Mental health absenteeism threatens to break disability bank

HR should set up an infrastructure for early intervention and a program to address challenges arising for employees returning to work
By Paula Allen
|Canadian HR Reporter|Last Updated: 03/22/2004

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here’s good news as well as bad news in the field of disability management. The good news is more employers than ever have access to disability management programs. The bad news is employer costs due to health-related absenteeism are rising rapidly. Disability management programs once had a positive impact on costs, but they are not as effective as they were. Why? And what can be done?

The why is straightforward: Most programs were designed to manage physical problems. However, there’s an increasing number of mental health claims and claims that are influenced by non-medical factors such as conflicts between co-workers. Disability management guidelines do not help resolve problems such as performance or personality conflicts.

To alleviate the situation, HR departments should establish an infrastructure for early intervention, and a program to address the unique challenges that may arise for employees returning to work.

The dramatic increase in disability management claims has put a strain on public and corporate resources — we just can’t cope anymore. Employers and disability management professionals must reassess their management of claims involving mental health issues. This reassessment must involve each of the three main areas that affect disability management: occupational, psychological and medical issues.

Occupational factors

Unresolved work-related conflicts can lead to feelings of fear, frustration, anger, hopelessness — all potential precursors to absence. When a conflict is coupled with a demanding and fast-paced environment, the result is often a “flight” response from the employee.

Several studies point to the importance of workplace relationships and employee perceptions as major predictors of how quickly someone returns to work. While such issues are not limited to mental health claims, a disproportionate amount of lengthy stress-related and physical disability absences have workplace issues as a complicating factor.

Negative perceptions are likely to amplify during an absence and affect how quickly the employee returns to work. The usual reasons for delay are the employee’s motivation and ability to focus on regaining productivity, and the motivation of the supervisor to facilitate reintegration.

As in all disability management interventions, early response is critical. Occupational interventions focus on workplace relationships, agreements regarding how work will be organized and the expectations of all parties. Critical elements of an occupational intervention should include:

•support for the workplace relationship by means of open and respectful communication focused on the issues at hand;

•clarification of issues that affect the ability to work productively, such as how work is organized;

•recognition of options and constraints, such as the ability of the employer to modify some non-essential activities of a job;

•a problem-solving framework that clarifies alternatives, including different ways to do a job, and provides an action plan so that the best options can be put in place;

•a communication structure that includes both the employee and direct supervisor discussing, negotiating and agreeing on how work should be structured to enable the employee to be the most productive.

The challenge is to establish a comprehensive response and a framework that shows respect for both the employee and the workplace.

Psychological issues

The employee’s perceptions, beliefs and patterns of behaviour all affect the response to a disability.

While not limited to these, three common situations suggest the need for psychological intervention:

•An employee who may or may not meet the criteria for disability benefits, but is experiencing a level of stress that’s interfering with the ability to function at work.

•An employee who has had a prolonged absence from work due to physical illness and appears to be losing the motivation to return.

•An employee who is in conflict about complying with recommended treatment, and sabotages treatment interventions.

The core principal of disability management is to help the employee return to normalcy, or as close to normalcy as the situation allows, as soon as possible. Unfortunately, the quality of psychological services does not always mesh with these goals. Psychological services, may actually advocate for absence without having all the information on the options the workplace can provide.

The first step must be a comprehensive assessment to clarify the psycho-social issues affecting working capacity. Experienced therapists can assist employees in building resiliency in the face of any psychological stress. They can also support the management of depression and anxiety, as well as other work-related concerns. In the best of all worlds, the therapist becomes a part of the disability management intervention team, playing a key role in the communication process.

Many psychological therapists feel their relationship with the employee precludes them from supporting a return-to-work initiative. These therapists should be provided with specific training and clear protocols to ensure they understand that disability management supports recovery, appropriate accommodation and eventually independence and health. Disability management goals are aligned with therapeutic goals.

Medical issues

In 2001, the Fraser Institute published research indicating that in 2000, Canadians waited 16.2 weeks from a general practitioner referral to appropriate treatment, a figure that’s 23.7 per cent higher than in 1999.

Lack of timely care adversely affects the employee’s quality of life, level of anxiety and recovery potential. For mental health problems, this is compounded by the relative shortage of psychiatrists and the under-treatment of depression in general.

The fact is that depression and many other mental health conditions are treatable. Understanding an employee’s symptoms is critical for comprehensive disability case management.

Once clear, the objective is care that both follows evidence-based guidelines and considers the potential impact of any medication on the employee’s ability to function during working hours.

There are, however, challenges. For example, physician’s reports are typically less precise for mental health conditions than they are for physical conditions, and secondary mental health conditions (dual diagnoses) increase complexity and prolong recovery.

Employers need to take a more active role in at least two key areas. First of all, they need to lobby, as a group, for improved access to care in the public system. Health affects productivity and ultimately the competitiveness of Canadian business.

Secondly, employers need to take some individual responsibility and not expect such change to be the solution. They must improve the management of disability issues by treating employees as individuals, not claims. Employers must address each situation comprehensively rather than relying on a one-dimensional approach.

Where to start?

Any delay in developing an infrastructure to comprehensively manage disability puts an organization at risk. Begin by considering the following:

•Consider how your organization responds to claims where multiple issues (psychological, workplace, and medical) exist.

•Determine where the approach to managing disability claims is strong and where it is not.

•For the areas where the approach falls short, determine whether you can fill the gap. For example, additional services from an employee assistance plan or disability management provider may be one option.

•Once resources are in place, make sure that processes are streamlined and efficient. Complex cases must be identified quickly and accurately to ensure the appropriate early intervention.

Disability management for mental health claims needs to be managed in a way that deals with all potential challenges. A comprehensive approach to address mental health issues ensures better management of the personal, organizational and financial risks for a corporate disability plan. Ultimately, it results in a positive employment culture and significant return on investment.

Paula Allen is business leader, disability management, for FGI, a leading provider of international employee and employer support services, based in Toronto. She can be reached at pallen@fgiworld.com.

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