Ed: When we shared Dr Mary Wyatt’s article, An Evidence-Informed Approach to Motivating Change, on LinkedIn in October 2021, Danielle Mik, an Injury Management, WHS, Cultural Change and Training professional with more than 25-years’ experience in the industry joined the conversation.

“To get injured workers [IWs] in a state of mind to be motivated, we first have to understand human needs and ensure their fundamental human needs are met.

“Very few IW’s have any interest in dealing with the bureaucracy of RTW while they don’t have money to pay the rent, or they feel disempowered because someone else is making decisions for them without any involvement in the decision making process.

“Many IW’s are in a state of learned helplessness, and until we empower them in the process, and they believe what they do will make a difference to the outcome, generating motivation is nigh on impossible."

We’ve previously written about the impact of workers’ compensation systems on motivation but are always keen to learn more. Danielle agreed to an interview, presented below as a Q&A. The conversation has been lightly edited for clarity and flow.

Q: ON LINKEDIN YOU SPOKE ABOUT UNDERSTANDING AND MEETING THE HUMAN NEEDS OF INJURED WORKERS – COULD YOU EXPAND ON THAT?

As human beings we all have basic fundamental human needs. As psychologist Abraham Maslow lays out in his hierarchy of needs, our most fundamental need is to have safety – food, water, a roof over our heads. When we don’t have those fundamental basic survival needs met, we have a basic neurological survival response to that. All our behaviour is targeted towards getting those needs met to ensure our survival – often referred to as the fight/flight response.

For people receiving workers’ compensation, basic human needs translates to things like getting their payments on time, securing access to sick leave, having the claim determined quickly and understanding the payment process. People fundamentally need those basic needs met, and until they are met, they can’t focus on return to work.

When there is a delay in making payments, for example, all the workers’ activities are focused on getting money to pay the bills. This person may be waiting on their fortnightly cheque, or have spent a lot of money on medication or taxis that hasn’t been reimbursed. They might have kids and be worried about providing for their family. You can’t motivate a person in that situation to think about return to work options.

Nothing you’re going to do is going to improve motivation until those needs are met.

Q: WHAT ARE SOME EXAMPLES OF INJURED WORKERS’ LACK OF A SAY IN THE DECISION MAKING PROCESS?

Another basic human need is for people to have control and certainty in their lives. This helps us feel safe. When we feel safe our brain is clear to function rationally and we can make better decisions.

When a worker enters a compensation system, someone else is making decisions about them and their life - surgery, medication, sometimes even treatment providers. This makes people feel nervous and uncertain. If a company doctor is being used, for example, they may worry whether the doctor is more interested in looking after them or the company.

When you feel disempowered you feel threatened, it sparks off that survival fight-flight response. When this happens repeatedly people give up as they feel nothing they can do will make difference to their outcome – this is learned helplessness.  We need to involve them in the decision making process as far as we can if this isn’t to happen.

If claims managers have good communication with claimants and make sure there are no surprises, let the worker know that they can expect a certain thing to happen at a certain time and then follow through, that builds trust and helps restore a sense of certainty to the worker. But time and again workers tell me: I didn’t know that was going to happen, that was a surprise, I had no idea.

When workers continually face this kind of surprise and uncertainty, the flight, fight, freeze response kicks in. No-one makes rational decisions in that state. You’re fear driven.  Workers in this state can take actions that appear non-compliant or self-sabotaging but often they’re just acting out of fear. Ultimately, this can lead to the development of serious mental health issues, even if the original claim was for a physical injury.

Q: WHO THEN IS MAKING THESES DECISIONS ON BEHALF OF INJURED WORKERS?

Every other stakeholder in the scheme can make decisions on behalf of injured workers.

It can be the employers - if they decide they’re going to pluck the worker out of the area they were working in and put them somewhere else, that’s disempowering.

If the doctor changes the treatment protocol without consulting the injured worker, that can be disempowering. If a claims agents rejects a treatment request without discussion or providing appropriate evidence, that can be disempowering.

