RTW Case Study: Recovery from PTSD Episode

DMEC Staff@Work

Navigating the Roadblocks of Invisible Disabilities – Teresa’s Story

PTSD RecoveryBy Virginia Shutt, MS, CRC, CEAS

Vocational Rehabilitation Specialist
The Guardian Life Insurance Co. of America

According to the National Institute of Mental Health, one in six U.S. adults lives with a mental illness (44.7 million in 2016).

Employers are significantly affected when mental health issues strike an employee, whether that impact is felt first through a health plan or a disability case. While the medical system focuses on diagnosis and treatment, employers often focus on symptoms and how to reduce or eliminate their impact on the employee’s functional abilities. This mental health return-to-work (RTW) process is very similar to the RTW process for other conditions such as musculoskeletal problems, cancer, or digestive disorders.

Recently, we worked with an employee who was off work on a long-term disability (LTD) claim due to a mental health condition; we will call her “Teresa Jones” to protect her privacy. I was her vocational rehabilitation counselor and primary service contact at Guardian.  Teresa never expected life to take this turn, but with our help, she navigated the winding road around her symptoms and back to work. She later told us that returning to work was a core part of her progress in wellness.

She had been working over 25 years at her church’s preschool, serving the past nine years as the Preschool Director, and she had been dedicated to her job and the needs of the students and their families 24 hours a day, seven days a week. She found immense joy and satisfaction in working with her students, their families, and the church community. She felt quite confident that the work she was doing was good and important. She had grown into her role as Director by working at virtually every position in the program, and much of her self-worth was tied into the preschool and her work in it.

In June 2016, she experienced a traumatic event that left her with anxiety and post-traumatic stress disorder (PTSD). While attending a family picnic, she was the sole witness to her brother-in-law’s drowning. She had been powerless to save him, whether by direct action or reaching others to help.

In the days and months following, she experienced flashbacks and feelings of hopelessness, being overwhelmed, and being responsible for the family’s tragedy. For her, these symptoms were debilitating. She was unable to perform activities of daily living such as getting out of bed and preparing for a work day. She ceased working at the job that she loved.

The experience she had with  PTSD has played out similarly in the lives of many. It is projected that 7% to 8% of the American population will develop PTSD at some point in their lives, making this condition one of the most common of the serious mental illnesses. About 8 million U.S. adults have PTSD during a given year, a small portion of those who have gone through a trauma. Nearly 10% of women develop PTSD sometime in their lives compared with about 4% of men. Among military veterans, PTSD is more common due to the daily exposure to potentially traumatic events. Recent data suggest that 11% to 20% of service members who return home from deployment in Afghanistan and Iraq have PTSD symptoms. PTSD occurs in about 15% of Vietnam veterans and 12% of Gulf War veterans.1

For some employers or in some cases, PTSD can be a frustrating diagnosis. But remember that a diagnosis is not a disability. Experiences that generate profound dysfunction and loss of work capacity in one person may have a lighter impact on someone else. When a disability is invisible, with no obvious physical manifestations, we tend to question if it is there at all. Some employers may assume that when  an employee has had  performance problems (andtrust has eroded in the work relationship),  that the employee is “malingering” or is a “symptom magnifier.”

Teresa Jones’ employer did not believe these things about her. She had earned her employer’s trust and become the go-to leader of the preschool program. Perhaps that helps explain why this disability scenario continued for months, long enough to generate an LTD claim: her employer was convinced that she was truly debilitated.

She was diagnosed with PTSD earlier in her disability. As we began working with her and she accepted a collaborative relationship focused on helping her return to work, she shared her concerns and fears around this transition. Over time, she was able to verbalize her lack of confidence and worries about her ability to succeed.

Jones expressed difficulties making decisions on her own and starting and finishing tasks. She shared how she was having difficulties in relationships, anxious/fearful thoughts, trouble falling asleep and staying asleep, diminished pleasure, and excessive worry. When the RTW effort began, she could not imagine returning to functionality.

To address her barriers, we provided vocational counseling regarding strategies to address her symptoms and mitigate their impact on her. This vocational counseling was coordinated with her psychological therapist to assist in reinforcing the coping skills that she was learning through therapy. She was also concerned she would not be able to return to work in the same industry or job. Vocational rehabilitation counseling was supplemented by mental health therapy provided by her psychiatrist.

Jones was educated on ways to address her functional limitations in interpersonal skills and work tolerance through consistent and predictable phone appointments and the provision of aptitude and interest testing that highlighted her strengths and gave her opportunities to explore additional options she had for returning to the workforce. We also provided tips and suggestions for addressing deconditioning and decreased stamina, as well as guidance to assist her in reducing her fears about being unsuccessful in handling stress while attempting to return to work.

We set short-term goals for Teresa Jones to complete at the start of her RTW planning. As she completed each short-term goal, we reviewed her progress to gradually increase her confidence. She could begin to see that each small increment of progress was actually bringing her closer to returning to work.

We helped Teresa Jones practice ways to reduce mental exertion and workplace stress. Rather than trying to imagine leaping back into her former 24/7 leadership role, she considered RTW increments that seemed more feasible: part-time to full-time ramp-up schedules, changing her role to a less stressful position, looking for jobs that are more predictable, and ways to practice coping skills with phone apps.

We created a strengths-based functional resume and assisted in mock interviewing and job searching. She was beginning to imagine a work life that might be feasible. We further helped her learn the “do’s and don’ts” of disability disclosure: how much of her symptoms to explain to people in asking for support and how much to manage internally using the strategies and coping tools she had learned.

Ultimately, through negotiations with her employer, Jones returned to work in a different role (child care attendant) than she had held in March 2017. These negotiations helped her participate in a successful return to work. We continued to stay in contact with her through her transition to employment, providing consistent contact to ensure that her needs were being met.

While participating in RTW services, Jones incorporated the tools she learned — her strong aptitudes, setting short-term goals, reminding herself of her successes, using coping skills, and knowing how to address her RTW barriers — which made her return to work a success.

Insurance Considerations

In a case like this, the employer plays an understated but crucially important role.

The employer’s decision to accommodate this employee — even after well over six months of disability — made this success story possible. In our experience, smaller employers may be more willing to approve extra efforts to retain the skills of key employees. Larger employers are more often driven by corporate policy;  some do not accommodate after six months. Typically the employee is terminated, with the potential of returning to work elsewhere before the end of the remaining LTD benefit, or transitioning to a Social Security Disability Insurance claim.

In every case, assessing the employee’s financial impact and options is an important piece in performing a comprehensive assessment and finding an appropriate RTW solution. In some cases, financial disincentives make disability preferable.   For Teresa Jones, the pay in her new position was only slightly less than the pay in her former position. This new position came open in time for the accommodation, and as an experienced employee who was now achieving stability, she was the natural choice. She didn’t regard the new position as a “step down,” it was a positive development to re-affiliate with work and an organization that she valued.

Conclusion

I called Teresa to follow up with her about a month after her successful return to work. Were things continuing to go well? Did she need any further services? She expressed gratitude and happiness, and spoke of herself as “recovered.” Recovery from a significant, temporary disabling mental health episode is possible. Employers can play a key role, through provision of insurance and supporting return-to-work
efforts.

Reference

  1. National Center for PTSD. PTSD. Oct. 3, 2016. Retrieved from https://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp