of the injured family member leads to unsafe behaviors.

What works in return-to-work interventions?

• It is important to focus on ability and function rather than disability. The symptoms and diagnosis need to be de-emphasized.
• Worker expectations of recovery are the single- most-determining factor in the ability to return to work. Attitude and state of mind are important.
• The availability of suitable and safe modified work and return-to-work coordination.
• A workplace culture of respect and support help to promote return to work.
• Claims-related stress / perceived injustices have a very negative impact on return to work.
• Purely clinical approaches lead to purely clinical outcomes. There needs to be an integrated approach between the physician and the workplace.
• Considerate early contact with the injured worker and continued contact to maintain job attachment.
• Having a return-to-work coordinator to facilitate labor/employer cooperation and ensure the healthcare provider understands the return-to-work goals.

What needs to improve for workers with mental health issues?

• Access to care is a concern. A quarter of Americans have inadequate access to mental health services.
• Healthcare for mental health conditions is NOT work focused. There are limited tools and published standards around return to work.
• Workers feel stigmatized, disrespected, and that there is suspicion about the legitimacy of their condition.

Best practices for return-to-work for workers with mental health conditions:

• Facilitation of access to clinical treatment for those that need treatment. Too often this treatment is delayed. Delays in treatment will, ultimately, delay recovery.
• Work-focused clinical interventions.
• Facilitation of navigation of the systems involved.
• Improved processes lead to improved sense of fairness, which, in turn, improves return-to-work outcomes.
• Early identification and screening to identify workers who are high-risk for psychosocial complications and assigning those claims to specialized adjusters.
• The case manager plays an important role in humanizing communications, decreasing adversariality, clarifying the claim process, decreasing delays, and developing more accurate expectations in the worker.
• Use IMEs judiciously. Injured workers view these as a very adversarial experience, which usually leads to litigation.

Best bets for future investments:

• Perceived justice. Perceived injustice leads to longer disability, higher pain complaints, more depression and increased narcotic use. It is important to fully explain the workers’ compensation system to injured workers, including the benefits that they will receive and the role of the injured worker in their own recovery. People need to be treated with respect and receive information that is clear, accurate and timely.
• Develop soft skills in the front line claims team. This includes communication skills, conflict-resolution skills and training related to identifying potential mental health issues.
• Early screening for psychosocial issues so that appropriate intervention strategies can be implemented.