Helping employees get back to work is a crucial goal of rehabilitation. However, the medical-only model fails to take into account the psychological aspects of injury that are essential in understanding how to get the injured back on their feet. Helen Merfield provides a prognosis
A speedy recovery, mitigated risk, a client-centred approach and an early return to work: all these results can be delivered by rehabilitation case management that is well implemented. However, too many people are seduced by a medical-only approach that may ignore the true barriers to recovery. Without considering an individual's personal belief system and how they react to their illness or injury, the insurance industry may be encouraging longer timescales for recovery.
Common sense might say that medical intervention will directly address the injury and speed recovery. This is true, but the striking realisation gaining momentum across the industry is the importance of self-empowerment to the recovery process. Addressing a victim's attitudes to an injury or illness can directly reduce recovery times, producing long-term benefits for all parties.
One of the biggest challenges for everyone involved in the rehabilitation process is to step away from the traditional series of physiotherapy sessions and embrace new evidence-based case management. To realise true potential, solicitors, insurers and employers must understand the interconnected benefits of considering social and psychological factors that influence an individual, and not separate the sustained injury to a higher priority.
The traditional medical model of rehabilitation emphasises the injury alone; it does not fully appreciate the overall affects on the injured person following an accident. For example, an individual may receive a continued course of treatment by a health professional that addresses the injury. The individual may then develop harmful coping strategies and a misunderstanding of their condition, which should otherwise by quite manageable. Continued medical intervention may reinforce behaviour that continues to emphasis a sick role.
Case managers must work closely with the injured or sick to understand their level of motivation and associated barriers to recovery. What does 'recovery' mean to most people? One hundred percent fitness? No more pain? People have different beliefs about what this means, and these ideas can be more powerful than the actual diagnosis in determining recovery.
More importantly, it may not only be the individual's belief system that is important. The projected beliefs of those that interact with them can have a major impact too. For example, the family member who tells them to rest while they put the kettle on, the health professional who is instructed to deliver a pre-paid course of treatment, the employer who prefers their employee to 'take it easy' while the liability claim progresses, or the system that financially encourages staying at home.
Back to work
People who have spent a protracted period of time off work - for example, due to maternity leave or redundancy - can find it difficult to re-enter the workplace. This can be due to social obstacles, fear or uncertainty. Those who have been sick or injured may also have to tackle the pressure of a GP who can only sign a sick note for a manageable condition that would actually offer no barrier to safe employment.
Progressive healthcare and improved medical intervention can address the injury or illness, but may not prevent prolonged illness in cases where the barriers to recovery are physiological. Evidence suggests that social and psychological factors are primary determinants in more considerable degrees of disability. For example, many soft-tissue injuries still proceed without rehabilitation - even if the injured is referred for injury management. The application of a medical-only model will fail to provide a full appreciation of the potential complexities of psychological and behavioural trauma that can lead to long-term disability.
A structured approach uniting all parties is more appropriate to quickly identify deep-routed beliefs and coping strategies. Professor Mansel Aylward, architect of the Department of Work and Pension's Pathways to Work, recently argued "belief drives behaviour", and that a "major cultural shift is required to enforce research proving work is generally good for physical and mental health".
By taking a holistic view of an injury or illness, an injured person can change their perceptions, speed up recovery and increase their motivation for returning to work. This is where holistic case management and an integrated approach can help. By directly addressing an individual's level of pain, worry, or low job satisfaction, it is possible to help decrease a potential spiral into perceived sickness with associated dependency.
As partners in the rehabilitation process, the key message is that rehabilitation case management must work towards guiding an individual back to health through a bio-psychosocial model that considers injury and illness in a wider context. By encouraging self-empowerment, all parties gain an enhanced and cost-effective outcome rather than long-term bed rest and deferred return to work.
The innovative solution is for all parties to start working together more closely to promote early intervention and prevent long-term work loss due to psychosocial factors. This is what the more enlightened insurers and solicitors advocate, helping the injured person gain a better chance of fast recovery, while the insurer benefits from a reduced cost of claim and loss of earnings.
By appreciating the social, psychological and behavioural factors, the market can help the individual better understand their injury and discover the most effective ways of managing their condition. This limits the potential of continued and costly medical intervention with little basis of success, which places an individual's life on hold.
Surely this is the ultimate rehabilitation case management goal - a client-centred, model that speeds up recovery, mitigates risk and helps an injured person return to work.
- Helen Merfield is the chief executive of Health and Case Management.
Breaking: In a move that will surprise few, the Govt has put back full implementation of #whiplash changes, including #smallclaims limit, to April 2020 with "large-scale testing" of new LIP Portal from October 2019 - Govt response to @CommonsJustice report https://t.co/EdWScreXZA— MASS (@MASSsays) July 16, 2018
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