Building the Next Generation of Behavioral Health Access in Workers’ Comp

By Joe Holtschlag, CEO, Ascellus

Originally published in WorkCompWire

For many years, behavioral health has been missing from workers’ compensation’s recovery approach. Clinicians have long understood that psychological and social factors slow recovery from physical injuries. Claims professionals see every day how anxiety, fear, trauma, or coping challenges can prolong disability. Yet the system has never been designed to consistently identify these barriers or deliver the right support at the right time.

That gap has become harder to ignore. State laws are broadening the scope of covered mental health injuries. Workplaces are reporting rising rates of violence, burnout, and emotional strain. Employers are experiencing the consequences of long-duration claims and workforce instability. And injured workers are often left navigating complex emotional challenges without specialized support.

In short: demand has surged, but infrastructure has not kept pace.

A modern workers’ compensation system needs scalable, reliable, clinically grounded behavioral health access. Building that capability requires more than adding providers to a network, it requires rethinking the entire system.

Why Behavioral Health Has Been Hard to Scale

Behavioral health in workers’ comp isn’t simply a question of access. It is a structural problem shaped by three constraints:

1. Provider availability

   There is a nationwide shortage of mental health clinicians, especially psychologists and psychiatrists. Half of psychologists are not accepting new patients; when they are, wait times are typically over a month. Even when available, many providers decline workers’ comp referrals due to administrative complexity.

2. Coordination burdens

   Every workers’ compensation case involves a web of stakeholders: adjusters, primary physicians, specialists, nurse case managers, employers, and sometimes attorneys. Behavioral health providers often lack the process support needed to navigate these complexities.

3. Mismatch between traditional therapy and occupational needs Conventional outpatient behavioral health models do not address return-to-function, industrial causation, impairment ratings, or work capacity. They are not designed to integrate with medical treatment plans or employer RTW programs.

These realities have limited the industry’s ability to scale behavioral health even as the need has grown dramatically.

What Next-Generation Access Requires

To close the gap, we need an integrated model—one that blends technology, clinical rigor, and operational excellence.

Technology alone won’t solve behavioral health.

A scheduling platform or telehealth portal may increase convenience, but it doesn’t address clinical appropriateness, diagnostic accuracy, or coordination.

People alone can’t scale it.

Traditional provider networks lack the infrastructure to deliver consistent outcomes or timely care nationwide.

The future depends on combining both.

Next-generation access means building the systems that allow clinicians to do their best, supported by workflows that remove friction and supported by data that inform decision-making.

Key Components of a Modern Behavioral Health Access System

Fast, reliable intake and identification

Early identification of psychosocial risk factors is essential. Predictive tools—such as pain and behavioral-screening questionnaires—can differentiate between routine recoveries and the 10-15% at risk for complications.

In one study, standardized early-intervention tools predicted delayed recovery with more than 90% accuracy, allowing timely intervention before claims spiraled.

Purpose-built clinical models

Work-Focused Cognitive Behavioral Therapy (W-CBT) has been shown to significantly reduce disability duration. A study published in the Journal of Occupational Health Psychology found that workers receiving work-focused CBT returned to work 65 days earlier than those receiving traditional therapy.

This happens because the model emphasizes functional goals: stamina, concentration, pacing, communication, and the gradual resumption of work tasks.

A national network trained in occupational care

Clinicians need specialized training on:

• industrial causation

• functional assessment

• work-capacity evaluation

• coordination with treating physicians

• navigating the jurisdictional differences of WC systems

Without this, even well-intentioned providers cannot deliver consistent outcomes.

Technology-supported logistics

Scheduling, documentation sharing, RTW coordination, and case communication must be fast and predictable. In workers’ comp, each additional day of delay increases costs sometimes dramatically. Speed isn’t a convenience; it’s a core component of effective care.

Measurement-based care and functional outcomes

Outcome measurement must be tied to work readiness, not just symptom change. Rating tools that track functional improvement session-by-session allow clinicians, claims teams, and employers to align around clear goals.

Why This Moment Is Transformational

For the first time, market dynamics favor change:

• State laws requiring mental health access.

• Employers are prioritizing rapid return-to-work to mitigate labor shortages.

• Claims organizations are seeking partners who can help them manage complexity.

• Tele behavioral health has become standard practice post-pandemic.

In short, the industry is ready—and in many cases, desperate—for a scalable, consistent approach.

A Balanced Model for the Future

The future of behavioral health in workers’ compensation depends on balance:

• Automation where it adds value.

  Intake routing, scheduling, data capture, and communication workflows should run automatically.

• Human expertise where it is irreplaceable.

  Diagnosis, treatment, coaching, and return-to-work planning must remain in the hands of trained clinicians.

The systems we build today must support clinicians, reduce administrative barriers, and create predictable, timely access to care—without sacrificing the human connection at the heart of behavioral health.

Conclusion

Workers’ compensation is entering a new era in which behavioral health is no longer a peripheral consideration—it is central to timely recovery, claim resolution, and worker well-being. Building next-generation behavioral health access will require structural changes, technology-enabled clinical models, and national networks capable of supporting large-scale coordination.

But the rewards are significant: shorter claim durations, better functional outcomes, healthier workplaces, and a system that finally treats mental health with the seriousness it deserves.

The industry now has the opportunity—and responsibility—to build the infrastructure that makes this possible.