TRAUMATIC MENTAL STRESS POLICY

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TRAUMATIC MENTAL STRESS POLICY

• September 2009

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Traumatic Mental Stress Policy

• Acute Reaction to a sudden and unexpected
  traumatic event
• Must arise out of and in the course of employment
• No entitlement for mental stress that is the
  result of employers decisions or actions

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Sudden and Unexpected Traumatic Event

• Clearly and precisely identifiable
• Objectively traumatic
• Unexpected in the normal course of the workers
  employment or work environment
• May be result of a criminal act, harassment, or a
  horrific accident

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Sudden and Unexpected Traumatic Event

• Worker must have suffered or witnessed the
  traumatic event first hand
• Or heard the traumatic event first hand through
  direct contact with the traumatized individual
• May involve actual or threatened death or serious
  harm against the worker, family member or others

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Acute/Delayed Reaction

• Reaction to the traumatic event that results in a
  psychiatric/psychological response
• DSM-IV Axis 1 Diagnosis i.e. PTSD, Depression
• Immediate if occurs within 4 weeks
• If delayed, must have clear and convincing
  evidence that onset is due to traumatic event
• No entitlement to stress developed over time due
  to general workplace conditions

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Cumulative Effect

• Exposure to a series of traumatic events
• Worker may not immediately react or is able to
  cope through several traumatic events to a
  certain degree
• Last traumatic event may create the acute
  reaction even if not the most traumatic

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Harassment

• Must have objective evidence
• Could involve violence or threats of violence
• If continuous, can be traumatic (cumulative
  effect)
• Includes but not limited to sexual, religious,
  and racial harassment
• Includes being placed in a life-threatening or
  potentially life-threatening situation

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Employers work-related decisions or actions

• No entitlement due to
• - Terminations
• - Demotions
• - Transfers
• - Discipline
• - Changes in hours or productivity
• Entitlement is considered if mental stress is due
  to employers actions that are not part of
  employment function, i.e., violence or threats of
  violence

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Application Date

• Policy applies to a single traumatic event or the
  most recent traumatic event (cumulative effect)
  occurring on or after January 1, 1989
• This reflects the date the WSIB started to
  actively review stress issues (chronic)
• Retroactive cases will be considered based on the
  information available

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TRAUMATIC MENTAL STRESS TEAM
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Purpose of a SeparateTraumatic Mental Stress Team

• To bring together WSIB employees with prior
  knowledge and experience
• To develop best practices for the administration
  and handling of traumatic mental stress claims
• To share knowledge about policy interpretation,
  available resources and treatment programs
• To provide optimal customer service
• To track and analyze trends and patterns

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WHAT DO WE HANDLE?

• Claims that have an accident date on or after
  January 1, 1989
• Claims that are registered on or after July 2,
  2002
• Only claims that are related to traumatic mental
  stress
• Claims from anywhere in Ontario
• Reconsideration of claims reviewed under prior
  policy

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WHO ARE WE?

• 10 Case Managers assigned to the team
• 4 Nurse Consultants. Higher than typical team to
  ensure appropriate health care treatment and,
  early and safe return to work (ESRTW)
• 1 Manager

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HOW DO WE ADJUDICATE/MANAGE CLAIMS?

• Consistent decision-making, while still treating
  claims on a case-by-case basis
• Intense interaction between Case Manager and
  Nurse Consultant
• Group conferencing to seek optimal solutions for
  all parties

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Nurse Consultant

• Intervention occurs as soon as possible after a
  claim is registered
• Full assessment to determine severity
• Intervene to ensure treatment is timely and
  appropriate
• Support and reassurance given to client that
  ESRTW is possible
• Education provided to employers regarding
  psychological conditions

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Nurse Consultant

• Work with the client, therapist and employer to
  facilitate a safe and suitable return to work
• Ongoing contact with all parties during and after
  the return to work phase to ensure a successful
  return to work

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Return to Work Best Practices

• Get involved early
• Early involvement--speaking with employee early
  in the claim process is crucial and has proven to
  have a positive impact on duration
• Ongoing supportive communication with the
  employee
• Work cooperatively with the Case Manager and
  Nurse Consultant
• Flexibility
• Flexibility to expose employees to the work
  environment
• Allow for ongoing supportive treatment within the
  work hours, if needed
• Education
• Employer has a good understanding of PTSD
• Education on both return to work and PTSD must
  occur at both the claim level and the workplace
  level. The sooner this happens the better.

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TRAUMATIC MENTAL STRESS STATISTICS
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TMS Incoming Volumes
Data Source PDM, as of Mar 31, 2009
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Entitlement Decisions
Data Source PDM, as of Mar 31, 2009
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Appeals Decisions
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Challenges of TMS

• Difficulty in obtaining medical reports
• Workers are often mentally fragile and unable to
  participate in an ESRTW program
• Psychological treatment and recovery are lengthy
• Difficulty in accommodating when the workplace
  itself is a trigger and precipitates further Post
  Traumatic Stress Disorder (PTSD) symptoms
• Workplace parties not always well-educated on
  PTSD

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How Are We Addressing These Challenges?

• Utilization of new protocols in obtaining medical
  reports
• Exploring a new approach to case management
  where
• Goal of return to work is identified upfront
• This goal is shared with all workplace parties
  and treatment provider
• Education of workplace parties on PTSD
• Short-term goals identified to enable an earlier
  return to work
• Education of treatment providers (psychologists)
  in return to work focused strategies

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QUESTIONS