Getting Back on Track With Routine Health Care

Getting Back on Track With Routine Health Care

The pandemic has become an unintended roadblock to routine health care. Learn about the importance of early treatment and how employers can support employee wellness.
Adam L. Seidner, Chief Medical Officer, The Hartford
Adam L. Seidner, MD, MPH, Chief Medical Officer, The Hartford
Christine Crawford, Associate Medical Director, National Alliance on Mental Illness (NAMI)
Christine Crawford, Associate Medical Director, National Alliance on Mental Illness (NAMI)
You might think it’s not a big deal to miss routine health appointments and screenings, but two medical experts explain that you’re actually risking harm to your physical and mental health.
Dr. Adam Seidner, The Hartford’s chief medical officer, and Dr. Christine Crawford, associate medical director with the National Alliance on Mental Illness (NAMI), share how routine health care helps our overall well-being and the mind-body connection.

Q. The Hartford’s new research found 43% of U.S. workers have delayed care since the pandemic began. Why are these findings concerning?

Seidner: The pandemic has become an unintended roadblock to routine health care. More than 40% of U.S. workers have delayed their routine health appointments amid the pandemic. The numbers are higher for those with children at home and younger workers.
As a leader in disability insurance and absence management, The Hartford helps thousands of U.S. workers each year to return to active, productive lives after an injury or illness. We know the delay in routine care is concerning because many health conditions can develop or worsen when they go undetected, leading to more serious health problems that prevent people from working or enjoying an active life. Examples include people with high blood pressure or high cholesterol – leading factors for heart disease.
Another example is people with diabetes. They may have high glucose and not recognize that they have high sugars. That can cause problems with the vascular system as well.
Cancer screenings are also important. If people aren't going for their normal screenings, then cancer may not be detected at an early stage when treatment can be better managed.
Lastly, there has been increased use of alcohol, opioids and other substances during the pandemic. Doctors typically screen for these health factors. If you're not going in to see your physician, then you're unlikely to be identified as someone that can use assistance and be pointed to available resources.

Q. In the survey, U.S. workers said their mental health has worsened since the pandemic began. How important is early treatment for mental health conditions?

Crawford: This pandemic has made it such that people are frequently experiencing significant uncertainty about what the future looks like for them, which can contribute to anxiety. There is a tremendous feeling of loss about the sense of normalcy or the death of a loved one, a loss of the usual routines and coping strategies that you would use to kind of mitigate some of your mental health symptoms. Because of all these factors, in addition to the trauma of being in a global pandemic, we have seen an increase in the rates of mental health symptoms during this period of time.
It's so important for people to be able to recognize and identify some of the signs and symptoms of the common mental health conditions, such as depression y anxiety. We know if people do not receive treatment within a timely manner, it could significantly impair functioning within various domains, including the workplace.
If you are experiencing significant depression and anxiety, just getting up and doing what you need to do to take care of your physical well-being can be hard. That's why it's so important for individuals to get the treatment they need early on.
One way to start mental health treatment is by talking to your primary care doctor about the symptoms you're experiencing. Another is to establish care with a therapist where you can talk about all the difficult and intense emotions that you're experiencing or some of the stressors that you're going through. These are ways to ensure that you are not only protecting your mental health, but your overall physical health.
Often, when people think about early treatment, they typically assume they must find an individual, long-term therapist. And that’s the only option. The reality is, there are a lot of options available. One example for early treatment is to seek help through an employee assistance program (EAP). These are often offered through your workplace and can be so helpful and provide such an invaluable resource. They may have appointments that are available a lot sooner than establishing care with a therapist. I often recommend exploring the options available through EAPs, especially when we're looking for early intervention and mental health related symptoms.

