Mental Well-Being in the Workplace

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A title appears on a laptop: Wednesdays with Woodward (registered trademark) Webinar Series. To the right of the laptop, a red mug features a Travelers umbrella logo. 

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JOAN WOODWARD: Good afternoon, and thank you for joining us. I'm Joan Woodward, and I'm honored to lead The Travelers Institute, which is the public policy division and educational arm of Travelers. Welcome to Wednesdays with Woodward, a webinar series where we convene leading experts for conversations about today's biggest challenges. We're really so glad you're here. 

So before we get started, I'd like to share our disclaimer about today's program. 

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About Travelers Institute (registered trademark) Webinars. The Wednesdays with Woodward (registered trademark) educational webinar series is presented by the Travelers Institute, the public policy division of Travelers. This program is offered for informational and educational purposes only. You should consult with your financial, legal, insurance or other advisors about any practices suggested by this program. Please note that this session is being recorded and may be used as Travelers deems appropriate. Wednesdays with Woodward Webinar Series, Mental Well-Being in the Workplace. Logos: MetroHartford Alliance, Travelers Institute (registered trademark), UCONN School of Business, MS in Financial Technology. 

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Today we're taking on a very serious and critically important issue, mental well-being, and specifically mental well-being in the workplace. The last 2 1/2 years really have been challenging in no uncertain terms for everyone. We've all felt it. Many of us have lost loved ones and friends during the pandemic. It created isolation and loneliness, which tested us in ways we probably could have never imagined happening before. There have been social and geopolitical unrest, financial and economic volatility. I don't need to tell you; the list can go on. And this is really all very tough stuff for all of us. 

One silver lining, however, of the last couple of years, I think, have-- which has really brought mental health to the forefront of the conversations like we've never had before. And today we'll use the next hour to take stock of where we are and society and shine a light on really how the workplace factors into this dialogue on mental health. 

September is also National Suicide Prevention Awareness Month, and we take it very seriously here at Travelers. And so we're really honored to do our small part to contribute to the national conversation along with our webinar partners for today and our co-hosts, which are The Masters in Fintech Program at UConn School of Business and MetroHartford Alliance. 

So, now I'm really pleased to introduce our distinguished speakers. 

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In photos, speakers smile. Text, Speakers. Joan Woodward, Executive Vice President, Public Policy, President, Travelers Institute, Travelers. Les Kertay, Ph.D., ABPP, Clinical Psychologist; Senior Vice President of Behavioral Health, Axiom Medical; Adjunct Professor of Psychology, University of Tennessee at Chattanooga. Rich Ives, Vice President, Business Insurance Claim, Travelers. Marcos Iglesias, M.D., Vice President, Chief Medical Director, Travelers. 

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Dr. Les Kertay is a clinical psychologist with over 45 years of clinical experience and over 20 years of experience in the disability and workers compensation arena. He is passionate about delivering meaningful behavioral health solutions in a work setting and a strong proponent, really, of worker-centric clinical care. Dr. Kertay has published in several-- and has served on several committees related to developing medical guidelines for us all. He's currently serving as the Senior Vice President of Behavioral Health for Axiom Medical, is an adjunct professor of psychology at the University of Tennessee at Chattanooga. Thank you for being with us. 

Next is Rich Ives. Rich is Vice President for Business Insurance Claim here at Travelers. He leads our workers compensation claim, Travelers Medical Center of Excellence, and is the Claim Business Lead for Small Commercial National Accounts and Constitution State Services. We're really incredibly lucky to have Rich's leadership at Travelers, including on pressing issues like breaking the cycle of opioid addiction and chronic pain. So Rich, thank you for joining us today. 

And then we have Dr. Marcos Iglesias. He's a physician, executive and national speaker with over 30 years of experience in workers compensation and disability treatments evaluation. He's certainly a leader in the insurance industry. Dr. Iglesias has a passion for helping workers-- workers active, productive-- live active, productive and fulfilling lives. He currently leads our Workers Compensation Medical Innovation and Strategy teams here at Travelers. 

So what a group we have here for you today. We're chock full of information and really interesting speaker presentations. So we'll get to the speaker presentations. We're going to come back with a lot of Q&A and discussion. So please drop your questions into the Q&A. I know I can't get to them all during these webinars, but we do read them all, and our speakers are sent all the questions that you put into the Q&A. So we really appreciate your participation. 

So now I'm going to turn it over to Dr. Kertay to start off our opening presentations. And again, thank you for being with us on this really critically important topic.

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Text, Mental health challenges are universal. Symptom report is high. In 2021, 76% of workers reported at least one mental health symptom over the course of a year. Burnout 56%, depression 46%, anxiety 40%. 80% greater than 1 month, 36% greater than 5 months. Mind Share Partners, Mental Health at Work Report 2021. Workplace factors prominent. 84% reported at least one workplace factor negatively impacting mental health. 50% of US workers have left a previous job at least in part because of mental health. Highest in the youngest workers, 81%. Mind Share Partners, Mental Health at Work Report 2021. Stress is ubiquitous. 52% of US employees reported stress "a lot of the previous day." 23% sad, 18% angry, 41% worry. 33% engaged. Gallup State of the Global Workplace 2022 Report. 

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LES KERTAY: Thanks so much, and thank you for, for having me, and welcome, everyone. I want to start out-- my job here is to really set the stage for the conversation that's going to follow at this point. Mental health challenges-- if we've learned anything, mental health challenges are universal or nearly universal. And I want to-- I'm going to come back to the fact that I use the word mental health challenges and not mental health diagnoses. 

At this point, what we need-- or what we know is that symptom report is very high. And since the pandemic, we are seeing a hugely increased number of people reporting mental health symptoms. 2021, 76% of workers reported at least one mental health symptom. And for 80% of those, they lasted longer than a month, and a significant portion of them lasted much longer than that, over five months. 

Burnout's high, people reporting feelings of depression, feelings of anxiety. These are-- these are huge numbers. And there-- and workplace factors are really significant here. Eighty-four percent of this same sample, which was large, were reporting at least one workplace factor negatively impacting their mental health. So, stressful work, changes in the workplace, having to juggle home and, and work life in ways that were unexpected. 

