“I have the normal complement of anxieties, neuroses, psychoses and whatever else – but I’m absolutely nothing special.”— Clive Barker
The National Institute of Mental Health reported in 2022 that more than one in five adults in the United States live with a mental illness. That’s 59.3 million people, or 23.1% of the U.S. population. That’s a lot of people. Older generations will sometimes say that’s because we’ve “gone soft”, that mental illness wasn’t a problem until recent years. But we know mental health only appears to be a more prominent problem in today’s society because of a gradual destigmatization of the topic. Mental illness has always existed. Now we just feel more comfortable discussing it out loud.
Mental Health and OSHA
We’ve all had that job once in our lives, right? The one where you wake up and immediately dread the day in front of you. If you haven’t, you’re fortunate, because it almost feels like a rite of passage. Most of the time, we get over it. Maybe with a change in circumstances or perspective. On the other hand, a work environment or event that contributes to true, life-altering mental illness is cause for concern and the Occupational Safety and Health Administration (OSHA) has something to say about that.
“Recordable injury or illness.” Words that will make anyone working in EH&S cringe. When I first became acquainted with OSHA, I assumed mental illness wouldn’t be on OSHA’s radar. I grew up in an era where discussing mental health was still taboo. I was wrong.
While preexisting mental illness isn’t a recordable illness, the OSHA Standard for Recording and Reporting Occupational Injuries and Illnesses says in 29 CFR 1904.5(b)(2)(ix) that mental illness will be considered work-related if
“…the employee voluntarily provides the employer with an opinion from a physician or other licensed health care professional with appropriate training and experience (psychiatrist, psychologist, psychiatric nurse practitioner, etc.) stating that the employee has a mental illness that is work-related.”
Therefore, mental illness can be a recordable illness. But there seems to be some of OSHA’s trademark ambiguity in the wording. What work-related environments and events can make a mental illness work-related? I can’t provide an exhaustive list, but I can provide some insight.
Stress
Everyone experiences stress. It’s part of life. A little stress isn’t unhealthy. It helps you meet challenges and motivates you to work toward your goals. We feel stress about relationships, money, big life events, etc. Most of the time we make it through unscathed and are happier on the other side. Sometimes, though, stress has a negative impact on our lives. Too much stress can lead to a variety of physical ailments such as muscle tension, headaches, stomach upset, high blood pressure and heart disease. What many people may not realize is that stress can also affect your mental health. It’s a leading cause of both anxiety and depression – both of which can be recordable if deemed to be work-related by an appropriate health care professional.
The question for employers, then, is what causes high levels of stress at work. Here are just a few examples:
- Long hours
- Heavy workload
- Job insecurity
- Conflicts with coworkers or bosses
- Harassment
If you want to avoid recordable illness, communicate with your employees. Check in with them and listen to their concerns. And then – do something about it. Too often, managers go through the motions to check all the required boxes when an employee has a concern, and then don’t do anything to attend to that concern. Leaving an employee complaint unaddressed does nothing more than create a paper trail to support a work-related mental illness claim. Take the time to make your employees feel valued and heard, so they’re more than just another line on your OSHA 300 form.
Traumatic Events
Sometimes an experience can be so intense that it can have an emotional, cognitive, behavioral, and physical impact on a person. Traumatic events can happen to workers in all industries. Someone in the chemical industry may experience an explosion or chemical release. Retail workers are constantly faced with the possibility of armed robbery. Construction workers risk building, crane, or equipment collapses. Anyone, in any industry, may witness the abuse or assault of a co-worker or client. The list goes on. Obviously, each of these examples are work-related.
It’s normal to feel intense fear during and even after a traumatic event. It’s even normal to experience symptoms such as:
- Feeling anxious, sad, or angry
- Terrifying invasive thoughts or flashbacks
- Recurring nightmares
- Confusion
- Insomnia
- Being on edge
Typically, these symptoms will subside substantially over time. However, if they continue long after the event or affect day-to-day life, they can be signs of acute stress disorder, or post-traumatic stress disorder (PTSD). Both require professional help to address, resulting in a potential recordable mental illness.
