Recognizing that every absence has a psychosocial element is increasingly important for employers, explains Ian Bridgman, executive director of the Claim Lab, and Fred Schott, consultant with the Council for Disability Income Awareness. It can help employees stay at work and return to work as soon as possible and reduce the risk of employees with mental illness developing physical disabilities. Listen in for insights about why it’s essential to emphasize the human element in absence and disability management.

Resources:

• DMEC @Work magazine article: Data Proves Correlation Between Depression and Anxiety and Disability
• DMEC Mental Health Resources & Tools
• Reasonable Accommodation Process Resources & Tools

DMEC: Welcome to Absence Management Perspectives: A DMEC Podcast. The Disability Management Employer Coalition, or DMEC as we're known by most people, provides focused education, knowledge, and networking opportunities for absence and disability management professionals. DMEC has become a leading voice in the industry and represents more than 20,000 professionals from organizations of all sizes across the United States, Canada. This podcast series focuses on industry perspectives and delves into issues that affect DMEC members and the community as a whole. We're thrilled to have you with us and hope you'll visit us@dmec.org to get a full picture of what we have to offer, from webinars and publications to conferences, certifications, and much more. Let's get started and meet the people behind the processes.

Heather Grimshaw: Hi, we're glad you're listening. I'm Heather Grimshaw with DMEC, and we're talking about how integrated disability and absence managers can help employees with mental health conditions stay at work and return to work more quickly. Our guests are Fred Schott, a consultant with the counsel for disability income awareness, and Ian Bridgman, executive director of the claim lab. Fred and Ian wrote a recent article in @Work magazine titled data proves correlation between depression and anxiety and disability, which we will unlock for listeners. We asked them to talk about how integrated disability and absence managers can ensure mental health conditions are not overlooked during the administrative process, especially when these conditions are comorbid with physical disabilities. When they are overlooked, as the authors note, they can significantly affect claims outcomes. So for today's discussion, I'm hoping you two will set the stage for listeners who may not have read your at Work magazine feature article yet. Would you give a quick hit overview of the article's premise?

Fred Schott: Ian, why don't you kind of give your perspective, and then I'll add in my color commentary.

Ian Bridgman: Okay? All right.

Fred Schott: Yeah.

Ian Bridgman: The biocycle social model. I mean, people have been banging on about this for a long time, how we should not over medicalize claims. Yet when you look at the way claims are managed, people talk about a diagnosis first, and they talk about a musculoskeletal claim or a mental health claim or that they position it in a box. And really, what we should be looking at is more of the wider view of what's going on with an individual, because it's that every absence or every claim has a psychosocial element to it. Whether you label it as mental health or whatever motivation or a workplace issue or whatever the underlying element to it is, we all take a decision as to, you know, we sprain our back over the weekend. We have a decision to make on Monday morning. Do we go into work? And I think everybody has a background as to what's going on at work. Do they like their job? Do they like their boss? All that sort of stuff will come into play as to whether they report in absence, whether they file a claim or what. And then, so you get into the realm of comorbidities. And so I think we said that around, in the article, around 20% of claims have a mental health component. I think it's probably more than that. I think, you know, it's to a level where it interrupts recovery, where it interrupts return to work. I'd put it probably 40, 50%. I don't know what you think. Right.

Fred Schott: It's a sizable amount, and a lot of it is, you know, it depends on how you look at it. One of the things that we highlight in the article was a research project that came out of the, at that time, it was called the Council for Disability awareness a number of years ago. Pre pandemic, I should add, where we were trying to get a handle on the extent of mental health comorbidity. One of the things that came out of that was, well, why don't we take a look at this data set, a big commercially available data set that integrates medical, pharmacy and leave of absence data, and see if we can come up with a good rigorous protocol for getting a better handle on comorbidity. We talk about that in the article about how the study was set up and provide some links to the study in there. But the big takeaway was that mental health is comorbid a lot more often than you would think it is. So if you take the, what is it, five to 8% or whatever of disability claims that historically have had mental health as a primary diagnosis. But then you layer in some of the comorbid morbidity that was found here. It definitely kicks the total impact of mental health well above 20%, 20% plus. So again, the takeaway there was mental health is far more comorbid than we would like to think it is, and that needs to be addressed in the course of the disability claims management process.