I think it's really significant to say that half of U.S. workers have stated that they've left a previous job at least in part because of mental health, which has huge cost implications. It's also interesting to me that the highest number of reported symptoms is actually in the youngest part of the workforce. But, interestingly enough, they were the part of the workforce that was least likely to take-- to take on standard or traditional mental health care, which is kind of an interesting juxtaposition that is part of the solution we have to produce. 

And, of course, stress is enormous. If we were live, I’d have a-- I'd ask for a show of hands of people who haven't felt stressed recently. But we're also seeing that employees are stating that they’re more stressed, or a larger percentage are saying that they're highly stressed recently, and other, other emotional symptoms in the context of pretty low engagement, engagement in the work-- in the workplace. So-- and that has implications. 

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Text, the impacts are measurable. Employees with even moderate-high distress, 34% increased chance of injury. Kim, J. Prev Med Pub Health, 2008. And are twice as likely to report a workplace failure. Hilton & Whiteford, Int Arch Occup Environ Health, 2010. Turnover costs average $4000. Mind Share Partners, Mental Health at Work Report 2021. And health costs are higher, absences are longer, and the risks of the losing employees is high. 

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So moving on to-- we can measure these impacts. There's a 34% increased chance of injury in someone who expresses moderate to high distress, emotional distress-- again, not a psychiatric condition-- but who reports these symptoms. They're twice as likely to report a workplace failure and substantially less likely to report a success, something that went well. I mentioned 50% of the workforce has said they've left the-- left the workplace in part because of a mental health symptom. Turnover costs average across the entire economy at about 4,000-- at about $4,000. Some of those are very-- are quite a bit lower and some are quite a bit more. But even at that average, if you took half the workforce of the U.S. over a period of time and multiplied that by $4,000, that's $256 billion. 

So, we know that in people who are reporting high stress and high emotional symptoms, health costs are higher, absences are longer, and we have a higher risk of losing employees. 

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Text, Diagnosis of Mental Disorder, a psychosocial barrier is not a psychological symptom is not a psychiatric condition. Psychosocial barriers occur on a spectrum. Psychological symptoms exist on a spectrum. Diagnostic criteria do not. 

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And then so, finally, I want to come back to this notion-- I have deliberately talked about symptoms and I've talked about mental health challenges. I think that one of the things we have to very carefully talk about in the context of a conversation about mental health, especially following from the pandemic and the changes, two things. One is that reported mental health symptoms were on the upswing before COVID ever was something that we thought of. So we are talking about it more, but this has been an upward trend for quite some time. 

I think it's also important to recognize that there are certain psychosocial barriers, attitudes that we have about the workplace, where people live, economic disadvantages, family circumstances. There are barriers to returning to work. Those barriers occur-- tend to occur on a spectrum. They're not either--they’re not an either or. Psychological symptoms exist on a spectrum. We've all felt anxious at various times. The question is, are we highly anxious enough of the time that it really becomes a treatable symptom, or a treatable condition or a condition that at least will benefit from treatment. 

So diagnostic criteria, on the other hand, are you either have a condition or you don't. And ideally, the borderline-- the borderland for that is, will this condition benefit from treatment? Whereas with symptoms, we want to address them. We want to help people cope. We want to help people build their resilience. But treatment isn't necessarily the answer for that. So with that, I hope I've set the stage for more presentation and a lively conversation, and I'll turn it over to Rich. 

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Text, Mental Health and Workers Compensation. 

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RICH IVES: Thank you, Dr. Kertay, and yes, you did exactly that. And thanks for being our guest today. Now I'll start by saying that Travelers is the largest workers compensation insurer in the United States. And I say that just to point out the context for us. Our interest is in the safety and the well-being of our customers' employees. Employee well-being has an obvious connection to accident prevention and productivity. I think Dr. Kertay did a nice job of pointing that out. 

But we also want you to know that it-- that it also has an influence in post-injury management. And what we'd like to do is to show you how that might be the case, and to share what we've learned in our journey, and specifically, what are we doing to address it? 

Now here is a key point. We see a corresponding increase in the time that it takes a person to recover from an injury when mental wellness issues are a factor. Let me say it this way. If you take two identical injuries and two different workers-- on this next slide it kind of points that out for you. 

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Text, The tale of two different outcomes. Two arrows labeled Happy path, and Delayed recovery, point in opposite directions. The blunt ends of the arrows sandwich the word "Psychosocial" between them. Copyright 2022, The Travelers Indemnity Company. 

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If you take two identical injuries, two different workers, both are healthy individuals, and one of those individuals recovers in eight weeks and is back to work. The other has not been back to work since the injury six months ago, quite often depressed or not sleeping, with no interest in regular activities, potentially and unfortunately maybe on opioids or sleeping pills. 

And we see these things and we ask ourselves the question, why are the outcome-- the outcomes so different in those two different cases? One takes, really, a happy path to recovery, and the other more delayed recovery. The physical characteristics that I just mentioned of the two were the same, meaning the physical characteristics, or the-- maybe the treatment pattern was the same. But the way they were, were or were not able to cope with the injury was not the same. 

So for those of you who are math majors among us, maybe we would think about it in this way. Think about it as an equation. You have two claims. They come in with the exact same injuries. You treat them both the same way. Your results are completely different. So that means we need to think about the variable or variables that might influence the recovery path. 

The variable, quite often, that we deal with-- it's a complicating factor-- is this idea of mental wellness or a psychological or a social factor, and I'll say more about that in a second. Now for us in our journey, we learned a lot of this in our work to proactively identify and change the course in a chronic pain claim. Chronic pain develops many months after an acute injury phase. And often it's a real challenge to help when a person's been diagnosed with chronic-- chronic pain. Our challenge has been, how do we get ahead of that? Or in other words, what are some of the factors that exist that we could have known about much earlier? 

