Why Some Employees Recover Slowly from a Work Injury

When an employee is injured, their mind can become a whirlwind of thoughts and concerns. Anxiety over recovery, financial implications, and potential long-term effects could all weigh heavily on their thoughts. Their recovery can be influenced by many factors — from injury severity to pre-injury health status; however, one factor that may not be considered is the psychological trauma of the injury. The myriad of emotions caused by a work injury can play a huge role in how long it takes an employee to recover.¹ Any progress an employee makes during recovery could be set back if their mental or emotional state is out of sorts. From a workers’ compensation claims perspective, this could lead to a prolonged and costly injury case. Whether it’s fear avoidance from the pain often associated with rehab, the strain the situation can place on an employee's family, or the impact any work limitation/recovery delay can have on an employee’s self-esteem, these stressors can have ill effects on an employee’s mental health. They can also adversely alter the course of recovery and return-to-work (RTW) outcomes.¹ Facilitating recovery and improving RTW outcomes sometimes requires treating more than an employee’s physical condition. This is where mental health and physical health can intersect during a workers’ compensation case.

Mental health and workers’ compensation

How does mental health fit into a workers’ compensation case from both a medical and regulatory standpoint? This is a question many workers’ compensation stakeholders cannot always clearly answer. Most states cover mental health under their workers’ compensation laws, but some state regulations remain unclear or restrict the delivery of behavioral health. Consequently, some stakeholders may not know how to efficiently manage a work injury case that includes — or should include — a mental health care component. Both worlds do coexist; understanding how is imperative for the sake of both the injured employee and the business.

Work-related injuries can trigger emotional distress that takes many forms including anxiety, depression, or even post-traumatic stress disorder.1 A treating clinician may detect warning signs connecting a mental health-related condition to an injured employee, but providing the appropriate diagnosis and treatment must come from a licensed mental health professional. Connecting an employee’s mental health to a workers’ compensation claim could prove challenging in some injury cases, but not recognizing the warning signs or referring the employee to a qualified medical professional could potentially allow an employee’s mental state — and ultimately, physical state — to worsen. And while minor in comparison, an employer cannot overlook the implications an employee with an undiagnosed or untreated mental health condition could have on the cost of a workers’ compensation claim.

Behavioral health telemedicine

When employees are not advancing in their recovery, and it’s potentially due to mental and/or emotional issues, psychological intervention could help. The clinicians at Concentra® utilize a care model that recognizes how health outcomes can be influenced by biopsychosocial factors. To combat the effects of psychological trauma during a work injury or related event, Concentra’s telemedicine service, Concentra Telemed®, expanded its injury care model to include virtual behavioral health. This added service provides injured employees with access to a licensed mental health professional.

"When employees are injured at work and have psychosocial barriers delaying recovery or have experienced a nonphysical traumatic event, they may need the help of a mental health professional to help them recognize their condition and cope more effectively so they can return to work and their lives," said Lisa Figueroa, MD, Concentra vice president of medical operations, national medical director of health information technology, and national medical director of telemedicine.

When the level of care required to treat an injured employee goes beyond treating the physical condition, Concentra’s behavioral health telemedicine service allows trained clinical psychologists to identify any psychological risk factors that place an employee at greater risk of work disability or delayed recovery. If a treating clinician detects warning signs during a work injury visit, the clinician may refer the employee to a telepsychologist who can perform a wide range of behavioral health services, such as:

• Delayed recovery qualification, assessment, and care
• Psychological screenings
• Mental health diagnosis and treatment

Behavioral health telemedicine will provide the same level of compassionate care as an in-person visit, allowing a telepsychologist to create a connection and build trust.

Removing mental health care barriers

As more employers are contending with the growing need for holistic care in the workplace, they are also facing an even greater challenge: access to mental health professionals. According to a 2023 mental health study, more than 152 million people in the U.S. live in areas with a shortage of mental health professionals.² In these areas, only 28 percent of the support needed from licensed mental health professionals (e.g., psychologists, clinical social workers, psychiatrists, counselors, etc.) is being met.³ Concentra’s behavioral health services will help overcome provider access barriers and eliminate transportation/logistical challenges by conveniently delivering mental health expertise directly to employees using a smart device or computer.