Heather Grimshaw: You wrote about a reluctance for claims managers to consider mental health as its own disability, and an unspoken message here is to train professionals to think differently about mental health. And the article notes that by acknowledging this reality, integrated disability and absence management professionals can help employees stay at work and return to work more quickly. I'm thinking that a key takeaway is that depression or anxiety is a risk factor. And actually, it's not me thinking it. You both wrote about this in the article for new physical disabilities, and one that claims adjusters frequently miss. Would you talk a little bit more about this? And the human as well as operational costs of not mitigating the issue?

Fred Schott: One of the big eye openers of that study, and again, that was one of these internal studies that we had shared, but the lead people on that decided to go all the way to submitting it to the Journal of Occupational Environmental Medicine for publications. And one of the big takeaways was somebody who had a pre existing anxiety depression diagnosis. The odds of having a disabling event for a non mental health, non pregnancy physical disability within six months of the. Of the mental health diagnosis, the odds were over two, I think 2.1 compared to a control group. And then, interestingly enough, for people who did not have a pre existing anxiety depression diagnosis, and they were out on one of these physical disabilities, the odds of developing subsequent to the disability leaf, a depression anxiety diagnosis was over 4.0. So the key takeaway from that is you have people coming in with, let's say, a low back problem, rotator cuff, whatever, there very often will be a mental health comorbidity, and that needs to be, the mental health aspect needs to be addressed simultaneously with the physical disability issues. So all of this focus on the mental health aspects of a claim, that's not limited. Again, the point is, it's not limited to a primary diagnosis of mental health. So there will be lots of times a component to that. So first and foremost is just an awareness on the part of the claims manager that there may be other things going on. Now, as Ian can talk about, there are ways of getting this information out. Right, Ian?

Ian Bridgman: Yes. And I mean, it's interesting because when you think about it, how claim managers are, how claim departments are staffed, they don't have enough people, they have an overwhelming number of claims to handle, and then at the same time, we're expecting them to understand the psychosocial elements of a claimant, of an individual. I mean, they're not qualified psychologists, they don't have the skills to do this yet. We're expecting them to be able to, in the course of a telephone interview, to pull out all these other issues that might be complicating a claim. It's just not practical. We have to find another way of doing it. Maybe in the old days, where we had hardened, experienced case managers who could actually do a really good telephone interview, and there's still a few out there, but most of them have retired now and bought goat farms up in Vermont and enjoying life as they should. The people coming into the profession today are our Gen Zs. They don't want to pick up the phone. They want to text people. So how can we provide them with additional data to support the view as to what are the complicating factors? And of course, that's where we come in. We advocate the use of questionnaires to get a holistic view of what's happening with the claimant beyond the diagnosis, and that can be very, very useful.

Heather Grimshaw: Okay. I love the comment about goat farms, and I think that key component here is what employers can do to address these mental health conditions which can influence leave durations by, as you two note in the article, up to 25%. And so, Ian, you just referenced questionnaires. Are there additional ways or is there additional guidance that the two of you can share for employers? Yes.

Ian Bridgman: Well, I think one of our on staff clinical psychologists, I'm not quite sure whether it's a study he found. I can dig up more details at some future point, but his view was, and I think it's across the industry, that an employer can check all the boxes. They can have an EAP plan, they can have STD coverage, limited coverage, all this stuff up the kazoo. But if they're not sincere about caring for their workforce, then the workforce will see through it. And I think it's the crucial thing for an employer is that if you look after your workforce, if you accommodate their mental health needs as well as their physical needs, then you'll see results from it.