And I will remind you that in the instance of chronic pain, it's not just the physical, but it's all three. It's the combination of the physical, the psychological and the social that actually goes into the factor of someone developing into chronic pain. 

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Text, Mental health impact in Workers Compensation. Most injured employees do not have psychiatric disorders. However, they may have psychologic and social barriers to return to function and work. Psychologic and social barriers increase the likelihood for delayed recovery after a work-related injury. Roughly 40% of injured employees have one or more psychosocial risk factors. Risk factor examples: perceived injustice, fear avoidance, pain catastrophizing, recovery expectations, maladaptive coping or absent coping skills. Injured employees with at least one risk factor have roughly 50% higher indemnity claim costs. Copyright 2022, The Travelers Indemnity Company. When compared to lost time claims absent any psychosocial risk factors. 

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So, in this next-- moving forward in this next slide, we ask ourselves all the time, how do we get upstream? How do we get upstream to change what otherwise would be a bad outcome? And this sets for us an objective to identify injured employees that might have a risk factor early after their injury, and then build our own awareness of that risk factor that can influence our approach, and to offer tools and approaches to help build resiliency skills and behaviors. 

Now what do we mean when we talk about psychological or social risk factors? And we have some examples here on the left-hand side for you. And those are things like, for example, perceived injustice, or maybe when we're injured that we might blame people or circumstances for our current condition. That's a-- that’s a factor. Or potentially fear avoidance. That would be the belief that physical activity may be harmful to our recovery. 

Or it could be pain catastrophizing, thoughts that recovery from our pain or our injury is not possible. I'll never be the way I was before. Or it could be a false recovery expectation, meaning that maybe we have no plan after an injury for return to work as a goal. Or maybe we have an unrealistic expectation, and we think we can return to where we were before the injury sooner than is realistically feasible. 

Another would be maladaptive coping, or the absence of coping skills, or particularly the absence of those positive adaptive behaviors that we all grow as we work through life's different challenges. 

Now would it surprise you-- probably not, because you're looking at the slide-- but would it surprise you if I told you that roughly 40% of our injured employees who are losing time from work have at least one psychological or social risk factors like I just mentioned? That's been our learning. Over this past year of time, we have taken a very concerted approach to figure out what are the questions we can ask early and identify how many individuals are actually struggling with things like these. And these factors, we've found, have the potential to delay recovery and prolong medical utilization and lost time from work.

The impact-- the impact of these factors is significant, as we've found that injured employees with at least one-- not all-- but if an individual has at least one of these risk factors, they have roughly 50% higher indemnity costs for those workers compensation claims. You can take that, though, as a proxy for the amount of time that they're out of work, which multiplies the impact for an employer given the loss of a knowledgeable and productive worker, especially in this current environment. 

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Two bar graphs represent Psychosocial Risk Factors by Top Industries and Psychosocial Risk Factors by Generation. Text, Mental health impact in Workers Compensation. The challenges and potential benefits of addressing the issue are present in every industry, geography, age, and income bracket. Copyright 2022, The Travelers Indemnity Company. When compared to lost time claims absent and psychosocial risk factors. 

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Now moving on, one of our strengths as Travelers is in our ability to use data to help address important issues like these. So, naturally, we asked ourselves the question, if those 40% struggle, how can we know more about them? Or, in other words, are there certain cohorts that struggle more or less with these types of challenges? So, of the 40%, can we learn something by the industry group that they are in? Or is there a difference based on geography or income bracket or by age segment? 

And normally we can always find an outlier. It surprised us-- and I'll tell you, I particularly went back to the team and said, can this-- can the data be right because it's pretty consistent. And I think Dr. Kertay pointed that out. Well, here's real claim information to show you that the challenges here are pretty, right across the board, widespread. 

So, in other words, it surprised us to learn that no group is immune. These challenges are present across age, across industry. We looked at it by state, and we looked at it by average weekly wage segments. And the issues are pretty, pretty common. But that also means that the topic we speak of today, and potentially the solutions, can benefit everyone if we were able to successfully address the issues that we're speaking of today. 

And with that said, I'm very privileged here at Travelers to partner with Dr. Marcos Iglesias, who is a great thought leader in this space. And he's going to take you through one of the ways that we are addressing this issue. 

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In a World Health Organization Venn diagram, three circles labeled Biological, Psychological, and Social overlap. Text, Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Copyright 2022, The Travelers Indemnity Company. All rights reserved.

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MARCOS IGLESIAS: Thanks, Rich and thanks, Les. So, you're right, Rich. I think one of the things that we've certainly been advocating for a number of years is the adoption of a biopsychosocial model. So let me take a step back. The biopsychosocial model essentially just says, let's look at an individual, whether they're healthy or injured, and look at them through three different lenses, the biological one, which we're very comfortable with as an industry, and even my colleagues have always been very comfortable with that. But less so with the psychological, but also the social. 

So it's important for all of us, whether we're employers, claim professionals, medical professionals, to really take this holistic approach to seeing an individual because only by doing that can we figure out how to help them better. And that's really it. We've been talking about this for over 15, 20 years. And I'm just really pleased that we are where we are today. I think-- I think as an industry, we're understanding that it's only as we adopt a model like this that we have a greater chance of helping individuals and helping ourselves as businesses. 

So let's move on from that approach and start talking about a concept called resilience or resiliency. 

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On the left, a circle labeled Teaching resilience. On the right, lines connect resilience factors to the circle. Text, Modifying psychosocial risk by teaching resilience. The ability to bounce back can be taught. Resilience may modify psychosocial risk. Better resilience equals better outcomes. App-based skill-building management. 

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And I think this is really, really useful as we look at individuals after a work injury. I think that the concept of resilience will help us make sense of why some injured employees have psychosocial barriers and others may not have as many, or not have any at all. 

And essentially, resilience, think about it as the ability to bounce back. It's like a rubber band when you pull it and then let go, it comes right back. Well, that's what resilience refers to, and it refers to that ability that we have to deal with stress, to deal with difficult circumstances. And that might be an economic loss. It could be a financial issue. It could be a social issue. But it can also be an injury or even an illness. And each one of us has, has a capacity to bounce back, and each one of us is going to be slightly different in how much we can bounce back after a tough circumstance. 

