When it comes to workplace injuries, mental illness often comes second to physical issues. Employers are focused on treating visible injuries, such as a broken bone or a strained muscle, and they often overlook symptoms of psychological strain. 

For injured employees, however, psychological symptoms may be at the forefront of their injury experience. Without work, many worry about financial security or become depressed by the loss of a usual routine. Physical symptoms, such as pain from the injury, will only add to their mental stress. 

“They’re worried about where their next check is going to come from. They’re worried about if they’re going to keep their job. They’re worried about their health in general … Some of that I do think can lead to depression,” said Marty Brooks, account manager at Absentia Solutions. 

In order to address mental health in workers’ compensation, employees need to rely on facts and proven treatment methods. A just-the-facts approach is difficult to maintain, however, given that numerous myths about mental health exist both inside and outside of the industry.

Here are seven persistent myths about mental health and their effects on the workers’ compensation industry. 

Myth #1: Mental Health Is a Personal — Not Professional — Problem 

One of the first mistakes employers often make when it comes to behavioral health in workers’ comp is treating it like a personal, rather than professional, problem. Toxic work environments can cause mental stress for employees, which could leave them anxious about returning to work after injury. 

Teresa Bartlett, SVP, senior medical officer, Sedgwick Claims Management Services

“Some employers fail to recognize that they have a bit of a strenuous, stressful or even toxic environment going on,” said Dr. Teresa Bartlett, senior medical officer at Sedgwick.

“Everybody in their life has had that coworker who doesn’t vibe or mesh with the team, and they don’t socialize; a lot of times they’re not pleasant to be around.

“Often, unfortunately, these conditions end up being those cases where the person will go off for a minor short-term disability or workers’ comp claim, and nobody wants to help place them back at work, because everything has been so good when they weren’t there … It ends up turning into a very toxic situation,” she continued.

In order to address this, employers should work to make sure that their office is a welcoming, compassionate place and that any issues between employees are swiftly investigated and handled appropriately. 

“One of the keys is having a good culture to begin with, making sure that there’s a culture in place where it’s open, there’s some transparency, where an injured worker isn’t reluctant to report a workplace injury in the first place,” Brooks said. 

Myth #2: Only Workers with Pre-Existing Mental Health Struggles Will Have Psychosocial Components to Their Claims   

One common misconception is that in order for behavioral health issues to affect a claim, either a catastrophic injury has to cause the onset of the psychological disorder or the worker has to have previously experienced a mental illness.

Many people think that less severe injuries, such as a broken limb caused by a fall or low back pain, won’t lead to negative psychological symptoms in a neurotypical person. 

Yet research shows that even minor injuries can bring on symptoms of anxiety and depression in otherwise mentally stable individuals. A study of 332 of workers who experienced work-related musculoskeletal injuries found that about half experienced symptoms of depression during the first year after the injury. 

“Having psychosocial issues doesn’t mean the individual has a psychiatric disorder,” said Mariellen Blue, RN, CCM, national director of case management services and product management and development at Genex. “Instead, they might be exhibiting minor cognitive distortions, which relate to how they think and feel about a situation.” 

Developing symptoms of depression after a minor injury, such as a broken bone, is so common that some psychologists have nicknamed this type of adjustment disorder “broken bone depression.” 

For some, this type of depression is caused by the disruption a workplace injury brings to their lives. Others may experience increased anxiety related to their unique personal histories.

A person who grew up in a family that did not make enough money to survive, for example, may worry their injury will prevent them from returning to work, which can cause them to catastrophize the event and delay recovery. 

“People that you hire have histories. They don’t come to you just fresh and new,” Bartlett said. 

“When someone is hurt on the job, you have to take into account the personal life experiences that may delay recovery and impact how they may perceive the accident and how it could lead them to maybe catastrophize the event.”

Myth #3: Once the Body Is Healed, Mental Health Problems Will Go Away

Some employers think that if they focus on treating the physical injury then the mental health conditions will go away, but often that’s not the case according to Bartlett. 

“Many claim companies believe that if they ignore the mental health aspects of a claim, they’ll just go away and that doesn’t work out well,” she said. 

Kevin Turner, chief executive officer, Paradigm Catastrophic Care Management

Sometimes the last hurdle an injured employee has to overcome is related to their mental health, rather than their physical injury. Employees may feel emotionally under-prepared to return to work and they may mistake their anxiety for physical symptoms of pain. Putting someone in a work environment when they’re not mentally prepared to return can also lead to re-injury.  

“Oftentimes that last outcome you need to reach is not physical, it’s mental,” said Kevin Turner, CEO of Paradigm Catastrophic Care Management.

“You don’t want to send somebody back to work who is not mentally ready to go back to work. They may have met the physical requirements to go back to work but if you put someone back in the work environment that still is suffering from depression or has family issues, it’s going to impact not only the injured worker and the family, but the employer as well.”

Myth #4: Mental Health Problems Drive Up Claims Costs and Delay Return-to-Work

It’s pretty easy to understand why many claims professionals believe that mental health conditions drive up the costs of claims and delay return-to-work.

