Medical considerations when treating psychological injuries
Dr Quentin Mungomery, Psychiatrist and Medical Assessment Tribunal Member is providing general practitioners with tips on completing the Work capacity certificate – workers’ compensation when a patient presents with a work related psychological injury. This webcast provides suggestions as to what meaningful information to include in the key medical assessment sections within the Work capacity certificate. Understand how this information is utilised by insurers and the patient’s employer to assist them to recover at work as part of their rehabilitation.
Download a copy of this film (ZIP/MP4, 88MB)
Welcome to today's webcast for Queensland GPs, proudly brought to you by the Office of Industrial Relations. The focus of today's webcast is to support and provide you with practical assistance on preparing a treatment plan to include capacity for work and functional ability when managing a patient with a work-related psychological injury.
The Office of Industrial Relations is committed to delivering short and sharp education to better support Queensland doctors working within the workers' compensation scheme.
The Office of Industrial Relations prepares and correlates all the workers' compensation scheme data for Queensland from each of the 29 insurers. The data shows that an average psychological and psychiatric claim can cost approximately $50,000 and this is continuing to slightly increase with more time-lost claims finalised. This is much higher than any other injury type claim. For example, a fracture claim or a strain and sprain for a back are between $10,000 and $30,000.
The average duration of these claims in 2015-16, were 156.8 days. This is the amount of days that they were off due to their work-related psychological injury. The OIR are committed to reducing the time off for psychological injury claims. To support this, the OIR welcomes Dr. Quentin Mungomery, psychiatrist and member of the Medical Assessment Tribunal. To share with you some tips on both the treatment plan, relating to capacity for work, and the functional ability for your patients who present with a work-related psychological injury. Thank you, Dr. Mungomery.
Hello, this is Quentin Mungomery and thank you for taking time to listen to this webinar.
In this webinar, we will be providing additional advice and suggestions to assist with completion of the new work capacity certificate, which was introduced in July of 2016. This is the second of two webinars on this topic with our previous presentation focusing on the diagnosis and mechanism of work-related psychological injuries.
Today we will be focusing on how to complete the remaining sections of the work capacity certificate, including treatment plan, capacity for work, functional ability, and return to work rehabilitation planning. Reduced capacity to work due to psychiatric illness is not always understandable or clearly observable to others.
Workers' rehabilitation can benefit significantly from an increased knowledge and understanding of the impact of psychiatric illnesses on their capacity to rehabilitate and return to work. Having a clear understanding of the potential impact of such injuries on their capacity to work also assists with the timely provision of an individualised treatment and return to work plan and increases the likelihood of a positive outcome.
The nature of work-related psychological injuries often requires consideration of an integrated treatment approach, such as the bio, psycho, social model. This model take a broad view that allows attribution of psychiatric illness outcomes to the intricate and variable interaction of a range of factors, including biological factors, such as genetics, comorbid medical conditions, and impact of drugs and alcohol, psychological factors, including premier personality factors and any associated behavioural issues, and various cultural, familial, and social factors.
Consideration of these issues assists with the formulation of an individualised treatment plan to meet the specific treatment and rehabilitation needs of the injured worker, and can include appropriate medication strategies, psychological counselling, and referral for special psychiatric care, and specific pathological and drug and alcohol testing as required. Considering whether an injured worker's medication may impair their capacity to work or travel, can be important as some psychotropic and opioid medications can cause sedative and cognitive issues, especially those with antihistamine or anticholinergic effects. Comorbid drug and alcohol issues can also effect work capacity, with consideration of therapeutic strategies to encourage reduction or abstinence from these substances increasing the likelihood of successful engagement and return to work activities. Considering how long an injured worker may require treatment based upon the severity of their work-related psychiatric injury, also assists with appropriate treatment planning.
While some work-related psychiatric injuries go on to become chronic and may require more extended treatment, it is more common for injured workers to achieve significant recovery once they have had a period of appropriate treatment and the precipitating work-related stressor or injury has resolved or stabilised.
