Navigating the Complex Terrain: Workers’ Compensation for Mental Health Issues

Source: CMSA Today

BY COLLEEN MORLEY, DNP, RN, CCM, CMAC, CMCN, ACM, RN, FCM

Workers’ compensation has long been associated with physical injuries sustained on the job. However, the evolving understanding of health recognizes the profound impact that mental health can have on an individual’s overall well-being. In recent years, there has been a growing recognition of the need to address mental health issues within the context of workers’ compensation. As a novice in the specialty of workers’ compensation, I was interested in learning more about this area and wanted to share my findings with you; we never stop learning.

Workers’ compensation is a state-regulated system in the United States, meaning that each state has its own set of laws and regulations governing the program. As a result, the coverage of mental health diagnoses and conditions can vary significantly from one state to another. Mental health-related injuries are specifically covered in some capacity by workers’ compensation in 34 states, although the extent of the coverage varies greatly. Seven states exclude mental health-related injuries from workers’ compensation coverage (Cunningham, 2022). Understanding the specific regulations in each state when it comes to workers’ compensation and mental health coverage is a working imperative for the professional case manager.

Mental health issues are more prevalent in the workplace than one might imagine.

  • Research from the National Alliance on Mental Illness (NAMI) indicates that approximately 22.8% of adults in the United States experience a mental health disorder in a given year (57.8 million people in 2021) (National Alliance on Mental Illness, 2023). This includes conditions such as depression, anxiety, post-traumatic stress disorder (PTSD) and others that can be exacerbated or triggered by workplace incidents.
  • The American Psychological Association (APA) reports that over 60% of workers experience work-related stress, with depression and anxiety being common outcomes. These conditions can lead to absenteeism and reduced productivity, costing employers billions of dollars annually (American Psychiatric Association, 2023).
  • Workers in high-risk professions, such as first responders and military personnel, face unique challenges. Statistics from the National Conference of State Legislatures reveal that first responders develop behavioral health conditions like PTSD at some point in their careers at a rate more than 50% higher than the national average. Additionally, “at the height of the pandemic, health care workers and first responders accounted for nearly 75%of all workers compensation claims” (Cunningham, 2022).
  • Occupational burnout, defined by the World Health Organization (2019) as “chronic workplace stress that has not been successfully managed…characterized by emotional exhaustion, reduced performance, and feelings of cynicism toward work,” is a widespread concern. The World Health Organization recognizes burnout as an “occupational phenomenon” and estimates that it affects 23% of workers worldwide (World Health Organization, 2019).

Incidents of workplace harassment and bullying can have severe repercussions on mental health. The Workplace Bullying Institute (WBI) reports that over 60 million American workers are affected by workplace bullying, with consequences including anxiety, depression and reduced job satisfaction (Workplace Bullying Institute, 2021).

These statistics paint a vivid picture of the prevalence of mental health issues in the workplace. It’s clear that the impact extends beyond the affected individuals, affecting workplace dynamics, productivity and overall employee well-being. As a result, addressing mental health concerns in the context of workers’ compensation is not just a moral imperative but also a critical step in maintaining a healthy and productive workforce.

Addressing mental health issues within the workers’ compensation system presents several formidable challenges. The pervasive stigma and discrimination associated with mental health often deter affected workers from seeking assistance, compounding their difficulties. Accurate diagnosis and documentation of these conditions require specialized expertise from mental health professionals, adding complexity to the process. Establishing a clear link between a workplace incident and a resultant mental health condition can be intricate, potentially impeding workers’ ability to claim the compensation they need. Furthermore, inadequate coverage in certain workers’ compensation policies leaves affected workers without the necessary support, exacerbating the barriers to accessing essential mental health care (International Risk Management Institute, 2017).

Addressing mental health issues within worker’s’ compensation cases demands a comprehensive approach aimed at fostering employee well-being and a supportive work environment. Early intervention stands as a cornerstone of this strategy, as identifying mental health issues promptly allows for timely support and intervention. Employers play a pivotal role in this by encouraging open communication channels and providing readily accessible resources for employees to seek help when needed. Additionally, implementing psychological first aid after a workplace incident can significantly mitigate immediate psychological distress and, importantly, reduce the risk of long-term mental health issues. This timely support demonstrates a commitment to the mental well-being of employees, helping them cope with the aftermath of a traumatic incident (International Risk Management Institute, 2017).

