The Rising Tide of Mental Health Support

Ian Bridgman

Editor’s Note: The Council for Disability Awareness board member, Ian Bridgman, makes a point in this post that few in the group disability insurance industry are willing to discuss publicly: Are US carriers ready to remove the 24-month mental health claim limitation?

It is most likely an understatement to say we need more effective methods of identifying mental health issues.

For example, wherever we look there seems to be more knock-on effects from the pandemic:

- - - - In the first year of the COVID-19 pandemic, the global prevalence of anxiety and depression increased by 25 percent.
        
        In October 2021, approximately half of Americans reported they were reevaluating their life priorities and prioritizing a better work/life balance. For approximately one in five overall, these changes were driven by the pandemic.
        
        S. employee annual voluntary turnover is likely to jump nearly 20 percent this year, from a pre-pandemic annual average of 31.9 million employees quitting their jobs to 37.4 million quitting in 2022, according to Gartner, Inc.
        
        An individual organization with a turnover rate of 20 percent before the pandemic could face a turnover rate as high as 24 percent in 2022 and the years to come.
        
        Resistance to return to the office.

Increased Acceptance of Mental Health as a Treatable Condition

However, maybe one beneficial side-effect of the pandemic is we are witnessing an increased acceptance of mental health as a treatable condition, rather than a sign of weakness.

Historically, we have seen in our data at The Claim Lab that a large proportion of mental health issues go unreported and, therefore, untreated.

Why is this?

- - - - People don’t want to admit to depression.
        
        And people don’t want to admit to feeling anxious.

We find this is particularly true in the workplace.

One of the issues with employment-based benefits – particularly in the United States – is most individual’s health and wellness services are provided through their employer.

Furthermore, for any physical condition, we know that return to work is complicated by mental health issues. A rotator cuff injury has a published medical guideline for recovery, depending on the level of physical activity required by the job. Yet there is no guideline for the complication brought by a mental health condition for that same individual during this same absence.

We see clearly that when an employee has complicating mental health factors, recovery takes longer. If a claimant is also depressed about their job, hates their boss, has family stressors and/or financial worries, the very thought of returning to work makes their shoulder pain even worse.

Is this classifiable as major depression? Probably not, but it will be enough to disrupt a normal return-to-work plan. Such an unreported mental health condition will make the return to the workplace more complex.

In The Claim Lab’s work with clients outside the United States, we see that it’s the minor levels of depression and anxiety that are likely to go untreated. This diagnosis is unlikely to be on the claim form, and employees are very reticent to talk about such feelings in anything related to a workplace situation.

Will the 24-Month Mental Health Limitation Continue to be Viable?

At the moment in the US, there is much discussion about the 24-month limitation on mental health claims. In this new world, post pandemic, is this policy restriction sustainable? For example, the Vermont state insurance commissioner released a statement in October 2008 that limits insurance carriers from using this policy clause unless “such limitations are no more restrictive than limitations placed on physical disability benefits.” In Canada and Australia, no such limitation exists.

In the US, it is our experience that many carriers do not actively manage claims with a mental health primary diagnosis because the policy terms prevent the claim from lasting more than 24 months. We see much evidence to suggest that post-24 month “mental health” claims morph into something else – maybe a musculoskeletal pain claim at some point.

The Canadian Disability Claims Mental Health Experience

Interestingly, in the US we see proportionately many more musculoskeletal claims than we do in Canada. In fact, if you combine musculoskeletal and mental health together the Canadian and US data shows a similar level of incidence!

So, perhaps, the fear in the US of: “OMG, how do we price for this?” may be unwarranted. Maybe US carriers unknowingly already priced for the removal of this limitation. Also, if the US was to invest proactively in mental health interventions in the same way the Canadian claims operations do, then results could improve further.

Unreported Mental Health Claims Impact Return to Work Plans

However, this is a diversion, as the real issue is not severe mental health claims as they are relatively easy to identify and there are interventions that work. Canadian claims operations have demonstrated this. The more complex issue is the volume of claims where there is an unreported, co-morbid mental health issue that will make return-to-work initiatives far more complex.

We can now identify these issues within claims data. The challenge is to build a more effective claim process and support environment that intervenes early in the process. This approach helps individuals with an underlying mental health issue get back to work sooner.

So, let’s use May (Mental Health Awareness Month) as a jumping off point to help bring such issues into sharper focus.

About Ian Bridgman

Ian Bridgman has written 5 posts in this blog.

As Executive Director at The Claim LabIan Bridgman leads a team of experts in analysis of claims for the disability and workers compensation insurance markets.