Tag Archives: mental health

Impact on Mental Health in Work Comp

According to the World Health Organization, mental health is described as: “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stress of life, can work productively and fruitfully and is able to make a contribution to his or her community.” But the World Health Organization’s definition applies only to part of the population.

At any given time, one in five American adults suffers with a mental health condition that affects their daily lives. Stress, anxiety and depression are among the most prevalent for injured workers. Left untreated, they can render a seemingly straightforward claim nearly unmanageable, resulting in poor outcomes and exorbitant costs.

Increasingly, many in our industry are recognizing the need to do all we can to address this critical issue. We must openly discuss and gain a deep understanding of a subject that, until now, has been taboo.

Four prominent workers’ compensation experts helped us advance the conversation on mental health in the workers’ compensation system during a recent webinar. They were:

  • Bryon Bass, Senior Vice President for Disability, Absence and Compliance at Sedgwick
  • Denise Zoe Algire, Director of Managed Care and Disability for Albertsons Companies
  • Maggie Alvarez-Miller, Director of Business and Product Development at Aptus Risk Solutions
  • Brian Downs, Vice President of Quality and Provider Relations at the Workers’ Compensation Trust

Why It Matters

Mental health conditions are the most expensive health challenges in the nation, behind cancer and heart disease. They are the leading cause of disabilities in high-income countries, accounting for one third of new disability claims in Western countries. These claims are growing 10% annually.

In addition to the direct costs to employers are indirect expenses, such as lost productivity, absenteeism and presenteeism. Combined with substance abuse, mental health disorders cost employers between $80 billion and $100 billion in these indirect costs.

In the workers’ compensation system, mental health conditions have a significant impact on claim duration. As we heard from our speakers, these workers typically have poor coping skills and rely on treating physicians to help them find the pain generator, leading to overuse of treatments and medications.

See also: Top 10 Ways to Nurture Mental Health 

More than 50% of injured workers experience clinically related depressive symptoms at some point, especially during the first month after the injury. In addition to the injured worker himself, family members are three times more likely to be hospitalized three months after the person’s injury. Many speculate that the distraction of a family member leads the injured worker to engage in unsafe behaviors.

Mental health problems can affect any employee at any time, and the reasons they develop are varied. Genetics, adverse childhood experiences and environmental stimuli may be the cause.

The stress of having an occupational injury can be a trigger for anxiety or depression. These issues can develop unexpectedly and typically result in a creeping catastrophic claim.

One of our speakers relayed the story of a claim that seemed on track for an easy resolution, only to go off the rails a year after the injury. The injured worker in this case was a counselor who had lost an eye after being stabbed with a pen by a client. Despite his physical recovery, the injured worker began to struggle emotionally when he finally realized that for the rest of his life he would be blind in one eye. Because his mental health concerns were raised one year after the injury, there were some questions about whether he might be trying to game the system.

Such stories are more commonplace than many realize. They point out the importance of staying in constant contact with the injured worker to detect risk factors for mental health challenges.

Challenges

Mental health conditions — also called biopsychosocial or behavioral health — often surprise the person himself. Depression can develop over time, and the person is not clued in until he finds himself struggling. As one speaker explained, the once clear and distinct lines of coping, confidence and perspective start to become blurred.

In a workers’ compensation claim, it can become the elephant in the room that nobody wants to touch, talk about or address. Organizations willing to look at and address these issues can see quicker recoveries. But there are several obstacles to be overcome.

Stigma is one of the biggest challenges. People who realize they have a problem are often hesitant to come forward, fearing negative reactions from their co-workers and others.

Depictions of people suffering from behavioral health issues in mass media are often negative, but are believed by the general public. Many people incorrectly think mental health conditions render a person incompetent and dangerous; that all such conditions are alike and severe; and that treatment causes more harm than good.

As we learned in the webinar, treatment does work, and many people with mental health conditions do recover and lead healthy, productive lives. Avoiding the use of negative words or actions can help erase the stigma.

Cultural differences also affect the ability to identify and address mental health challenges. The perception of pain varies among cultures, for example. In the Hispanic community, the culture mandates being stoic and often avoiding medications that could help.

