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Fatigue, stress take toll on frontline workers

masked nurse

Health care workers are more frequently reporting symptoms of anxiety, depression, post-traumatic stress disorder and increased substance abuse, as they work through the COVID-19 pandemic. Without interventions, experts fear this could lead to a rise in compensable mental health claims down the road. 

Several studies released in the past few months have identified the troubling mental health effects that coronavirus has had on the health care workforce. A study from King’s College London found that nearly half of all intensive care unit staff in the United Kingdom are likely to meet the threshold for PTSD, and a University of Utah study found that more than half of doctors, nurses and emergency responders involved in COVID-19 care are at risk of acute traumatic stress, depression, anxiety, problematic alcohol use and insomnia. 

“What we’re seeing with COVID … is probably a 100% increase in stress and anxiety claims,” said Lori Daugherty, St. Petersburg, Florida-based CEO of IMCS Group Inc., which provides behavioral health care to injured workers in the workers compensation system. 

Even before the pandemic, health care workers reported higher rates of stress, burnout and addiction resulting in disability and workers compensation claims than the general public, said Dan Jolivet, Portland, Oregon-based workplace possibilities practice consultant and licensed clinical psychologist at brokerage Standard Insurance Co.

Standard’s research found that reports of serious mental health issues among health care workers rose 10% in 2020 compared with the prior year and that more than half the workers surveyed said behavioral health issues had been affecting their work more since the start of the pandemic.

“It’s no secret that health care workers are really struggling,” Mr. Jolivet said. 

Third-party administrator Sedgwick Claims Management Services Inc. has not seen an uptick in mental health claims, but “it’s something we’re watching very closely,” said Dr. Teresa Bartlett, Troy, Michigan-based managing director, senior medical officer. “Perhaps we will see some PTSD out of this. (Health care workers) are so inundated and so severely needed, they just keep trudging on day in and day out, and some day that may catch up with them.”

One of the biggest concerns, experts say, is not being able to get in front of these potentially costly claims. 

If untreated early on, mental health issues may develop into severe conditions, such as depression, anxiety, psychosis and thoughts of suicide, said Tammy Bradly, Birmingham, Alabama-based vice president, clinical product development at Genex | Coventry, part of Mitchell International Inc.

“Just one of those diagnoses alone could be upwards of $40,000 to $50,000 for treatment and time away from work. Most people may be experiencing more than one diagnosis. … Their cost and time from work are going to be even higher.” 

The Genex | Coventry crisis response team has been fielding calls from ICU nurses seeking behavioral health support. 

“What they’re seeing, it’s horrific … and there’s no endpoint,” said Natasha Charleston, the TPA’s crisis response program coordinator and vocational field case manager.

There has been an increase in employer interest in addressing stress and other behavioral health issues, said Mary Langowski, Washington-based CEO of Solera Health Inc., which connects patients and payers with nonclinical health care. 

“Payers are really trying to figure out, how do we get to people earlier, so we can build the resilience, so they don’t end up at the higher end of the (behavioral health) acuity spectrum,” she said.

In early February, IMCS launched a program to treat the behavioral health issues of essential workers brought on by the pandemic. 

“Our clients are coming out of the workers comp system. … (We’re) giving them the skills to cope with whatever their situation may be to make them productive members of that employer,” Ms. Daugherty said. 

Dr. Bartlett said she’s seen health care systems create peer support programs or engage in morning huddles to allow stressed-out employees to vent and share their recent experiences and prepare for what they might see that day in the COVID-19 wards. Others have promoted their employee assistance programs, she said. 

Sedgwick has started analyzing its COVID-19 claims for key words that might point to stress, anxiety, depression or addiction issues so those workers can be referred to a behavioral health specialist for help. 

“You want to create opportunities for dialogue,” Mr. Jolivet at Standard said. “As we’re seeing increases in anxiety, depression and PTSD … hospitals, like all of us, need to be prepared to address that.”

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