Union representatives and lawyers can do it too. People say to me: I didn’t know my lawyer was going to do that. That’s disempowering.

When people make decisions on behalf of the injured worker without having prior discussions with them about what’s coming, why these decisions are being made and what the implications will be, it’s incredibly disempowering.

Q: WHAT ARE THE CONSEQUENCES OF THIS DISEMPOWERMENT?

It’s really important for everyone to understand that even a worker who doesn’t present with a primary mental health injury, a worker who has something physical and straightforward, can be pushed towards developing a mental health injury by a workers’ compensation system that generates distress and uncertainty.

If we want to prevent secondary mental health injuries arising and assist workers to become motivated, we have to manage the different aspects of workers’ compensation systems that currently spark the fight / flight response. We have to avoid activities that push workers towards learned helplessness, things that put them in a state of distress and anxiety. When we don’t manage these things, people can end up with secondary mental health conditions, presenting a bigger block to return to work than the original physical injury.

Q: CAN YOU TELL US MORE ABOUT HOW LEARNED HELPLESSNESS IMPACTS MOTIVATION TO RETURN TO WORK?

If a worker feels continuously disempowered they can go into a state of learned helplessness, they don’t think anything they can do is going to make a difference to the outcome. They end up becoming passive in the RTW process. They let things happen to them. They don’t really participate and they appear unmotivated.

It’s very hard to motivate a worker in that state, because they can’t see that it’s going to help. Instead, they feel like being a puppet on a string, it doesn’t feel good and leads to mental distress.

Motivation is much, much easier to obtain when we are meeting people’s needs and they feel that what they do will make a difference to the outcome.

Q: WHAT ARE THE SIGNS A WORKER IS IN A STATE OF LEARNED HELPLESSNESS OR EXPERIENCING A SURVIVAL RESPONSE?

There can be a lot of different presentations, it depends on the individual and the situation. People can often become very disinterested in their own recovery. They might isolate themselves. They might self-sabotage, cancelling appointments that it would be advantageous to attend, rejecting offers of assistance.

There are others who will become aggressive. We all react differently to a danger – some people run, some fight, some freeze. There’s a whole variety of responses. If someone is disengaging, not wanting to communicate, a case manager may interpret that as: “they’re avoiding me because they’re being disingenuous”. In fact, the reality might be that the worker is scared and overwhelmed and can’t cope with engaging.

My recommendation is that case managers be trained in interpreting human behaviour. The field needs more people trained in emotional intelligence. With every behaviour there is an emotion behind it: what are the feelings behind it, and what is driving that feeling? Once you understand that, then you can work out how to communicate and motivate the individual.

We all have basic human survival needs, and then there are other needs that are individual to each of us, for example we don’t all feel the same about risk taking.  So when presented with risk, some of us get excited and others of us run for the hills.  So when we present a scenario to an injured worker that has some degree of risk attached, they won’t all respond in the same way. For example, some people might really want retraining, to acquire new skills, but for someone else that might be terrifying or meaningless (for example if they are dyslexic). It’s about accepting the individuality of human behaviour and trying to understand it and work in collaboration with the injured worker. You have to get to know people as individuals and understand what their behaviour means to them. Human beings are very complex creatures.

Q: WHAT ARE SOME STRATEGIES FOR WORKING WITH SOMEONE IN A STATE OF FIGHT/FLIGHT OR LEARNED HELPLESSNESS?

The basic principles which work in all human communication apply here. First of all you have to be authentic. People can sniff out a lack of authenticity very quickly. It impacts their ability to have trust in you and form a relationship where they believe what you are saying to them.

It’s also important to be open and honest in communication. Don’t be afraid to be honest with people. Tell them how it is. People always do better with knowing how it is than being lied to. It’s hard to have those conversations when you’re denying something, turning down treatment for example, but it’s important to be open and honest anyway.  Learn how to have those difficult conversations and deliver information in an empathic way.  A lack of empathy is a major barrier to being able to successfully manage an injured worker.