Perceptions of medical providers or employers as authority figures can deter recovery. Family dynamics can play a role, as some cultures rely on all family members to participate when an injured worker is recovering. Claims professionals and nurses need training to understand the cultural issues that may be at play in a claim, so they do not miss the opportunity to help the injured worker.

Another hurdle to addressing psychosocial issues in the workers’ compensation system is the focus on compliance, regulations and legal management. We are concerned about timelines and documentation, sometimes to the extent that we don’t think about potential mental health challenges, even when there is clearly a non-medical problem.

Claims professionals are taught to get each claim to resolution as quickly and easily as possible. Medical providers — especially specialists — are accustomed to working from tests and images within their own worlds, not on feelings and emotional well-being. Mental health issues, when they are present, do not jump off the page. It takes understanding and processes, which have not been the norm in the industry.

Another challenge is that the number of behavioral health specialists in the country is low, especially in the workers’ compensation system. Projections suggest that the demand will exceed the supply of such providers in the next decade. Our speakers explained that, with time and commitment, organizations can persuade these specialists to become involved.

Jurisdictions vary in terms of how or whether they allow mental health-related claims to be covered by workers’ compensation. Some states allow for physical/mental claims, where the injury is said to cause a mental health condition — such as depression.

Less common are mental/physical claims, where a mental stimulus leads to an injury. An example is workplace stress related to a heart attack.

See also: New Approach to Mental Health  

“Mental/mental claims” mean a mental stimulus causes a mental injury. Even among states that allow for these claims, there is wide variation. The decision typically hinges on whether an “unusual and extraordinary” incident occurred that resulted in a mental disability. A number of states have or are considering coverage for post-traumatic stress among first responders. The issue is controversial, as some argue that the nature of the job is, itself, unusual and extraordinary and that these workers should not be given benefits. Others say extreme situations, such as a school shooting, are unusual enough to warrant coverage.

What Can Employers Do

Despite the challenges, there are actions employers and payers are successfully taking to identify and address psychosocial conditions.

For example, Albertsons has a pilot program to identify and intervene with injured workers at risk of mental health issues that is showing promise. The workers are told about a voluntary, confidential pain screening questionnaire. Those who score high (i.e., are more at risk for delayed recoveries) are asked to participate in a cognitive behavioral health coaching program.

A team approach is used, with the claims examiner, nurse, treating physician and treating psychologist involved. The focus is on recovery and skill acquisition. A letter and packet of information is given to the treating physician by a nurse who educates the physician about the program. The physician is then asked to refer the injured worker to the program, to reduce suspicion and demonstrate the physician’s support.

Training and educating claims professionals is a tactic some organizations are taking to better address psychosocial issues among injured workers. The Connecticut-based Workers’ Compensation Trust also holds educational sessions for its staff with nationally known experts as speakers. Articles and newsletters are sent to members to solicit their help in identifying at-risk injured workers.

Continuing communication injured workers is vital. Asking how they are doing, whether they have spoken to their employer, when they see themselves returning to work reveal underlying psychosocial issues. Nurse case managers can also be a great source of information and intervention with at-risk injured workers.

Changing the workplace culture is something many employers and other organizations can do. Our environments highly influence our mental health. With the increased stress to be more productive and do more with less, it is important for employers to make their workplaces as stress free as possible.

Providing the resources to allow employees to do their jobs and feel valued within the organization helps create a sense of control, empowerment and belonging. Helping workers balance their work loads and lives also creates a more supportive environment, as does providing a safe and appealing work space. And being willing to openly discuss and provide support for those with mental health conditions can ensure workers get the treatment they need as soon as possible.

As one speaker said, “By offering support from the employer, we can reduce the duration and severity of mental health issues and enhance recovery. Realize employees with good mental health will perform better.”

To listen to the full webinar on this topic, click here.

Top 10 Ways to Nurture Mental Health

May is Mental Health Month! Across the world, many companies are highlighting mental wellness, mental health condition awareness and recovery. Over the past 25 years, I have been helping organizations create effective mental health campaigns, and here are 10 tips I’ve learned and resources I’ve discovered to help your mental health awareness campaigns be most successful.