Q. Can you explain more about the connection between physical health and mental health?

Seidner: Mental health and physical health are closely connected. Our study showed many U.S. workers reported a decline in both. In addition, the burnout rate among U.S. workers remained high at 61%.
When dealing with our mental and physical health, we have to understand mental health can prolong a person's recovery from a physical injury or illness. We know from our experience as a disability and workers’ compensation insurer that a person diagnosed with a primary injury or illness, along with the presence of psychological or mental health issues such as anxiety or depression, can take two-to-three times longer to recover than someone with similar injuries or illnesses with no additional psychological factors.
Sleep is another example of how mental and physical health are connected. Anxiety can keep someone awake at night. There are psychological benefits to keeping a regular sleep/wake cycle or maintaining a regular circadian rhythm. Disruptions in sleep can lead to insulin resistance, which may cause people to gain weight and put them at higher risk for increased blood pressure, diabetes or obesity.
Crawford: Dr. Seidner did a nice job sharing some of the data, but I think the other thing that people should keep in mind when it comes to the mind-body connection is that when people are experiencing a chronic medical condition or they’ve sustained a serious injury, people who have sufficient emotional support and social support tend to have better overall outcomes than individuals who do not have such supports in place. That’s because having some of those social connections and emotional support helps to lift up your mood, reduce some of your anxiety and make it such that you're not experiencing long periods of depression and anxiety.
The act of connecting with other people is one way for people to be active, to leave your house and be able to engage in various activities. Physical exercise is also a great and positive impact on your mood. We see the data left and right about the importance of taking care of your physical health and taking care of your mental health. But we can't underscore the importance of making sure that you have all the resources and tools you need to take care of your mental health so that you can promote longevity.

Q. How is burnout connected to mental health conditions, such as anxiety and depression? What should we all do to address burnout?

Crawford: Burnout is something that we certainly have been talking about a lot over the years, especially during the course of the pandemic. It felt like it was a widespread experience given all the burdens we were experiencing within our home lives and various work responsibilities during a very stressful time. Some of the signs and symptoms of burnout include:
  • A loss of enthusiasm for work
  • Feeling negative or have a negative attitude towards others
  • Having feelings of cynicism
With all of these things, such as the loss of enthusiasm, the cynicism and negative attitudes, one can also experience a low sense of accomplishment when it comes to their work and not feeling satisfied with work that they're doing, not being able to derive any pleasure or enjoyment about their work-related responsibilities. For people who are experiencing burnout, they may notice that the weekends are not long enough for them to recover. As they return back to work, they feel like their batteries haven’t been fully charged – and it impacts the quality of their work. 
It’s important for people to recognize these signs and symptoms and to talk to their supervisors about what it is that they're experiencing. Often there may be ways in which the organization can be supportive of that employee and make the necessary changes to ensure that that person's mental health remains stable.
The thing about burnout is that it's not a psychiatric condition. It is not a diagnosable condition. But it is certainly a marker to indicate that things aren't going well for that individual’s mental health and intervention is warranted. It’s important for people to have these conversations with their employer to reduce burnout and ensure that their mental health is strong and sound so that we can get people to feel satisfied and content with the work they're doing each and every day.

Q. What about the connection between health and productivity? Also, what can employers do to help their workers’ wellness?

Seidner: The Hartford is helping employers understand how delayed care and overall employee well-being is not only a health issue, but a workplace issue that can affect employee engagement and productivity. That includes something called presenteeism, which is when individuals are at work, but they're not as productive as they otherwise would have been.
Our research found 63% of U.S. workers said their overall health and wellness impacts their productivity at work, 30% noted they're less engaged with their work and 25% said they were having trouble concentrating or focusing on their work. Feeling unengaged and tired can lead to an increase in workplace accidents.
Together with NAMI, our nonprofit partner, we are sharing the resources employers can provide to their employees that encompass well-being and look at both physical and mental health, as well as financial resilience.
Employers can:
  • Offer benefits that address overall well-being of their workforce.
  • Communicate more often to their employees to remind them of the benefits and services that are available. This can include sharing important information such as company policies on work absence so employees can feel empowered to attend doctor visits and address other medical issues without worry.
  • Encourage managers to lead by example by making their own appointments a priority.
  • Offer flexibility to employees who need to make an appointment, fostering an open, inclusive work environment.
All of that will help improve productivity in the workplace and improve employees’ overall health.

Q. What can employers do to encourage conversation about mental health, help break down stigma and encourage employees to seek the treatment they need?