As Concentra assembles a team of clinical psychologists to deliver behavioral health to workforces, a key prerequisite for job candidates is that they are licensed through the Psychology Interjurisdictional Compact (PSYPACT), a multi-state licensing alliance that allows a psychologist licensed in a state that has joined PSYPACT to engage patients [in a virtual environment] in other PSYPACT states.⁴ Concentra believes this will be a game-changer that can help bridge the workplace mental health care gap.

“The reason PSYPACT exists is specifically because of the shortage of psychologists,” explained Jim Harvey, Concentra vice president of telemedicine operations. “So, in conjunction with the growth of telemedicine, it has been a tremendous help in making qualified providers available to patients in need in PSYPACT member states.”

Fighting the workplace mental health stigma

One of the biggest hurdles in addressing workplace mental health could be overcoming the stigma often associated with mental health. A recent study revealed that privacy concerns can be a deterrent when it comes to engaging mental health professionals in the workplace setting.⁵ This revelation helps reinforce a true advantage of telemedicine and adds value to behavioral health telemedicine. Mental health support delivered in a virtual environment can offer a safe space to employees referred to a psychologist following an occupational injury or traumatic work incident. Instead of visiting a brick-and-mortar facility and sitting in a waiting room, an employee can log in for an appointment using a smart device or laptop in a location selected by the employee for greater privacy and comfort.

Aside from privacy concerns, there is also the discomfort of recommending mental health support to coworkers; however, state workers’ compensation policy changes have made it easier to facilitate these conversations.

Mental health support can be critical to the well-being of some workforces, as some mental health conditions can stem from work-related incidents that leave no physical signs of injury. An example would be the need for mental health support in law enforcement and emergency medical services — two industries in which the need to break the mental health stigma is greater due to the unique work-related stress these workforces experience.

“Since 2018, more than 50 percent of U.S. states have enacted PTSD policies for first responders, making it a covered condition under workers’ compensation, or made other policy changes that relax some of the old stigmas around seeking mental health care,” said Harvey.

While some occupations such as police officers and paramedics may be considered more stressful than others, an employer should not retain mental health support based on industry, job type, or perceived level of occupational hazard. An employer’s goal should be to implement behavioral health preventive and treatment solutions that help foster a psychologically safe workplace culture with no regard to the type of work.

Improving mental health for better injury outcomes

Concentra’s focus is on mitigating chronic care delays for employees who need more than traditional injury care during a workers’ compensation case. By embedding a team of mental health professionals in their workers’ compensation telemedicine service, Concentra is helping injured employees recover faster by providing a level of care that addresses the biopsychosocial aspects of an occupational injury or nonphysical incident. Employers and payors stand to gain subsequently from shorter injury case durations and reduced workers’ compensation spend.

Find out if Concentra’s behavioral health telemedicine is available in your state. Contact your Concentra account manager for more details or request a telemedicine consultation.

Sources:

1. Kellezi, Blerina, et al. “The Impact of Psychological Factors on Recovery from Injury: A Multicentre Cohort Study.” Social Psychiatry and Psychiatric Epidemiology, vol. 52, no. 7,  Nov 1, 2016, pp. 855–866. https://doi.org/10.1007/s00127-016-1299-z.
2. Reinert, M., Jr., Fritze, D., and Nguyen, T. Mental Health America. (October 2022). The State of Mental Health in America 2023 [Report]. Mental Health America. https://mhanational.org/sites/default/files/2023-State-of-Mental-Health-in-America-Report.pdf.
3. Health Workforce Shortage Areas. (n.d.). U.S. Department of Health and Human Services. Health Resources and Services Administration. https://data.hrsa.gov/topics/health-workforce/shortage-areas.
4. Legal and State Advocacy Staff; California Psychological Association. (2021, January 15). What to know about doing telehealth in a different state. https://www.apaservices.org/practice/legal/technology/telehealth-different-state.
5. Newell, C. J., Ricciardelli, R., Czarnuch, S., and Martin, K. (2021b). Police staff and mental health: barriers and recommendations for improving help-seeking. Police Practice and Research, 23(1), 111–124. https://doi.org/10.1080/15614263.2021.1979398.