1. Normalize struggle safely

One goal for many mental health campaigns is to let people know they are not alone. When mental illnesses and suicidal crises strike, people often suffer in silence. By letting people know that others have lived through similar challenges, campaigns can offer hope and community. Pain shared is pain lessened. The trap that some mental health campaigns fall into, however, is overemphasizing the prevalence of extreme behaviors as an “epidemic.” This type of messaging can make people feel hopeless about change. Worse, when it comes to suicide, this type of exaggeration might even create a cultural script that inadvertently influences people to engage in suicidal behavior, because it is the “norm” of what people do to cope with pain. Following the safe messaging guidelines helps ensure that the messages they are sending are promoting health and not creating additional risk.

2. Offer screening tools that lead to action

Screening is a great example of a low-cost, high-impact tool to highlight during mental health campaigns. As with other health issues, screening for mental health conditions increases the likelihood that we can identify emerging symptoms and alter their course with early intervention. Screening offers people a way to anonymously self-assess, which is often an attractive first step for those who are ambivalent about seeking help. A screening that just gives participant a label, however, will fall short. Effective screening tools give participants a call to action and link them to additional local and on-line resources. Many on-line and paper screening options exist (e.g., Screening for Mental Health), and nationally recognized days can make screening a part of a community’s regular health programming:

See also: New Approach to Mental Health  

3. Know your resources on a first-person basis

Effective mental health campaign leaders do their homework. If you want to be a trusted referral source, you need to walk your talk. Get to know your local mental health providers. Visit your local psychiatric hospital. Invite local counselors to a “meet and greet” event. Call your local crisis line, text the Crisis Text Line or contact your EAP (employee assistance program) to get a better sense of how it works. Ask the questions you need to have answered so you can refer people confidently. Your referral will be so much stronger if you can say, “Oh, I know Dr. So-n-so, she’s really approachable and competent. I’ll take you there to meet her if you’d like.”

  • Need more information about EAPs? Here is a buyer’s guide:

4. Share stories of hope and recovery

A main goal of many mental health campaigns is to reduce the stigma of mental illness; however, paradoxically, the more we talk about stigma, the more we actually reinforce it. Instead, we can fight stigma by sharing stories of hope and recovery. When we can demonstrate how others transform their wounds into sources of power, we create hope. When respected people come forward and say, “I suffered, and I got better,” others feel they can get better, too, and the issues become less marginalized. When campaigns highlight the experience of living with a mental health condition, focus on the turning points, the coping and resilience and the interventions that worked. One powerful storytelling resource that models best practices in safe and effective testimonies is the photojournalism of Dese’Rae Stage. Her project “Live through This” is an anthology of portraits and interviews of people who have lived through their own suicide attempt. Dese’Rae’s story and project are highlighted in a new documentary just released in April 2017 called “The S Word.”

5. Make messaging attractive, compelling — and even fun

What attracts us to advertising? Messages that make us laugh, catch us off guard or inspire us. It’s human nature to turn away from things that are scary, confusing and depressing. The challenge for mental health campaigns is to make messaging uplifting, engaging and compelling without becoming so superficial they miss the point. Here are some examples of messages on the mark and one example of what not to do:

6. Tell people what you want them to remember

Sometimes, in our attempt to get attention to our cause, we play up tragic outcomes and overlook important calls to action and messages of hope. We need to tell people what we want them to remember: Treatment works, prevention is possible and people recover. Let people know what to do if they are struggling or if they are worried about a friend or loved one. Tell people exactly how to get involved in suicide prevention in their communities.

  • More tips on creating an action-oriented, positive narrative

7. Engage leadership

Often, mental health campaigns gain momentum at the grassroots level – passionate families, students or faith community members come together and apply their collective energy to make changes. “Grass-top” approaches should also be considered to augment this strategy. People in positions of influence can often move things along more quickly and usually just need to know that people care about an issue. So, engage your leaders to start the conversation. Ask them to speak publicly on why mental health matters to them, why it’s an important health and safety topic for your workplace and how mental health challenges have shown up in their own lives. If they have experienced a mental health condition including depression, addiction or overwhelming stress themselves and have received any form of support that was helpful, their “lived experience” is often the most important driving force in changing culture within a company. By sharing their vulnerability and positioning their story as overcoming hardship by reaching out, they model for the rest that “we are all touched by this, and we can get through it together. I’ve got your back and will persist with you to get you the help you deserve.”