Fred Schott: So just to build on what Ian was saying here, you know, all of these things like Eap and the like and stress reduction programs, resilience building, et cetera, et cetera, they're all helpful, they're necessary, but they're not sufficient. And there is definitely a very real risk, as Ian mentioned, of going through that and checking all the boxes. And if the employee has the sense that while in real life, you know, this is all window dressing, this isn't really, you know, this isn't really real type stuff, then you have the very, very real risk of phenomenon that I heard named and called out a couple times at the annual conference not all that long ago, namely care washing. And, you know, yeah, that requires, you know, an ability to. To kind of build in some basic relational stuff with the employee. So something as simple as just staying in regular touch, for example, somebody who's out on disability, being out on disability is a very, very isolating experience. What helps is just staying in regular touch with the employee. And even if it's a question of just providing regular check in calls, how are you doing? And so court and so on. I've seen, just as a little sidebar here, I've seen a nice little study that's been done by University of Texas medical School. There was a program that meals on wheels of central Texas conducted for their clientele. They had a cadre of people who were trained in supportive and empathetic listening, and they assigned them to do, I believe they called them sunshine calls or whatever, to stay with the clientele in regular touch. And what they had done was they had done some nice. Before the intervention, after the intervention, they had done some measures using all the various psychometric instruments, depression screening questionnaires, loneliness scales and the like, before and after. And they found that providing this kind of service had a significant, significant impact on reported levels of depression and loneliness on the part of this population. So what does all of that mean for disability claims? Well, you know, doing something similar, you know, training the claims management staff and also those, more importantly, those people on the employer side who are the, you know, the employee facing people in the absence management process, training them in this kind of supportive, empathetic listening and checking in on a regular basis. How often did I hear at the conference, you know, not just this year's conference, but at conferences in years past, you know, the, the age old thing about all employers aren't sure, you know, can I, you know, I can't talk to the employee when they're out. Of course you can. You know, just make sure that, you know, you're not badgering them to, when are you going to get back to work? When are you going to get back to work? Make sure you're not doing that, and also make sure you're not obviously prying into their affairs more than is appropriate and legally justified. But just being able to maintain that human connection, that in and of itself is a huge first step in that direction towards providing for a supportive environment from a mental health perspective.

Ian Bridgman: Yeah, that's really interesting, Fred, because we've done a little bit of work on other factors beyond the sort of regular mental health sort of diagnosed screening tools. And we had one question in our questionnaire, do you ever feel lonely? And we saw there was a significant correlation between people who are lonely and the duration of claims. The ultimate duration of the claim, something like 32% increase in claim duration where people were lonely. Yet loneliness has no medical diagnoses there's no ICD ten code for loneliness, but we can see it's a huge factor. That social isolation thing is very significant in recovering, particularly from mental health conditions. But, I mean, you know, so I'd echo what you just said there. Absolutely.

Fred Schott: And that's a huge factor. I'll tell you, I've been, for the last two years or so, very much involved with a local nonprofit as a volunteer that addresses issues of loneliness. And the nonprofit also works with local healthcare systems and the like to how can that issue be addressed better by the healthcare force? And just in terms of the reading about the, the impact, talk about a mind body connection, the impact that loneliness and social isolation, disconnection from others can have on your physical well being. I mean, that's an amazing illustration of the power of the mind body connection.

Heather Grimshaw: These are such good points, and it really illustrates that human aspect. Ian, you commented on the fact that there's no ICD ten code for loneliness, and for people who are administering these claims, who are trying, trying to help their employees stay at work and return to work. It's easy to see how some of this might get lost in the shuffle, especially Fred. As you mentioned, it is an ongoing theme at DMEC conferences that, remembering that human component, I think there's a lot of fear about maybe crossing the line between asking the right questions and as you noted, Fred prying, you know, being able to distinguish where that line begins and ends. I'm hoping that you two will talk a little bit about why you think the bidirectional association between mental health and work disability is overlooked. And if you see any hope for change in this with employers that are ideally implementing different types of approaches, and whether this issue is worsening or if you see signs of improvement here, oh.

Ian Bridgman: Well, straight off the bat, it's because it's complicated. It takes time. You have to invest time to understand an individual, to get the information back from an individual. And I think that's the issue. People don't have the time to consider absence or claims anymore, and it's only now we're starting to we get the data so we can see the dramatic effect that these psychosocial issues have on recovery, that we can start to say, no, no, we shouldn't be managing claims medically. We have to invest this time to find out what's really going on.

