How to help your patients with

work related psychological injury

Wednesday 25 March

6.30pm

Speakers

Dr Ben Barresi, General Practitioner

Dr Peter Cotton, Clinical Psychologist

Dr Dielle Felman, Consultant Psychiatrist

Learning Outcomes

1. Describe the health benefits of safe work and the vital

role of GPs and health providers in setting treatment and

recovery expectations for their patients.

2. Identify the key principles of best practice in assessing,

treating and managing psychological injury.

3. Identify and access available services to support patients

with psychological injury.

4

How to help your patients

with work related

psychological injury

Mental health in the general

practice setting

• Common scenario for GPs but can be difficult*58% of GPs indicated that they would like further support to

assess a patient’s mental health condition and how this is

impacting their functional capacity

• Challenging for GPs to positively motivate patients

*54% indicated they would like support in treatment of mental

health patients, particularly in relation to supporting return to work

* The Social Research Centre (December 2014) GP perceptions of the Health Benefits of Safe

Work and experiences with Return to Work

Mental health is still dealt with

very differently at all levels

• Increased awareness about mental health issues

• Avoidance of addressing mental health issues in the

workplace

• Opportunities for early intervention missed

• More of a ‘hands off’ approach at all levels

• Medical certification practices much more liberal than with

physical injuries

• Assessment of functional capacity based more on patient

expressed preferences rather than any assessment of

substantive functional capacity

Good work is good for you

Meaning

Purpose

Self-worth

Remuneration

Distraction

Social Interaction

Stimulation

Lack of meaning

Reduced purpose

Reduced self-worth

Financial difficulties

Time to ruminate

Isolation

Boredom

Unhealthy habits

At

wo

rkN

ot at w

ork

Did you know?

There is risk associated with certifying

a patient as unfit

Did you know?

Outcomes for patients in the

compensation sector can be worse than

those not in the compensation sector

The impact on family can be significant

Collaboration results in better outcomes

Did you know?

There is a strong positive association

between unemployment and increased

rates of overall mortality from:

– Cardiovascular disease

– Respiratory disease

– Mental health disorders

– Suicide

G. Waddell and K. Burton (2006)

Is Work Good For Your Health And Well-being?

‘Worklessness’ is associated with poorer

physical and mental health

Work is generally good

for health and wellbeing

and long term work

absence has a negative

impact on health and

wellbeing

Good outcomes are

more likely when

individuals

understand the health

benefits of work, and

are empowered to

take responsibility for

their own situationHealth professionals exert

a significant influence on

work absence and work

disability, particularly in

relation to medical

sickness certification

practices

Realising the Health Benefits of WorkRealising the Health Benefits of Work

The role of GPs in realising the Health

Benefits of Work

Evidence-based messages:

Work is an important part of

rehabilitation

Work is a therapeutic intervention

Typically, waiting for recovery, delays

recovery

Staying away from work may lead to

poorer health

Employer-supported, early return to

work helps recovery

WorkCoverSA 13

Why is early support important?

The longer an injured worker is away

from work the less chance they have of

returning work

WorkSafe Victoria data June 2013

In summary, work is good for your

health and well-being

Strong evidence base that work is generally good for

physical and mental health and wellbeing

‘Worklessness’ is associated with poorer physical and

mental health

Work can be therapeutic and can reverse the adverse

health effects of unemployment

G. Waddell and K. Burton (2006)

Is Work Good For Your Health And Well-being?

15

Assessing, treating and

managing psychological Injury

Types of Psychological Injury

Straightforward Type:Temporary reaction to discrete stressor and usually

bounce back and return to work in short-term

Low Morale Type:

Driven more by a decline in morale rather than a

substantive increase in psychological

distress/mental health symptoms. Typically involves

interpersonal conflict and/or work dissatisfaction

issues

Complex Type:

Usually a pre-existing vulnerability (personality-

based factors, childhood adversity etc.) – interacts

with perceived workplace stressors and is

associated with high risk of complex treatment

needs and a poor return to work outcome

Disengaged Type:

Passive and avoidant, poor response to treatment,

unmotivated to return to work: fast track to long term

disability

Evaluating patients –

Diagnosis, symptoms and functioning

Having a diagnosis does not of

itself mean work incapacity.

What is the measure of

illness/wellbeing?

– Do you focus on symptoms

or functioning?

– What do your patients focus on?

Functioning

Symptoms

Diagnosis

What does it mean to be fit for work?

Attendance/punctuality

Ability to attend regularly, reliably and sustainably

Performance

Quality and efficiency

Code of conduct

Can they behave

appropriately?

