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Referral and Coordination of Treatment Considerations

Referral and Coordination of Treatment Considerations:Strengths and Weaknesses in Current Processes

Again, the main weakness in the current workers’ compensation system is thatphysicians are economically incentivized not to find the psychosocial issues, andthat once discovered, many workers’ compensation insurers seem to deny the treatmentauthorization for these issues. Some jurisdictions do not recognize mental healthissues accompanying physical work injury claims (only the “accepted condition”can be mentioned in reports and treated), so any referral to a psychologist orpsychiatristin those jurisdictions has to be done by using the employee’s healthinsurance. Employees who are out of work with a work-related injury are generallyvery reluctant to spend their own money to see mental health professionals for whatthey perceive as purely an injury that is the employer’s fault.

Many larger employers have an Employee Assistance Program (EAP) that enablesemployees to see a mental health specialist for a limited number of confidential visits(outside the workers’ compensation system with its lack of doctor patient confidentiality).Physicians can suggest the workers’ compensation patient with apparent psychosocialissues access the employer provided EAP. Most EAPs are not organized to deal withthe complex psychological and psychosocial issues that impede the Stay-at-Work/Return-to-Work process, but they may recognize the issues, convince the injuredworker that these issues need to be addressed, and then refer the worker to a psychiatristor psychologist for more intensive treatment. This may be the only access tomental health services available to many injured workers. Unfortunately, manyemployees do not have access to an EAP as a benefit of employment.

In general, the mental health professionals (psychiatrists and psychologists) arethe strength in the current system, but the strength that is underutilized. As previouslymentioned, nonforensically oriented mental health professionals may not recognizethe psychosocial issues hindering recovery. Some mental health professionals fail toappreciate work as a source of emotional support, and the importance of keepingpeople at work (American Psychiatric Foundation, Partnership for Workplace MentalHealth, 2005). These mental health workers may inappropriately keep patients offwork with open-ended medical leave recommendations.

Another weakness in the current mental health system that has not been systematicallyresearched is the recurring pattern of the mental health professional that isemployed by, or frequently used by, pain clinics that want a normal psychologicalexam before undertaking pain procedures that usually do not work well. There is apattern of consistent reports from these mental health professionals that the patienthas no Axis I or Axis II disorder, and that depressive symptoms are appropriate tothe chronic pain for which the pain procedure has been proposed. Despite the literaturefinding a high rate of Axis I and Axis II disorders in these patients, somemental health providers seem rarely to diagnose these disorders in chronic painpatients referred for psychological “clearance” for invasive procedures.

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