Fred Schott: It basically boils down to so much of our lives are spent trying to put everything into mechanistic reduction, break it down into its components, quantify it, put up the checklist, check check. Check. Did I do this? Did I do that? The reality is, again, the bidirectional association, the mind body connection, to Ian's point, it is a little bit more complicated than that. And what we should not do is kind of try to yank the human out of the situation. Now, it's funny, we talk algorithms and artificial intelligence, and I know there was a fair amount of discussion and presentation at the annual conference about that, but one of the things that I kind of picked up on was that it helps to, you know, to use your technology and use all of this to minimize the amount of drudge work that people have to engage in, that claims managers have to engage in, that HR professionals who interface with the employees that they have to engage in and free them up for the really meaningful, you know, human interaction and then, you know, building some kind of element. I don't know. You know, what, what about, you know, mentoring? You know, I mean, I'm just going to throw something really wild out there. You know, how many, how many claim shops, you know, have, have mentoring programs? And I'm thinking by analogy to, you know, to medical practice, I just, I just finished a book. This may seem like a kind of a bizarre analogy here, but I just finished listening to a book, a memoir by a palliative care physician, listening to this doctor talk about consulting with the patients and with other doctors and trying to get this understanding of what's really, really important to this patient and what can we do to have a care plan that addresses not just the physical symptoms that the patient is experiencing, but the overall sense of well being, being, quality of life and the like. A lot of that, you know, involves just, you know, ongoing, you know, mentoring, exchange of information with colleagues, a supportive environment to do that. And, you know, ideally, where, you know, all of the various demands on the, on the individual's time are, you know, kind of reduced by, you know, proper use of technological tools. So that's, you know, that's another way we can get at what we're trying to accomplish here.

Ian Bridgman: That's really interesting, Fred, because, I mean, fundamentally, getting back to the basics of this whole thing, every absence event has a psychosocial element to it. It's a question then, of trying to work out whether that psychosocial event is enough to interrupt recovery or whether you can recover without, without it being a problem.

Heather Grimshaw: Fred, if you're willing to share the title of the book, we can include that in the notes section, because I do think, again, it all pulls back into that human component.

Fred Schott: Right. Right, Heather? Yes. The title is that good night. And the author is Sunita Puri. And it's just a fascinating memoir. And my takeaway there was like, gee, all medicine should be practiced like this. And not just all medicine, but also all situations where you are interacting with a human being that has some kind of a medical issue that is disrupting the rest of their life and a disruptive medical life event, which is really what we're talking about when we're talking about disability, work disability.

Heather Grimshaw: Absolutely. I appreciate that very much. And so the article includes some personal information about how psychosocial factors helped you through your own healing journeys. And I'm hoping that you will talk a little bit about this and what lessons employers can learn from those experiences.

Fred Schott: Okay. Since I was the one that kind of put my personal story out there, and I did provide a link to it, I had, a couple of years ago, I had some complications after hip replacement surgery that were unexpected and unsettling and disturbing and very isolating. And as I wrote in the article, hey, I could see, yeah, I can see now why that finding of the odds being over 4.0 of developing new onset anxiety, depression after a physical disability. I can see how that can happen. But yet somehow I managed to make it through. And, like, what were some of the things, you know, that helped some of the mitigating factors? And I was talking about this with Ian the other day, and I said, you know, I think about that, and really the central point was, work is therapeutic, and I'll unpack that in a moment. I was able to fairly quickly after my surgery, and even with the complications, I was able to get back to work and do some work. Yes, it helped that the work didn't involve any heavy lifting. Yes, it helped that I was able to work remotely. And, yes, it also helped that, you know, the work I did was, you know, project based and the like that all, you know, there was like a perfect storm that allowed for that. But the fact was I was able to, you know, get back to work and to be connected with the work environment. And I realized during that, you know, what it did was it gave me structure, it gave me purpose, it put me in contact with outside people, you know, outside of my, you know, my little recovery area, you know, the living room, because I had some, you know, mobility challenges and the like. It was my, you know, my key to the outside world. But, you know, more importantly, it kind of, you know, it was a way of, again, structure, purpose, and the like. But it got me out of myself, and it made me focus less on my personal health issues and, you know, physical slash mental distress and put my focus on something else. And funny thing, when Ian and I were talking about this the other day, Ian, you had a really great story. Why don't you share here about the wasps nest? This is an example of how getting out of your head can really help you.