Ensuring that workers’ compensation policies encompass mental health services is another vital step in this multifaceted approach. Employees should have seamless access to mental health professionals who can provide accurate diagnosis and effective treatment. Integrating mental health support into rehabilitation programs is equally critical. By addressing both physical and mental health needs, these programs enhance the likelihood of employees returning to work successfully and maintaining their overall well-being. Furthermore, employers should invest in training and education programs that promote mental health awareness among employees and supervisors. Equipping individuals with the knowledge and resources needed to recognize and address mental health issues fosters a more empathetic and supportive workplace culture, reducing the stigma associated with mental health and enhancing overall workplace mental health (RogueRisk, 2023).

Professional case managers play an indispensable role in the management of workers’ compensation claims tied to mental health issues. Following the Case Management Society of America’s Standards of Practice (2022), they act as the linchpin, guiding a comprehensive approach that prioritizes the well-being of injured workers. Their involvement commences with early identification, where they may detect signs of mental health distress in injured employees and act as conduits to appropriate resources, ensuring timely support and care for addressing mental health challenges.

Advocacy stands as another cornerstone of their responsibilities, where professional case managers ardently champion the best interests of injured workers. Leveraging their expertise, they ensure access to vital medical and psychological care, serving as vocal advocates navigating the intricate workers’ compensation system to secure essential support. Furthermore, they facilitate the seamless coordination of care by connecting healthcare providers, mental health professionals, employers and insurance companies. This collaborative approach fosters a holistic recovery process, addressing both physical and mental well-being aspects while streamlining communication to minimize obstacles in the workers’ compensation journey. Lastly, professional case managers maintain ongoing contact with injured workers, closely monitoring their mental health progress and enabling timely adjustments to the rehabilitation plan as needed. In essence, they serve as unwavering guides through the complexities of mental health-related workers’ compensation claims, providing consistent support and expertise to facilitate the journey to recovery and a successful return to work (Case Management Society of America, 2022).

The recognition of mental health issues within the workers’ compensation system is a significant step toward creating a more comprehensive and compassionate approach to employee well-being. Professional case managers, with their expertise in navigating the complexities of these cases, play a vital role in ensuring that workers receive the support they need to recover from mental health challenges and return to work successfully.

References

American Psychiatric Association (2023). 2023 Work in America survey. https://www.apa.org/pubs/reports/work-in-america/2023-workplace-health-well-being

Case Management Society of America (2022). Standards of Practice, 5th edition. https://cmsa.org/sop22/

Cunningham, J (2022). Mental health and workers’ compensation snapshot. National Conference of State Legislatures. https://www.ncsl.org/labor-and-employment/mental-health-and-workers-compensation-snapshot

International Risk Management Institute (2017). Mental health and well-being in worker’s compensation. https://www.irmi.com/articles/expert-commentary/mental-health-and-well-being-in-workers-compensation

National Alliance on Mental Illness (2023). Mental health by the numbers. https://www.nami.org/mhstats#:~:text=22.8%25%20of%20U.S.%20adults%20experienced,represents%201%20in%205%20adults.

RogueRisk (2023). Workplace wellness: how workers compensation insurance supports mental health initiatives. https://www.roguerisk.com/insights/workplace-wellness-mental-health

Workplace Bullying Institute (2021). 2021 WBI US Workplace Bullying Survey. https://workplacebullying.org/2021-wbi-survey/

World Health Organization (2019). Burn-out: an occupational phenomenon”. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

 Dr. Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN, FCM, is the associate chief clinical operations officer, care continuum for University of Illinois Health System and the president of the Case Management Society of America National Board of Directors. She has held positions in acute care as director of case management at several acute care facilities and managed care entities in Illinois, overseeing utilization review, case management and social services for over 14 years; piloting quality improvement initiatives focused on readmission reduction, care coordination through better communication and population health management.

Her current passion is in the area of improving health literacy. She is the recipient of the CMSA Foundation Practice Improvement Award (2020) and ANA Illinois Practice Improvement Award (2020) for her work in this area. Dr. Morley also received the AAMCN Managed Care Nurse Leader of the Year in 2010 and the CMSA Fellow of Case Management designation in 2022. Her first book, A Practical Guide to Acute Care Case Management, published by Blue Bayou Press, was released in February 2022.

Dr. Morley has over 20 years of nursing experience. Her clinical specialties include med/surg, oncology and pediatric nursing. She received her ADN at South Suburban College in South Holland, Illinois, BSN at Jacksonville University in Jacksonville, Florida, MSN from Norwich University in Northfield, Vermont and her DNP at Chamberlain College of Nursing.

Image credit: ISTOCK.COM/RUDZHAN NAGIEV

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