But the good news, and we've known about this for many, many years, is that resilience is not something innate. We may be born with some of it, but a lot of it can also be learned. We can learn to cope with our circumstances. We can learn to bounce back.

So thinking about this about 18 months ago, we decided to put this to a test in the workers compensation world. What if we took a population of injured employees that may have psychosocial barriers like the ones that Rich just mentioned, and what if we were to teach them resilience and coping skills to help them overcome some of the barriers to returning to function and to returning to work?

So what we did is we partnered with a leading provider of app-based, resilience skill building, and we helped design a program to coach at-risk employees, basically coach them in their recovery after a work injury. So, over the past 18 months, our nurses here at Travelers have now screened over 16,000 employees. So again, these are individuals who suffered a work injury. They have lost some time from work as a result of that injury. And our nurses, in their interview with that individual, screened them for psychosocial barriers, so essentially the things that Rich mentioned earlier and put up on the slide. 

If an injured employee had one or more of these psychosocial risk factors, like catastrophic thinking or perceived injustice, we then offered them the use of this app. Now this is a totally voluntary program. We can't force anybody, and we wouldn't want to force anybody to use the app. But it was essentially a tool that we offered these employees to help them in their recovery. 

What we found was that injured employees engaged with the app, they're able to use it at their convenience at home. They can use it 24/7. And they interact anonymously, essentially, with an artificial intelligence chat bot. And so what this chat bot, chat bot does is it coaches the individual. It gets to know the individual, what their goals are, what their fears, what their needs are through a chat function, and provides a supportive environment in which they can learn coping and resilience skills. 

So, these are things like stress management techniques, for example, progressive muscle relaxation or deep breathing exercises. It also helps them to change the way that they think. For example, it may help them reframe their negative thinking. It may help them deal with stress. So through a series of micro learnings, exercises, reminders, essentially it's able to help that individual build some of these skills that they may not have had. 

So when employees first start using the app, there's an intake in which the app gets to know them a little bit better. And what we discovered-- and again, these are individuals who have lost time from work, but it's in an early setting. So they've only lost a few weeks of work. About half of them, at that point already, felt that the recovery was taking longer than expected. 

The other thing that we learned is that 3/4 of them felt that return to work was one of their highest priorities. It was one of the goals that they were working towards. So that was very, very encouraging. As we saw patterns of use of the app, what came-- what came through loud and clear was that people were trying to deal with not only pain, but low energy. They were dealing with frustration. They were dealing with poor sleep. And so they used those techniques, they used those skill-building exercises, that help them deal with those situations. What we take from that is that these individuals see the benefit of having a virtual coach to help them along their recovery pathway after a work injury. 

I can tell you that our results-- our early results are very, very encouraging. Injured employees indicate a very good user acceptance. Over 80% of them are giving the app a five-out-of-five rating. And what we're seeing is that injured employees who use this app are using it about three times more frequently than a non-injured general population using the app. 

Then, from a workers comp perspective or from an outcomes perspective, what we're seeing, too-- and again, these are very early results from the pilot-- but they point that the app is able to help these individuals have fewer disability days, lower medical costs and also lower overall claim costs. 

We're super excited about this app and what we're doing to help injured employees with it. And so we will be expanding its use to a larger population of claims in the next couple of months. 

All this is to say, I know we're focusing on what we can do during a work injury. But this is just one example about how we can leverage technology, how we can use some of the insights into psychology, some of the things that Dr. Kertay mentioned earlier. These basically are helping us enhance the mental and emotional well-being of a specific employee population. But there are applications beyond just work injuries. 

So really excited to be part of this panel. And I really thank you, Joan, for having us here. 

JOAN WOODWARD: Well, absolutely. Les, Marcos and Rich, I really appreciate your perspectives.  And we really want to just give the audience kind of a level set about what we're seeing at Travelers through our claim data and what we're hearing from our customers and our clients and our agents about this topic. So we wanted to give you kind of a brief overview. 

But we also want to get into your questions. And there's a number that have been put in. We appreciate your questions coming in. They're very thoughtful. Before we get to your questions, we're going to ask you a question, our audience. We would love to know the answer to this question first because this does tell us a lot about how you've done over the last couple of years. 

So first question to our audience-- and again, just click the poll. All anonymous here. Has your sleep quality decreased over the past two years? So are you sleeping not so well during the pandemic? And have you noticed a change in your sleep patterns? As Arianna Huffington says, sleep is very important for all of us, and it's an indicator, I think, of whether or not our sleep can help us through the day. 

So, has your sleep quality decreased over the past two years? Seventy-one percent of us say yes, and only 30% of us say no. So, Dr. Marcos, do you want to just speak to that? What does sleep tell us about how we're feeling about our own mental well-being? 

MARCOS IGLESIAS: Yeah. Well, it's not surprising, right? And I think I would be one of the 71%. I didn't get to vote, but I would vote that. Sleep is so important to all of us and how we function cognitively, how we see the world, how we feel emotionally. It can be a factor in, along with other psychological symptoms. Sleep, disordered sleep is something we see very, very commonly in pain. So, in a lot of work injuries, sleep-- lack of sleep or poor sleep goes along with it. So it's something that we need to pay more attention to. 

And going back to what we've experienced with the app is, actually the sleep toolkit is the one that's used the most, which just reinforces the importance that sleep has in our lives and how we're not feeling good about how we're sleeping. Not surprised. 

JOAN WOODWARD: OK. Second question for our audience, and the last question we're going to ask you, just to get a sense of how you're dealing with stress and coping with that. So, managing stress. How do you manage stress in your life? And you can choose a couple of these here. Do you exercise? Meditation? Do you work more? Do you seek counseling? Do you use medication for your stress? Do you use alcohol? Alcohol consumption has been up dramatically during the pandemic. I think a lot of the liquor stores were deemed to be “essential businesses” during the pandemic, which was quite interesting, in a lot of different states. But how are you managing stress in your life? And just go ahead and answer those questions, and let's see what the polls show us. 

