By Tammy Bradly, VP Clinical Product Development, Coventry
When someone gets hurt on the job, the workers’ compensation system is often adept at zeroing in on an injury and delivering timely care. But that well-intentioned focus on a patient’s physical bruises can make it easy to miss the mental ones, which might be harder to spot.
To achieve the best outcomes and get someone back to work with minimal delay, it’s wise to focus on the whole person, including whatever mental-health toll the episode might be exacting. Failing to do so risks treating only part of an injury and achieving an insufficient recovery.
Today, a comprehensive approach that identifies and meets an injured worker’s needs is more important than ever because the coronavirus pandemic is blanketing everyday life with added stresses that threaten to imperil a worker’s recovery.
Depression often follows workplace injuries
Experience makes clear that numerous forces push and pull at workers after they are injured. These are baseline factors, such as quality of care and timeliness of care, and they play enormous roles in laying out the courses of workers’ recoveries. Yet the more we dig into claims and into the research, the more we understand that less-apparent variables can also tilt the direction many cases take.
It’s important to be aware of the mental-health challenges that can emerge following an injury.
One study revealed the likelihood of injured workers being treated for depression was 45 percent greater compared with workers who were not injured. And getting hurt on the job, in particular, brings a heightened risk of mental hardship.
One study revealed the likelihood of injured workers being treated for depression was 45 percent greater compared with workers who were not injured. And getting hurt on the job, in particular, brings a heightened risk of mental hardship. A group of researchers found people who were injured at work were more likely to become depressed than those who were hurt outside of work. The researchers surmised that worries about reduced income, for example, might be partly to blame. They also noted, not surprisingly, that increased severity correlated with a higher likelihood of depression.
Of course, there are other cognitive factors beyond depression that can help drive the speed and scope of recovery. One is workers’ trust—or lack thereof—that their employers will do right by them. And it’s not only trust in managers and employers that matters: For injured workers, having trust in adjusters, case managers, and, of course, providers is also important in shaping the trajectories of their recoveries.
It’s clear that actions such as working to identify mental-welfare concerns and fostering trust can bring value. To those ends, there are approaches adjusters can take right away to limit the drag that poor mental health can inflict on a worker’s recovery. One method is to take a step back and ask questions:
- How does the injury affect the worker’s overall wellbeing?
- If the person is unable to work, what effects is the situation causing?
- Is the fallout from the injury creating problems at home, perhaps with family?
- Is the worker experiencing feelings of isolation from coworkers or friends?
These aren’t the only inquiries that might be necessary, of course, though they illustrate some of the considerations that can come into play for adjusters trying to assess where a worker stands on the path to recovery. It’s wise to be on the lookout for when there is more going on with an injured worker than the extent of the physiological injuries might suggest.
There is ample reason for concern. Because much of the nation’s workforce is already rattled by a host of worries and strains, mental-health considerations are looming larger than ever over the welfare of workers, even those who haven’t suffered a physical injury.
The coronavirus pandemic is exacerbating a stress pandemic
It’s well understood that workers have been feeling stress stack up for years now. One study conducted before the pandemic found that for some workers so-called job strain—low levels of control over their work and high demands—was “strongly” associated with moderate to severe levels of suicidal thoughts.
These types of punishing workplace landscapes, and the stress they yield, had emerged well before the coronavirus began spiriting around the globe and disrupting nearly every aspect of daily life. Now, in the U.S., COVID-19 restrictions, widespread layoffs, school closures, social unrest, and political tribalism are forging 2020 into one big pressure cooker.
Many workers are feeling it. A late-June snapshot of the mental state of U.S. adults from the Centers for Disease Control & Prevention revealed that younger adults, racial and ethnic minorities, essential workers, and unpaid adult caregivers reported suffering “disproportionately worse” states of mental health as well as higher substance misuse and increased thoughts of suicide.
While the global rate of suicides has fallen for decades, the rate in the U.S. has jumped 35 percent since 1999.