This section of the work capacity certificate asks us to consider the impact of the psychiatric or psychological condition on the injured worker's capacity to return to work and functional ability. Common mental disorders can affect a worker's ability to undertake their work carefully and sustain focus on mentally demanding tasks, and interact appropriately with customers and work colleagues. Workers often experience problems with lack of motivation and getting started in the morning as well.
They can also experience problems with feeling anxious prior to work, with associated avoidance, and have difficulties handling workload due to mental fatigue. Impairment and work function often crosses over a number of areas of work functioning, causing increased problems with general areas and difficulties with more complex motor skills and work speed and productivity. Capacity for work can also be impaired by medication and any ongoing illicit drug or alcohol issues.
Cognitive complaints are common in more severe psychiatric conditions, especially in major depressive illnesses. The most commonly reported problems are diminished ability to think or concentrate, which can lead to indecisiveness. Other core symptoms can include problems with psycho-motor retardation or agitation and motivation, mental and physical fatigue, insomnia and mood disturbances, which can also cause cognitive difficulties.
Major psychiatric illnesses have been shown to cause more specific deficits identifiable on testing in areas of attention, verbal and nonverbal learning, short-term and working memory, visual and auditory processing, problem solving and processing speed, and motor functioning. All of which can potentially affect the worker's functional capacity and may need to be considered when undertaking return to work planning.
If cognitive issues become a significant ongoing issue, consideration of other medical causes is suggested. The injured worker may also benefit from baseline and serial cognitive testing using instruments such as the mini-mental state examination or MoCA. And if more marked deficits are identified, consideration for more formal psychometric testing by a clinical psychologist.
Anxiety disorders such as post-traumatic stress disorder can also cause similar cognitive deficits but often also present with additional challenges when considering returning to work planning. If you'd had problems with fear avoidance of certain work environments, especially if the index work-related injury was of a more traumatic nature. This may require the provision of suitable duties in an area away from the index traumatic event or the opportunity to undertake host employment in another work environment, in the initial stages of returning to work.
Graded exposure activities to the feared workplace environment or situation, with the support of a clinical psychologist, can greatly assist with overcoming any phobic avoidance of this nature.
Provision of a return to work rehabilitation plan at times can seem a somewhat daunting prospect, especially when attempting to assist a worker who has a combination of both psychiatric and physical injuries.
Taking the opportunity to liaise with the worker's treating psychologist and psychiatrist however, can greatly assist with the formulation of such plans. Identifying tasks that can contribute to emotional refuelling at work, that the worker finds pleasurable or gives them a sense of competence and capacity, can also enhance their success of rehabilitation.
Rehabilitation programmes can generally be tailored to accommodate the impairment associated with most work-related psychiatric injuries, once a degree of stability and improvement has been achieved and can also facilitate their further recovery. In closing then, the provision of relevant clinical information in the work capacity certificate, is of great assistance in facilitating the injured worker's engagement in treatment and rehabilitation activities.
Timely and accurate completion of the work capacity certificate greatly assists with the coordination of treatment and rehabilitation of the injured worker, towards the goal of returning to work. And understanding of the potential impact of work-related psychiatric injuries on the injured worker's capacity to work will also assist with the provision of an individualised treatment and return to work plan, and increases the likelihood of a positive outcome.
With help, practitioner's completion of the work capacity certificate, playing a pivotal role in achieving these goals. Thank you again for taking time to listen to this webinar and hope that the information provided will be of assistance in completing the work capacity certificate for injured workers.
Thank you Dr. Mungomery. And thank you for listening to this webcast for Queensland GPs, presented to you by the Office of Industrial Relations. For more information about workers' compensation services, please visit our dedicated medical practitioner website on worksafe.qld.gov.au/medicalsupport.
Please look out for future webcasts from the Office of Industrial Relations.
- Last updated
- 24 November 2017