Managing Behavioral Health Disability
June 21, 2017
Over the years, mental illness has become much more frequently a cause of disability. Five of the leading 10 causes of disability in the United States are mental health conditions (major depression, schizophrenia, bipolar disorder, alcohol use disorders, and obsessive-compulsive disorders)1 (WHO) and by the year 2020, major depression is expected to be the leading cause of disability for women.2 It’s already the leading cause of disability for adults under age 45.3 The costs associated with disability extend far beyond the individual suffering. There are ramifications to work performance, lost productivity, absenteeism, accidents, and staff turnover. Depression alone costs approximately $30-$40 billion per year, with part of that being an estimated 200 million lost work days per year.4 The importance of managing these situations to both the employee and the employer cannot be overstated. But unless you are the treating provider, is there anything you can really do? In a word: Yes.
First, get involved early. The longer an employee is off work, the harder it is for them to come back and the more difficult the return. Ideally, intervening within the first six to eight weeks of the leave has the best chance of mitigating the length of time needed for leave.
Next, communicate. Communicate regularly, appropriately, and confidentially. Communicate regularly with all parties involved such as therapists, prescribing physicians, human resources staff, and employees. Make sure to obtain the appropriate authorizations from the employee. Be compassionate, but avoid taking on a therapeutic role. The goal is to facilitate returning to work. Focus on the claimant’s functioning, treatment plans, motivational issues, and the employee’s perceptions of workplace issues. Don’t share information beyond what must be shared to facilitate appropriate treatment and return to work to respect the employee’s privacy and confidentiality.
While it is not part of the claims management role to direct treatment, being an advocate for appropriate treatment is essential. It is generally accepted that the minimum standard of care for an impairing mental health condition is individual therapy at least every other week, preferably weekly; along with at least monthly medication management ideally by a psychiatrist. If this level of treatment doesn’t produce functional improvement within a reasonable amount of time, it would be expected that treatment would be intensified. Often just asking the provider questions about the “next step” is enough to get the conversation headed in the right direction.
On the other hand, sometimes, iatrogenic influences need to be managed. Sometimes, treating providers believe the mere presence of a diagnosis justifies a disability leave or that a long period of time will be needed away from work but without any changes to the treatment plan. Educating providers on what the research says about the quality of life for people on long term disability or about how the experts suggest mental health disabilities be treated, can often have quite a positive effect on both the resulting treatment plan and the ultimate outcome for the claimant.
1. World Health Organization (2000). Mental health and work: Impact, issues and good practices. Geneva.
2. National Alliance on Mental Illness (October 23, 2016) Together, We Can Save A Life.
3. World Health Organization (2000). Mental health and work: Impact, issues and good practices. Geneva.