Employment Practices

Distress Signals

There are a growing number of resources available to address employee mental health issues.
By: | October 15, 2016 • 5 min read

What happens when an employee starts exhibiting signs of mental illness after they’re hired? It can be difficult for organizations to balance the need to reasonably accommodate mentally ill people with productivity needs and fears of potential violence.

But the amount of resources available to help employers support such workers is rising.

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“Work is such an important influence on a person’s quality of life, including their financial well-being, that giving up a job is not an option,” said Debra Lerner, director of the Program on Health, Work and Productivity at Tufts Medical Center in Boston.

For many, the onset of mental health issues can make it difficult to perform a job, even one the person did well before becoming ill, Lerner said. For example, some people dealing with depression have trouble with memory or being organized.

Others may not sleep well, which can make it difficult for them to get to work on time or to “hit the ground running” after arriving.

“Staying on task, especially when interruptions occur, can be difficult,” Lerner said. “Interpersonal issues are common and interfere with relationships with customers, supervisors or co-workers.”

Employers can get recommendations from the Equal Employment Opportunity Commission’s job accommodation network, which are tailored to the person’s illness and limitations as well as their job demands. Employers can also refer workers to resources such as Tufts’ Be Well at Work program to help people suffering from depression learn approaches to being effective on the job.

“One of the program’s benefits is a method for assessing which aspects of working are most difficult and intervening with specific suggestions for improving ability to function,” Lerner said.

Tom Parry, president, Integrated Benefits Institute

Tom Parry, president, Integrated Benefits Institute

Another resource is the Integrated Benefits Institute, a San Francisco-based research organization that aims to demonstrate the connection between improved health, well-being and business performance at companies, said Tom Parry, president.

“We take a very broad view of these issues, so that employers make proper investments in health and understand the much broader outcomes that are more important to their business than just health care costs,” Parry said.

Most employers have typically used medical and pharmaceutical claims data to identify key health conditions. But since behavioral issues tend to be underreported, they typically “don’t rise to the top,” Parry said.

IBI provides employers with information from third parties to find ways to identify issues and conditions, without violating privacy rules per the Health Insurance Portability and Accountability Act. Alternatives include working with their employee assistance programs and conducting well-being surveys.

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“One of the real challenges to improved behavioral health management is the stigma that goes along with those conditions, which has made it hard for employees to self-identify around those issues and seek help,” Parry said. “That’s changing, but it’s still a big part of the problem.”

Need Can Be Implied

Sometimes the employer must initiate the interactive process required by the Americans with Disabilities Act, said Carla O’Sullivan, education programs manager at Disability Management Employer Coalition.

“The employer always has to take the employee’s privacy into account, and they should not request information or ask inappropriate questions,” O’Sullivan said.

“But it is absolutely in the employer’s best interests to speak to the employee … particularly if the employee had been doing great but then all of a sudden they are not. It could be that the employee needs to be referred to an employee assistance program, or maybe it’s just a matter of being supportive.”

While the onus is typically on employees to request accommodations, they don’t have to actually use the words “reasonable accommodation” if the need is obvious, said Frank C. Morris, Jr., of Epstein Becker & Green P.C.

“For example, if an employee tells a supervisor that they need to go twice a week for medical treatment for the next six months, or requests time off for extended medical treatment, the EEOC and the courts will likely find this to be sufficient notice of an accommodation request,” Morris said.

One potential accommodation could be allowing employees time off to adjust to new medications or a new combination of medications, he said. But it should be for a reasonable and finite period of time until the problem can be controlled and for the employee to resume being productive at work.

Carla O’Sullivan, education programs manager, DMEC

Carla O’Sullivan, education programs manager, DMEC

Employers can ask workers for the medical opinion that demonstrates their disability, and then get a second opinion by their own medical professional, said J. Bradley Young, partner, Harris, Dowell, Fisher & Harris LC. Those professionals can help structure reasonable accommodations.

“For example, if the employee’s psychiatrist has prescribed the anti-psychotic Thorazine, that medication typically makes people sleep 20 hours a day — and it would not be reasonable to have the employer provide a bed to sleep on the job,” he said.

“However, a reasonable accommodation would be to have a different psychiatrist prescribe different medications instead of Thorazine that would not make the person too sleepy, allowing them to continue in their job.”

Outside Assistance

Employers do not have to accommodate people who are violent or make any threats of violent action, even if the employee has a mental disorder, Young said.

“They can be removed from the property and terminated,” he said. “But if an employee is simply acting erratically, that’s a completely different story.”

Employers can ask to have the person taken to a psychiatric hospital for evaluation, and if the employee is diagnosed with a mental disorder, the employer and employee have to work together to try to come to a mutually agreeable decision on a reasonable accommodation, Young said.

Some disability carriers have mental health consultants who can assist employers with proactive accommodations to help at-risk employees avoid a disability leave, or with return-to-work plans that can help an employee transition back to the workplace after taking a leave, said Brian Kost, director of the workplace possibilities program at The Standard, a disability insurer based in Portland, Ore.

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For employers that have at-risk employees, mental health consultants can help ensure that employees are connected with resources — such as an EAP or wellness program — for assistance, Kost said.

“Above all, a consultant can help an employer and employee communicate better by keeping everyone involved up-to-date on an employee’s condition, his or her medical restrictions, when they may be returning to work and potential accommodations,” he said.

“This collaboration and communication can go a long way to ensure success.”

Katie Kuehner-Hebert is a freelance writer based in California. She has more than two decades of journalism experience and expertise in financial writing. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]