When Creativity Counts: Helping Employees Return-to-Work Sooner

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Episode 17 • 10th October 2024 • Absence Management Perspectives • DMEC

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 with us. I'm Heather Grimshaw with DMEC, and today we're talking about how employers can support employees with mental health issues in ways that help them stay at work and return to work more quickly and result in fewer disability claims. Our conversation today ties into a recent at work magazine article titled adjusting mental health accommodations can make a meaningful difference for employees by Kerry Wiesner, head of epidemiology for Alight MD guidelines, and Dr. Keemia Vaghef, director of value engineering for Alight Leave Solutions. There were a few things in your article which we will unlock for listeners that we're hoping you will elaborate on today. The reference to mental health conditions being considered individual obstacles when they are actually organizational concerns with significant economic implications is a concept that I'm hoping you'll talk more about. For example, how do employers shift that perception, and are you seeing effective attempts to do that?

Kerri Wizner: Thanks for having us, Heather. I think that this is a really great topic, so I'm excited to talk about it today. So in response to your question, I would say in public health, we always think about behavior changes at different levels, what we can influence, and what are the pros and cons of implementing change at the individual level, like you mentioned, or the community level, or at that policy level? So, like employer wide, with mental health, all of these levels have an impact on return to work, how the person feels, but also how they feel among their coworkers and how they feel within the company, what their place is at work. So I found a few research studies to kind of add to our article. But one study found that nurses working under leaders with toxic work traits had higher stress levels, higher absentee, and lower job satisfaction. And the opposite was true when you had a good leader. So if you had good leaders talking about mental health, embracing a healthy workforce, you had happier workers. Leaders can also be models for health behaviors, and that impacts employee behaviors. So it's really a situation of who's walking the walk. And employers have a lot of influence about what their leaders are doing. So again, that's kind of at that policy level. And then a third study found out of Johns Hopkins, they rated building a healthy work culture as the number one practice to support mental health in the workplace. They suggest talking about mental health and communicating expectations and supporting what's available to employees. So sending out emails, communications about the mental health benefits that they offer. And I've seen a lot of companies embracing this personally. I've noticed leaders sharing personal stories about their own health conditions or struggles within their families. And it really helps inspire employees to think about their own condition or their family's condition, as well as being more open and transparent in the workforce if they feel like that's helpful or being able to take more leave. So people just feeling more comfortable in their own skin at work. I've also seen a lot of companies embracing a lot more communications about using sick time for mental health days. I think that that's a big shift in how it used to be that sick days were when you were physically ill but using them as mental health breaks is a new trend that I've seen among a lot of employers. And then finally to like that community level and workplace culture piece, I've seen a lot of employers embracing diversity and then helping people connect with social groups. If that's volunteering, if that's representation of minority groups, allowing work time to kind of bond with people. And I think this is especially important as we have larger workforces, work from home, global teams, all different time zones. Building that sense of community really helps support that mental health aspect at work.

Heather Grimshaw: Those are great examples Kerri. Dr. Vaghef, did you have anything you'd like to add in there?

Keemia Vaghef: Yeah, absolutely. I think Kerri hit on some amazing points there. Really getting the baseline culture shifted towards understanding and destigmatizing mental health is really important. That buy in from the leaders is critical. I think it's really also understanding the leader that is sharing that mental health journey, specifically in regards to how others perceive that leader that is sharing that. Sometimes it does allow certain leaders to look vulnerable and provide a new light to not only mental health, but that leader themselves. So really kind of emphasizes the buy in the, but also can potentially have certain backlashes. So I think organizations should definitely be mindful in who shares this story, or at least get it more across the board. Multiple leaders, multiple employees sharing that story, getting behind the concept of destigmatizing in multiple avenues of the culture and the norms of the organization, and really improving that ultimately helps in areas of reduction of absenteeism, like Kerry mentioned, by leveraging other types of leaves, ultimately preventing, hopefully down the road, a longer term mental health disability leave by using one or two sick days, that could help leverage and prevent down the road, and I.

