Post-traumatic stress disorder, or PTSD, is a mental illness prompted by trauma or serious injury. While most often associated with the emotional or physical injury sustained by soldiers during combat, PTSD can arise out of any horrible or severely traumatic incident. Over the years, studies have shown a consistent link between symptoms of PTSD and orthopaedic trauma. Whether resulting from a violent encounter or a debilitating accident, such injuries may lead to PTSD in disabled patients – and in some cases, symptoms of the disorder may continue even after the physical injury itself is healed.
In response to the overwhelming number of returning veterans suffering from traumatic brain injuries and related mental health concerns, the Department of Veterans Affairs has initiated an expansion of military mental health operations effective last month. According to The Washington Post, the VA will bring on approximately 1,600 health clinicians, ranging from nurses and social workers to psychiatrists and psychologists. In addition, the VA mental health workforce of 20,590 will increase its support staff by 300, for a total expansion of more than 9%.
Last month, the California Assembly conducted a hearing regarding proposed overhauls to the state’s workers compensation system. According to the Sacramento Bee, critics of current California workers comp regulations proposed modifications including greater compensation for disabled workers, less rigid control over medical care and improved security for insurers. Such changes would alter provisions of the system’s 2004 overhaul, during which former Governor Arnold Schwarzenegger enforced cost-cutting measures that reduced expenses for employers. However, some contend that workers and insurers suffered unfairly as a result of these changes– both financially and, in the case of some disabled employees, physically and emotionally – and that more spending is needed to ensure adequate care.
The connection between pain and PTSD is making headlines with regard to returning veterans and their likelihood to receive prescriptions for opioid pain relievers. According to the Los Angeles Times, a new study has shown links between PTSD diagnoses and opioid painkiller prescriptions among military veterans – as well as a disturbing prevalence of such prescriptions for PTSD-stricken veterans with substance-use disorders. Researchers behind the study suggest that these results indicate a need for better understanding of the connection between pain and PTSD; and while the issue is undoubtedly paramount for veterans and their families, it can also be a major factor in rehabilitation and return-to-work efforts for civilian workers struggling with pain and PTSD as a result of on-the-job injuries.
Several months ago, this column touched on the importance of medical and psychological evaluations in workers comp disability cases where the patient’s injuries are likely to incur psychological trauma. Delving more deeply into the relationship between work-related injuries and psychological distress, researchers have found that, among orthopedic and musculoskeletal injuries sustained throughout industrial societies worldwide, those that lead to chronic pain and disability not only incur the greatest compensatory costs, but are also the most likely to be complicated by biopsychosocial factors.
Malingering, as it applies to the context of criminal, civil, personal and workers comp disability evaluations, is the practice of intentionally producing false or exaggerated symptoms in order to reap the benefits of compensatory measures such as money, prescription drugs, relief from duty or avoidance of criminal prosecution. More often than not, the public becomes aware of malingering due to criminal cases, like that of Russell E. Weston Jr. – an individual diagnosed with paranoid schizophrenia who is currently undergoing mental health treatment in anticipation of an eventual murder trial, according to Bloomberg Businessweek. In both this context and others, however, malingering can be incredibly difficult to assess. Studies have shown that certain behaviors can help lead to a clinical determination of malingering in a variety of different contexts. However, even when suspicious activity or evidence is present, it can take psychological testing and evaluation by a qualified psychiatric professional in order to confirm malingering on the part of an injured individual.
Herman Cain may have denied the sexual harassment allegations that ultimately deflated his hopes for the 2012 Republican presidential nomination; but that didn’t stop the media from making the most of the story as every detail, no matter how mundane, came to light. However, despite the emotional pathos and media buzz surrounding this and other high-profile sexual harassment cases, research suggests that a much subtler form of workplace abuse may in fact be even more damaging to employees in the long run.
Workers comp fraud prevention and related reform efforts receive the lion’s share of media coverage when it comes to California employee benefits and claims. However, while reform may be both necessary and imminent, as noted in a recent Business Insurance report, it is important for both employers and legislators to recognize that some of the most superficially dubious cases – specifically those dealing with work-induced stress from sexual harassment, trauma or other causes – are also the most frequently justified.
Last week, Governor Brown both signed and vetoed several new pieces of California workers compensation legislation, bringing much media attention to the matter of work comp costs and to statewide efforts to prevent abuses within the system. According to commentators quoted in the Insurance Journal, the newly enacted laws are designed to keep costs steady and “create greater efficiencies” to benefit workers and employers alike. However, while such legislative action is a critical component of an equitable workers comp system for both California business owners and their employees, it is also only part of a much larger picture – one that relies as much on comprehensive injury analysis and thorough diagnoses and treatment as it does on system-wide management of rules and regulations.
As a patriotic city with a strong military presence, San Diego proudly defends the honor and heroism of local service members and retired veterans – not to mention its own civic heroes who step up daily to fight crime, fire, illness and violence. But even as we celebrate bravery and service, we are also acutely aware of the trauma-induced mental and emotional disorders that some must suffer after multiple tours and deployments, battles and losses – and of the struggle that many San Diegans face in coming to terms with occupational hazards and their consequences.