Rethinking Mental Health Disability Claim Management
HOW AN INNOVATIVE DISABILITY MANAGEMENT PROGRAM SIGNIFICANTLY LOWERED THE INCIDENCE AND DURATION OF COMPLEX MENTAL HEALTH CLAIMS IN A CANADIAN WORKPLACE
By Dr. Liz R. Scott, Ph.D. and Carl Dalton
The number of people suffering from mental health issues in Canadian workplaces continues to grow. Even for those not directly affected, the impact a mental health issue has on an individual’s quality of life often affects their families, work colleagues and the wider community. The economic impact is staggering. A study in 2008, including the cost of health care, lost productivity and the reduction in health-related quality of life, estimated the sum at about $51 billion per year.
For HR professionals, it is a big and growing area of concern. Not only is there the direct influence on work environments and productivity, but many employees with complex mental health issues (such as depression or anxiety) will go on short-term disability leave. This happens in about 20 to 30 per cent of cases. The issues can also cause repeated and chronic absenteeism.
Is there a way to help make things better? A new approach suggests there is. Incorporating return-to-work-focused psychological treatment with the disability management process is an innovative process that organizations can implement to increase success. The first major trial, conducted with a large Canadian manufacturing firm, has shown a significant reduction in both the volume and duration of complex mental health claims. Over the first two years, the number of claims fell by 56 per cent and the days away from work fell by 52 per cent (see Table 1).
Table 1: Complex Mental Health Cases
Number of Claims
|Average Duration (in days) of Complex Mental Health Claims|
|Post-Program – Year One 2014||61||57|
|Post-Program – Year Two 2015||34||45|
HOW IT WORKS
The strategy works by combining return- to-work-focused cognitive behavioural therapy (CBT) with disability case management. Together, they often increase the employee’s wellbeing and decrease the employer’s overall expenses.
WHAT IS COGNITIVE BEHAVIOURAL THERAPY?
CBT comes from the theory that how we think about and interpret our feelings is an unconscious choice – something outside of our control. These behaviours lead us to establish firm beliefs about our identity, about “who” and “what” type of person we are. If a person is exposed to adverse or negative challenges, there is the risk that they will believe a negative reaction is beyond their control: “This is who I am.” This can increase emotional distress. An example of this is in cases of depression where repeated negative thoughts (or rumination) can often make the symptoms of the illness worse.
In CBT, the employee learns to question their own firm beliefs, opening up new roads for personal growth and building a different way of being in the world. During the treatment, the person learns to become aware of dysfunctional thinking and behaviour and develops new interpretations of it during a gradual re- introduction to the stressful situation.
HOW CBT SUPPORTS THE DISABILITY MANAGEMENT PROCESS
One of the most important factors for success in the program, and overall disability outcomes, is the support of the HR department and the wider organization. It is vital that workplaces, as well as teams, support the employee’s unique situation and are not adversarial. The culture of the company must also embrace and support return to work. When the employee knows that their employer, healthcare providers and disability case managers have their best interest at heart, it significantly improves the success of a timely and sustainable return to well-being and productivity.
In the program, the treating psychologist understands how to utilize the skills, strategies and resources of disability case managers. This makes a big difference to the outcome. The case managers have a strong focus on the employee’s progress during treatment and how it fits into a return-to-work plan. Disability management programs also focus on psychosocial rehabilitation; that is, building the confidence and ability of the person to the point where they can take an active part in work, community and normal life.
By working closely together, the therapist and the disability case manager are able to build the employee’s resilience and ensure that the person has the confidence to return quickly back into an active working role. The program also has a holistic approach to help develop long- term resilience and coping skills – for example, personal “homework” strategies and sustaining healthy lifestyle habits such as exercise, relaxation, social interaction and others.
“WHEN THE EMPLOYEE UNDERSTANDS AND BELIEVES THAT RESILIENCE IS A PROCESS THEY CAN LEARN THROUGH THERAPY AND SELF-WORK, THEN IT BECOMES EASIER TO FOCUS ON BUILDING THE SKILLS THAT WILL PREPARE THEM TO ADDRESS THEIR PROBLEMS.”
Resilience is a person’s ability to properly adapt to negative life situations and adversity. This could be family or relationship problems, health problems or workplace and financial worries, among others. How a person copes with these situations can be influenced by anything from personality to social relationships, cultural context to the environment. When the employee understands and believes that resilience is a process they can learn through therapy and self-work, then it becomes easier to focus on building the skills that will prepare them to address their problems. They can do this in a way that is not detrimental to themselves or their workplace.
It is also important to understand the psychological demands of the job and design the return to work accordingly. These include: cognition, critical thinking, social interaction, memory, etc. The
disability management and therapy teams must understand the essential nature of the employee’s job. Some jobs are “achievement oriented,” for example, they need traits of effort, persistence, concentration and initiative; others may be “interpersonal,” with focus on co-operation, teamwork and concern for others.
Crucially, programs need to be closely supervised and monitored to ensure the return to work is sustained. They should also identify if and when any additional treatments are needed to improve the overall outcomes. It is believed this program will lead to continued long-term positive outcomes.
Liz R. Scott, Ph.D. is the principal of Organizational Solutions Inc. Carl Dalton is a registered social worker and vice-president of Dalton Associates Psychological Services.