It used to be that bio-medical — physical — factors were thought to be the only variables which impacted the timing and condition of an injured person's return to work. However, it is being increasingly recognized that other invisible factors — social and psychological — can be important too.
"There are many factors that determine when and in what capacity a person can return to work after an illness or injury," said Shannon Wagner, a professor in the School of Health Science at the University of Northern BC in Prince George.
"Some examples are job demands, supervisor and workplace support and organizational culture and policy."
Marc White, CEO and president of the Vancouver-based Canadian Institute for the Relief of Pain and Disabilities, says we need to understand the big picture of a workplace illness or injury.
"Because so many factors are involved, we need to take a broad point of view," White said.
"We're learning that the causes and symptoms of workplace-related illnesses or injuries can have invisible psychological and emotional components."
There are three types of injuries with a mental component, says Terry Bogyo, a workers' compensation and disability consultant
in British Columbia. First, a physical-mental injury can occur when a construction worker falls off a ladder and suffers multiple injuries. His body heals eventually, but he becomes depressed and is diagnosed with post-traumatic stress disorder.
Second, a mental-mental injury can occur when a worker standing next to the one who fell becomes so upset over the incident that he is unable to return to work and has to be treated for trauma.
Finally, a mental-physical injury can take place if a project supervisor has to work overtime for months on end and then has to handle two emergencies in rapid succession. He suffers a mental breakdown, uncontrolled high blood pressure and a stroke. Bogyo says that despite the reality of an illness or injury's mental component, it is often difficult to prove its existence.
"How do you prove overwork or stress?" he said.
"Some stress is actually good for you, and not everybody reacts the same way. Not everyone regards repeated hurtful statements as bullying. And not everyone who works in a toxic environment will suffer a debilitating mental injury.
"How do you decide if the work environment was a determining factor in the injury and if the harm was significant enough to be debilitating? Those are the challenges."
How can it proven that an injury has a mental component?
"The question is more about how you decide," Bogyo said. "Who has the onus of proof and what is the standard of proof? If a worker claims a mental injury, should you take the family doctor's diagnosis? A counsellor's? A psychiatrist's? Should the standard be a balance of probabilities, predominant cause or beyond a reasonable doubt?"
Some people in the Canadian construction industry do not accept the idea of workplace mental illness or injuries, says Bogyo.
"For some, it's a question of money," he said. "Other people don't believe mental injuries are real. And others accept the reality of mental injuries, but doubt that they can be debilitating or objectively measured and assessed."
However, attitudes in the construction industry toward mental injuries have been changing.
"Mental injuries were always there but when people were injured, we either blamed the victim, said it was the result of a preexisting illness or disability or that the injury was not caused at work," Bogyo said. Public acceptance that work can cause mental injury has grown, too.
"It isn't universal, but look at the Bell campaign (Bell Let's Talk)," he said. "A decade ago, you wouldn't have seen a major
company do that."
Bogyo says it will take time for Canada to develop the right legislation and procedures to deal with mental injuries.
"But it is certainly possible and other countries, such as the U.K. and Australia, are doing it," he said. "They are much further ahead of Canada. They have accepted that such injuries are real and they are doing what they need to in terms of policy, procedure and prevention."
Finally, the matter of mental health needs to be seen in the context of workplace health and safety as a whole. There have not been many workers compensation claims for mental injuries, says Grant McMillan, strategic advisor to the Council of Construction Associations in BC and former WorkSafe BC president.
"According to the latest WorkSafe figures, there are 150,000 claims in the system, of which 7,000 are construction-related timeloss injury claims," McMillan said. "Of that number, 143, or about two per cent of the total, are psychological or mental health claims."