Kerri Wizner: Would add, like the word authenticity. I think that, like Keemia said, it's important to have a time and place and a culture to support a lot of these things. And I think people really appreciate authentic leaders.

Keemia Vaghef: Absolutely. Exactly, Kerri.

Heather Grimshaw: Those are such important points, and I love the phrase feeling more comfortable in their own skins. So the article touches on ways that integrated disability and absence managers can have a positive effect on employees who need mental health accommodation and help them stay at work and return to work as soon as possible. Would you talk a little bit more about that premise and the data you have to support it? Dr. Vaghef, will you kick us off here and then we'll ask Kerri to weigh in?

Keemia Vaghef: Absolutely. Yes. This is a critical issue, I think, in the workplace right now. Whether the integrated disability and absence management is internally managed through HR or benefit leave team or even outsource, these folks are critical points of time. What we say at a light, they're, they're interacting in moments that matter. So what we see is typically a lot of this role. It could be kind of seen as a negotiation role. Return to work is almost 90% a negotiation between the employee and employer. And when we're talking about mental health, that negotiation is a little less tangible for the outcomes. We're kind of expecting the turnaround time we anticipate. And so when we talk about interventions and preventing and solving this disability and absence management challenge, these folks, case managers in particular, are critical in that role. And I've said critical a few times, because they come at an intersection where there are individuals in need and an opportunity at hand to take that opportunity. And whether employers or case managers listen closely and are able to understand, comprehend, and clearly apply those understandings from the employee's perspective while keeping the employer's productivity and bottom line in mind. We want to make sure that we get employees back at a healthy time, but also in a time where their livelihood isn't necessarily influenced as much. And we're trying to mitigate that. And especially with case managers, they're sometimes the front line in hearing employees and their perspectives and the challenges and really why they're taking a leave. So their role is important and the role of listening, the role of empathy is extremely important for case managers. So what I ultimately believe is that for integrated disability and absence managers to play a streamlined role between the employee and the employer negotiation process to return to work, putting in mental health accommodations can really help transition these employees during that really important time of need. Whether it's someone going through severe anxiety or returning from depression to get back to work, the case manager is really important in influencing this individual's livelihood. And then when we accumulate one individual's livelihood across an entire workforce, where we see these mental health challenges, we really have an opportunity to influence an entire industry, if not the whole nation's workforce.

Kerri Wizner: And I would add, like, I think that's a great response. Keemia. I would add that it's also important that employers, if you're outsourcing, finding a company that really gives enough time to case managers, or if you are managing your own employees, that you give case managers the time and resources to do these conversations, like Keemia said, like, these are some of the frontline workers. I've heard so many stories of occupational health physicians saying, the key to success for this story was that I had a great case manager that kept all the pieces together and was flexible and creative. And a lot of that comes from experience, but it also comes from the case manager is having enough time to go through those processes and spend the time to have the conversations with the patient to help them understand all the nuances of returning to work and accommodations. Like, there's so much going on for the patient that these case managers are really the glue keeping these pieces together. And it's important that we add value to case managers for their work and really let them have time to make these important influences.

Keemia Vaghef: I completely agree. Yeah.

Heather Grimshaw: So one of the things that I'm curious about is how well known it is that there is this ability to really influence return to work with mental health accommodations and the people who can make that happen.

Keemia Vaghef: Interestingly, while the role of these managers is growing, it's actually not yet extremely common knowledge how impactful they can be. Even though Kerri mentioned that some folks are still recognizing the importance of that role. What we do see is that many companies still view disability and leave management in silos. So we see it on a physical health side. So oftentimes, speaking of musculoskeletal system claims and pregnancy claims, and then mental health is siloed. So one of the challenges, I believe, that has not yet been addressed, is really breaking down those silos. And for us to begin breaking silos down, like you said, it's really important for organizations to even begin becoming aware of the importance of bridging that across not only the physical, but the mental health side, seeing where those comorbidities are, seeing where certain complications are in regards to folks, maybe with digestive system and mental health categories. So when we see these diagnostics checked off across the board, but we have it siloed, organizations should see even more importance in the role of these integrated disability and absence case managers and just the importance of breaking down those silos. To be able to understand what's truly going on with the workforce, whether it be mental health standing alone as a diagnostic or piling on top of other diagnostics, it's really critical to understand and adopt those integrated approaches for applying benefits and really understanding how the workforce is using those benefits.

