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.