See also: Language and Mental Health (Part 3)  

8. Provide opportunities for deep learning

Many mental health promotion efforts seek to promote awareness, but education alone will not move the needle. We call it the “State Trooper Effect.” We pay attention to educational or awareness raising efforts when they are done well and right in front of us, but once they are in our rear view mirror we tend to go back to what we were doing before. Deep learning goes beyond passive input of knowledge. Deep learning engages people in a knowing-being-doing process. Yes, education is part of that equation – a necessary, but not sufficient piece. We also need to get people “doing” – physically, emotionally and even spiritually involved in the work, and, to really make it stick, personal reflection on the experience is key.
One example of “learning, being, doing” is Project Helping – a corporate, positive psychology engagement program that gets people engaged in actions that create a caring culture at work.

9. Create a symbol of solidarity

We’ve seen how the color pink has symbolized breast cancer awareness. Symbols of solidarity work, but they need to be unique. When these symbols work well, people can see at a glance the community that is being built. Symbols used to promote suicide prevention can let people who are struggling know who might be a safe person to approach with questions. When the symbol of solidarity starts to spread to large groups of people it is a powerful testament to a person secretly in despair. Some examples of symbols of solidarity include:

Photo by Joits

  • “Honor bead” necklaces worn at the American Foundation for Suicide Prevention’s Out of Darkness Walk. Participants choose to wear different colors to symbolize their experience – one color represents “I have lost a loved one to suicide,” another color might mean “I have struggled myself,” while another says that “I support the cause of suicide prevention.”

10. Promote belonging and purpose

Thomas Joiner’s model of suicide risk tells us that a thwarted feeling of belonging and a perception of being a burden are two critical factors that increase a desire for suicide; the opposites of these states are belonging and purpose. When we create meaningful communities and let people know they are needed, we are doing suicide prevention.

How can your mental health campaign help people connect to one another and find a new or renewed sense of purpose? How can people “pay kindness forward” and develop trusting relationships with one another?

Conclusion

Mental health awareness campaigns need to go beyond “awareness raising.” They need to do more than just share statistics and the local resources’ contact information. Promising campaigns model hope, inspire creatively, practice safe messaging and call us to action. The campaigns that are most effective go well beyond any awareness day, week or month and are “baked in” to a company’s health and safety culture. The ones that are truly culture-changing are “by, about and for” the people within the company; real employees telling real stories of hope and recovery. When we realize we have a secret we all share, the walls come down and we heal together.

Can Apps Manage Mental Health?

Improved awareness and recognition of mental health problems and their complexity puts pressure on health systems to increase care. In turn, this stimulates exploration of the potential value of software applications (apps) run on mobile devices. The ubiquity of smartphones makes them an ideal tool for apps that can help individuals manage mental health.

Apps create long-term patient health data in a way episodic clinic consultations cannot and generate a personal health record fundamentally different from a clinical patient record. Doctors have much to gain from the gaps in information being filled by continuous monitoring in this way. Insurers also can benefit from the potential of this technology, especially for claims.

Health apps used on mobile devices can monitor physiological cues associated with sleep disturbance, anxiety, depression, phobias and psychosis. For example, depression is associated with a fall in activity levels – less exercise, movement and fewer social interactions. Sensors in smartphones can help spot patterns of altered behavior that may represent the early warning signs of lowered mood.

See also: New Approach to Mental Health  

Some apps help diagnose problems. Others help people track and manage mood using self-assessment techniques augmented by coaching functionality. Online environments are a gateway to support from more specialist clinical resources. The resources allow patients more control of their mental health management while enabling clinicians to monitor and support them remotely. (Read my blog, “The Growing Impact of Wearables on Digital Health and Insurance.”)

Apps can also help with treatment by sending reminders about medication or appointments, regardless of the person’s location. And they can provide distraction from cravings or link with social networks at times of stress. This “nudging” is effective at altering behavior; for example, integrating text messaging in smoking cessation programs improved six-month cessation rates by 71% compared with the regular treatment.

However, work remains to be done before apps can integrate with insurers’ processes. The confidentiality and use of personal data generated and stored by apps is complicated and needs clarification. The accuracy and sufficiency of information is a potential concern, and hardware constraints may limit potential. More evaluation of the impact of digital technology is needed in research and clinical practice.

