Mental Health in WC: Increased Demand for Psychological/Psychiatric IMEs

Even before the COVID-19 outbreak, there had been a rise in requests for mental health evaluations on workers’ compensation claims – what is known as psychological or psychiatric independent medical examinations. These types of evaluations help determine if there are behavioral, emotional, or cognitive issues resulting from a workplace incident, as well as the extent of those issues.

Now that we’ve endured, hopefully, the worst of the pandemic, we anticipate seeing an even greater demand for psychological/psychiatric IMEs. It’s been a difficult 15 months since the novel coronavirus was declared a national emergency in March 2020. Even though vaccines are being broadly administered, we’re still in the midst of a mental health reckoning.

As a nation, people lost jobs – as well as loved ones. Some attempted to stave off financial hardships, potential evictions, and food insecurity. Due to social distancing, others experienced loneliness and isolation. During this same span of time, our nation also faced civil unrest, increased gun violence, a rise in domestic violence, and heightened racial tensions.

May was Mental Health Awareness Month. At Mitchell | Genex | Coventry, we participated in the national movement to bring more understanding to mental health issues, especially in the workers’ comp industry. To help in our endeavor, we launched a mental health eBook – Strategies for Combating Mental Health Challenges in Injured Employees. However, as we move into the months ahead, we want to continue this discussion of critical mental health issues and effective approaches to help alleviate them.

One reason to do this is because unresolved emotional and mental health concerns can impact workers’ comp claims — both in terms of costs and duration. Psychiatric or psychological IMEs (depending on what type of evaluation is needed) can help employers, insurers, and claims organizations make treatment and return-to-work determinations, and ultimately help ensure injured employees get the mental health services they need. Some of the factors affecting the uptick in psychiatric or psychological IME requests include: 

• The COVID-19 Impact. Fear of the virus and the resulting economic recession has had negative effects on people’s mindset. Anxiety, depression, post-traumatic stress disorder (PTSD), and other trauma- and stress-related disorders are prevalent. Many who suffered from mental illness and substance abuse disorders prior to the pandemic have experienced a worsening of their conditions. 

In the midst of the pandemic, the CDC said approximately 4 in 10 adults reported symptoms of anxiety or depressive disorder – up from 1 in 10 adults who reported these symptoms from January to June 2019. 

Mental health and societal pressures could result in workplace aggression, bullying, or violence. Even in situations where physical injuries were not sustained, if hostile behavior occurred, mental health issues could result. 

• Trauma on the Frontlines. Many health care workers and frontline responders still carry the trauma of treating COVID-19 patients. During surges, hospitals were inundated with the critically ill. Health care workers and first responders acted heroically, suppressing emotions so they could respond to medical emergencies. But they may need help processing the things they saw and experienced.  

According to one study, COVID-19 burnout is present among health care professionals at higher rates than previously suspected. There are many contributing factors – chief among them is bearing witness to so much death, and seeing patients suffer and die without loved ones around. The health care industry has already seen several suicides among COVID-19 health care workers – as well as other mental health issues like depression and substance abuse. Hospitals, police, and other frontline response organizations are striving to offer much-needed counseling.

• PTSD. With previous viral outbreaks, rates of burnout and PTSD among health care and frontline workers actually spiked after the crisis had passed. Processing trauma will be an ongoing issue. Different employees may need different things at different times. 

Many health care and frontline workers have already been meeting the qualifying criteria for PTSD, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Some contracted COVID-19, and, as a result, suffered serious illness – as well as mental health effects. As you can imagine, it would be traumatizing for these workers to see patients die from COVID-19, contract the virus themselves and fear for their own lives. 

Criteria for PTSD include nightmares, flashbacks, upsetting memories, and feeling haunted by trauma-related images, thoughts, and emotions. A person might also experience decreased interest in their usual activities, negative thoughts about the world and oneself, risky and destructive behavior, irritability and/or aggression. Symptoms lasting for more than one month or creating distress and functional impairment are all signs indicative of PTSD. 

• COVID-19 Presumption Laws. Due to state laws passed in response to the pandemic, it will be easier for certain employees like the ones we’ve mentioned above to qualify for workers’ comp benefits for health-related issues due to the COVID-19 infection. 

