Watch For Depression After Workplace Injuries
Depression following a workplace injury is an all too common problem facing business managers, even though they may not realize it.
A small business with a solid return-to-work process may still find employees lose considerable productivity because of underlying depression stemming from a workplace accident, often because depression goes undiagnosed and untreated. Worse, that depression is often misdiagnosed as malingering or as a “bad” employee.
How can managers ensure their employees are receiving the correct medical and psychological treatment after an injury?
First, ask the employee.
Employers hesitate to discuss medical issues with employees, but with a workers’ compensation injury, you should solicit frequent feedback from your employees. If treatment isn’t working, the employee may need help. Your interest and input may be the trigger that impels the employee to push for that help.
You should push, as well.
Ask your claims adjuster to provide the official timeline estimates for recovery given the nature of the injury. If the employee is not healing according to basic medical disability guidelines, ask the adjuster for a plan of action. What will they do to push the claim toward closure?
Some workers’ compensation professionals believe that many injuries involving lost time should include at least one screening visit to a mental health professional. However, adjusters fear “buying” the mental health aspect of a work injury.
So rather than deal with psychological issues when they begin to arise and delay recovery, employees may linger off work for months, waiting for intervention. This sets up a vicious cycle of increased stress, which aggravates pain and increases disability. Then it is often the “They aren't getting well — it must be psych" phenomena that occurs after months of unsuccessful medical treatment. Often, by the time adjusters accept there are psychological issues, that stress pattern is solidly established and much harder to manage. Ignoring the psychological impact of an injury is a good formula for a claim that will be open for a long, long while.
Claim supervisors and managers must understand the benefit of prompt psychological intervention if they suspect depression is impacting recovery. Adjusters must be willing to refer to mental health providers when appropriate, whether they pay for the treatment or urge the employee to use his or her employee assistance program. I am not sure that most claims practitioners understand the importance of that interplay between mental health and wellness.
The Ohio Bureau of Workers’ Compensation, Ohio’s only Workers Comp insurer, is starting to honor that interplay. The Bureau is trying to move away from an “additional psychological allowance model” to emphasize that a certain degree of emotional reaction and distress is a normal consequence of an injury. This is especially true when the injured workers feel they are not making progress or may have problems returning to work.
David P. Schwartz, Ph.D., Chairperson of the Ohio Psychological Association Task Force on Bureau of Worker's Compensation Reform, says, “I always point out that the vast majority of injuries resolve quickly with traditional care. But when an injured worker is not improving six-to-eight weeks post injury, there is now a tremendously increased risk of prolonged disability and increased costs. There is a growing body of evidence that 1) this period is a crucial time for development of long-term disability and 2) brief, focused intervention in this time period has been shown to be both clinically effective and cost effective.”
Even when the adjuster recognizes the depression and is willing to accept the cost early in the claim, finding the right providers can be difficult. There are few practitioners who provide brief, focused return-to-work treatment. Most mental health practitioners are not trained to deal with the issues faced by injured workers. These post-injury mental health concerns are quite different from the family systems problems most psychologists and counselors encounter. Of those providers who do treat injured workers, many work from a chronic pain management model. There the focus is acceptance of permanent loss versus recovery and return to work. Ohio is again a leader in an initiative that involves training psychologists to be “early intervention specialists” with acutely injured workers, using an employee-assistance program model versus a long-term psychotherapy approach.
When those who experience trauma get the right help, they get better more quickly, even when that trauma is a serious workplace injury. According to Dr. Schwartz, it is really about “treating emotional reactions such as fear and concern [following a workplace injury] before they evolve into a full-blown depression.” Insurance companies should overcome their reluctance to “buy” the psychological component and provide mental health referrals early rather than wait until the employee has emotionally devolved.
As an employer, you can reduce costs and assist your employees by discussing your worker’s injury and ensuring your insurance carrier provides appropriate medical treatment, including psychological treatment when indicated.