Kerri Wizner: Yeah, and I would add, I don't know if you guys have interacted with the american healthcare system recently, but it's very complicated. So you have patients that are dealing with, like, health conditions, you know, maybe mental health conditions, and they're dealing with insurance companies and their employer, and now they have this case manager coming in, and that person can really be an advocate for them. They can help describe how long you might be out according to guidelines. They can offer recommendations for accommodations to ask employers. Like a case manager is really the resource of information for the patient to then make the best decisions for themselves. So being able to return to work, get back to an accommodation at work to do partial time, or different interactions, like, all that information, much better coming from a case manager than, you know, just Doctor Google.

Keemia Vaghef: Yeah, exactly. And I think that what we're seeing is that instead of Doctor Google, when that uncertainty is triggered and folks aren't sure, you know, how long is this recovery going to take, or they have concerns about where they might, you know, fail in the recovery process or what steps to take to really transition and be successful when they get back to work, that's where that case manager is so important, and they play that role. And I think as organizations begin to understand more and more of that importance, they're going to eventually have no choice but to see how important case managers are in comparison to doctor Google. I completely agree.

Kerri Wizner: And if employers can embrace those case managers even more to create shorter communication trails, that's going to help patients more and help them get back to their normal routines faster.

Keemia Vaghef: Yep. Speedier recoveries. You're absolutely right.

Heather Grimshaw: It's wonderful to hear you refer to integrated disability and absence managers and case managers as that advocate or patient resource as well as the negotiator, really to illustrate the value of that role. So I'm hoping that you will talk a little bit more about how adjusting mental health accommodations can result in fewer disability claims and shorter return to work durations. These are two of the pieces that you talk about as well in your article. Dr. Vaghef, will you kick us off here and then we'll ask Kerri to weigh in as well?

Keemia Vaghef: Certainly. So I believe in the ability to adjust and adapt and really provide the employee with meet them where they need us will ultimately be a tenfold, and I'm making that stat up, but a tenfold return on the investment for the employer, particularly because there are so many ripple effects. And when the employer is willing and showing employees they're willing to meet them to get them back to work, one, they're showing that they value that employee, they see how important they are and they're willing to adjust to get them to return back to work in the manner that is best fitting for the employee. So being in a term adjustable or willing to adjust. Now, of course, when we talk about accommodations, it's very case by case. So depending on the job role and what the essential job functions are, those of course need to be met. But just the employer showing that they're willing to do that negotiation, it speaks volumes oftentimes for not just one employee, but for multiple employees. So they're able to see the employee themselves, are able to see that the employer is willing to meet them halfway. It makes them feel more obligated or connected to not cut and run. When things get tough or there's more requested from an employee, they have some buy in because the employer has shown that there's a caring nature, that there's this value that they see in the employee and that ripples into the culture of the organization and to the benefits. Even the benefit plan design often mirrors this caring nature of organizations and oftentimes that can lead to downstream effects like fewer disability claims and shorter work durations. What we see is, for example, certain clients that have return to work accommodations, for mental health in particular, they're able to transition. It's part of the transitional return to work process. But oftentimes folks are able to transition back to work much easier. And oftentimes there's issues with workload or just a need for some reduced hours, some flexible scheduling. What we find is oftentimes having some short term deadline or something that's a little bit more tangible, whether it be, hey, this is going to be a six month reduction of hours or six month telework work from home, opportunity to help align certain job roles that can be flexed, that would essentially show that the organization is willing to work with the employee who's maybe coming back from a very challenging time, you know, through a mental health disability leave. By showing those indicators, employers are really able to highlight the, the value of the employee, but also that they want them to stay and that they can ultimately reap the benefits, the costs and the savings associated with that. By not having to rehire, by not having to, well, going even before that to recruit for hiring, training, of course, once that individual comes in. So just eliminating that potential turnover in itself is very valuable. So there's a number of ways that it's important for these accommodations to be adjusted, but also the influence that it can have down the road is huge.

