What a great weekend.
N6641M took me on a visit with Mom on Saturday (she's doing great!), then to see my life long friend, TZ (we literally have been together since 2 years old) to go to the International Motorcycle Exposition at the Long Beach Convention Center, then a Sunday morning motorcycle ride up Angeles Crest Highway to Newcomb's Ranch for breakfast, and then a nice (but Santa Ana wind swept) bicycle ride in the afternoon followed by a delicious tri-tip dinner... My mental health yesterday peaked at an all time high.
Imagine that - what could be better than seeing loved family, wonderful life long friends, flying airplanes, drooling over and then riding motorcycles and bicycles, and filling the tummy with delicious wonderment - a life affirming, psychologically stimulating time important to mental health.
I'd been on a huge path to burn out prior to this weekend - the stress of numerous speaking engagements in November, the upcoming WorkCompCentral Comp Laude Gala, running a business and all the uncertainty and stresses, plus all of the other complications in life...
My wife texted, after seeing a picture of me that was sent to her, "you look extremely happy David," to which my son dutifully replied, "that's because motorcycles make one happy."
They're both right.
I'd say that this past weekend was a great experiment supporting all of the evidence out there that mental health is as much, if not more, important to good functioning than nearly anything else.
|Happy - motorcycles do that.|
But there is a huge component of science the industry chooses to ignore: psychology typically makes up a larger component of outcomes than any physical treatment.
There are several professional medical organizations (such as the American Academy of Orthopedic Surgeons or the American Academy of Disability Evaluating Physicians) that have, for years, been espousing the science behind this concept - that an injured worker's mental health is as much, if not more, important to good outcomes than nearly anything else. There are numerous studies and peer reviewed papers published in credible medical journals supporting this.
And a pair of articles published in this month’s issue of The Spine Journal support this concept even further.
Researchers principally from University of Zurich in Switzerland conducted a review of previous studies and found that two psychological phenomena – catastrophizing and fear-avoidance beliefs – are associated with return to work and levels of pain among patients with lower back pain.
Catastrophizing is essentially a thinking pattern that elevates perceptions of problems to catastrophic levels. Fear avoidance is refraining from engaging in behaviors out of concern that it will increase pain.
There are two common methods used to determine a patient’s level of fear avoidance. A team of researchers led by Gordon Waddell, a professor at Glasgow, Scotland’s Western Infirmary, created a fear-avoidance belief questionnaire in 1993 that creates a number score. The questionnaire asks patients to agree or disagree based on a numbered scale with statements such as "I should not do physical activities which make my pain worse" and "my work might harm my back."
The Tampa Scale of Kinesiophobia, developed in 1991, is structured in a similar way and asks comparable questions to produce a score.
The score a patient gets based on those responses, according to the University of Zurich researchers, is associated with the outcomes patients had. Several studies included in the review found higher pain levels and fewer patients returning to work when they had higher scores. When patients went through interventions targeting those problems, they had better outcomes.
A series of studies from the Workers Compensation Research Institute bolstered the evidence supporting that theory in June. The studies, which examined predictors of worker outcomes in eight states, surveyed more than 3,000 workers in those states. When asked whether they feared being fired because of their injury, 52% said they strongly disagreed, 9% somewhat disagreed, 12% somewhat agreed and 27% said they strongly agreed.
The survey was conducted in 2013, and the participants were all injured in 2010, meaning they had been in the workers’ compensation system for at least three years. Of those who said they strongly agreed that they might be fired because of their work injury, 21% weren’t working at the time of the interview. For those who strongly or somewhat disagreed, the number was 10%.
Further, the disability of those who strongly agreed lasted an average of 13 weeks, compared with nine weeks among those who disagreed that their injury might lead to being fired.
I can go on and on and on.
But here's the hypocrisy - while there is substantial, if not almost insurmountable evidence that taking care of an injured worker's head is critically important to desired workers' compensation outcomes, the claims community would rather not take on that can of worms.
And I can understand why - because insurance and claims management in particular isn't designed to do this; the actuaries didn't factor in the cost of correcting one's behavior and psychology when analyzing the cost of claims.
Nor did the business people that have the obligation of making money off of claims management factor that into their models; it's frankly cheaper to pay off a claim than to tackle the "long tail" of psychological therapy necessary to turn a person around. Indeed, that all may be for naught - there may never be a "turn around."
Because for all the rhetoric about an employer taking an employee as he or she is, and thus being responsible for whatever occurs on the job, there is very little ability to monitor, much less influence, one's psychological state.
So here's the deal - we can talk about mental health of a workers' compensation claim ad nauseum, but the business of workers' compensation is not about taking care of the whole person; it was designed only to take care of what happened specifically at work.
The best claims management can do with this information is be aware of the extent to which psychology plays a part in an injured worker's recovery and, if it looks like psychology is in the way of the desired outcome, then cut the claim chord off as quickly as possible.
It's a harsh reality, but that is the reality.
Kind of like when I told my wife that I finally decided on what new bike I needed to get after the motorcycle exposition - that part of the David-management system got cut off as quickly as possible.
Something about having one motorcycle is enough ...