See also: Not Your Mama’s Recipe for Healthcare  

Meanwhile, insurers could engage with emerging providers of software solutions. Services like these will, over a relatively short time, become highly influential in the lives of people living with mental health problems. Pilot schemes that compare current insurance methods while evaluating new ones would take us one big step forward.

New Approach to Mental Health

In recent years, thought leaders in business, government and risk management have developed a sophisticated understanding of the bottom-line impacts of untreated mental illness in the workplace. For example, mental health and brain science dominated the agenda at the Davos World Economic Forum in 2015. And the National Business Group on Health held its first CEO Mental Health Summit in October 2015. Among the costs highlighted in these forums: worker productivity loss, high healthcare utilization rates, skyrocketing disability outlays and employment litigation.

To further advance mental wellness in the workplace, it’s essential for legal and human resources to be part of this collective effort. Here, we explore this disparity in approaches, and discuss why it is so harmful to the interests of all – employers, insurers, employees and their families.

See also: Language and Mental Health

What most thought leaders know about workplace mental health, in a nutshell, is this:

  1. Mental illness is common and treatable, with a 25% incidence rate and an 80% recovery rate, akin to chronic physical illnesses;
  2. Early detection and treatment are the most effective and inexpensive means of helping employees get well and return to full productivity quickly; and
  3. If an employee takes a leave of absence, the longer the absence, the less likely the employee is to return to work.

Thus, the organizational strategic imperative is to create workplace conditions designed to enhance early detection and treatment, restoring the status quo as efficiently as possible.

In stark contrast to this organizational imperative, legal and human resources professionals often advise supervisors, managers and EAP professionals to treat potential emotional and mental health issues exclusively as a performance matter. This advice is usually driven by a desire to “avoid an ADA claim.” However, this approach usually postpones the inevitable and makes a claim under the Americans with Disabilities Act more, not less, likely.

The result is often this pattern: a continuing decline in the employee’s condition and work performance, a severing of trust between employee and supervisor and isolation from others at work. Once a disciplinary action or performance improvement plan is imposed, both parties cut ties, and the result is a toxic cycle of leave of absence, disability claim, a request for accommodation, a failed interactive process, separation of employment and either litigation or a pay package. This is an expensive, disruptive and painful process that can often be avoided.

Employers would do well to consider this as an alternative approach:

Design a mental health policy that will unify executive leadership, legal counsel and human resources around the organization’s strategic approach to overall wellness.

  • This policy defines the vision, and the business case, for improving the mental health of the workforce and using the ADA interactive process as an effective means of achieving early detection and treatment of these impairments.
  • Training for supervisors, managers, legal counsel, HR, EAP staff and healthcare providers will highlight: A timely and collaborative exchange of information and interactive process maximizes success; the ADA does not require a fundamental alteration of any job; work teams and supervisors need to partner with HR on making accommodations work.
  • The policy will establish a confidential process for employees to obtain affordable, accessible treatment (either through existing vendors or through curated referrals).
  • Developing and implementing the mental health policy can stimulate and engage your organization in a discussion of the high incidence of emotional and mental health impairments and how these common, treatable conditions can be accommodated.
  • Mental Health 101 Training should be integrated into total wellness programs, including how to mitigate and address stressors in the workplace, how to respond to a colleague or supervisee who may be struggling and how to seek help confidentially.
  • Mental health champions should be designated, trained and made available as confidential resources to anyone at any point in the chain of command dealing with a mental health issue.

When executive leadership, legal counsel and human resources unify behind a strategic, business-savvy approach grounded in total wellness and ADA compliance, everybody wins.

See also: Why Mental Health Matters in Work Comp  

Insurance Thought Leadership’s continuing series of articles focused on suicide prevention is written by the Workplace Task Force of the National Action Alliance for Suicide Prevention, the public-private partnership championing suicide prevention as a national priority.

When Workplace Safety Is Core…

In a true Culture of Safety, safety always wins. It is the first among equals; it is the card that beats all others. In short, Safety is a Core Value of the organization.

Safety and other Core Values are:

  • Continuously communicated.
  • Lived by leaders in their words and behaviors.
  • Formally and informally reinforced, recognized and rewarded
  • Integrated throughout all operations.
  • Used as a compass to guide decisions.
  • Measured and monitored against goals.
  • Committed to, not simply complied with.