So this is good news. Almost 70% say they use exercise or meditation. A couple of us are using work to help with our stress. The alcohol number and the medication number are right up there as well. Very interesting. Rich, I'm going to ask you to comment on this. Is this surprising to you? Is this good news that a lot of people have used exercise over the last couple of years? 

RICH IVES: Yeah, I think this is-- I think this is good. I will say-- maybe this is a great spot to do a little bit-- a little bit of a watch out, right? So especially in our day and age, sometimes when we don't feel great-- anxiety, depression or whatnot-- rather than trying to address, maybe, some of the root cause or develop some behaviors to try to get us to a different place, there's a temptation to turn to a substance. 

And the crazy thing about it that most don't realize is that sometimes the substance that you might turn to actually produces more of the same that you're trying to flee from. And we see that sometimes with-- and I'll put it in an opioid situation-- where sometimes folks will take an opioid drug to cure-- to cure the pain, and it's not curative. It only masks the symptom. And then later, because they've been on it for a longer period of time, it actually triggers in the brain the exact thing that they were trying to flee. So it becomes a vicious cycle. 

So that's a little bit of the watch out. And I think we have some more to say about some of these things later on. 

JOAN WOODWARD: OK. Terrific. Well, thank you all, audience, for participating. It's just interesting data points. So, Les, I have a couple of questions for you, and we'll get to Rich and Marcos in a minute. You've been out there 45 years in your professional career in clinical psychology. Does this mental health impact arising from the pandemic compare to anything you've seen professionally during your time working in this field? Or maybe what has surprised you the most coming out of the pandemic with mental health? 

LES KERTAY: I think the biggest thing that's changed is the degree to which we're talking about it. As I, as I mentioned toward the beginning, we started seeing a significant increase in reported symptoms starting about 2015. And it just accelerated right on through the pandemic. I think awareness changed. I think willingness to talk about it changed. And no, I've never seen anything like that. 

And certainly, the disruption in people's lives is a unique event. Some of us were working from home already, but a lot of us were working in offices, and we shifted to home. Kids were home. So I think-- I think the level of kind of dealing with multiple stressors, I've never seen anything like that before. 

JOAN WOODWARD: Yeah. Yeah. Actually, I remember I was working on Capitol Hill about 30 years ago, and Senator Pete Domenici was Chair of the Budget Committee. He's the first one who said, let's add mental health services to the general health care offerings and benefit policies that companies and the government and Medicare even offered. So it wasn't that long ago that mental health services were actually not even a covered, covered area for the federal government for a lot of employers. 

So, Rich, let me ask you this question. We're always talking about the pandemic, it seems. But why has it taken us so long to have society kind of come along with us as we talk about these issues? Or how far do we still have to go in terms of raising awareness about mental health issues? 

RICH IVES: Yeah. So here are some thoughts, and some of these are some personal thoughts in here as well. But these issues, like Dr. Kertay has said, have been growing for some time. And here's a-- here’s a scary stat for you. According to the CDC, the total age-adjusted suicide rate in the United States has actually increased 35% between 2000 to 2020. So we think about, oh, it's the pandemic. It's the pandemic. 

Well, that stat says this has been growing past the pandemic. Maybe the pandemic has accelerated some of these things. But this has been growing for a while. Now my personal belief is I don't believe that we as a society have been as aware of the warning signs as we need to be. We've covered a broad spectrum so far in our conversation. I mentioned a suicide stat, but we've been talking about stuff below that waterline that are symptoms of issues that exist that we're really talking about trying to-- trying to address. 

And I don't think that we as a society have been aware-- as aware. I know I personally have not been. There have been a couple of issues very close to me that I’m not-- they’re painful enough that I'm not even ready to talk about, I will tell you, right at this point in time. And it's opened my eyes to say, this is a bigger issue than we might have really thought about. 

Now, for various reasons, I think people are hurting today. And there are-- and many are concerned or unwilling to say something, or not willing to seek help. And I think that alone says something about how much further we have to go. I think additionally, we need to remember that when we talk about wellness, I often put it in this context, that wellness is four-dimensional. Wellness is four-dimensional, and it's physical, it's emotional, it's mental, it's spiritual. And I didn't order those in any order specifically. I think each of them are very important. 

And when I talk about that, physical, you're talking about nutrition and exercise. Mental, being a lifelong learner or having a mission, right? Spiritual, having a reason for hope or purpose. Emotional, relationships. And I think for mental-- for wellness, all-around wellness, it's important that we as individuals and a society invest in all four of those dimensions. 

JOAN WOODWARD: I think that's really well said. Certainly, a lot of people, and a lot of employers-- so if you're a company out there, whether it's a small agency, a small insurance agency or a large broker, I mean, just having the conversation and asking people, are you OK today? As a boss, as someone who manages people, it's OK to go on a personal level and ask people if they are OK, if there's anything bothering them. 

But I think employers who really take this seriously and allow a safe space for people to have a discussion about mental well-being in the workplace is the first step, right, and making sure people understand it's OK to talk about these issues. And so we're obviously proud at Travelers because, as you say, we're the number one insurer of workers comp. And that really does give us a lot of data points and show us a lot about what's happening in the space. 

Dr. Iglesias, I want to get to you. So one of the, I think, the silver linings, maybe, of the pandemic is the rise of the use and access to telehealth, right? Telehealth medicine, before the pandemic, was kind of a nice to have, on the side of the table, but wasn't really a core element of our health care system. So can you comment on telehealth and what has come out of the pandemic, in your view, on that? 

MARCOS IGLESIAS: Sure, Joan. And telehealth, especially during the lockdown, was incredibly important for all of us personally, but also for us as a business. So we saw a huge uptake in terms of the number of injured employees that were treated or received at least some treatment via a telehealth platform. Virtual, sometimes phone, but usually video as well. And that took place not just in internal medicine, but also in musculoskeletal care, even in physical therapy.

