WSIB’s Community Mental Health Program

WSIB’s

Community Mental Health Program

BY JOHN SNIDER, CO-CHAIR, WSIB COMMITTEE

In April 2016, after considerable campaigning from many first responder groups, the Ontario government enacted presumptive legislation for Post-Traumatic Stress Disorder (PTSD). Since the presumptive legislation, the WSIB committee has assisted and supported almost 300 members in filing compensable mental health claims.

In the first six months after the presumptive PTSD legislation, there were a large number of claims filed. What quickly became obvious from these initial claims, is that there were a number of members already accessing therapy for PTSD; however, due to limitations of coverage under our extended health benefits, and/or the red tape and discriminatory past policies from WSIB, which restricted access to care, many members had chosen to fight their injury in secret and often were paying out-of-pocket for treatment.

To this day, we continue to assist members in filing suspected PTSD claims at a rate of 1 new claim per week (on average). Contrary to the firehall rumour mill, we do NOT have 300 members off work on WSIB for compensable mental health injuries. At any given time, there are approximately 50 members off on WSIB Loss of Earnings for mental health injuries. Many members with approved PTSD claims never miss a day of work and receive therapy on a weekly basis. Sadly, due to the stigmas around mental health in the first responder community, many members wait far too long to reach out for help. There is a direct correlation between how long you have been suffering PTSD (before getting treatment) and how long you may need to be off to get the injury under control.

So what happens when you file a possible mental health claim with WSIB?

Shortly after the presumptive legislation was enacted, WSIB instituted a program called Community Mental Health Program (CMHP) with the purpose of streamlining access to a psychologist for an initial assessment and ongoing treatment. In general, the program has worked well for our members. The CMHP has allowed psychological assessments to be approved quickly and members to access approved psychologists for the initial assessment and treatment in a timely manner.

Finding a therapist that works for you!

WSIB has a list of pre-approved psychologists, so members can be directed to psychologists that work with WSIB clients under the CMHP. These are independent mental health professionals. They do NOT work for WSIB. The only issue with the pre-approved list is that there is no way to find psychologists that are familiar or work with first responders. This is a very important criterion, as not all therapists are comfortable or experienced with the realities of the first responder traumatic exposures. We encourage anyone looking for a therapist to engage with the TFS Peer Support Team or the TPFFA WSIB Committee for help in finding a suitable therapist.

Ultimately, a relationship with a therapist is personal. We have had members rave about a psychologist and yet other members have not been happy with the same psychologist. This therapeutic relationship is based on trust and if you are not comfortable with your mental health professional, you should (and can) find another that works for you.

We are often asked what type of mental health professional you should look for. In addition to the mental health professional having experience with first responders, we strongly recommend that you seek out a psychologist or a mental health professional that works under the direct clinical supervision of a psychologist. Psychologists and Psychiatrists are the only two regulated health professionals that can diagnose mental health injuries in Ontario (and that is required for a WSIB claim).

What to expect from the Initial Psychological Assessment

If you have already chosen a psychologist from the CMPH list, WSIB will approve an assessment by that provider. If you have not chosen a provider, WSIB can arrange an initial assessment at places like CAMH. Generally, it is preferable to have the initial assessment done by a treatment provider of your choosing who will be providing ongoing care; however, if you are having difficulty finding a provider or getting a timely appointment, an assessment at CAMH may be logical.

WSIB has also streamlined the psychological assessment that is conducted for WSIB purposes. This is good and bad. The good part is that the WSIB assessment is typically done over several hours and includes the client completing a variety of psychological inventories as well as interviews with the clinician. Often a full psychological assessment can take place over several days.

The negative part of the streamlined assessment is that it is only designed to assess the claimed “issue” and may not assess and/or diagnose concurrent mental health illnesses. Depending on the research, approximately 40% of people with PTSD have a concurrent mental health illness (anxiety, depression, substance abuse, etc.). These concurrent conditions may not be fully assessed and diagnosed in a WSIB PTSD assessment.

Psychological assessments are difficult processes but are a necessary component of the healing process. First responders struggling with mental health difficulties often have trust issues; however, it’s important to participate fully and openly with the clinician to ensure the assessment is accurate.

Ongoing Treatment

Once an assessment is done, assuming a clinical diagnosis of PTSD, WSIB will approve the claim under the presumptive legislation and approve treatment. Under the CMHP, WSIB approves treatment in blocks. A block is 6 session or 8 weeks (from the first session), whichever comes first. Typically, WSIB approves 2 or 3 blocks of treatment initially and then ongoing approvals are based on feedback from the treatment provider. At the end of each block of treatment, your therapist submits a progress report to WSIB.

What to expect when you visit the psychologist’s office?

Unlike Hollywood’s portrayal of a psychological session, your mental health professional is unlikely to have a stereotypical couch for you to lie on. The environment will be quite relaxed, with comfortable chairs for you and the therapist to sit in. The therapist will have the ability to arrange the environment to best meet your needs and level of comfort. Understandably, you are likely quite nervous and anxious about your first few appointments; however, mental health professionals are experienced in working with you in these first appointments to get you more at ease. In fact, it is likely in the first few therapeutic appointments that you may end up discussing a lot of things that aren’t directly workrelated or even directly related to your symptoms. This is all part of the process of gaining a trusting therapeutic relationship so that you can start to work on the more difficult issues.

WSIB Assessments

Sometimes, as your therapy progresses, WSIB will indicate their desire to send you for an independent psychological assessment (often at CAMH in Toronto if you live in the area). This can cause a lot of distress, as you are likely comfortable in your therapy progress and are worried that this assessment will disrupt your claim or your progress. While these concerns are understandable, in our experience, these independent psychological assessments often further reinforce your diagnosis and treatment plan. Occasionally, they make suggestions regarding different medications or therapeutic modalities that may be beneficial at that point in your progress. In short, we have not had a claim suddenly denied due to these independent assessments, rather they have often helped provide more clarity and direction.

Return to Work

When your mental health professional determines it is time for you to start considering a return to work, it is something that you will discuss in your weekly sessions. The return to work process is just that…a process. It begins in your therapist’s office and may be a subject of discussion for several months, to determine the best pathway forward as far as timeframes, restrictions, and limitations.

If you and your mental health professional are struggling with the recommendations, please feel free to contact the WSIB committee and we will be happy to discuss our experiences. Often, at the request of the therapist (and always approved by the member), we have attended (physically or virtually) therapy sessions, to provide our support to the return to work process.

Once you and your therapist have developed return to work recommendations, they are forwarded to WSIB. At that point, WSIB will assign a Return to Work Specialist to facilitate the process. Our experience with the RTW Specialists assigned to mental health claims has been, generally, positive (unlike many members’ experiences with WSIB RTW Specialists for physical injuries).

All mental health return to work plans are unique. The cookiecutter approach just doesn’t work. WSIB has acknowledged the uniqueness of return to work plans for mental health injuries and, in general, has been supportive of our members. The WSIB Committee and the Association will support you throughout the accommodation process, whether it be temporary or permanent, to ensure that your RTW is as efficient and effective as possible.

Managing a mental health injury is not something that we ever plan on needing to do, but if you do develop symptoms of PTSD, there are mechanisms in place to assist you. Feel free to reach out to the WSIB Committee at any point to discuss a possible claim.