The Importance of Mindsets

It’s my firm belief that for an individual to be successful at anything, he or she has to have the right Mindset, Skill set and Tool set. And of these, the most important is Mindset. Why? Because Mindsets drive Behaviors.

Mindsets are created by a wide variety of factors: upbringing, social circles, religion, education, etc. But when it comes to the workplace, mindsets are created and reinforced by the organization’s Culture.

People behave safely when they have a Safety Mindset, a belief that safety in the workplace is their responsibility, both for themselves and others. That belief leads to decision-making based on the potential hazards and risks of any behavior.

Safety and Mental Health

The Core Value of Safety is not just about the right safety gear or procedures. It creates an environment where the mental well-being of the people is just as important as their physical safety.

Did you know 1 in 5 Americans in the workplace live with a diagnosable mental health condition? While many are able to use medication, treatment, wellness practices and peer support to manage these health conditions, too many go unidentified and untreated, And like most neglected health conditions, their status often worsens unnecessarily.

Unaddressed mental health conditions and addictions can negatively affects productivity, attention to detail, quality of work and the safety of the individual as well as co-workers, but with treatment, support and wellness, people living with mental health conditions can be some of your most gifted employees. Most employers simply aren’t aware that often people with the strongest work ethic, creativity, charisma, detail-orientation, and interpersonal skills as also sometimes vulnerable to depression, bipolar condition, obsessive-compulsive disorder and anxiety.

When left unchecked mental health conditions and addiction can be life-threatening. Tragically, the suicide rate in the United States has been steadily increasing since 1999, especially among working age men. According to the Centers for Disease Control and Prevention, suicide was the fourth leading cause of death for males ages 25 to 54 in 2014.

See also: Language and Mental Health  

When Safety is a Core Value, it goes beyond preventing physical illness and injury. It also includes supporting the emotional well-being of employees. Beyond being the right thing to do, it is in the organization’s economic best interest to ensure that its employees are mentally resilient, healthy, and productive. There is a significant return on investment by promoting employee mental health, positively impacting everything from disability and workman’s compensation to productivity and employee retention.

Does your Culture reflect the value of Mental Health?

It can be difficult to determine the true nature of an organization’s culture when you’re inside it. As the noted media theorist Marshall McLuhan put it, “We don’t know who discovered water, but we know it wasn’t the fish.”

But that doesn’t mean you shouldn’t continually evaluate your Safety Culture, especially in terms of mental health. These questions can help you determine if mental health is part of your Core Value of Safety:

  • What does your company’s culture say about how you value mental health as a part of overall wellness?
  • What does the work environment tell people about how they should best deal with stress? Conflict? Depression? Addiction?
  • Does your company’s leadership model mentally healthy behavior? Is emotional intelligence and mental health self-care supported?
  • Is anyone at the top level of leadership “out” and talking about their recovery journey from addiction or mental health challenges?
  • Is mental health promotion and suicide prevention part of your Health and Safety Programs? (e.g., training on early identification and intervention, mental health resources like Employee Assistance Programs, suicide prevention hotlines, peer support resources, etc.)
  • Do employees recognize unidentified and untreated addiction and serious mental health conditions as a potential safety hazard just as they would someone with a head injury, heart condition or broken leg?

Culture is Everyone’s Responsibility

Cultures aren’t something “out there”. They are created and maintained by individuals, not organizations. They are the sum total of the shared values of everyone in the organization, how each individual shows up and creates an environment for others to show up.

Anyone can — and does — have influence over the culture. Of course, Leaders have significant influence, but Culture is not simply their responsibility. To a larger or lesser degree, every employee influences the Culture every day.

If you want to have a true Safety Culture, everyone in the organization must have:

  • A Mindset of Safety, viewing every situation and decision through the lens of safety.
  • Safe Behaviors that ensure a safe workplace.
  • A recognition that mental health is as vital as physical health.
  • An understanding of resources available to stay physically and mentally healthy.

Cultures are created, reinforced, or even changed one person at a time, having the right Mindset to lead to the desired behaviors. That’s how you move Safety beyond a program or set of rules to “the way things are done around here.”

See also: Why Mental Health Matters in Work Comp  

Promoting mental health, suicide prevention as well as physical health and safety is how an organization truly lives its Core Value of Safety.