 But I think really, really importantly, and related to what we're talking about now, is the advent or the betterment, if you will, of tele-psychological and psychiatric care because it’s-- that type of care lends itself very much to virtual. It's something that we can do from the convenience of our home with a professional. And it may be helping reduce some of the stigma. I don't have to go to a psychologist's office. I don't have to go to a behavioral health clinic. I can simply talk to a counselor. I can talk to a mental health professional in the comfort and privacy of my home. And that may be helping to destigmatize some of what we've just been talking about. 

So, for all sorts of reasons, I think telehealth is wonderful to have. After lockdown was something that was passed. Yet we started seeing less use, especially in musculoskeletal care. I think that's appropriate, completely appropriate. But I think it's a very nice to have. And I think for certain specialties and certainly for mental health, I think it's a must-have. 

JOAN WOODWARD: Thank you for that. Dr. Kertay, I want to go to you on a topic that's really emerged. According to the CDC, millions of people are now suffering from long COVID and the impact that that's having on their lives. What do we actually know today about long COVID? What don't we know yet? And what are the conversations in the workplace around long COVID? 

LES KERTAY: Well, there’s-- we're learning more all the time. I think it's fair to say that what we know for sure is that we're seeing a high number of increased physical and mental health symptoms. We recently have seen some work that indicate that the mental health impacts of COVID seem to taper off so that they're more time limited. We also know that the physical symptoms tend to be correlated with the severity of the original illness. 

And the mysteries still are what exactly is happening with people who are reporting symptoms who either had a mild case or never did have a specific diagnosis? We're still working through what that-- what that means. But we're learning fast. And I think the only thing I would add to that is that I think it's really important to read those studies with a careful eye so that-- I started out researching what was happening with mental health. And what I noticed is that all of these studies with these huge numbers of increased mental health conditions were based on brief screening tools. Well, that means that symptoms are increased, but that doesn't necessarily correlate or amount to increased numbers of diagnostic-- diagnosable conditions. 

So that sort of got me started on this whole journey around, well, let's be careful. Let's think thoughtfully and take care of patients when we see them. But let's also be conscious that we're still learning a lot. 

JOAN WOODWARD: OK, and on that vein of learning a lot, I want to kind of shift the conversation to describing what our problem is, the problem we have and we're facing in the workplace, and to solutions because solutions, for us, I love to give our audience concrete things they can walk away from this webinar with and implementing in their own lives to help them have better lives. 

So, resilience was something that really came through Dr. Iglesias' conversation about helping people. So, what have you found works in increasing resiliency? He said-- I think he said you're somewhat born with it, but you can also kind of stretch that muscle of resiliency and increase your ability to deal with difficult situations. So, give us some advice for our audience today. 

LES KERTAY: Yeah, I mean, I think the notion of resilience is really, really critical. I mean, it's core to the solutions that we've been developing also. Not too surprising, since Dr. Iglesias and I have known each other a long time, that we think similarly. 

One thing is, one of the reasons that I'm very specific about making distinctions between diagnosable conditions and symptoms is that it's really important not to overtreat. If someone's experiencing common stressors, what we want is we want to teach people coping strategies for that. So one of the things that I teach people to do is, have a self-care plan that you can tack up on a wall that you do ahead of time. I don't want to be thinking about what I'm going to do when I feel stressed when I'm stressed. I want to know that in my case, in 10 seconds, I can be outside my front door walking in the park across the street. So I keep my walking shoes with me.

These are simple things. It doesn’t have to be-- it doesn't have to be complicated. But I think it's important to have the plan ahead of time. And since you picked on me first, I'm going to add one more thing, which is, you said, are you OK? The people who know me are really sick of hearing me say, the four most important words there are, are how are you doing?

Being willing to ask that question and being willing to tolerate the answer, well, not so good, that's hugely important. That connection with other people is a huge part of resilience and making sure that people stay connected. So managers can reach out to their employees. That's something that we know is important in workers compensation. We know it's just generally important, asking each other that question. So that's a start. 

JOAN WOODWARD: Quick follow-up before I'm going to go to you, Rich, next. So quick follow-up. As a manager, when I hear feedback that I'm not OK today, that puts that manager kind of, what is the next response back to that employee if they say, I'm not doing so well today? 

RICH IVES: Yeah. Yeah, that's a good question. I think ultimately, I think we're living through some future generation's case study in many different perspectives. And there's no solid playbook for dealing with many of the current challenges that we’re-- the leaders, every single one of us-- and even if you're not in a formal position, we all have a leadership role, an influencing role. And I'll say this. Regardless of the issue, what we know works is to take an injured employee-centric mindset. Start from the outside in. Rather than our perspective, try to think of things from that employee's perspective. That's a key. We develop a lot of our strategies in that way. 

The second is to be able to show genuine care and concern for the individual. I think Dr. Kertay rightly said-- Dr. Marcos does all the time as well-- how are you doing? Are you OK? If there's a genuine desire to understand what a person's going through there, that's going to bridge a lot of gaps. So genuine care and concern. 

And then I think actions on the behalf of an employer that can help reduce anxiety during our period of time, and they can also help to build trust and confidence. Now that-- how you do that is very unique to that context and that situation. But knowing that that's what you need to try to do is important. 

So here's just one real practical one, right? We see often instances where somebody gets injured on a job. And they're out of sight, out of mind. How many leaders actually check in and say, hey, how are you doing? We miss you, because in the mind of that employee it's, I wonder if I'm going to have a job to go back to, and I wonder what my employer thinks of me. That's just one practical, right? But I think those are the things that we work.

JOAN WOODWARD: So, Dr. Iglesias, just a quick question on this one topic and we're going to move on. How do you proactively, as a manager, ask those questions without getting too personal? Some people are more formal, and they don't want to get personal with their manager. So, what are some recommendations there? 