Heather Grimshaw: Oh, my gosh.

Ian Bridgman: And I ended up with eight wasps. Things that then proceeded to swell up overnight. And it was. It was. It was grisly to say when I've been so careful. You know, it's like. But what was really strange was that actually, when I actually went on stage to present at the conference, the wasps, things stopped hurting.

Heather Grimshaw: Interesting.

Ian Bridgman: So there you go.

Fred Schott: Yeah, but I mean, because your focus was outside yourself.

Ian Bridgman: Yeah, there you go. Yeah, but this whole topic is. Is really fascinating because we see time and time again that doctors sign people off from work because of anxiety, workplace anxiety, stress at work. It makes you think that. Since when has signing someone off from work that's causing them anxiety being the right treatment for anxiety? Since when is avoidance being a treatment for anxiety? And I think there's an awful lot of, how should we say, mistreatment of mental health issues in the world today. And we've got to get a better understanding as to what the best treatment is at the best time to address these issues.

Fred Schott: Just jumping back in. Another related takeaway is that work is therapeutic. You know, you get back into the work environment, but there's a big caveat around that, and that is if the work environment itself is unhealthy, then you have a little bit of a problem. And that's why it's so important. And, you know, Ian talks about this a lot. It's so important at the, you know, as part of the, you know, the claims management process to have an understanding of not only what is going on with the. The employee and their, you know, their emotional health and, you know, state of mind and sense of self efficacy and all that other good stuff, but also based on their assessment of their work environment. What's going on there is that person dealing with a toxic work environment, and it's understandable how somebody might want to resist being returned back to a toxic work environment and how returning to that environment can undo a lot of the positive benefits of, of work is therapeutic. And again, I'm thinking it as we talk about this, I think again back to the annual conference, that step Dreier spoke at, about the importance of the guided claims process, but she's talking about her condition, which affected her lung function and the like. She was able to track her lung function and then notice that there was a correlation between those times where she was in, I think she used the term toxic work environments, non supportive work environments. There was not a strong element of psychological safety. People didn't feel valued, supported, civil interaction, all of that good stuff. There's a whole body of work done around that. But she noticed that, sure enough, when she was in a toxic work situation, her lung function would be impacted. Talk about a real vivid illustration of the mind body connection. So that's why it's important to understand the environment that the claimant is working in and also for employers to work on those programs that build out the healthy safe in the larger term of the sense work environment. That's a big component and building block of the national strategy for healthy work. The surgeon general has weighed in in support of that. National Institute for Occupational Safety and Health has been addressing that in incorporating that for many, many years. Worker comp programs are definitely building that element of psychological safety into overall safety and loss control programs. Well, hey, and again, that gets to another one of my little pet peeves. Why are we still to this day, still siloing worker comp and non occupational disability? What's good for the goose is good for the gander, so let's pay attention to that. And for those employers that are still kind of holdouts against implementing programs of the sort, because they sound like, well, they're touchy feely and frilly and the like. The same kinds of things in the research is abundant, that the same kinds of things that promote these kinds of healthy and safe working environments are also ones that ratchet up, you know, productivity and effectiveness of the workforce and that have, you know, positive effects on the bottom line. So I'll get off my soapbox.

Heather Grimshaw: That's a good soapbox, and I think it's really important. So the data that you all share in the article really helps pull those pieces together and create more of a strategy that ideally more employers will consider. One of the last questions I have for you all today is that practical piece of how claims managers can gain a better understanding of psychosocial factors and related tools. In other words, what implementation looks like here.