Kerri Wizner: I agree. I think the name of the game in a lot of the success stories that I've heard over the years has been creativity. So I think one of the best examples I saw was factory work, very heavy work, unable to offer a lot of accommodations or modifications to work. They partnered with a nonprofit, so if you're out on leave, you can get your same wage by doing a working with the nonprofit. And in places like that, you can have more accommodations, flexible scheduling, lighter work, more breaks, those kind of things. And I agree with Keemia, she said earlier, it's a ripple effect. So not only is that employee benefiting from getting to return to work in some capacity, maybe a little bit earlier than expected, but everybody else at the office is also seeing that empathy really at work and saying like, oh, if that was me, my company would support me in that. So it's not just that one employee, it's, you know, everybody around them and building that healthy workforce and that positive health culture.

Heather Grimshaw: You've both referenced the caring nature, the importance of empathy, and I think that ripple effect is important for employers to hear so that it's not isolated to one. People see how other people are treated, and it certainly affects them. You mentioned employee confidence as a factor that can help or hinder an employee's ability and willingness to stay at work or return to work when mental illness is a factor. Would you talk a little bit more about that, Kerri? I'm hoping that you'll kick us off here, and then we'll ask Dr. Vaghef to weigh in.

Keemia Vaghef: Yeah.

Kerri Wizner: Turning to medical literature, looking at some studies I pulled out, you know, there's a lot of research that has shown that pride in the work that you're doing, trust and confidence in your team and professionalism have all been linked to occupational health. Like, this seems obvious, right? Like, if you love your job, you love your team, return to work can really support your mental health. But if there's a mismatch somewhere, for example, your workload or with your colleagues or leaders or company policy, all of a sudden recovery and return to work seem less compatible. Another study in the Lancet found that a four hour manager mental health training. So again, that policy level implementing training with managers led to a decrease of 7 hours per employee per six months because employees felt more confident in their communication with managers and they're able to ask for flexibility at work. So again, there's that confidence that the employee is able to see that their management kind of has their back and that they can ask for what they need and that there's positive communication between, you know, frontline employees and managers. Like that has a big impact on sick leave. One more study I found said that while employers don't have control of home life, again, you're building a connected community at work, and that has its advantages. I really like this quote from a UK study that said, quote, the need for sick leave was not disputed, but an important discovery was the side effects whereby isolation and reduced activity levels could exacerbate mental health problems. So in this case, you know, we really see that returning to work can have a positive influence. But again, it has to do with, like, the confidence in the employee in returning to work. Do they have a positive work environment? Do they trust their management? Do they have their, does their employer have policies that are going to support their needs or communications that are easy? So there's a lot of interaction between that individual level, the community level, like coworkers and managers, as well as the policy and really leader, employer set policies that influence all these return to work things for mental health.

Keemia Vaghef: Exactly, Harry, you're right on. I think it's, it's funny, I don't know how academically accurate this quote is, but Thomas, the little engine that could. Right? I think I can, I think I can, I think I can. I mean, it's probably not a peer reviewed article, but I think that that is just a perfect example of where self confidence and what the academic literature touts as self efficacy is essentially really important in the return to work process. Like you were saying, it's showing that an individual truly believes that they can. And if they don't believe that they can, chances are they're going to get ahead of themselves and somehow believe that they really can't. Whether it's, I believe I can get better or, oh, I don't know, this is going to be really challenging. Can I really return to work in this situation? That's really kind of a key decision that individuals can make on their own that can really impact, you know, the decision, the, the output, the outcome of the leave, how long it is, and whether they're even going to return to work or not. So being a, being able to measure and understand if even the employee does think they can return to work can be a good indicator for actual return to work.

Kerri Wizner: Yeah. And I think especially for mental health, like we're talking about, you know, incidents, how common these leaves are occurring. But, yeah, also the length of how long somebody needs to be out for their leave. But with mental health, we also have that recurring theme like, does this happen multiple times? Do they try to come back to work? The environment isn't great, so they end up back out. You know, there's a lot of pieces that come into play with mental health.