MARCOS IGLESIAS: Yeah. I think it boils down to be genuine, be real, right? Know who you're talking to. Ask them in a compassionate manner and a casual manner, and then be willing to back off. Now may not be the time to talk about this. But you might simply say, hey, if you ever want to talk about this, I’m-- my office is open to you. If you'd like to talk more about it, please let me know. So know when to push, know when to back off. And just be there for the employee, be there for the other person. And I think they will seek you out eventually if they don't-- if they don’t take you up right at first. 

JOAN WOODWARD: At the moment. OK, great. Rich, I want to go back to you because you did say that of the psychosocial risk factors, you mentioned that 40% of injured employees have at least one of those. What issues are you really seeing more frequently, and how do you adjust those? 

RICH IVES: Yeah. So two that we see more frequently are recovery expectation-- and it does go on both sides of the spectrum. Unrealistic, I'm going to be back to normal sooner. And that actually, then, produces more stress and anxiety in the person when they feel like, I'm not getting better. Well, part of it is because you just need to show a little empathy. You need to have a little bit more patience. Follow your treatment regimen. 

But then on the other side of it, how we offer help through the app is through a system of organization. So, what is your goal? When do you expect you can get back? If that's the case, then what are some of the things you need to be doing in the meantime?

So, recovery expectation is big. And then coping is big as well. And I'll share a personal experience because nobody is immune to the storms of life, let me put it that way. Nobody is immune to the storms of life. We all face them. We've been trying this. I thought, well, I'm going through something six months ago. Let me try it out.

And what I love is the reframing exercise. So that virtual, the anonymous nature of the app to say, hey, I'm not doing well. And then it would then-- it doesn't care about what it is that I don't do well. It doesn't have a heart in that way. But it has a programmatic way of being able to say, well, tell me about it. There's health in that. And then how do you think about that differently? 

You just think about that process that you go through in a reframing exercise is another thing that adds great value. 

JOAN WOODWARD: OK, now I want to turn to different generations and how they're dealing with stress and managing anxiety. And I know a number of us on this call-- I've heard a lot of feedback have-- teenagers, who-- had to do high school on Zoom and how immensely stressful that was. 

But last week-- Dr. Kertay, I want to talk to you about this-- last week we had a session on Gen Z, what makes them tick, how companies can recruit and retain them. So let's talk about Gen Z and any noteworthy differences and their stress and anxiety that you have found? I know Rich had a chart in terms of what we see. But how do you think about Gen Z and what they want to see in an employer? 

LES KERTAY: Well, I think-- I want to preface this by saying that we've seen for a long time that the differences within generations are at least as big as differences between generations. So I don't want to make too much of this. But I do think that Gen Z are digital natives. They know nothing about life before computers. And so it's a very different world. When I was young, it was hard to get information. I had to go to the library to get information. But I could count on it being relatively consistent and reliable, right?

Now I'm flooded with information constantly, and I have to deal with the stress of trying to sort through, well, what's real? What isn't? What's being amplified? What isn't? I think that's a stress that Gen Z is feeling more than the rest of us did, and for longer. 

And I think what they want, what they're not willing to do, I think, is put up with the kinds of work demands that we just thought were expected. Just work more hours. It's like, well, yeah, no. I'll get my work done. I'm going to work really hard, and then I'm going to have a life. And frankly, my response to that is, good for you.

JOAN WOODWARD: Yeah. Yeah. Good. Dr. Iglesias, I want to turn to our children and teens during the pandemic. What are you seeing now? This has been a really, really stressful time, not just for the teens kind of on Zoom trying to get through high school or middle school, but for, obviously, parents. And how do you speak to parents about how to deal with their children's anxieties and issues that really are kind of new to us? 

MARCOS IGLESIAS: Yeah, the pandemic didn't affect us all equally, right? It certainly affected younger people and adolescents a lot more, at least in terms of the symptoms. And again, some of this has been alluded to. Stress, depression, even substance use in that population took off quite a bit more than in other populations. So I think it's incumbent upon us as parents, as adults, to really have conversations to help them socialize and make sense of what has happened, what is happening now. 

I mean, we live in a very different world than it was three years ago. They need a perspective from others. And we can't just rely on media. We can't rely on apps. Like Dr. Kertay said, they're going to gravitate towards that, but in fact, that may also be because we've abdicated some of our responsibility and some of our opportunity to build into their lives. So we need to build positive coping skills in them. We need just to be there for them. And I think we need to be there for them more than we have in the past. 

JOAN WOODWARD: Wonderful.

RICH IVES: One thing on that, just because it brings to mind my own couple personal examples. But the other thing is, those kids are going through a lot, regardless of which age. And being able to create a safe zone for them that's non-judgmental.

A lot of times kids don't say something when they're dealing with something because they fear letting you down, not meeting your expectation. And for them, being able to experience unconditional love, and safe zone and I'm here to help. And for them to see some vulnerability of, I've gone through some things too and share some of that journey. So I just wanted to offer that. 

JOAN WOODWARD: No, I appreciate that, Rich. I think all of us parents out there, anyway, we-- it's difficult to watch your child go through this kind of a period. And so I think it's helpful to really be non-judgmental, which sometimes it's tough because you want them to get good grades. You want them to good social life. And it's just overwhelming. 

So, I want to get to a couple of audience questions here. This hour is flying by. Gary Lindsey at Hotchkiss Insurance in Texas asks us: In this period of understaffing and constant expectations changing, what does-- how does one find time for self-care and promote self-care without sounding disingenuous? What are some practices that may have worked remote self-care of yourself and your employees? So Dr. Marcos, I'm going to go to you on that one. 

MARCOS IGLESIAS: Yeah. Take micro times, right? You may not be able to devote an hour to exercise, but if you can go for a five-minute walk, that's better than not. Take care of yourself, going to bed a little bit earlier, trying to unplug from social media. For me, that's a big thing, right? I think little things like that add up. And I think they do help us cope with things better. 

JOAN WOODWARD: OK. Wonderful. This comes in from Gallagher. James Dix says, if there is one thing you can recommend each of us do every workday for our mental health, what would it be? We're going to go around the room. We'll start with you, Rich. What would the one thing that you've done in your personal life or your employees’ that has been helpful for you for your mental well-being? 