A report from the International Risk Management Institute estimates that substance abuse and mental health disorders cost employers between $80 and $100 billion in indirect costs. 

Another study found that of workers who reported feeling symptoms of depression one month, six months and a year post injury, only 10% were able to return-to-work. 

The link between high claims costs, delayed return-to-work and mental health seems obvious, but many employers have the connection backwards. It’s not the depression that causes the inability to return-to-work; it’s the inability to to return-to-work that causes the depression.

“Work really defines who you are as a person. It gives you purpose in life. When that’s taken away from you, depression is something that can set in,” Blue said. 

Once depression sets in, symptoms like insomnia, headaches and body pain can make it harder for an employee to return to their pre-injury routine, leaving them trapped in a cycle where they feel depressed because of a lack of work, but can’t return due to side effects from their mental health condition. 

Myth #5: You Have to Buy the Psych Portion of a Claim to Treat Mental Health 

One of the most common things employers and workers’ compensation program managers say about mental health is that they don’t want to buy the psych portion of a claim.

 Sometimes this is due to the fact that the injured worker’s mental health problems are not compensable, which causes employers to want to focus solely on the work injury. 

“The employers want to separate ‘that is not a work-related condition; this is my work-related condition; let me solely focus on the work injury,” Brooks said.

“Oftentimes the mental health component is not compensable,” Bartlett added. “But to just ignore it is such a big mistake because it doesn’t go away and it often lengthens the duration and the complexity of the claim.”

Mental health benefits, such as Employee Assistance Programs, can give injured employees a resource outside of workers’ compensation for managing any behavioral health symptoms they may experience during a claim. “I think it’s important for an employer to have an EAP program so it isn’t just limited to workers’ compensation,” Brooks said. 

Workers’ compensation programs can also treat the mental health components of a claim by shifting to a biopsychosocial model, where an injured worker’s physical health, mental health and social environment are considered when making a treatment plan. 

Workers’ comp programs can either create their own methods of biopsychosocial care, or they can work with partners, such as nurse case managers, to provide it. 

Recently a wealth of new technologies have sprung up claiming to evaluate an injured worker’s biopsychosocial factors and identify treatment for them. In Paradigm’s case, they’re working with AiRCare Health, a data-driven behavioral health care company, to identify and treat biopsychosocial risks. 

“They brought us social workers, clinical psychologists, financial advisors that are there to solve for those types of things that are not directly related to the claim, but are needed to get that recovery that we talked about,” Turner said of the partnership. 

“I just think in our industry the time has come to really define what advocacy is, and to broaden the scope in order to solve for the injured worker’s whole person, which includes medical, behavioral, and social.”

Myth #6: Mental Health Can’t Be Approached from a Preventative Standpoint

Mariellen Blue, RN, CCM, national director of case management services and product management and Development, Genex

While mental health conditions may not be able to be prevented, they can be effectively managed if approached from a preventative mindset. Detecting and addressing mental health conditions early can help reduce the length of a claim and its costs.

“The first sixth months following an injury is the  best opportunity for screening, to determine risk for depression and other psychosocial issues and be proactive in implementing  strategies and interventions to address these issues so they don’t spiral out of control,” Blue said.

Screening tools such as the Orebro Musculoskeletal Pain Screening Questionnaire and the Pain Catastrophizing Scale, can help providers understand how a patient is processing their pain and can help uncover potential mental health pitfalls they may experience. 

Having injured employees work with a nurse case manager can also help workers’ comp teams identify workers who need more psychological support. 

“Case managers often play a role, similar to a detective, in discovering what underlying problems there may be that could be delaying the claim,” Blue said.

“They’re interviewing the injured employee, they’re gathering information. They’re listening for cues. They’re listening for ways to identify potentially hidden risks, hidden factors that are affecting the outcome and the recovery process,” Brooks added. 

Myth #7: Mental Health Is No Longer Stigmatized

As discussing mental illness becomes more commonplace in society, many in the industry may think that the stigma behind behavioral health in workers’ compensation may be gone as well.

But many workers’ compensation professionals are still wary of discussing and treating mental illness.  

“Despite society becoming more open to realizing the importance of mental health, I think the stigma still exists,” Blue said. 

“Mental health has traditionally been considered, for lack of a better word, a pariah in workers’ compensation and case management. People didn’t want to talk about it because they thought, ‘if I say something about it, my costs are really going to go out of control.’ ”

This stigma prevents workers’ compensation professionals from realizing just how widespread mental illness is in workers’ comp. Seventy-nine percent of workers said they experienced stress at work during the last year and 49% believed that their manager or supervisor wouldn’t know how to respond if they talked to them about mental health conditions, according to a report from Capita Employee Benefits. 

“There are more mental health issues than people realize,” Brooks said. “I think that employers underestimate the number of folks that have mental health challenges and the impact that it could potentially have on a work-related injury.”

In order to prevent mental health issues from causing claims to spiral, experts say that everyone in the workers’ compensation industry needs to work to confront the stigma. If employees feel supported, they may not be as fearful or worried in the aftermath of a workplace injury. &