Disability insurance and workplace wellbeing consultant, Monica Garcia, examines the disability insurance claims process and the role of rehabilitation and return-to-work support for mental health conditions.
When we look at mental health in the context of Disability Insurance (DI), we need to outline a few considerations. Most mental health claims are related to Common Mental Health Disorders (CMHD). This mirrors the trend observed in the non-insured population, where it is estimated that one in six adults are affected by a CMHD at any one time.
We then need to focus on the working population, where reports suggest that 50% of all UK work-related sickness absence is due to stress, depression or anxiety. The risk of mental health related disability is therefore significant, and this is without accounting for the presence of mental health problems, secondary to other causes of claim, such as cancer and musculoskeletal disorders, also main causes of DI claims in the UK.
In addition, access to accurate data that captures secondary mental health conditions is limited, and therefore it is difficult to quantify the size of the risk. However, we do know that the presence of co-morbidities can have an impact on recovery and return-to-wok outcomes.
The importance of bio-psycho-social factors
Not everyone develops a diagnosable mental health condition, with severity and recovery timeframes dependent on the individual biopsychosocial circumstances of the claimant.
What we know from research, is that factors such as past mental health history, biomedical pre-disposition, individual beliefs, self-efficacy, job strain, job-control, co-morbidity, length of absence, social support, and availability of treatment, amongst others, are key moderating factors of long-term disability, and can predict whether an individual would be able to return to work or not, beyond the medical diagnosis.
All of this means that the assessment and management of mental health claims can be quite complex, with significant differences in the level of disability and work incapacity reported by claimants.
The role of rehabilitation and return-to-work support
Most Income Protection (IP) propositions in the UK have evolved to offer some form of rehabilitation interventions for claimants, at no extra cost. This has been shown to be a cost-effective way to support claimants when they are most vulnerable. When appropriately implemented, the individual, the insurer, the employer, and society benefit from return to health and work outcomes.
In terms of rehabilitation implementation, insurance companies have a duty of care to their customers, and as such, any treatment interventions provided must be evidence-based and follow best practice guidelines. Within this context, the most common form of mental health treatment provided within an IP policy is Cognitive Behavioural Therapy (CBT), which is used for the treatment of anxiety and depression, as well as other mental and physical conditions (6). In a nutshell, CBT is a talking therapy that works by breaking down the way we think, feel and behave, to help change thinking patterns and thus alleviate/manage symptoms.
To facilitate the most appropriate course of treatment, insurers are encouraged to follow a tailored approach, whereby the most appropriate mental health care pathway is facilitated, depending on the condition and clinical history. For instance, some claimants with mild-moderate mental health symptoms might require short-term support, whereas more complex mental health cases may require psychiatric involvement, and long-term care. It is therebefore important to have the patient/claimant's NHS treatment team involved and informed of any interventions funded by the insurer.
A key element to any successful rehabilitation intervention is to have tailored return-to-work (RTW) support at the core of any IP claims intervention. Whilst CBT focuses on the clinical aspects of the mental health condition, RTW support is usually provided by vocational rehabilitation professionals (VRP). Depending on the needs of the individual, support may focus on helping the claimant to build back their self-confidence and to focus on their work ability, so they can resume work in a safe manner and on a graded basis.
The type of intervention provided also depends on the length of time the claimant has been off work, the cause of the mental health problem, work status, social situation, and employer's availability of support. VRP's should be full members of the Vocational Rehabilitation Association, UK (VRA) for access to professional guidance and quality standards.
The role of the workplace
Workplace wellbeing and mental health are very closely linked, with many mental health conditions arising due to work-related factors. When the main stressor and cause of the mental health claim is related to the workplace, it is key that work issues are addressed promptly before symptoms escalate, and the relationship with the employer deteriorates. In my experience, many mental health claims remain in payment in the long-term because the work issues are not resolved. VRPs usually assist with mediation to help address any issues, but unfortunately it is not uncommon to see that a claimant remains off work in the long-term because of the lack of a successful resolution.
In that context, statistics show that approximately 300,000 people per year leave the workplace in the UK because of mental health problems. As such work-related sickness absence is an issue that insurers alone are unlikely to be able to address without the full participation of employers, and although there have been improvements in terms of awareness of mental health and stigma, we still see a huge amount of people affected by mental health and struggling to cope with work.
Ultimately workplaces, need to have health and wellbeing policies and procedures that have truly supportive frameworks to accommodate the needs of employees with mental health conditions.
As we learn the impact Covid has caused from a mental health perspective, it is important to keep abreast with evidence, particularly in relation to population groups most at risk of developing CMHD. Recent modelling around population groups in the UK who are at most risk has been made available and included: individuals who survived severe COVID-19 illness, individuals working in health and care settings, those who experienced bereavement, and people who have been economically affected by the pandemic.
In summary, rehabilitation interventions for mental health conditions within the DI setting can be effective, but a holistic and tailored approach, suitable to the individual claim circumstances needs to be adopted. In addition, it is key that a RTW focus is at the core of any intervention, and that employers are engaged as soon appropriately possible to enable a smooth transition back into work. In the case of self-employed claimants, rehabilitation interventions need to equally reflect the needs of this population group.
This article was published by COVER as part of the Mental Health in Life Insurance week.
 Gragnano, A, et al 2018. Common Psychosocial Factors Predicting Return to Work After Common Mental Disorders, Cardiovascular Diseases, and Cancers: A Review of Reviews Supporting a Cross-Disease Approach. Journal of Occupational Rehabilitation.
 Waddell, G, Aylward, M (2010) Models of Sickness and Disability: Applied to Common Health Problems. London: Royal Society of Medicine
 Garcia, M et al, Swiss Re. (2015) Psychosocial factors as predictors of return-to-work after six months of absence in Income Protection claims. Cited in: Van Den Akkler, C, Swiss Re. Driving successful claims outcomes.
 Supporting the mental health of employees during and beyond Covid-19: https://www.employment-studies.co.uk/system/files/resources/files/AXAEMHGuide.pdf