Mental health continues to be one of the most misunderstood elements of the workers' compensation process. While many organizations acknowledge that psychological factors influence claim outcomes, few have restructured their processes to address them proactively. The result is a system that often reacts to mental health challenges only after they have already extended claim duration and driven up costs.
Adding to this dynamic is the well-documented opioid abuse epidemic where injured workers, who may have had a pre-existing mental condition, are given addictive opioid medications, upon which they become dependent.
A 2024 report published in New Solutions: A Journal of Environmental and Occupational Policy, indicated that the very process of applying for and receiving workers’ compensation benefits can result in psychological issues that were previously undocumented.
The barriers standing in the way of treatment
The barriers to addressing mental health in workers' compensation are cultural, operational, clinical, and regulatory. Stigma remains pervasive. Behavioral health providers are limited, and many are reluctant to accept workers' compensation cases because of the paperwork involved. Return on investment is difficult to demonstrate because mental health is considered subjective, and regulatory frameworks often make organizations hesitant to formally recognize psychological components of a claim.
"In workers' comp, we are so focused on the physical issue that mental health is seen as a secondary issue and oftentimes noncontributory when it really is a contributory factor,"
said Nanesha Courtney, Ph.D., LMHC, CRC, CDMS, CET, National Product Manager, Advocacy, Disability, and Return to Work Services, Broadspire. "The system tends to be very reactive rather than proactive."
Complicating matters further, providers treating the same injured worker frequently do not communicate with one another. Pain management, psychiatric care, and physical therapy often operate in silos, creating gaps that can lead to polypharmacy and worsening outcomes.
"Treating providers often address pain conditions and psychological health as separate aspects of an injured worker’s condition," said Devon Mahaney, PharmD, Assistant Vice President of Utilization Management & Physician Review Services at Broadspire.
"These providers interacting on the same case are not always talking to each other, and they're not always considering how medications prescribed from different providers might interact."
The cost of inaction for workers and employers
When psychosocial factors go unaddressed, the consequences compound quickly. Mahaney described a case involving a 49-year-old employee with a rotator cuff strain from lifting inventory. Imaging revealed no surgical pathology, and physical therapy began immediately with an expected return to work within weeks.
Instead, opioid therapy continued past the three-month mark. A muscle relaxant was added, followed by gabapentin, an antidepressant from a separate provider, and eventually a sleep aid. The worker became fearful, stopped attending physical therapy because of pain, and grew increasingly anxious about finances and the possibility of permanent disability.
"Now you've got a patient with five medications all contributing to sedation and providing limited benefit," Mahaney said. "All of these factors — the medications, symptoms of anxiety and depression — can increase pain. That's a specific story where things didn't need to go in that direction."
Courtney described this pattern as "the snake eating its tail." Physical injury produces pain, which drives anxiety, depression, and fear avoidance, which in turn amplifies pain. Once the cycle takes hold, it becomes increasingly difficult to determine whether the injury caused the psychological distress or the reverse.
The financial impact is significant. While psychiatric medications represent one component of behavioral health spend, the surrounding costs — additional imaging, appointments, and prolonged treatment — are substantial. In Broadspire's patient population, we commonly observe overlap between psychiatric medication use and opioid therapy which is associated with longer claim durations and can contribute to chronic opioid use disorder that keeps claims open for decades.
Workers also suffer beyond the medical impact. Most people derive social connection through their workplace, and when injury removes that connection, isolation quickly sets in.
"For the first week or two things are great, maybe even a month because people are calling in and checking on them. Then very quickly, that wanes off," Courtney said. "The injured worker can quickly begin to feel isolated and like nobody cares."
What early, integrated intervention looks like
The benefits of proactive engagement such as those listed below are integral to effective management of the workers’ claim. Workers experience shorter recovery periods, reduced medication reliance, and stronger connections to their workplaces. Employers often see lower claim costs, faster return-to-work outcomes, and reduced disability duration. Claims professionals gain clearer visibility into risk factors that would otherwise remain hidden until they become expensive problems.
Achieving those outcomes requires a shift in how organizations structure their processes. Courtney and Mahaney recommend several practical approaches:
Use pharmacy data as an early warning system. Pharmacy benefit manager data can flag polypharmacy patterns, antidepressant additions, and sleep aid prescriptions that often signal psychosocial deterioration. "Looking at that data can help identify cases that warrant a closer look to determine whether the injured worker could benefit from additional resources," Mahaney said.
Establish communication across providers. Bringing physicians, physical therapists, and behavioral health providers together — along with family members when appropriate — ensures everyone is aligned on treatment goals. "This way, we can get everybody on the same page and everybody headed in the same direction, identifying a primary source who's going to be able to talk to the injured worker," Courtney said.
Keep workers engaged with the workplace. Programs that allow injured employees to remain connected — whether through modified duty for a few hours a week or worker-on-loan arrangements — help prevent the isolation that fuels catastrophizing. "It's improving their well-being and helping to prevent escalation because, again, they are remaining connected to something versus being disconnected and isolated and focusing on how much it hurts," Courtney said.
Set expectations early. Uncertainty is one of the strongest drivers of anxiety for injured workers. Clear communication about what to expect throughout the recovery process gives workers a sense of control.
"You don't go to the grocery store without a plan and a list. Otherwise, you end up taking home unneeded items or forgetting the ones you wanted in the first place," Mahaney said.
"You need initial support, initial plans, and initial communication, making sure that the injured worker knows what to expect."
As a provider of integrated claims management and advocacy services, Broadspire has developed its programs around this early-intervention philosophy, combining data-driven identification with case management support and employer engagement strategies designed to keep workers connected throughout recovery.
The window for meaningful intervention is narrow. "You want to speak to injured workers before that optimism of healing goes away," Mahaney said. "You really want to engage with that injured worker when they're still mentally looking forward and can see a path beyond their injury, rather than later on when they’re exhausted and no longer have that mental stamina to keep going."
To learn more, visit: Broadspire.
