The Working Brain, The Challenged Mind: When Is Mental Health Vulnerable to Working Conditions

by John M. Stalberg, M.D., J.D

Most Workers Compensation claims involve a physical injury, usually orthopedic. When the injury is to the back, neck, or extremities, mental consequences may follow, such as anxiety or depression. Often the body (“soma”) has problems that combine with the mind (“psyche”) resulting in a so-called “psychosomatic illness.” As a matter of law employers are obligated to provide treatment for such conditions. 

The Manual for Permanent Disability Ratings acknowledges that psychiatric injuries are about one-and one-half times more disabling than injuries to most other body parts, such as musculoskeletal, internal, neurologic, etc. The State of California correctly recognizes that injuries to the psyche are the most disabling.

Many workplace environments are emotionally challenging. Pressure to perform and achieve goals may create circumstances whereby some individuals have trouble thinking straight. This may harm their productivity or diminish their capacity to solve problems or work well with others, and may even lead to an accident. 

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When an injury occurs, both employees and employers may be at fault, or either, or neither. Of course, Workers Comp is a no-fault system.

While the mental health of an employee tends to be vulnerable to working conditions, it is the responsibility of the employer to provide a safe environment, psychologically, as well as physically, within limits, of course. Although a workplace environment can be threatening, more so to some than others, it can also be a very rewarding and healing experience for the mental health of the individual. When employees feel threatened by a superior’s display of power, rumors that circulate about their future, micro-managed work, overlooked contributions, or they are locked out of interactions, their brains will focus attention on such threats. In such instances, the well-being of a critical area of the brain — used for setting goals, making plans, controlling impulses, solving problems, visualizing the unknown and thinking creatively — may be compromised. In short, the prefrontal cortex (PFC) used for conscious thinking may be deprived of the fuel it needs to do good work. The result may be an increase in stress, mistakes, a sense of danger, and greater possibility for accidents. It is equally the responsibility of an employee and employer to work together to create a positive environment that fosters alertness and awareness. A good working brain, even in a very challenging environment, will be better prepared to prevent accidental injury.

In California, an unrepresented injured worker (in pro per) may receive necessary advice from the Information and Assistance Officer at a local Workers’ Compensation Appeals Board (WCAB). This is often the quickest way to get the necessary treatment and enable the employee to return to work promptly.

More specifically, for workers with a psychiatric injury, employers and employees and their attorneys often use an Agreed Medical Evaluator (AME) or a State Panel Qualified Medical Evaluator (QME) to resolve any disputes between the parties. Seeking expert evaluation from an AME or QME Forensic Psychiatrist may also provide the quickest route to treatment and hence resolution of the case.

There are several types of mental health practitioners. A Forensic Psychiatrist is a physician (MD) who is trained in and knows both the body and the mind.  He is a medical doctor who specializes in psychiatry and further in the sub-specialty of forensic psychiatry and medicine, which encompasses both the law and psychiatry.

About Dr. John M. Stalberg

A practicing forensic psychiatrist, M.D., J.D. based in Santa Monica, CA. Dr. Stalberg is a certified QME in the State of California conducting Work Comp evaluations. He is also experienced as an expert witness and in criminal evaluations. As a licensed physician and surgeon (G-23091), and a non-practicing licensed attorney (California Bar No. 232894), Dr. Stalberg also has experience with cases involving sexual offenders, dangerousness, mental health commitment, etc. He has provided evaluations in the civil law arena on treatment recommendations, fitness for duty, fitness for surgery, competency to write a contract, competency to write a will, and many other mental health issues.

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