By Kate Farley-Agee, Vice President, Network Products, Coventry
Mental-health challenges present numerous hurdles for injured workers even in “normal” times. Now, because of the extraordinary fallout from the pandemic, it’s imperative to ensure that injured workers obtain access to high-quality mental-health assistance when it’s needed.
For years now, we’ve understood that anxiety and depression threaten to undercut injured workers’ recoveries. Often, these pernicious inflictions don’t creep up until well after a physical injury occurs. This stealthy advance can make these conditions hard to identify and difficult to treat. Yet before the novel coronavirus began pummeling the physical and mental welfare of so many people, it was possible, if ill-advised, to take a wait-and-see approach when considering mental-health options for an injured worker who showed signs of unease. We have come to understand this no longer works.
Now, the collective gut punch delivered by the pandemic has made it necessary to devote added attention and resources to identify and treat behavioral-health challenges before they risk upending an injured worker’s recovery. To further that goal, it’s helpful to examine how successful models of care incorporate mental-health aspects from the start.
Last week, Tammy Bradly, vice president of clinical product development at Coventry, laid out how important it is to consider the whole person when looking at the needs of an injured worker. This includes mental-health strains each worker might be experiencing. She made the point that looking solely at a physical injury risks jeopardizing the best-possible outcome and an expeditious return to work.
Here, I’ll walk through how a solid care model makes available various pathways for helping injured workers whose injuries are chipping away at their mental wellness.
To start, it’s wise to turn to a strong network that has deep bench strength. This is important because finding the right provider and gaining timely access to that provider is key to helping injured workers deal with mental-health hurdles if such challenges begin to arise.
This is critical because we continue to develop a better understanding of the often-inextricable links between physical and mental soundness. For example, one study of more than 15,000 retirees pointed to anxiety and depression as posing similar—and sometimes greater—risks for poor health outcomes than obesity and smoking.
one study of more than 15,000 retirees pointed to anxiety and depression as posing similar—and sometimes greater—risks for poor health outcomes than obesity and smoking.
Success comes from matching workers’ needs to their treatments
There is ample evidence that mental-health assistance can play an important role in a worker’s recovery. Where things get less clear is determining what behavioral-health interventions an injured worker needs to achieve success returning to work.
One fundamental question centers on the type of provider. In workers’ compensation, behavioral health providers often include psychiatrists, psychologists, and professional counselors.
Beyond looking at the type of provider, it’s critical to understand the level of care needed to promote a strong recovery. This includes questions about whether a treatment will be outpatient, or, though rare, inpatient. Here are some of the distinctions we often see in workers’ comp:
- Inpatient hospitalization
- Partial hospitalization
- Intensive outpatient care
- Outpatient counseling
- Medication management
Looking a little closer at some of these variations, interventions such as inpatient hospitalization obviously represent acute care whereas partial hospitalization might be limited to day treatment. Next, intensive outpatient care stands as a still-lighter touch, perhaps with three hours of treatment three to five evenings per week. Outpatient counseling and medication management each have their place as well in helping injured workers combat mental-health concerns. Often, talk therapy can serve as an appropriate first-line treatment when mental-health obstacles emerge.
Of course, none of these interventions—provider types, treatment settings, or treatments themselves—exist in a vacuum. Today, injured workers are facing the added strains of seeking recovery under the pall of a global pandemic. This compounded stress can impinge on workers’ recoveries by stirring unease about physical and financial wellbeing, among other concerns.
At the same time, the breadth and scale of the pandemic, not seen in a century, also raises sometimes-difficult questions about compensability. After all, if most everyone is feeling stressed, is an injured worker forced to bear a heavy mental load because of an injury or simply because these are stressful days? There are a number of questions adjusters might consider asking to navigate to an answer:
- Did symptoms begin to emerge before or after the injury occurred?
- Did the injury exacerbate any mental strains the worker was already facing?
- Was the injured worker seeking treatment for mental-health challenges prior to the injury?
- Are the difficulties linked to fallout from the injury, including decreased income, loss of contact with coworkers, or challenges associated with recovering at home or in a facility?
The nature of mental-health aliments can make it difficult to uncover clear-cut ties between an initial incident and subsequent bouts with conditions such as anxiety and depression. That’s why it’s helpful for adjusters and case managers to reach for proven tools such as active listening and recurring engagement with an injured worker. These conversations can help adjusters both better answer questions about compensability and help direct injured workers toward the most appropriate treatments.
The pandemic makes the work of guiding recoveries more difficult
It’s possible and even probable that getting hurt on the job amid a pandemic could bore further into a worker’s mental wellbeing than it otherwise might. Working and living in a heightened state of strain for an extended duration makes it more likely that a worker could become injured in the first place. And unrelenting stress can likewise make recovery harder. It’s also evident that the exogenous fault lines that grew to define 2020—worries about contagion, the economy, and society at large, among others—could make anxiety and depression more likely to follow when an injury occurs.