Keemia Vaghef: Exactly.

Heather Grimshaw: I think all of that is really helpful and it rounds out the picture. Kerri, you've mentioned a few studies, and I just wanted to note to listeners that we will have the citations in the notes section so that listeners can learn more about these wonderful studies after the podcast.

Kerri Wizner: Thank you, Heather. Yes, definitely.

Heather Grimshaw: So the article references temporarily limiting mentally demanding tasks for employees with mental health issues that prompt the need for accommodation, similar to what employers would do for physical illnesses and or injuries. Would you share information about what you all are seeing in terms of how employers are assessing and mitigating psychological risks, as well as what types of preventive approaches you're seeing with clients? Kerry, let's start with you here, and then we'll ask Dr. Vaghef to weigh in.

Kerri Wizner: Yeah, I just wanted to quickly touch on again from the research perspective, there's a lot of chatter about cognitive demand. That's kind of the new hot topic, especially with the waves of mental health claims that we've been seeing, you know, rising in disability. We often use physical demand level, like you said, Heather, to set return to work expectations. But there's not a great way to measure how mentally demanding somebody's job is. Like a case manager currently has to look at a job description and determine how much mental demand is needed. Are there long blocks of focus, time needed? Is there a lot of collaboration with other people? Are they presenting or talking to people all day, or is it a lot of scheduling, multitasking like that information is really hard to gather from a job description that's, you know, pretty vague and all encompassing of any type of work you would be doing. So I'm really excited about where this topic can go, but I think it's really in its infancy right now. Mostly. An employee would need to complete a survey to measure all, like, the cognitive demand before they went out on a leave. But this has not been demonstrably effective. So it's really up to case managers to be creative and thoughtful about accommodations, which is a lot to ask with how much work case managers already do. So I'd be interested to see, Keemia, what your perspective was from more interactions with employers and what people are doing on the front lines.

Keemia Vaghef: You're absolutely right, Kerri. I think that there's so much more room for the cognitive demand area, especially in absence, and disability management, particularly because, like you were saying, the importance of understanding one's job ultimately ties back to their, like we were saying before, confidence in being able to return to work and even their ability to return to work after a leave. So organizations should really start looking into more job analyses, particularly analyses like cognitive task analysis, that could identify where the mental lift or the heavy cognitive demand, the mental load is essentially within the work, the task at hand. How cognitively demanding are these? Do the employees have to learn new tasks all the time? Or even are they emotionally, having to regulate a lot emotionally? So these types of jobs can often lead to fatigue, both emotionally and cognitively, and ultimately can influence burnout. And so if there's jobs out there that are heavy on the cognitive demand, and organizations haven't done that job analysis to truly understand the role that that individual is filling, as well as helping provide more information to that case manager, or the integrated disability and absence manager just doesn't understand fully or doesn't have the information to fully understand what that employee is doing. Like you were saying, folks can get a survey and provide some details, but to understand kind of the perception versus the expectation of the employee and what they really have to perform on a day to day and how heavy that cognitive load is on them, that ultimately ties back to what the job role is. And oftentimes, especially in tough economic times, you'll see they kind of do more with less mentality across employees, and they feel even more burdened than before when it was like, okay, well, I have a full-time job now. I have three people's full-time job because there's turnover and all this stuff is really ultimately a symptom and not the issue. So often folks are trying to look at turnover separately from burnout, separately from conflict and teams and frustrated employees in employee viewpoint survey. But that's where those silos have to get knocked down. And you have to understand this ties back to the job that these individuals are doing, and so understanding the support that's present within the organization, so how the direct line managers are connecting with each other as well as the workload present. So are we overloading these employees and is that putting a lot of demand on them? Whether it is, of course, it's easier to count widgets that are created versus how many lines of code or you had to analyze to find an error. There's a lot of fatigue that can happen in both, but one is a little bit more easily tangible, ultimately. And so it's easier for employers to count the widgets and to determine certain job roles versus, like you were saying, it's a lot more growth and ability to mature in this cognitive demand area.