RICH IVES: Yeah. So I go back-- it's hard for me to nail down to one because I really do think the four dimensions are key. But here's the one. When something's not going right for me, when life's not working for me, I ask myself, which one of those is out of balance? That's what I do. 

So I think it comes back to an assessment. So those four dimensions of physical, mental, emotional, spiritual. So I go back, an honest self-assessment and say, where am I not moderated in some way? 

JOAN WOODWARD: OK. Dr. Kertay, you have a thought on the one thing we could do? 

LES KERTAY: One thing. Set an alarm to go off so that every hour you get up and walk away from your desk for at least three minutes. That's the one. If I had to pick one thing, that would be it. Don't just stare at the screen all day or sit on the phone all day. 

JOAN WOODWARD: That's a good one. I like that. I want to go to another question here. We have a lot coming in. I apologize we can't get to them all. Should we be proactive with talking about mental health well-being during our one-on-one sessions with our colleagues or people we manage, or just prepare ourselves when it comes up to react appropriately when they would bring it up? Dr. Marcos. 

MARCOS IGLESIAS: Yeah. I think if you're one on one, be proactive. Again, what I said earlier. Get to know the person. If they're reticent to talk about it, then I don't bring it up every time. But just let them know that you're there for them if they ever need you.

JOAN WOODWARD: OK. Another thought, Rich? 

RICH IVES: I think you'll know if something's off, right? If there's open transparency, normally you know something's not quite right. So I think it's in how you ask the question. How you feeling? What's going on? So I think there are just different things you can offer without feeling like you're prying too much. 

JOAN WOODWARD: OK. A couple of quick questions coming in. The app that we spoke about, that's only available now for our workers claim customers. Is that correct? Dr. Marcos? 

MARCOS IGLESIAS: Yes. And I also saw a little bit about is there one-on-one personal counseling, and there isn’t. And I want to emphasize that what we're doing is really non-medical. So we're not diagnosing. We're not treating medical conditions. It's a coaching app. 

JOAN WOODWARD: OK. Wonderful. 

RICH IVES: Can I jump in? Can I jump in, though? So check with your employer. Sometimes there are good apps like that would connect with an employee benefits-type solution. We have one here at Travelers for our employees. So that's an option. And Marcos, is there anything commercially available that you would recommend? 

MARCOS IGLESIAS: There are lots. You can do an internet search and read a little bit about them because they're all a little bit different. 

RICH IVES: OK. 

JOAN WOODWARD: OK. One question here coming in-- this is probably for you, Rich. What are your thoughts-- and this is from a nurse-- a registered nurse coming in-- what are your thoughts to expand the psycho-biosocial barriers to include the environment? 

RICH IVES: Oh, that's very specific. So I think the team, Marcos' team, designed some of the questions that would last longer than the period of time that we're in. So I think what's in the mind of that individual is, we've been in a pilot state within this work, which has been a pretty broad pilot. But we are currently, within this announcement, announcing that we are going full implementation across. So for our internal folks, you'll hear more about that, which I'm sure will be welcome news. 

JOAN WOODWARD: OK. Dr. Iglesias, what are you reading, or what can you tell our audience too, if there was one or two books or podcasts to go and get some more information or you found particularly valuable, do you have one or two thoughts? 

MARCOS IGLESIAS: Yeah. So I'm reading a couple of books written in the 1990s. One deals with stress, Why Zebras Don't Get Ulcers by Sapolsky. Really good to help you understand stress better. And the other one, to me, was fundamental to a lot of what we do, which is Learned Optimism, written back in 1990, but an excellent book that that'll teach you how to reframe some of the negative thinking that a lot of us experience every day. 

JOAN WOODWARD: Terrific. Well, with that, I have to end our webinar. This hour just flew by. But I do promise our audience we will stay on top of the mental well-being and mental health in our workplace, and we will host regular webinars on this topic. It was really, really, really an incredible conversation. I want to thank our panelists and our speakers for being so thoughtful. 

We are here for you, our customers, and our agents and our clients. We want to be, and we are, a leader in this space when it comes to mental well-being. So thank you all. I do want to give my audience a heads up for next week. 

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Wednesdays with Woodward Webinar Series. Upcoming Webinars. September 28, Woodward on Washington: An Economic, Public Policy and Political Outlook. October 12, What's Required? Understanding the New Cybersecurity Laws Impacting U.S. Critical Infrastructure. October 19, A Conversation with Neel Kashkari, President and CEO of the Federal Reserve Bank of Minneapolis. October 26, Under Pressure: Real Estate Market Update with National Association of Realtors (registered trademark) Chief Economist Lawrence Yun. New! Register for multiple events at once through our new registration page. Register: travelersinstitute dot org. 

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I'm turning the tables a bit on myself. As you know, probably a lot of us know that I go out and I do a lot of speaking for agent broker groups around the country on the economic outlook and the public policy outlook and what's happening here in Washington, D.C., where I sit and work. 

And so, join me next week, September 28, for my annual Economic and Public Policy Outlook. We're going to talk a little bit about politics, too, in a very nonpartisan or a bipartisan manner, and think about what's happening with the midterm elections and how you can get involved. Also, October is Cybersecurity Awareness Month. So, we'll kick it off on October 4. We're going to be live in St. Paul, Minnesota. So, if you live in Minnesota, you're welcome to join us. You can look for that on travelersinstitute.org. 

We'll also have a webinar on October 12 looking at the new cybersecurity laws. There are new laws on the books that are impacting businesses across the United States. We'll talk about that on October 12. 

And then the very next day we're in downtown Los Angeles. If you're in the area, please join us on October 12 to have a cybersecurity symposium with Department of Homeland Security and Small Business Administration speakers. So, we're back on the road, folks, but what we love most is your feedback. So fill out any survey you get from us. We want to know what other topics you want to hear on our Wednesdays with Woodward. 

Thank you all for being with us and caring so much about this issue. It's critically important for all of our mental well-being. So again, panelists, thank you so much. We'll be back with you with more on this topic. 

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