Crawford: It’s really important to address mental health stigma within the workplace. Stigma is a fear of being discriminated against and being treated differently because you are living with a mental health condition, and that you are present at work with a known mental health condition. People are worried that their supervisors or other employees may treat them differently or look at them differently. Having all of those worries and concerns can really interfere with their ability to work. For some people, they feel and may believe that the easy way out is to not share or disclose any mental health conditions that they may be experiencing, even if it is interfering with their ability to work.
It’s important to normalize conversations around mental health within the workplace and to talk about taking the necessary time to go to appointments. Take the time out to ensure that you have moments in which you're able to engage in self-care throughout the day. Talk about the role that anxiety, depression and burnout can have on someone’s work performance.
When people are openly acknowledging the fact that mental health is real, it’s empowering. It’s a challenge to deal with in the workplace, but when we are more open about it, then people can feel better supported by other employees and by their supervisors. If supervisors and people in leadership within these workplaces also talk openly about how their mental health may be impacted in some kind of way, that sends the message to employees that this is a place that is safe for people who may be experiencing anxiety and depression. They feel like they will be understood if they were to approach their supervisor about a mental health concern.
Supervisors also need to be on the lookout for some of the signs and symptoms of burnout. It is an indicator that things may not be as stable as they should be regarding one’s mental health in the workplace. If you notice that there's a sudden change in your employee’s productivity and the quality of their work, you’re noticing that they're making a lot of negative comments or they don't seem to be in the same mood as they usually are at work, that may be an indication that there's an underlying issue that needs to be addressed. Burnout is just one indicator to warn not only the individual who is experiencing burnout, but those around them that they may need some more mental health support.
It’s really important for employers to continue to remind employees about all of the resources that are available within the company. It's not enough to just say there’s a poster hanging in the workspace or an email was sent out to the entire organization. Invite those who’ve received some support through the EAP to talk about what it was like. Make these resources come to life by having people share their experiences. Accessing these resources can go much further than just sending out company-wide emails.
I encourage people to check out all the resources that are available on where people can learn more about the various mental health conditions and treatment options available. NAMI has a hotline people can call if they want to learn more about how to navigate the mental health system. (NAMI HelpLine: 800-950-6264 Monday through Friday, 10 a.m. – 10 p.m., ET.)

Q. Any other tips for keeping up with routine health care? 

Seidner: It’s important for people to engage again in their health care and talk to your doctor's office about any concerns you have.
  • Understand what precautions your doctor has in place to protect patients and understand that we are moving from a pandemic to a new phase of the COVID infection, which is the endemic phase.
  • Stay current on your prescription medications and continue to follow any medical guidance related to medical conditions.
  • Consider telehealth options if it would make you more comfortable instead of an in-person visit. Ask to be placed on a cancellation list if you are having trouble scheduling an appointment. Use online health portals your doctor's office may have set up to communicate directly with you.
Crawford: We are transitioning back to more in-person work as we transition out of the pandemic into an endemic phase, as Dr. Seidner described. This could certainly bring on a tremendous amount of anxiety for a number of individuals.
It may not be as easy for a lot of people who might have experienced significant trauma and loss over the course of the pandemic. Going back to work and seeing that everyone is OK, that they've been able to move forward with their lives, could really be quite stressful and challenging for those individuals. One may face anxiety being back in the workplace environment, especially now that there are certain changes being made regarding COVID-related precautions.
It is important to be able to recognize and acknowledge some of the worries, concerns and fears that people may have. We must normalize the fact that not everyone is comfortable with this transition back to normalcy.
Know that if you are not feeling OK, if you are feeling really anxious or experiencing any signs and symptoms of depression, talk to someone about it. Talk to your employer about how you’re feeling transitioning back and see if there are any accommodations that could be made given your unique situation. Talk to your primary care doctor about what it is that you are experiencing to see if there are any specific mental health supports that could be put in place prior to your return to work, whether that be medication management or therapy.
Understand that it is normal for people to feel anxious as we're entering this new phase of life. Make sure you have all the support you need.
Call the NAMI HelpLine at 800-950-6264 Monday through Friday, 10 a.m. – 10 p.m., ET. In a crisis, text "NAMI" to 741741 for 24/7, confidential, free crisis counseling.
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