Within the occupational health care ecosystem, payers and providers have long recognized the need for behavioral and mental health services. This is particularly true for first responders, health care workers, and transportation sector workers who are more likely to witness traumatic situations firsthand, but also pertains to any injured worker who may be experiencing psychological stress.

“With workplace violence on the rise, organizations must be ready to address emotional effects of trauma and employee needs following an incident. Often mental health struggles are not evident on ‘day one;’ by definition, symptoms of PTSD are identified much later. To ensure readiness of response, employers must take action to identify resources and specialists who can proactively address the emotional aftermath associated with a serious workplace incident,” said Beth Burry-Jackson, MA, CRC, ARM, Managing Director – Managed Care Programs, Sedgwick Claims Management Services, Inc.

“By engaging the appropriate mental and behavioral health specialists early on, employers can help address these very real concerns following a traumatic event. The ultimate goal is to enable the employee to achieve a sense of normalcy and feelings of safety in returning to work. Introducing such resources on the front end of the claim life cycle can help facilitate and achieve improved outcomes on many levels.”

James Harvey, Vice President, Telemedicine Operations, Concentra

While there is high demand for occupational behavioral health services, there are not enough qualified professionals to address the need.

According to the American Psychological Association’s 2022 COVID-19 Practitioner Impact Survey, psychologists have seen significant jumps in demand for treatment for anxiety, depression, trauma-related disorders and substance use. The majority of respondents also said they are struggling to meet this demand, with no openings for new patients and ever-growing waitlists.

This further impacts occupational health care as fewer providers are willing to contend with workers’ compensation regulations and paperwork.

“Before the pandemic, we had customers that were becoming a lot more interested in behavioral health, but it certainly intensified during and after the pandemic. There are more patients needing care than there are clinicians to provide it, even in the non-occupational health space. When you get into the occupational injury space, the delays are even longer. There are patients having to wait weeks, sometimes months, to see a clinician,” said James Harvey, Vice President, Telemedicine Operations, Concentra.

Positive Changes in the World of Mental Health Services

But the pandemic brought a positive change to the mental health care arena as well with the growth of telemedicine. While many types of medical visits moved online amid social distancing mandates, studies have shown that more people actively sought virtual mental health services during the height of the pandemic.

One analysis of Medicare claims for telehealth services found that claims involving treatment for depression, anxiety or substance use disorders rose from about 1% in February 2020 to about 20% in March and 53-59% in April 2020. By April 2020, telehealth claims for mental health diagnoses accounted for more than 51% of all mental health claims.

In another study of 12,828 mental health treatment facilities, the percentage of facilities offering telehealth services more than doubled from 39.4% in 2019 to 88.1% in 2022.

It’s clear that there was a sharp increase in the need for mental health services, and that telemedicine played a pivotal role in meeting that need.

“The pandemic shifted clinicians’ and payers’ thoughts on providing care via virtual platforms, and we have more access to mental health professionals who are willing to see patients via telemedicine,” said Dr. Lisa Figueroa, MD, FACEP, National Medical Director, Health Information Technology, Concentra.

Dr. Lisa Figueroa, MD, FACEP, National Medical Director, Health Information Technology, Concentra

Several employers have already witnessed the difference that telemedicine makes in improving access to behavioral health care for their injured workers.

“There is little debate that mental health has a significant impact on every aspect of our lives, including injury recovery and return to work capacity. However, it can be very difficult to address the mental health issues that may come along with occupational injuries in a manufacturing environment. Having increased telehealth resources to quickly and conveniently assess our employees needs will help employers to leverage this underutilized service,” said Kim Pfingstag, Manager, Occupational Care & Recovery and Casualty Risk, at International Paper.

“The Washington Metropolitan Area Transit Authority is unique in that we have an internal Employee Assistance Program (EAP) that provides both on-site and telehealth options for counseling, support, resources, and education. Many transit workers have irregular working hours, and telehealth enables them to access mental health care when needed instead of traveling to an office or waiting for an appointment. Telehealth improves health equity and access to care, thus increasing the likelihood that an individual may seek help compared to in-person visits,” Amy Espy-Smith, MD, MPH, FACOEM, Chief Medical Officer, Office of Occupational Health and Wellness (OHAW) – Safety and Readiness, Washington Metropolitan Area Transit Authority.

Questions around state licensure initially presented one of the biggest barriers in telemedicine, with clinicians unsure if they could legally offer virtual services across state lines. Luckily, an interstate agreement called PSYPACT allows for licensed psychologists to practice anywhere in the thirty-nine states that currently participate in the agreement.

“The reason PSYPACT exists is specifically because of the shortage of psychologists. So, in conjunction with the growth of telemedicine, it has been a tremendous help in making qualified providers available to patients in need, almost anywhere in the country,” Harvey said.

Legislative changes over the years have also improved access to mental and behavioral health care.

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

Expanding Virtual Behavioral Health Services

To take advantage of these positive changes, Concentra is launching an initiative to better meet the mental health needs of patients under its care.

“We are going to hire our very first full-time Ph.D. psychologist to work exclusively via telemedicine, to help serve the population of these patients that don’t currently have access to behavioral health services,” Dr. Figueroa said.

The initiative will be an expansion of Concentra Telemed. Injured workers can currently elect to use Concentra Telemed for treatment of minor physical conditions such as strains and sprains, bruises or contusions, tendonitis, minor burns, cuts or scrapes, or rashes. It offers 24-7 access to care from the convenience of the patient’s home.

Concentra currently offers behavioral health services through independent contractors in several states, including psychologists as well as licensed clinical social workers.

“Concentra has had psychologists in particular locations for years and they stay quite busy. What we see, though, is a growing demand for more, among both our patient population and among our clinicians,” Dr. Figueroa said. “Our clinicians get frustrated because they want their patients to get the care they need.”

Bringing these services in-house and making them exclusively virtual will improve accessibility and help to speed up and streamline care delivery.

“Our goal in having psychologists in-house is to shorten that runway of patients waiting and waiting to receive care, leaving them and their employers in limbo,” Dr. Figeuroa said. “Led by our first full-time psychologist who will come on board this Spring, we plan to build a best-in-class behavioral health program using our telemedicine platform, eventually to be offered nationwide.”

To learn more, visit https://www.concentra.com/occupational-health/telemedicine.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Concentra. The editorial staff of Risk & Insurance had no role in its preparation.