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Work-related mental illnesses cost more than physical injuries

We need to change the way we view, respond to, and accommodate these conditions


When workers suffer from chronic stress or other mental illnesses related to their work, many organizations are at a loss. (blacksalmon/Adobe Stock)

When people are physically hurt on the job and need time off work — for example, when they strain their low back or shoulder — employers generally know how to help them safely return to work.

But it’s a different story when it comes to psychological injuries. When workers suffer from chronic stress or other mental illnesses related to their work, many organizations are at a loss. So, too, are workers’ compensation systems and health-care providers.

To understand how the return-to-work experiences of people with work-related psychological injuries and physical injuries differ, I and a team of research colleagues at the Institute for Work & Health and Monash University in Australia recently completed a study using information from the Australian state of Victoria.

Why Victoria? Most workers’ compensation agencies in Australia have long covered mental health conditions that arise out of, or in the course of, employment.

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Yet, SafeWork Australia has estimated that psychological injury claims cost 12 times more in wage replacement and health-care expenses than physical injury claims.

As some provinces in Canada have started to compensate these types of work injuries, we wanted to learn from Victoria’s experience about how the return-to-work process differs for psychological injuries compared to musculoskeletal injuries.

Our study compared return-to-work outcomes of 870 compensation claimants. About a fifth had work-related mental illnesses while the remainder had work-related back and upper-body musculoskeletal conditions.

We interviewed them three times over a 12-month period to find out if they had been able to return to work for at least four weeks. We also asked them about a broad range of “modifiable” factors — for example, factors that, if changed, can make a situation better or worse.

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Evaluating our study results

At our first interview (two to five months after injury), nearly half (47 per cent) of workers with musculoskeletal conditions had a sustained return to work, compared to only 28 per cent of workers with work-related mental illness conditions.

Six months later, 67 per cent of workers with musculoskeletal had returned compared to 54 per cent of those with mental illness conditions.

We also found that those with work-related psychological injuries had more negative workplace experiences after their injury compared to those with musculoskeletal conditions.

For example, while half of workers with musculoskeletal conditions described their supervisors as supportive and helpful, eager for them to return to work, or wanting them to file a workers’ compensation claim, only 36 per cent of respondents with mental illnesses said the same. And while three-quarters of workers with musculoskeletal conditions had been offered modified duties and/or a plan to return to work, only half of workers with mental illnesses were made such offers.

The disparities went beyond workplace responses to injury. The psychologically injured workers in our study also had more problematic experiences in the health-care and workers’ compensation systems.

For example, 38 per cent of workers with musculoskeletal conditions had been given a return-to-work date by their health-care provider, compared to only 24 per cent of workers with mental illnesses. And more than half (56 per cent) of those with musculoskeletal conditions said that their interactions with their claims agent were not stressful, compared to only 32 per cent of respondents with psychological injuries who said the same.

It’s important to note that these different experiences did not occur in isolation. Our study showed that a negative supervisor response was associated with more stressful interactions with claims agents, a lower likelihood of being offered a return-to-work plan or modified duties, and less positive recovery expectations.

Together, these factors were as important as mental health symptoms in explaining the differences in returning to work among those with mental and physical conditions.

What needs to be done?

Our systems to manage work-related injuries and get people back to work were developed in a different time and context. That was when most injuries and illnesses were physical and visible, and treatment guidelines were relatively straightforward.

This is not the case with work-related psychological injuries. Establishing their work-relatedness can be more challenging. Medical opinions can vary with respect to appropriate treatment, the optimal time to return to work, and the return-to-work arrangements most likely to be successful.

Treating mental health symptoms is an important response as it accounts for about a third of the differences in return to work among those with mental and physical conditions.

But to improve return-to-work and recovery outcomes for workers with work-related psychological injuries, we need to address factors throughout the return-to-work process.

This includes how supervisors react to workers’ injuries and how workplaces help them return to work; how health-care providers integrate return to work in their assessments and treatment of their conditions; and how workers’ compensation systems make workers’ experience a supportive one, regardless of their type of injury.

Beyond these changes, we still need to address one of the more persistent challenges, which is how to address the work conditions that may have led to the mental injuries.

It is likely that work-related psychological injuries are caused by work conditions such as unrealistic deadlines, low job control, and workplace harassment and bullying.

Addressing these factors requires more organizational-level changes, which are harder to implement. However, failing to do so will mean that returning people to work to these environments will remain a challenge.

Peter Smith is a senior scientist and scientific co-director at the Institute for Work & Health, a not-for-profit research organization in Toronto.

For more about the study, watch a webinar presentation he gave in April 2021 or read a summary about the latest findings. Sign up for research findings and resources on work injury and work disability prevention from the Institute for Work & Health at www.iwh.on.ca/subscribe.