There are other ways the pandemic malaise could eat away at a worker’s mental wellbeing. Fear of retaliation might keep someone from raising a hand to report an injury. Perhaps the worker feels gratitude about still having a job in the first place and doesn’t want to appear unappreciative. Or it could be that the worker fears direct retribution or even a soft reprisal such as losing favor with management. It’s likewise possible an injured worker might worry about being subsequently targeted if layoffs were to occur.
Given the financial and operational difficulties many employers are facing, it’s little surprise that some workers might not want to rock the proverbial boat. This is the case for a segment of workers even in less economically perilous times. A 2013 survey by Findlaw.com, a legal-information clearinghouse, found 9 percent of workers didn’t report a workplace injury for fear of retaliation such as being fired or passed over for promotion. Now, with the U.S. economy staggering under the weight of coronavirus disruptions, it’s possible more workers would be reluctant to reveal injuries.
A 2013 survey by Findlaw.com, a legal-information clearinghouse, found 9 percent of workers didn’t report a workplace injury for fear of retaliation such as being fired or passed over for promotion.
Extra scrutiny can lead to better understanding
Difficult times can require adjusters and case managers to do a little more looking under the hood of a claim to try and anticipate where an injured worker’s case might be headed. This might mean examining the medications providers are prescribing or the types of treatments providers are seeking. By applying a bit more scrutiny to some of these aspects of a claim, adjusters and case managers might be able to tell when mental-health challenges could threaten to complicate a worker’s rebound and return to work.
Even for workers who aren’t injured, mental-health constraints such as depression can do enormous damage.
In fact, about one-quarter of the U.S. workforce suffers from depression and these workers are out from work twice as often and they have five times the “lost productive time” of other workers. The cost to personal wellbeing is plainly severe. The same is true in monetary terms: A review of U.S. insurance claim data by the consultancy McKinsey reveals that the 23 percent of members with mental-health or substance-use disorders drive 60 percent of overall medical spending.
Put another way, behavioral-health issues and physical issues often go hand-in-hand. McKinsey reports that people with behavioral-heath conditions suffer two to six times the frequency of concurrent physical conditions compared with those who don’t struggle with these challenges.
McKinsey reports that people with behavioral-heath conditions suffer two to six times the frequency of concurrent physical conditions compared with those who don’t struggle with these challenges.
Increased demand will require a new playbook
Challenges around access appear only likely to grow in the U.S. and, indeed, throughout the world. Paradoxically, as some mental-health advocates have noted, some states hemmed in by financial difficulties arising from the pandemic are reducing the money they set aside for mental-health treatments just as demand is spiking. Other states, desperate for space to treat patients contagious with COVID-19, the disease caused by the coronavirus, have shuttered or taken over behavioral health facilities.
While the outlook for treatment access remains worrisome, some mental health professionals hope the societal inequities and shortcomings highlighted by the crisis will lead to further innovations in delivering care such as using telemedicine to reach far-flung patients. The need is great. More than half of counties in the U.S. don’t have a psychiatrist and nearly two-thirds have a shortage of mental-health providers.
There are other potential benefits for injured workers that could grow out of a broader need across society for mental-health interventions. One is a further breakdown in the stigma that too often surrounds mental illness. A worker already straining under physical maladies related to an injury can then suffer a cruel secondary blow—one tied to the shame that struggles with anxiety, depression, and stress can render. If more people recognize how commonplace mental-health trials are, then perhaps more workers will ask for help. Similarly, perhaps more workers will understand how physical pain, social isolation, financial worries, and other everyday concerns can conspire to throw up sizable barriers to mental wellbeing.
Ultimately, it’s clear that in most cases injured workers require a menu of supports that will enable them to see their health restored and allow them to return to work. Only by viewing the whole person can adjusters, case managers, and providers hope to help injured workers achieve the best-possible outcomes. Part of this task involves reviewing the mental-health difficulties that an injured worker might be facing as part of the fallout from an injury. Once an obstacle is identified, it’s imperative to turn, in a timely fashion, to a network of accomplished providers to help the injured worker vanquish these mental-health complications and return to health, to productivity, and to the job.
About Kate Farley-Agee
Kate Farley-Agee oversees Coventry’s national broad-based provider network and state-certified managed care organizations across the country. She also leads Coventry’s Network Quality Management and Improvement department, Network Paneling and Reporting, and Network Performance groups. Kate has over 20 years’ experience in the health care industry with an emphasis in network development and leadership. She holds a B.A. in Business Economics and a Master’s in Management and Organizational Behavior. In addition, she holds certificates in Managed Care and Health Care Administration.
Coventry offers workers’ compensation, auto, and disability care-management and cost-containment solutions for employers, insurance carriers, and third-party administrators. With roots in both clinical and network services, Coventry leverages more than 40 years of industry experience, knowledge, and data analytics. Our mission is returning people to work, to play, and to life, and our care-management and cost-containment solutions do just that. Our networks, clinical solutions, specialty programs, and business tools will help you focus on total outcomes.
Coventry recently became a part of Mitchell | Genex, creating the broadest continuum of technology and products serving the auto, workers’ compensation, and disability markets.
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