March 2024 – It’s the Right Thing To Do…!

On Mental Health Parity – It’s the right thing to do
 
It’s time to recognize that the line between mental and physical health is arbitrary and an artifact of the way that we talk about it, and not something that has any reality. Think about it: the last time you felt sick with a cold or the flu – let alone anything more serious – how did you feel emotionally? Were you on top of your game, did you have the same energy you usually do, were you your normally optimistic self? Probably not.
 
How about the last time you woke up after a restless night’s sleep, perhaps having had a disagreement with a loved one the night before, feeling like you wanted to pull the covers over your head and unable to imagine facing the day at work – how did you feel physically? Did you feel ready to go out for a jog or head to the gym? Probably not.
 
In our everyday experience, it’s obvious that being sick or hurt has a negative impact on our mental well-being, and vice versa. In lay terms, being sick can be depressing and feeling depressed tends to exaggerate our aches and pains. Mental health and physical health are two sides of the same thing. Mental health is health.
In the two previous newsletters, in this series, we have outlined the medicalization of disability claims management. The roots of this often over emphasis and reliance on the medical diagnosis and prognosis is the biomedical model. Singularly focusing on the biomedical model can lead to an over emphasis on the medical diagnosis and prognosis.

Mental health parity as a matter of policy
 
It’s time to change the way we think about this in disability and workers’ compensation. In an article I published online in December, and which you can find here [link to posting], I applauded the ERISA Advisory Council’s recommendation that Congress legislate a requirement that disability insurers treat mental and physical health claims equally. Despite some caveats and misgivings, I stand by that position, and become more convinced daily that it’s the right thing to do.
 
Suffice to say that not everyone in the industry agrees with me. Their concerns are legitimate. There are cost considerations, though as I point out in the article, I think these are smaller than anticipated and can be managed. More importantly, there are technical hurdles to overcome, specifically that it’s more difficult to assess impairment that results from a mental health condition as compared to many physical conditions for which we have testing, imaging, and exam techniques readily available.
 
Even more importantly, as I also said in the article, we can’t have lost-time coverage continue business as usual if we are to truly address the complexities of disability caused by a mental health condition or the complex ways that psychosocial factors impact physical disabilities. We are going to have to get better at understanding the risk factors that contribute to extended disability, and we are going to have to develop more and better ways of helping people get back to functioning whenever possible, including but not limited to returning to work.
 
It’s going to take time and effort to do this right. We have to do it anyway.
 
Yes, I’m taking an extreme position
 
There’s a reason I started this blog post with mundane examples and common-sense experience. We need to understand we cannot solve the most complex problems facing disability and workers’ compensation without understanding at the most basic level that parity between mental and physical health isn’t optional: it’s just a fact that they are two sides of the same coin. Addressing one without the other is simply bad medicine and, to come to the point, bad policy.
 
I do also want to be clear that I’m not saying that we’ve done it wrong all these years. I’m not criticizing policies and procedures for fair claims handling that have served us well for a long time. I do, however, want to make the point that we can do better, and it’s time.
 
Here at The Claim Lab, we have honed a predictive model that can help organizations in disability and workers’ compensation to reliably identify claims that are likely to become complex. We are also expanding our capabilities at helping organizations know what to do with those data in order to improve outcomes. It turns out that those complex claims can, with insight and additional management, turn out well for the employee, the employer, the insurer, and the whole health system. And that, after all, is the point of what we do. Mental health parity, understanding that mental and physical health are one, is just part of the process for improving outcomes.

If you want to discuss what this in more detail, please contact us at info@claimlab.org.

Dr. Les Kertay is a clinical and consulting psychologist with extensive experience in workplace mental health, impairment medicine, disability insurance, and workers’ compensation. He is an industry consultant with current roles that include Chief Psychologist for The Claim Lab.