In a perfect world, every employer is taking every precaution to prevent traumatic events. But no matter how many precautions you take, the likelihood of an event will never reach zero. So, if your workplace experiences a traumatic event, support your employees and assist them in getting the help they need.
Substance Use Disorder
Most of us have probably been directly or indirectly affected by substance abuse, or we know someone who has. What you might not know is that substance use disorder (SUD) is a mental illness. It’s a disorder that affects a person’s brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications. Symptoms can range from moderate to severe, with the most severe form being addiction or overdose.
So how can substance abuse be work-related? Part of the answer to that question is the definitions use of the word “environment.” Just like anxiety or depression, substance abuse may arise from the stress of a poor work environment. In this instance, the solution is the same as it is for employees who are stressed. Communication and action. You might not be able to treat the addiction, but you may be able control the underlying cause.
SUD can also be work-related in other ways. Consider an employee who has been injured on the job. All the right steps were followed, treatment sought, and, thankfully, that employee was able to return to work after their injury. However, while they were out, they were prescribed opioids to treat the chronic pain they now suffer. What was once casual use now develops into a full-blown addiction – making their illness work related.
Employers can’t control genetics. One employee might develop SUD from the same treatment that another may not. Most importantly, remember that SUD isn’t a choice, it’s an illness, and employers can help by making sure employees have the resources they need to seek assistance if they find themselves in a battle with SUD. Regardless of the underlying reason, substance use disorder can be treated and controlled.
The Gray Area
OSHA recognizes mental health as an important component of overall well-being and also acknowledges that mental health concerns due to work have the potential to impact the performance, and therefore, safety, of employees. Which means it should be taken as seriously as other work-related injuries and illnesses. I think most people can agree on that. However, there are some things you can always count on: death, taxes, and people who will take advantage of the system.
Not all people are good people. And sometimes even the most well-intentioned people get desperate. There has always been a level of skepticism when it comes to worker’s compensation cases because there have always been people who will be dishonest to be excused from work and still earn a paycheck. Counterfeit worker’s compensation cases go back decades, and they will continue.
Worker’s compensation claims related to mental illness are no different. In fact, there may be even more gray areas with these cases than with physical injuries. Most people don’t meet with a therapist, psychiatrist, etc., until they start experiencing severe symptoms. How, then, do you determine if a condition was pre-existing? The OSHA standard relies on the employee voluntarily sharing their doctor’s opinion. Does that make the rest of their mental health history voluntary as well? If a patient says they have no history of mental illness prior to the event in question, medical professionals have no other option than to take them at their word if they’re not willing to share medical records. Sometimes doctors are only privy to one side of a multifaceted story that might otherwise affect their opinion.
Likewise, not all doctors are upstanding citizens. Some are willing to help their friends, or even a stranger, if it means they benefit as well. We want to believe that all doctors uphold their oath and do good, honest, law-abiding work, but doctors are human too – which makes them susceptible to human temptations like money, notoriety, and bribery.
Generally, the majority of worker’s compensation cases are legit, so offer the benefit of the doubt, but remember it’s not always black and white.
More Than a 300 Form
Some jobs are stressful by nature, and that’s okay. Maybe those jobs aren’t meant for all people. But everyone has a breaking point and it’s important to know what that is.
Employers, make it your job to understand what your employees are facing. Offer them support and don’t ostracize them for seeking assistance. We are all experiencing the human condition, so let’s do our best to help each other out along the way. You’ll see the impact of your efforts on your OSHA 300.
PS – Mental health is a touchy subject for a lot of people, and a lot of people don’t get the help they need because stigmatization persists today. Below are the numbers for the suicide hotline and substance abuse hotline. You can help by making these readily available to your employees, post them on a bulletin board, send them in a newsletter, whatever you need to do to get the word out. Remind your employees that their life is important, and they matter.
Suicide and Crisis Lifeline
Call or text 988 for free, confidential crises counseling anytime, 24/7
Substance Abuse and Addiction Hotline
Call 1-844-289-0879 for free, confidential support and guidance, 24/7
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