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A notable recurrent theme in workers' compensation recently is mental health. This dovetails into aspects of the broader focus that has been proposed and advocated in the claims business in recent years. There are those who see the worker as needing broad attention in the course of recovery. They advocate a process of Treating the Whole Person, as Roberto Ceniceros Wrote in Risk and Insurance back in 2015.
Some of the focus there was directed at more visually apparent co-morbidity issues like obesity, but the underlying theme is similar regarding any conditions or predispositions of the worker. The point is that treating the underlying comorbidities or pre-morbidities may be a method to indirectly attack the results of an injury and facilitate recovery or remediation. It is a sentiment that recognizes the fact that humans are each unique in various ways, and that such singularity carries through following an injury. Our individual predispositions, including emotions, may influence our individual perceptions, reactions, successes, and challenges.
Many discussions I have at conferences and meetings focus on emotional or mental health. Many contend that the distinction between positive and negative recovery/outcome following an injury comes down to mental health. While they accept that mental health issues may follow a work injury, some stress that such reaction or evolution may as likely be founded in mental health, coping, and conditioning that pre-exists, at least to some degree. They describe various potentials for outlook, motivation, and perception that may be influenced by the way an injured person reacts to injury, perceives pain, reacts to support, and the complex community of personal perceptions of work, family, and more. They argue a worker's existing emotional perspective and disposition to coping may support or impair efforts at recovery.
A corollary of emotional reaction may be aptly illustrated in a larger sense by comments in The Guardian regarding the aftermath of Hurricane Ian (October 2022). That story recounts a litany of challenges faced by survivors as they emerged from sheltering and re-entered the community to find devastation. If you have never lived through a natural disaster, the feeling may be unfamiliar, but it is likely everyone has had life events that may engender commiseration for the reaction. The article notes that people become "frustrated, agitated." They have expectations of progress in recovery; "They think the power’s supposed to turn back on,” and respond with frustration to the situation not meeting expectations.
Following an injury, patients may similarly have recovery or restoration expectations that are not realistic but are nonetheless sincere. The result may therefore be frustration and emotional stress. A local government official is quoted by CNN: "People need to take care of their emotional and mental health because we’re really going to need to work together on this.” Certainly, that seems good advice following a massive tragedy. Is it any less apropos regarding a work injury? Wouldn't it make sense following an injury, work interruption, or alteration of our personal "normal" to "take care of . . . emotional and mental health?" Wouldn't it make sense to undertake a collaborative path to recovery?
To say that emotional well-being is "potentially" complex is perhaps akin to suggesting that Euclidian geometry is "potentially" frustrating. I had a professor once who explained my failure with an equation noting that "geometry may or may not be linearly dependent." And I was irretrievably lost to mathematics thereafter. I still have no idea what she meant. For some reason, various of my peers were less confused by that statement, and even seemed inspired by it. We are each, it seems, different. Some differences may be in reaction and others in predisposition. Perhaps my peers were merely better prepared to receive the advice that professor was providing?
So, step one in considering the impacts of emotional predisposition or comorbidity might best be to agree that the issue is potentially complex. It is possible that there will not be a unanimous agreement on various issues of presence, severity, impact, and more. It is possible that the convoluted interrelationship of emotions will be less apparent to some than others. It is possible that there will no sooner be unanimous agreement on the topic than there will be on deciding "the best" college football team.
The numbers are challenging. The National Institute of Mental Health (NIMH) suggests that America has significant challenges with mental illness, estimating that "nearly one in five U.S. adults live with a mental illness (52.9 million in 2020)." That is significant, 20%. In illustrating a similar statistic once, a comedian said (essentially) that you can "think of your five closest friends. If one of them is not ________, then it's you." That is troubling. But more troubling is the fact that it may be one of those friends and either you have not noticed or they are really good at hiding the struggle they live. Or, it is possible that I know two such people and you know none. Or, perhaps the one suffering is you. Statistical analysis can be helpful, but not always definitive.
The broadest definition in this grouping is referred to as those with "any mental illness" (AMI), and it "can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment." Note that, some of the 20% may have absolutely no knowledge they are suffering and have no impairment. Remember the "predisposition" discussion above? What if that is the worker that gets injured and thereafter the predisposition manifests or complicates recovery?
There is also a subset that is referred to as "serious mental illness (SMI)," which is a "disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities." Despite that this level of impact may be notable and even potentially debilitating, such a person receiving active care might nonetheless be functioning and working well until an interruption event like a work injury. Thus, the severity of what that 20% suffers can be spread across quite a spectrum. And, it seems practical to anticipate any particular level of severity may exist in a given workforce.
Notably, the 20% is likely a slight understatement of the reality. The survey specifically does not include any assessment of "persons who, for the entire year, had no fixed address (e.g., homeless and/or transient persons not in shelters," according to NIMH). That population is estimated to be around one-half million Americans. Adding some or all of them to the analysis might not change the percentages substantially, but it is important their existence and struggles are similarly considered and discussed.
What is certainly worthy of consideration are statistics about the workplace. Notably, 100% of workers' compensation accidents are suffered by working people. While that is axiomatic, it bears noting. The working population is broadly defined as those between 15 and 64 years of age. Obviously, there is potential for workforce participation beyond those two poles, but, the statistic is intended to provide consistently defined parameters by which we might express and consider this group in a broad sense, the "working population."
The U.S. working-age population has ranged over the last 50 years between 62% and 67% of the overall population. Thus, it is possible that this group might include none of those suffering with AMI (20%). But, that is not the case. AMI is unddoubtedly among the "working age population."
The figures reveal that the working population is: 25-29 years old = 23.24 million (m); 30-34 = 22.84 m; 35-39 = 21.83 m; 40-44 = 20.31 m; 45-49 = 19.97; and 50-54 = 20.39 m. These age groups coincidentally include individuals with AMI: 30.6% of 18-25 year- olds report the presence of AMI. In the 26-50 age group, the reports equal 25.3%, and for the over 50 age group, the reports equal 14.5%. Thus, there is a coincidence and therefore probability that some in the workforce will suffer from AMI, and some may already suffer from SMI.
The analysis here is not to suggest that there are individuals with challenges in any particular workplace, but to state it. The probabilities are that there are employees in any workforce that suffer at least AMI. They may display symptoms, they may seek accommodation, and they may be absolutely undetectable. In the wake of some traumatic event, be it injury or hurricane, the stress and reaction may therefore manifest in different individuals in different ways.
Whether that is reason to "treat the whole person" or not is left to the reader. However, whether care is undertaken for comorbidities or not, there is the distinct probability that those will impact and influence recovery, whether it is diabetes, obescity, emotional challenges, or otherwise. Whether the whole person is treated or not, the whole person will impact and influence the course of recovery, palliation, and return to work.
By Judge David Langham
Courtesy of Florida Workers' Compensation
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About The Author
About The Author
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Judge David Langham
David Langham is the Deputy Chief Judge of Compensation Claims for the Florida Office of Judges of Compensation Claims at the Division of Administrative Hearings. He has been involved in workers’ compensation for over 25 years as an attorney, an adjudicator, and administrator. He has delivered hundreds of professional lectures, published numerous articles on workers’ compensation in a variety of publications, and is a frequent blogger on Florida Workers’ Compensation Adjudication. David is a founding director of the National Association of Workers’ Compensation Judiciary and the Professional Mediation Institute, and is involved in the Southern Association of Workers’ Compensation Administrators (SAWCA) and the International Association of Industrial Accident Boards and Commissions (IAIABC). He is a vocal advocate of leveraging technology and modernizing the dispute resolution processes of workers’ compensation.
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