Improving outcomes: PTSD in the workplace

June 27, 2022

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By Beth Burry-Jackson, SVP, managed care operations

Post-traumatic stress disorder (PTSD) claims can be particularly tricky due to the shifting nature of the diagnosis.

Greater awareness around mental health is helpful, but there are several factors that greatly impact a patient’s outcome. The challenge with PTSD claims is in identifying the circumstances that could lead up to a future diagnosis. Unlike a physical injury, PTSD is not something that gets diagnosed on day one of a claim; rather, it develops over time.

Here are a few examples of the types of PTSD cases Sedgwick’s claims teams may see, and how we respond:

  • Margaret, a retail pharmacist who was robbed at gunpoint while working at the pharmacy, has been off work ever since the incident. She was not leaving her home and not driving her car at all secondary to feeling unsafe. Sedgwick’s behavioral health solutions (BHS) team was engaged to provide support and immediately started direct communication with Margaret and her treatment provider to explore and provide trauma psychoeducation and coping mechanisms to address her anxiety and agoraphobia. The team worked with Margaret’s care provider to develop a gradual return to work plan alongside therapy appointments to acclimate her slowly and supportively back into the workplace.
  • Kathy is a flight attendant who was physically assaulted by an irate passenger. Kathy sustained physical injuries, including a concussion and suffered from Acute Stress Disorder, eventually turning into a PTSD diagnosis. Sedgwick’s BHS team helped coordinate the appropriate care for Kathy’s physical injuries and kept in contact with her neurologist. We were also able to connect Kathy with an EMDR trauma-focused therapist two times a week to address her initial symptoms with early action. Kathy received psychoeducation and coping training, and her care teams coordinated regularly to provide ongoing support, access to care and the appropriate health services to provide a safe return to work opportunity. Eventually, Kathy was able to successfully return to work after some test flights and a final evaluation from her care providers.
  • Insurance investigator Bob was injured in a motor vehicle accident. His car was struck by another car on a two-lane highway, and the other car then collided with a truck that was following Bob’s car. Although Bob survived the crash with minor injuries and some neck strain, the other driver was killed instantly in the crash and Bob witnessed the traumatic scene when he left his car to try to help the other driver. Sedgwick’s BHS team was engaged quickly to find a trauma/EMDR therapist and a psychiatrist to address Bob’s severe stress symptoms following the accident. This psychoeducation gave Bob guidance on case-specific self-help techniques to incorporate into his life while he waited for a referral for clinical care and return to work readiness preparation. The BHS team stayed engaged with Bob’s care providers throughout his treatment.

In each of these examples, Sedgwick’s behavioral health solutions team followed several key guidelines to ensure effective PTSD treatment with positive outcomes.

Early identification

People affected by PTSD have a better chance of recovering and returning to work quickly if early intervention steps take place, rather than waiting for the person’s symptoms to introduce themselves. In these cases, patients may eventually report heightened and fearful responses to everyday stimuli, re-living the event in their thoughts or dreams, or experiencing survival guilt about the event. By the time patients report these trauma symptoms, they’ve lost crucial recovery time. Some patients may not even report their symptoms at all.

There are different ways to determine how early PTSD may be a factor in a claims case. Sometimes, care providers can evaluate the case based on the description of the traumatic event – common cases include those involving assault, mass casualty events or large accidents where people witnessed traumatic events at the scene. Providers can anticipate the need for mental health support so that if PTSD symptoms begin to form, patients are already receiving counseling, so the mental health impact won’t be as severe.

As claims technology improves, artificial intelligence (AI) models can assist claims services and case management experts in determining early ways to identify claims that are a more complex clinical circumstance. AI technology has improved to begin to recognize potential PTSD patterns earlier in the life cycle of claims and can flag these claims to management experts much earlier. With further evaluation, claims providers can intervene and initiate PTSD care steps sooner, reducing the overall time and cost of care while getting the patient back to work sooner and healthier.

Right providers, right treatment plan

It’s important to identify PTSD symptoms as early as possible, but it’s equally important to ensure that the patient is getting the right kind of help for their unique circumstance. Just as a patient wouldn’t visit a spine surgeon to address a cardiac issue, Sedgwick’s BHS team helps ensure that patients are referred to the right provider with the right experience.

Providers are not created equal in the psychiatry space – each mental health expert has their own specialties, fee schedules and insurance guidelines. In the above examples, our team worked with care providers to match each example PTSD case with multiple mental health specialists with specific expertise to match the patient’s needs and ensure providers accept workers’ compensation plans.

What’s most encouraging is that there are many resources available for people that experience traumatic events on the job, especially with the right care team and protocol helping process their claims. There are many treatment options available to address PTSD symptoms in a therapeutic environment where patients can continue to live their lives and eventually reengage with society and their job.

To learn more about Sedgwick’s managed care services, visit our website.

