25 March 2019

‘My job stress is killing me, doc!’

General practice Mental Health Workers Compensation

If you dread worker’s compensation consultations – particularly those horribly complicated psychological injury cases – you’re not alone.

The complexity of managing mental health conditions rises considerably when the condition is work-related.

Fortunately, the first ever guidelines to help GPs manage these patients has just been released.

The 134-page document, titled “Clinical Guideline for the Diagnosis and Management of Work-related Mental Health Conditions in General Practice” is approved by the NHMRC, the RACGP and ACRRM. It provides evidence-based advice on how to diagnose, manage and support patients with work-related mental health conditions.

“This is very focused on GPs’ needs and supporting GPs with whatever evidence there is in answer to their questions,” Professor Danielle Mazza, the head of the department of general practice at Monash University and one of the authors of the guidelines, said. 

These patients largely require the same support as any other patient with a mental health issue – but there are a few additional factors to consider.

For a start, GP reports are often used by patients as part of the compensation claim process, so it helps if the GP makes a diagnosis using the best tools.

The guideline summary includes a list of hyperlinks to appropriate diagnostic tools for anxiety, depression, PTSD, alcohol use disorder and substance use disorders.

The guidelines also recommend GPs form an opinion about whether work is contributing to the mental health condition, as this will help them manage these patients clinically.

However, they concede making this determination is “a notable challenge” because the triggers of mental health conditions are often multi-factorial and difficult to authenticate.

And, while the guidelines advise GPs investigate the timing of the mental health issue and the plausibility of its work-relatedness, they acknowledge more research is needed. 

On average, employees with psychological injuries take longer than employees with physical injuries to return to work (17 weeks versus five weeks), Safe Work Australia says.

Being out of the workforce is, in itself, a cause of social isolation, loss of purpose and a source of ongoing anxiety or depression. Returning to work is often a step on the road to recovery – and if a patient’s condition isn’t improving as expected, GPs can help by systematically addressing the barriers to work.

GP medical records were often the primary source of evidence regarding their patient’s pre-injury health in the compensation process, Emma Hines, Shine Lawyers’ GM of Victoria, told TMR.

“Legal decision makers, such as judges and tribunals, are also often most interested in the GP’s opinion because of the regularity of contact between the GP and patient which often means that doctors know the injured person’s circumstances and history the best,” she said.

Ms Hines recommended that GPs maintain appropriate separation between themselves and the insurer, including resisting any attempts by insurers to participate in that relationship, such as requests to sit in on appointments.