California Psychiatric Association Documents

Volume I No. 1
April 1, 1993

Workers Compensation and Psychiatric Stress Claims

Eliminating Fraud and Abuse

The Legislature and the Governor continue to struggle with Workers' Compensation Reform. A California Psychiatric Association Task Force has developed suggestions for how to best deal with the so-called; "stress" claims. This task force points out that stress is not the equivalent of injury. In fact, stress is a universal phenomenon which should not be equated with injury. The confusion over this has allowed for much fraud and abuse in the system. Careful criteria are needed to respond to this abuse. Our basic recommendations include:

Excluding claims for psychiatric injury which arise solely from:

• Job termination, layoffs or plant closings;
• Employees with less than one year's employment from claims of cumulative trauma; and
• Substance abuse

The task force puts forth as noted below, a group of typical areas, which result in psychiatric injury. These include:

• Being held hostage in the work place, or being a victim of violent crime there, or being subjected to unprovoked assault on the job;
• Being assigned an unrealistic workload as defined by the labor Code, and where the Labor Code is inadequate, new criteria should be developed;
• Being assigned to a position with responsibilities and function for which one is markedly unsuited with little or no training and developing a psychiatric disorder as a result;
• Being required to relocate more than three times in the previous two years of employment and developing a psychiatric disorder as a result:
• Being subjected to a personnel, supervisory, or disciplinary action that is unwarranted as determined by reasonable employer practices, or being harassed.
  

Treatment Advances...

Serious Depression vs. "The Blues"

There are over 15 million people in this country who have serious depression, the type that can lead to suicide or inability to function for prolonged periods at work, school or home. We all have occasional "down periods" of relatively short duration--we call it the "blues" For the "blues" most people do not need professional help. Time and the natural buoyancy of human spirit usually overcome this temporary problem. Time is the most cost-effective "treatment."

If serious depression persists, however, then various underlying medical problems may be the cause. Talk therapy alone may not be enough, may even make the problem worse or, at least, unnecessarily prolong agony, pain and inability to carry on responsibilities as a wage-earner, spouse or parent. Talk alone also may delay definitive medical treatment of underlying biochemical problems that masquerade as psychosocial disorders. Talk alone may lead to unnecessary over-utilization of limited mental health resources.

Much of the scientific evidence of biologically serious depression comes from genetic studies of malfunctioning neurotransmitters, chemical substances in the body that apparently are not in balance. The organ in the body they affect most is the brain. Fortunately, if serious depression is correctly diagnosed, and any underlying medical problems are correctly identified, it can be treated with success medically in 80-90 percent of the cases. This can be accomplished in a relatively short period of time, usually within 2-8 weeks. The California Psychiatric Association can provide more information to interested readers.

Physical Problems Can Masquerade As Psychological And Behavioral Disturbances

Case 001:

A sixteen year old girl had three days of nausea, vomiting, fever and generalized weakness. But laboratory test and chemistry profiles were normal. While in the hospital she cried and wanted to go home. She became very agitated. Her family could not calm her down. A psychiatric consultation was requested for "management of hysterical breakdown. "

The psychiatrist, because he was a physician who had completed his medical training recalled working previously with a renal transplant patient who also was very agitated. Because of this experience, he recommended brain imaging studies, electroencephalography (brain wave studies) and cerebrospinal fluid analysis. This led to the conclusion that the patient's behavioral problem was not just a psychological matter but was a medical problem. She was diagnosed as having encephalitis (inflammation of tissue that overlies the brain).

Modern psychiatry today can go beyond behavioral symptoms and pinpoint underlying neurological and physiological medical problems that can masquerade as behavioral problems. Further, it can provide cost-effective treatment that is biopsychosocial in nature. Many times, prolonged, relatively ineffective, and costly talk-only services can be avoided if a proper psychiatric medical evaluation and a medical psychiatric treatment plan are developed and carried out.