Psychology and Long Term Disability

Mental health providers sometimes feel like the poor siblings of physical health practitioners.  We don’t stitch people up, we don’t perform heart transplants, we don’t cure cancer.  Many of the conditions we see are not life-threatening, and some of them improve with the simple passage of time.

So how important are we, really?

This is a complicated question that merits consideration from many angles.  Here let’s just focus on one:  Long term disability (LTD) figures.

In Canada, the “big three” disability insurance providers are SunLife, GreatWest Life, and Manulife Financial.  To this we could add the Canada Pension Plan, which provides Disability Benefits to individuals with severe and prolonged conditions.  There are many more minor players in the field as well.

LTD usually kicks in once a person has exhausted their store of sick days and, in many cases, after a period when the person is covered by Short Term Disability benefits.  LTD premiums represent a major expense for employers, and large numbers of people are on LTD at any given time.

Insurers are in the business of collecting premiums and saving money by offering benefits only to those who really need them, and only for as long as they are needed.  A worker on LTD may cost the insurer several thousand dollars per month.

One way of reducing payouts is to provide the disabled person with extra treatment so that they will get better, be more likely to return to work, and return a month or more sooner than they would have otherwise.  So insurers gamble on this and free up funds on a case by case basis for physiotherapy, psychological care, and other kinds of help.  This pays off frequently enough that it’s worth doing.

But what are the main causes of LTD claims?  Many people guess that things like cancer would be a major source.  But Manulife Financial reports that malignancies only account for about 3% of cases.

The number one category in their report, at 23%, is musculoskeletal concerns – a grab bag of disorders including back pain and other problems.  An additional 5% involves chronic pain, fatigue, and fibromyalgia.  Mental health providers are major resources for this group.  We help people cope with long term pain conditions, making lifestyle adjustments and training clients in a variety of management strategies.

The number two category, at 22% just a single percentage point behind the leader, are the mental and nervous disorders (plus an additional 9% for diseases of the nervous system – likely a category more neurological than psychological).  Mental health practitioners are again involved in helping people to overcome the variety of psychological difficulties to which people fall prey.

The summary report, if you are interested, can be found here: http://www.farrowfinancial.ca/images/pdf/MIDI.pdf.

Other studies, which divide up causes differently, have found that major depression alone is the single largest or second largest cause of LTD.

And what are the costs?  Depending on the length of time a person is off work, the insurer can pay out many thousands of dollars.  In their report Manulife provides examples of various professionals, the nature of the disability, and the amount paid out in each case, ranging up to $973,000.

If these are the costs just for the LTD insurer, consider the costs to the short term disability supplier, the company providing sick time benefits, the workers who are on the job but functioning at an impaired level, the governmental employment insurance and pension costs, the medical system costs, and others.

So mental health care is not an also-ran after all.  It represents a treatment resource for a hugely expensive societal problem.  If we provide efficient and evidence-based interventions that actually produce positive change, we can bring about major improvements in the lives of our clients – and huge savings for funders.

We are used to thinking in terms of benefit to our clients.  This is the main reason most of us went into the field.  But it may not be the main reason that people employ us or refer people to us.  Suffering is costly.  If we take our work seriously, we are not an expense.  We are a money saver.