By Lori Daugherty, Chief Executive Officer at Integrated Medical Case Solutions (IMCS) Group
As the COVID-19 pandemic enters its second year, experts warn that even when this disease crisis has passed, the behavioral health ripple will linger far longer– maybe a decade. Why? Rapid lifestyle change, residual after-effects of the disease itself, stress from a rise in unemployment, shrinking confidence in our institutions to handle crises effectively, increased substance abuse, just to name a few. What affects the general population will be reflected in our workplaces, forcing organizations to scramble to find mental health support in an effort to bolster workforce resiliency.
A unique circumstance for the workers’ compensation industry, the possibility of contracting COVID-19 while at work has forced states to draft policies for their workers. Workers’ compensation benefits do not ordinarily cover viruses. However, the new designation of “essential workers,” to include healthcare workers and first responders, has led some states to amend their policies to cover workers who contract COVID-19, under the assumption that they acquired it while on the job. The National Conference of State Legislatures reports that 17 states and Puerto Rico have included language that allows COVID-19 to be covered under workers’ compensation as a work-related disease.
This reform to workers’ compensation policies will prove crucial, as the country faces what will soon be a mental health crisis in the wake of this pandemic. As it stands, a February 2021 article reports that essential workers are facing a continuing risk of contracting COVID-19 and experiencing heightened mental health issues. Essential workers are at an increased risk for developing mental health issues, having a 42% v. 30% probability of reporting anxiety or depression, a 25% v. 11% likelihood of substance use, and a 22% v. 8% heightened risk of suicidal thinking compared to non-essential workers.
Society at Large
The pandemic, in its merciless impartiality, has spared no one, and the percentage of those suffering depression, stress, anxiety and substance abuse affects society on the whole at unprecedented levels. The mental health issues brought about by losing loved ones to COVID-19 is compounded by the depression, anxiety and stress felt from experiencing extended hardships, as one study reveals:
- 53% of adults affected by job loss or low income during the pandemic report mental illness issues, a sharp contrast to the 32% still employed, but who also experience these symptoms.
- 56% of young adults between the ages of 18 and 24 report symptoms of anxiety and/or depression.
- Mothers and fathers challenged by remote learning and the absence of childcare options report feeling anxious and depressed at 49% and 40%, respectively.
- Minorities, more likely to lack medical and mental health care options, experience anxiety and depression in 48% of non-Hispanic Black adults and 46% of Hispanic or Latino adults.
- Another study reveals that adults 65 and older constitute 80% of COVID-19 related deaths, resulting in a quarter of this population feeling heightened anxiety and depression throughout the pandemic.
Furthermore, substance use, particularly opioid use, has seen a dramatic rise during the pandemic. According to the Centers for Disease Control and Prevention, after three months of quarantining, 40% of American adults reported mental health or substance use problems. The CDC also reports that the first quarter of 2020 saw 3,000 more deaths due to drug overdose than during the same time frame the previous year, and a 24.2% increase in U.S. opioid deaths from July 2019 to July 2020. At this rate, the United States is situated to exceed its yearly record-high number of overdose-related deaths.
Mental health professionals stand ready, as the issues caused by this virus have created a tremendous need for mental health services that will continue to increase for years to come. The National Institute for Healthcare Management shares that 51% of people report their mental health at work has worsened since the pandemic began, and 50% of workers fear returning to work after quarantine. In addition, anxiety has increased three-fold and depressive symptoms are nearly four times higher than pre-pandemic numbers.
COVID-19 Evidence-Based Claim Pathways
Research has long suggested that even in physical-only workers’ compensation claims, behavioral health assessment and brief intervention can cut WC costs by 50%. Early findings report that licensed clinicians can effectively treat mental health issues brought on by the pandemic using cognitive behavioral therapy (CBT). Many studies confirm the success of CBT on COVID-19 patients exhibiting increased levels of depression, anxiety and stress. COVID-19 claims can be classified into four distinct categories for assessment and treatment:
**Case examples do not represent specific patients. Vignettes were drawn from common clinical scenarios and treatment outcomes in the context of the coronavirus pandemic.
Physical Only: COVID-19 positive, without hospitalization, with reported return-to-work anxiety.
For example, a nurse in her 30s, who contracted COVID-19 experienced anxiety and difficulty sleeping. She showed 80% improvement in anxiety, stress and depression after attending just four cognitive behavioral therapy sessions.
Physical-Mental: COVID-19 positive, without hospitalization, with a psych issue or claim.
For example, a man in his 50s contracted COVID-19 and began exhibiting both physical and mental symptoms, stress and anxiety exacerbated by complications of sequelae. Having been a caregiver to his parents, who both passed away after contracting COVID-19, he also suffered grief. After attending four CBT sessions for stress, anxiety and survivor guilt, he reported a better ability to cope with stress and anxiety and experienced improved function, returning to work without any psychological work restrictions.
Complex Physical-Mental: COVID-19 positive, with hospitalization, with reported return-to-work anxiety.
For example, a clerk in her 60s spent 7 days in intensive care with COVID-19. After returning home, she experienced trouble getting out of bed in the morning, poor appetite, mental fog and shortness of breath. After treatment that included cognitive restructuring therapy, she reported resuming self-care, eating habits and regular sleep schedule.
Mental Only: COVID-19 negative, with reported return-to-work anxiety, in states which allow Mental-Only claims.
For example, an admissions clerk in his 40s did not contract COVID-19, yet felt stressed at work, had trouble sleeping, couldn’t focus and had difficulty completing work duties. He underwent a psychological evaluation, an assessment and two treatment sessions, after which he reported improved coping, function and activities of daily living, including self-care and communication.
Know the COVID-19 Workers’ Compensation Options
As organizations recoil from the mental health impact of a shaken workforce, the need for mental health treatment will be necessary to precipitate swift, effective recovery. A proven strategy that assuages obstructive thoughts and behaviors and restores mental and emotional well-being, cognitive behavioral therapy made available to workers, students, families, and society at large, is surely the best, immediate defense for reducing the fear and negativity brought on by the pandemic. While program coverage varies, knowing what’s available to reinforce your workforce can reduce risk, cut costs and provide life-altering benefits.
About Lori Daugherty
Loraine Daugherty is Chief Executive Officer at Integrated Medical Case Solutions (IMCS) Group, soon to be Ascellus Behavioral Health, where she provides analytical decision-making, strategic planning and executive leadership. As a CEO with more than 30 years of industry experience in workers’ compensation, she is focused on developing best practices for organizational processes, performance measurement systems and building IMCS’s infrastructure to maximize the company’s growth. Ms. Daugherty is known for her exceptional leadership style and professional savvy for cultivating high-performance teams.
IMCS – Integrated Medical Case Solutions – is the leading provider of work-related trauma prevention and treatment with a proven track record of transforming workers’ compensation cases with notable success in early return-to-work outcomes. Providing biopsychosocial assessments to assist patients, employers, and workers’ compensation and disability organizations to optimize chronic pain management and disability claims, IMCS makes intervention efficient with a national network of 1,500+ licensed clinicians in all 50 states.