While the global rate of suicides has fallen for decades, the rate in the U.S. has jumped 35 percent since 1999. It now stands at the highest age-adjusted rate since 1941, according to 2018 data, the latest available.
Difficult economic times tend to fan the problem: During the Great Recession more than a decade ago, the suicide rate rose between 1 and 1.6 percent for every percentage point increase in unemployment. That’s worrisome given the job cuts this time are more severe.
Virtually overnight, the virus touched off an unprecedented jump in unemployment claims and ended the country’s longest-ever economic expansion. Never had so many people in the U.S. been thrown out of work at once. While the jobless rate has yet to reach some of the direst predictions from the Federal Reserve and other forecasters, only about half of jobs have re-materialized. Some industries, such as the airlines and live entertainment, could take years to recover, if they do. Indeed, the number of laid-off workers whose job losses became permanent jumped to a seven-year high in September.
The blows to mental wellbeing we’re seeing in 2020 extend beyond the impossible-to-quantify fallout of suicides. Even less-severe strains on mental welfare make it more likely that workers will get hurt and suffer longer when they do. Stress, particularly when it’s chronic, can lead to distractedness and can heighten comorbid conditions such as elevated blood pressure. A high degree of worry can likewise cut into productivity, reduce job satisfaction, and likely even cause brain damage.
Tough times demand we ask more questions
Sadly, the mental-health challenges dogging many U.S. workers aren’t likely to subside when the virus does. In fact, the effects of trauma tend to linger in populations long after the source of the distress fades. That has disquieting implications for the future. The pandemic is likely to widen already yawning gaps in the U.S. between those who require mental-health interventions and those who get them.
The pandemic is likely to widen already yawning gaps in the U.S. between those who require mental-health interventions and those who get them.
Similarly, the pandemic’s role as stress multiplier could further harm injured workers and only underscores a need to lower the hurdles they face. Failing to deal with the mental-health lesions that can accompany physical injuries can prolong suffering. In addition, inaction on tackling workers’ mental challenges makes it more likely those who are injured will develop chronic pain. That means the workers who don’t get the help they need could be facing years of discomfort, which, in turn, can further erode mental wellbeing.
This is why it’s imperative that adjusters and case managers consider the whole person and scan for behaviors that could signal an injured worker is having trouble managing the attendant stress of an injury. As with the need to ask questions about mental wellness from the start, it’s important to routinely look for signs that mental-health challenges are beginning to bubble up.
- Does the worker appear less confident about making a speedy recovery and getting back to work?
- Does the worker appear to be turning to self-destructive behaviors in an attempt to cope?
- Is the worker receptive to recommendations for self-care and other means of promoting wellness?
Asking these types of questions regularly can help indicate whether a worker might be enduring a mental-health condition such as depression, which can hurt the chances for a successful return to work. And taking action to identify potential barriers is important because we know the longer workers are away, the less likely they are to return at all.
Relying on proven tools can help guide injured workers back to health
For complex claims, in particular, case managers can use techniques and tools such as active listening and behavioral coaching to facilitate improvement and boost the likelihood of a successful return to work. We know these methods can promote success. A review of research pointed to the apparent benefits of tools such as rehabilitation programs and psychosocial interventions in getting injured workers back on the job.
At first, the mental and emotional components to a recovery might appear squishier and perhaps even secondary to workers’ ongoing physical needs. Yet waiting to go back and sweep up the mental-health aspects of an injury well after strains begin to emerge can jeopardize the pace and degree of recovery. Instead, by looking at the whole person from the outset, it’s possible to help an injured worker grapple with some of the forces taxing mental welfare.
Next week, we’ll turn our focus to the care model and the different pathways available for helping injured workers whose injuries are chipping away at their mental wellness and their physical health.
About the Author
Tammy Bradly is vice president of clinical product development for Coventry. Bradly is a certified case manager with more than 25 years of comprehensive industry experience through service delivery, operations management, and product development. She holds several national certifications, including certified case manager (CCM), certified rehabilitation counselor (CRC), certified program disability manager (CPDM), and critical incident stress management (CISM).
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.