In California, when first responders, health care workers, and other high-risk employees test positive for COVID-19 within 14 days after working at their employer’s direction and place of employment, they will be entitled to a presumption the infection and illness were work-related. A handful of other states — Alaska, Florida, Michigan, Minnesota, Missouri, New Hampshire, Utah, Washington and Wisconsin — have also passed similar presumption legislation, and other states have similar pending legislation. 

While some of these laws don’t specifically outline mental health coverage related to COVID-19 infection, once these claims are accepted into the workers’ comp system, it’s logical that the mental health component may also need to be assessed and addressed.

• The Stress of Returning to Worksites Post-COVID. Navigating the aftermath of the pandemic is another challenge ahead. Employers will want to discuss with individual employees whether they want to return to worksites. Some may prefer remote work or a hybrid situation, but others may feel working from home has been isolating and lonely and want to return full time. The health, safety, and mental well-being of the workforce should remain the top priority. 

While vaccinations are being administered, they will not make employees 100% immune to COVID-19. There’s continued risk of contracting the virus. And while resulting symptoms and illness will likely be less severe, the risk could still be a source of stress and anxiety for employees, especially in states where vaccinations rates are low, infection risks remain high, and for those workers who are medically vulnerable. 

Initial reopening may happen with a heightened level of psychological distress, while individual employees may still be dealing with financial hardships at home, recovering from social isolation, or fearing they’ll lose their jobs. Stressors could lead to accidents or workplace aggression. And when worksite injuries occur, stressors could lead to delayed recovery and return to work. 

Of course, employers can help by making sure employees understand the steps that are being taken to safeguard their health. Safety guidelines and protocols should be clear and agreed upon by all employees before returning to worksites. 

• Mental Health Issues as Comorbidities. Due to the many factors outlined in this article, more employees than ever are struggling with mental health concerns. In fact, in October 2020, the Kaiser Family Foundation (KFF) reported that mental health illnesses could soon eclipse obesity as the most common preexisting condition in the United States.This speaks to the prevalence of mental health issues, which can lead to increased challenges in managing workers’ comp claims. When an employee gets injured on the job, and if they already have a preexisting mental health condition, it could be exacerbated with the occurrence of an injury. 

For instance, if that person was already suffering from social isolation, post-traumatic stress, or depression from the pandemic, a workplace injury could intensify these conditions. To achieve the best possible outcome and get that person back to work with minimal delay, it’s important to focus on the whole person, including the mental health toll the episode could have. Failing to do could risk a negative impact on the claim and employee.  

Beyond COVID-19: Fostering Mental Health Ahead 

In all of the situations discussed above, a psychological or psychiatric IMEs can help. In the past, there’s been reluctance to order these evaluations, as they can be expensive, especially in cases where testing is needed, and a two-day exam is required. 

However, psychiatric and psychological conditions are widespread and, as a result, use of neuropsychological testing is on the rise. It provides objective data – beyond what can be obtained in a counseling session or if the employee talks to a psychologist or psychiatrist. Having this data can be instrumental in confirming a diagnosis, determining appropriate treatment, assessing functional ability and, ultimately, deciding whether employees can safely and effectively return to their positions. 

Today, we’ve seen the crisis around COVID-19 dramatically improve, and cases have dropped significantly nationwide. But, as we move forward, we must remain vigilant for those who may be mentally wounded – especially the health care, frontline, and essential workers who helped get us through the pandemic. We must ensure they receive the mental health services they need to recover from trauma or depressive disorders.

By Donna Bradshaw

Donna Bradshaw is vice president of IME Operations at Genex Services (www.genexservices.com) and a contributing author to the mental health eBook – Strategies for Combating Mental Health Challenges in Injured Employees. With more than 25 years of experience, Donna has been responsible for writing operational plans to meet various state regulatory requirements, as well as securing and maintaining URAC Core V3 Accreditation. In her current position, Donna is responsible for overseeing Genex’s IME branch offices where she develops and implements policies and procedures to increase operational efficiencies and effectiveness. She also serves on Genex’s IME division executive leadership team which is charged with establishing and applying strategy for the division.

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