Let people know what’s coming. NO surprises – this just drives uncertainty and the fear response.

Really listening to what injured workers have to say. Listening with a view to hearing what they’re telling you and then responding to it. So many workers report not feeling heard. Validating what they’re feeling and thinking helps, and discussing the situation with empathy, then communicate what can and can’t be done to assist them and follow through.

Approaching every worker individually, not coming from a position of suspicion at the outset. Many workers report that they are treated with suspicion from day one. If the case manager or employer thinks that the worker is exaggerating or not being honest, people pick that up on that suspicion very quickly, and it again drives a fear response and inhibits a trusting relationship being developed.

Unless there is congruence, empathy and trust with the case manager it will be very hard for the worker to listen to anything they have to say, because they will take it all with a grain of salt. No matter what elaborate motivational models you try in order to motivate people, it won’t work.  It really comes back to an individualised, client centred approach where emotional intelligence is understood and utilised. 

Q: IS IT UP TO INDIVIDUAL CASE MANAGERS TO MAKE A DIFFERENCE OR IS THIS A SYSTEMIC PROBLEM?

Its definitely a systemic issue, but individual case managers obviously play a role as well. Part of the issue is that workers compensation has emanated from an insurance model of insuring “things”. When you’re insuring people, it’s not the same as insuring an object. People have feelings and needs. They’re not robots. If you’re getting feedback from the very thing you’re insuring, you can’t just be model and data driven in the same way as when you’re insuring an object. You’re dealing with emotions and feelings. It’s a whole new ball game.

The system is not designed well enough to train people to deal with human beings and deal with emotions and the reactions of people and how to manage them. It’s about emotional intelligence. Across the board, every player in the system needs that training: employers, doctors, treatment providers, claims agents and insurers all need that training. There’s a lot of technical training but not enough training around what drives human behaviour.

Until there is a greater acceptance that treating injured workers as responsive human beings is pivotal, we’ll only ever be able to achieve RTW outcomes to a certain level. Every complex case I’ve ever been involved with (and that is literally hundreds), when the injured worker tells their story, there is always a very large component of not being heard, not being understood, and of them being treated like a number. It’s rarely just about the actual physical injury.

As a community, society, there’s more of a drive now to understand mental health issues. We’re all starting to get people’s complexity.

I often ask case managers - How would you feel if you weren’t paid for three weeks? What state of mind would you be in? Most likely, getting paid would drive your every thought, feeling and action. We can’t expect not to pay or reimburse people and think that they can perform to the best of their ability and focus on return to work. Injured workers are mostly not trying to be difficult, they’re just trying to get their needs met, feel relevant and ensure they have a meaningful future.

There are more case managers moving into the workers’ compensation space with a desire to understand people. They want to use empathy and emotional intelligence to help people. That’s fantastic. However, the system needs to see that these skills are needed across the board as a basic skill set for the role, make it part of training programs for everyone in this space. The system should be driving the need for stakeholders to have these skills, rather than it just being hit and miss and dependent on the individuals coming into the space to drive the change required.

About Danielle Mik

Danielle is a Vocational Rehabilitation and Occupational Risk Management Services Consultant with a career that span 30 years and encompasses Workers Compensation, Injury Management, OH&S, Mental Health, Workplace Risk Management, Human Resources and Training.

Danielle has in-depth knowledge of multiple compensation environments, applying this knowledge to the design and implementation of innovative injury management solutions to achieve sustainable return to work outcomes with long term, complex, serious injury and psychological claims. 

Danielle utilises strategies based on emotional intelligence enhancement to assist people recovering from injury or illness to return to life and to good work.  

Danielle has previously been an Executive Member of ASORC, been President of a not for profit organisation supporting injured workers, and has been awarded Rehabilitation Counsellor of the Year in 2019.