Let's Hear It for Mental Health Awareness Month

That deafening roar you are not hearing is the workers’ comp system celebrating Mental Health Awareness month. In fact, when you mention mental health issues to employers and carriers, you’ll mostly hear mumbling about “predominant cause” and the non-work source of stressors in a given worker’s life. Carriers have traditionally shied away from psychological problems, avoiding them like a plague due to the fear of an infinite and unending liability.

There are two standard openings — each awkwardly worded — into a compensable mental claim: the first, “mental-physical*” involves a physical injury leading to a mental problem. For example, a robbery turned violent, where a store clerk is stabbed or beaten. The physical wounds may heal quickly, but the post-traumatic stress lingers. These claims usually have traction in the comp system.

Then there are the “mental-mental**” claims. Using the same example, someone shows a weapon to the store clerk, empties the till and leaves. There is no physical injury, but surely there is post-traumatic stress. The memory lingers, along with fear and terror. For many in this situation, a return to work is simply terrifying. These claims are routinely denied due to the absence of physical harm.

Finally, there are the physical injuries that give rise to generic mental issues such as anxiety or depression. Here the carrier will focus on the physical symptoms and treatments, and, with the occasional exception of PTSD, generally dismiss any requests for psychological counseling. “We don’t want to open that Pandora’s box!”

Body and Soul

Post-injury, a few sessions with a psychologist may be “just what the doctor ordered” (or in this case, didn’t order). The goal here is to bring people back to productive employment. Emotional issues — some work related, some not — are often the most significant obstacle to a return to work. So if carriers were more willing to focus more on the goal and less on the specifics of causation, the outcomes might be substantially better. I’m willing to bet that the short dollars spent on a little counseling would pay off in fewer indemnity payments and a quicker return to full duty.

I once worked with a young psychologist whose college basketball career was ended by a knee injury. He had what I thought was a great idea: Set up a group therapy program designed to help injured workers get back to their jobs. He proposed a sports medicine approach… The goal being to focus less on pain and anxiety and more on getting people back in “the game” as quickly as possible. He was planning to charge about $25 per person, per session. What a great idea! How cost effective! Last I heard, the carriers wouldn’t budge.

In the spirit of Mental Health Awareness month, let’s consider a paradigm shift in the workers’ comp system. Let’s recognize that injured workers are not just workers, they are people trying to make their way in a demanding and often harsh world. Like most of us, they are surrounded by stress — in the workplace, at home and in the community.

An injury at work substantially complicates what is already a stressed existence. Admittedly, sorting out where the “predominant” stress resides in any given life is no easy task, but perhaps that sorting misses the point. It would be in the carriers’ financial interests to ensure that injured workers get a little coaching, a little sympathetic listening, a little healing of the psyche along with healing for the injured body part. With a hop in their steps, these workers just might have the motivation they need to get themselves back in the game.

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*Mental-physical Claims refer to psychiatric injuries that occur as a result of a physical pain, diminished functional ability, or the loss of a profession related to a work-related injury. Examples of mental-physical claims include sleep disorders, depression, anxiety, and panic attacks.

**Mental-mental Claims do not involve a physical injury and may be caused by a traumatic or violent event, such as witnessing or experiencing violence, crime, and threats of physical or sexual abuse at work.

ABOUT THE AUTHOR:

Since 1990 Jon Coppelman has trained thousands of business owners from Main Street to Fortune 500 on the fundamentals of workers’ compensation cost control. From 2006 to 2012 he was a principal writer for the Workers’ Comp Insider, LynchRyan’s first-in-the-nation blog dedicated to risk management issues. He currently divides his time between his consulting businesses and his role as Senior Workers’ Compensation Consultant for the Renaissance Alliance, an aggregator based in Wellesley, MA serving more than 90 local agencies across New England.

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