Kerri Wizner: Yeah, I think what employers can really do right now is give power to managers. Managers have training so they know what they're talking about for mental health, but also so that they can think about accommodations and are aware of these pieces and can implement something creative, because right now managers are kind of that frontline worker, you know, frontline employee that's, you know, helping build these bridges that don't really exist right now.

Keemia Vaghef: Exactly. They don't have the tools, essentially, or a lot of managers aren't provided the full tool set to be able to support. So the more we can do that and really train up managers because they're the ones that ultimately we hope the employees are going to when they're even starting to have these challenges in their life, or at least at work when they're coming across these things.

Heather Grimshaw: So it would also be really helpful to hear you both share some details about the return on investment for employers that invest in these preventive efforts as well as the work to mitigate psychological risks at work. Dr. Vaghef, will you kick us off here? And then we'll ask Kerry to weigh in?

Keemia Vaghef: Absolutely. So investing in preventative mental health efforts and mitigating psychological risks, it's not just about doing the right thing. I mean, we've been talking about that this whole podcast, but it also makes really good business sense, and the ROI on these investments is substantial. So there is a national safety Council study that showed there's about $4 of improved health and productivity return on investment for every dollar that's spent on mental health. So that's four times the ROI on a mental health intervention. I think that this is really evident that just by investing, like I said, and it has a ripple effect. So by investing in mental health and the challenges that surround it, ultimately the organizations, the employers, the employees themselves are going to see a huge return on investment. They're going to be, you're going to have happier employees with more productivity. I mean, it's a win-win. So there's, it's. It's like an obvious choice, in my opinion, to be able to adjust and accommodate for these mental health needs.

Kerri Wizner: Yeah, I totally agree, Kemia. I think that investing in mental health now is super important. You know, with the numbers that she provided, you know, that's just the tip of the iceberg, because mental health claims, it's just one small piece. There's also recruitment, retention, quiet quitting, burnout. All these pieces, pre absenteeism, presentism, there's a lot of pieces that build into that work culture. And so, you know, that's why a lot of the best practices, the number one thing is to build a workplace culture that works for everyone and that is open with communication, trustworthy. And I think that employers have a lot of control over that. And setting those expectations is important now, especially as you know, mental health is not likely a problem that's going away anytime soon.

Keemia Vaghef: Absolutely, Kerri. Right on. Because I was thinking along the lines of what you had said before, employers needing to invest in mental health training for managers, saying they're the buffer, they're the support, the shield for these employees and to be present, I think there's a need or a momentum shift. I know a lot of research has gone on around the importance and the impact that direct line managers can have on absenteeism. And so the more we can provide them with a full tool set of things that could help reduce the absenteeism, ultimately, it cuts down on the claims and improves that overall productivity. But the investments are, like you said, it's more than just that $4 perennial. Every dollar spent on mental health interventions. It's a lot more than that. We just haven't calculated it yet to understand what that true savings dollar sign is. We just know it's more than $4. That's. That's definitely for sure.

Kerri Wizner: Yeah. And it's building that brand. You know, the first thing when people look at a new company, if they want to invest or get hired or buy the product, is looking at company reviews, seeing what employees say. So I think that work culture permeates so many different aspects of ROI, that it's really going to be up to employers to set that priority so that their company can be successful, employees can be successful, and the overall ROI is going to be through the roof.

Keemia Vaghef: Exactly. And I think that there's going to be this almost a new expectation from employees that the employer cares about mental health and shows that support. I think that's what folks are seeing, especially those who are looking for new jobs out there and looking at new companies. They're looking at their benefits and their mental health benefits specifically, 100%.

Heather Grimshaw: Thank you both so much for this really enlightening conversation. I so appreciate the data and the willingness to talk about both prevention as well as mitigation, and also that ROI to the investment, I think incredibly helpful. So thank you again, sharing your expertise with us today.

Kerri Wizner: It was great to be here. Thanks, Heather.

Keemia Vaghef: Thanks for having us.

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