Stress, mental health issues and workplace injuries and illnesses – a look at the impact

June 25, 2014

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The University of Illinois at Chicago (UIC) research paper on Stress in the workplace highlights the costly impact of stress and mental health issues on workplace injuries and illness, including higher risk of injury, medical treatment, lost time from work and presenteeism. We also know that mental health issues, including depression, have been found to have a much higher impact on presenteeism than other chronic illnesses.[1] Mental health disorders often have symptoms that are not readily apparent; employees may attend work, but their underlying health condition affects their ability to do the work or even distracts them from safe work behavior.

Many employers already offer health management benefits that provide employees with support for mental health and emotional well-being overall through employee benefit programs. This is partly because of other research, like that of UIC, demonstrating a strong relationship between these health issues and employee presenteeism, lost time from work, overall productivity and risk of injury/illness.

UIC researchers identified three key areas for employer initiatives. With National Post-Traumatic Stress Disorder Awareness Day approaching on June 27, we would like to build on their recommendations by offering some thoughts for additional actions employers can take – using available resources and medical/disability data – to mitigate the impact of lost productivity and presenteeism from stress and other mental health illnesses. We also encourage employers to develop initiatives that cross internal silos to share information and health intervention strategies for occupational and non-occupational injury and illness. Integration can vastly improve results in addressing this issue.

Organizational

  • Develop a broader organizational initiative to not only develop managers who are supportive of employees at work, but also to create a strong organizational culture – with C-suite leadership – that is supportive of employee health and well-being 24/7.
  • Ensure employee access to wellness and prevention offerings such as: employee assistance programs (EAP), disease management, personal financial counseling, stress management and resiliency training. Make sure managers are familiar with them and can talk to employees about using the services. For parents, services like same-day care services for sick children and flexible work schedules can be valuable stress alleviators that increase attendance as well as attention to work tasks.
  • Other stress reducers in the work environment can include offering exercise classes, group walks or walking contests and other social/community events that engage employees in building positive, friendly relationships with colleagues. Having community and shared experiences can reduce perceived stress and isolation.

Screening and supportive services for high-risk individuals

  • Use an employee health risk assessment (HRA). This self-assessment, offered to all employees, is a common employee benefits tool for identifying other individual and population risks. Many companies use employee incentives (cash, gift certificates or health premium reduction) to encourage high engagement levels.
    • HRA individual results are usually kept confidential from the employer. However, independent healthcare management vendors can be engaged to reach out to employees with health risk indicators and help guide them to intervention programs like EAP or provide referrals to mental health providers, etc.
    • HRA summary data information can be used to see the varying risks in the population as a whole; sometimes data can also be broken down by business unit or occupation. Interventions can then be designed – i.e. resiliency training for employees who are under high stress, or more visible communication on EAP resources, stress reduction techniques, crisis intervention initiatives, etc.
  • One data resource often overlooked is Family Medical Leave Act (FMLA) and short term disability (STD) frequency and cause of absence. High absence rates, especially in units that have high-stress environments, can be an important red flag. FMLA summary information can be reviewed in conjunction with summary data from HRA, STD and workers’ compensation reports to identify occupations and business unit populations where stress or depression may be a factor.
    • Integrated Benefits Institute (IBI) research in 2013 showed FMLA usage to care for a family member more than doubles the risk of an STD claim for employee disability[2] due to mental health issues within a year. It seems reasonable to think this stress could show up in other areas, as well, i.e. increased risk of presenteeism, work injury or extended disability while off work due to other health issues.
    • For many employers, FMLA intermittent leave has a high absence rate for mental health and depression, and often the reason for leave is available to the leave administrator. This is an area where referral to employee health resources can be a valuable intervention.

Managing the risk of prescription drugs that impair performance

  • Many employers have access to their prescription drug usage in summary data. Usually this data includes drug names, frequency of prescriptions and costs, as well as break-out by business locations or zip codes.
  • Use of this summary data to identify drug use in employee populations that may increase the risk of injury is a first step to understanding what risks may exist and what methods can be used to ensure all employees are safe to perform work tasks.
  • Use of the company medical director or a trusted physician consultant as an advisor to assist in this data review and in development of alternative intervention strategies is recommended. Interventions could have high impact on employees, as well as operations and safety. Incorporating legal and human resources into this process is also highly recommended.

Many employers are realizing that mental health and emotional well-being can greatly impact overall health issues, employee presenteeism, lost time from work, overall productivity and risk of injury/illness. Is this a growing concern for your organization too? I look forward to hearing your perspective.

Denise Fleury, SVP, Disability and Absence Management

Read more in our “stress in the workplace” series: part 1part 2


[1] IBI Chronic Disease Profile, Depression, IBI, 2013 [2] “Early Warnings: Using FMLA to Understand and Manage Disability Absence,” IBI, 2013