OH&S risk

Being at work cannot make them more

unwell

• Sleep/wake cycle, activities of daily living – cooking, cleaning, shopping, management of children/school, other activitiesStructure / Routine

• Rest / napping during day / after activity, exercise, hobbies, energy to get through day.Energy / Endurance

• Read newspapers, books, watch television, emails, interaction with social media (Facebook), remember thingsCognitive capacity

• Engagement with family and friends, social activities, group recreational activitiesInterpersonal functioning

• Frustration tolerance, Avoidance behaviours, substance useCoping

• Involvement in study, volunteer workEvidence of work capacity

• Medication effects on daily routineSide effects of medications

Things to consider when assessing

capacity

Workplace reasonable adjustments

WorkCover legislation – The employer is obligated to

make reasonable adjustments.

Consider:

Hours e.g. reduced hours, alternate start time, graduated increase in hours.

Duties e.g. modified duties

Expectations e.g. longer time frames, lower KPI’s, additional training

Environment/reporting lines e.g. change in manager

WorkSafe and TAC can fund the cost of reasonable workplace modifications

to assist a worker to return to suitable employment.

Certification

Consider what the

injured worker can do,

rather than what

they can’t do

•What is the impact of the

injury on their function?

•Focus on return to work as

an early treatment goal –

address work issues early

Certification – having the conversation

Access the document and videos:

www.tac.vic.gov.au/gp or

www.worksafe.vic.gov.au/gp

Management – Part 1

Make time

Provide support and education

Engagement, alignment, collaboration

Setting expectations

Thorough assessment of condition, comorbidities, barriers

Management – Part 2

Treatment – psychological, pharmacological, early referral to a specialist

Functional restoration / rehabilitation considerations

• Avocational/vocational rehabilitation / Graduated return to work program

Communication – employers, rehab providers

Addressing issues including industrial

• separating industrial from medical issues

Regular review. Detailed clinical notes. Ongoing treatment after RTW

Referral

– Psychiatrist

– Additional services:

– Workplace support service (WorkSafe)

– Vocational rehabilitation services

– Return to work case conferencing

– E-therapy – This Way Up

– Outreach Services (TAC)

– Others eg. Network pain programs

26

Case Study

Case Study: Sarah

– 38yr on single woman

– Computer data entry. Works for a large company.

– Presents towards end of annual leave saying “I can’t return to work due to

bullying from two colleagues who sit near me”.

– She says the colleagues are talking about her behind her back and are

excluding her.

– She was feeling highly anxious and uncomfortable at work before her leave

and is now fearful about returning.

– She is not sleeping and worried she will cry at work.

– She believes her Manager does not support her.

– She wants to put in a WorkCover claim and requests time off work.

– She is visibly distressed and teary.

– No past history of mental health issues.

Case Study

Discussion: Sarah

– Discussion of results from polling question .

– Summarise the main points

Case Study: John

– 42yr living with wife and two children.

– Lending manager for a bank.

– Assaulted by an intoxicated client at a visit to their business.

– Presents to GP two days later with facial bruising.

– Not sleeping, nightmares, ruminating, hypervigilent, poor concentration.

– Drinking two glasses of alcohol prior to bed to assist with sleep – doesn’t

normally drink.

– Anxious about returning to role. Does not think he can manage a home visit

again.

– Was in a bad car accident a couple of months prior – poor sleep following–

but no other sequelae.

– One possible prior depressive episode after birth of his second child in

context of relationship and financial issues. Treated with Sertraline for 2

months. No functional impairment at that time.

Mental injury claims resources

– Workplace Support Service – WorkSafe initiative

– Mindhealthconnect – www.mindhealthconnect.org.au – the

Australian Government’s website provides up to date information

and resources to assist with mental health issues including

anxiety, stress and depression. The site also provides a list of

endorsed online e-therapy services.

– Return to WorkNet – returntowork.net.au – designed to help

anyone involved in the process of returning to work after

absence due to depression, an anxiety disorder or a related

mental health problem

– Beyondblue – NewAccess – an early intervention program

intended to provide easily accessible, free and quality services

for people with mild to moderate depression and anxiety who are

currently not accessing mental health services

Professional Development resources

The following RACGP QI and CPD accredited

e-learning modules are also available:

The Role of the GP in return to work including certification

The Health Benefits of Safe Work

Persistent Pain in the General

Practice setting (coming soon)

Access the modules from the following websites:

www.worksafe.vic.gov.au/certificate

www.tac.vic.gov.au/certificate

http://learning.nhv.org.au/

Other useful resources

• www.worksafe.vic.gov.au/gp

• www.tac.vic.gov.au/gp

• Resources on the role of the GP, health benefits of work, talking about a return to work – conversation starters, info on invoices, payments and policies

General

• www.worksafe.vic.gov.au/certificate

• www.tac.vic.gov.au/certificate

• Resources include Medical Director and Best Practice user guides, FAQs, certificate guide and examples

Certificate of Capacity

• Network pain management program

• Return to Work Case Conferencing

• Occupational Rehabilitation providers

• E-therapy

• Outreach Services (TAC)

Services

33

Thank you

Further information:

worksafe.vic.gov.au/gp

tac.vic.gov.au/gp