Ian Bridgman: I think from our perspective, the traditional way of collecting this psychosocial data was on some sort of a telephone interview, a case. A qualified case manager has a 30 minutes call with the claimant to understand what's going on in their lives, to dig deeper into some of the issues. And as I mentioned before, they're increasingly becoming harder to do. So we've sort of swung away from that. And to get better data, we advocate in use of a questionnaire, a self reported questionnaire that goes out to the claimant or the employee right at the very start of the claim or the absence. And we just get a view as to, you know, a holistic view of what's going on in their lives, anything from, you know, workplace issues to domestic issues to how their finances are going, what. What skills they have, what attitudes to change they've got.

Fred Schott: We.

Ian Bridgman: So we paint this sort of picture of motivation, of drive, of mental, mental health, which, which, again, can become the backdrop to sorting out the. The rotator cuff injury, whatever it might be. Because time and time again, we see, particularly with mental health claims, where you see a claim come through, where there's obviously a workplace issue sitting alongside this depression or anxiety problem. The issue you've got then, is to try and pull those two apart so you can understand if the depression and anxiety is just a symptom of the workplace problem, because that person goes to their doctor and says they're depressed and anxious, they're going to get put on medication, they're going to get signed off from work, they're going to get counseling, potentially a CBT, all that sort of stuff, when what they really need is a different job. And, you know, all you're doing is prolonging the claim by taking it down the wrong path to recovery. So I get my soapbox on this because I'm so passionate about the work we're doing in this field.

Fred Schott: Yeah. And just to kind of jump in and kind of build on that something. And Ian and I talked about this the other day. I was telling them about the conference. There was a lot of good stuff that came out of this year's annual conference. You know, one of the things I had mentioned, again, listening to that maintenance session on the guided claims experience, and one of the things that really hit me was what we're hearing here is the voice of the claimant. And how often in business processes and quality circles and the like in business planning do we, over the last 30 plus 40 years have we heard the emphasis on the voice of the customer, which is all very important, very good? Well, in the claims management process, what kind of a mechanism is there for hearing the voice of the claimant? Is that, I know carriers routinely have claimant satisfaction surveys and the like, but is there some way of, you know, for all I know, this, this may be done, but, you know, it's something that needs to be done more broadly and needs to be talked about and, you know, shared as a practice, you know, doing a deeper dive and, you know, getting a sense of, from the people who have been through the process, you know, how, how were they experiencing things on, on their end and what was their primary focus. And to look for areas of commonality, areas of overlap, or just areas where you can tune in a little bit better in terms of understanding everything that is affecting that person. It's all so easy, and I get how it can happen, especially if you have a big caseload during claims management, it's also easy to, you know, dismiss people as, you know, the claim numbers and the like, but, you know, there's actual, you know, human situations that are going on there and, you know, how do you better develop that, that feel and that, you know, that, that sense of empathy for the person who's on the other side, you know, of the, of the phone and of the transaction. So, you know, being able to couple again the, the kinds of things Ian is talking about again, you know, necessary, but in and of themselves, you know, they are not the, you know, the only thing you can do, but, you know, coupling, you know, high tech, high touch at the same time.

Heather Grimshaw: That's a great point, Fred, and I do remember the, the session that you're referring to from the DMEC annual conference and hearing from employees and hearing their experience of feeling either dismissed or really feeling as though a claims manager thought they were trying to fake their condition or take advantage of the system has a terrible effect not only on that employee's morale and ability to heal, but also what they feel like their employer is saying to them. So, Fred, I think you mentioned earlier in the conversation, using technology to minimize some of the drudgery is the word I think you used with this process, while also recognizing and emphasizing that personal component and really the opportunity to express your support for that employee, whether the person is able to stay at work, as Ian has commented on the knee jerk action of going first to leave, which might not be the best treatment or process for the the person. So I think it's such a complicated issue. You both did such a beautiful job with the article. Again, we will, we will unlock that article so listeners can read the piece and see all of the wonderful references that you all include. And just want to thank you both for your willingness to share your expertise with us today.

Fred Schott: Thank you. Thank you. This is great. Yeah.

Ian Bridgman: Thanks, Heather. Bye.