pitfalls in managing psychological injuries · 2015-05-14 · dr josie sundin dr sundin will...

Dr Josie Sundin

19 March 2015

Pitfalls In Managing

Psychological Injuries

Webinar Presenter

Dr Josie SundinDr Sundin will provide a snapshot of

common work related psychological injuries,

as well as tips on identifying potential pitfalls

in managing these and optimising

management to assist the return to work

process. Dr Sundin is a psychiatrist with 25

years of clinical experience and has an

extensive medico-legal background, playing

an active role at Queensland Civil and

Administrative Tribunal, the Mental Health

Court of Queensland and the Medico-Legal

Society of Queensland.

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Adjustment Disorders

• Development of emotional or behavioural symptoms in response

to the onset of the stressor, occurs within 3 months

• Causing either distress in excess of that expected or social/

occupational impairment

• Expected to end within 6 months of cessation of the stressor or

its consequences

• Features either depression, anxiety, both or disturbance of

conduct

• Severity of symptoms less than in Major Depression3

Major Depressive Disorder

• Pervasively depressed mood for more

than 2 weeks

• Disturbed sleep, appetite, energy and

motivation

• Impaired cognitive function

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Post-Traumatic Stress Disorder

• Direct experience of a traumatic event

e.g. ambulance officers

• Witnessing the event as it occurred

• Learning of a traumatic event involving a close family

member or close friend

e.g. families of police or ambulance officers

• Repeated or extreme exposure to aversive details of

traumatic events

e.g. police exposed to CEM

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PTSD continued

• Does not apply to exposure through electronic media, unless this exposure is work related

• The event is persistently re-experienced through dreams or nightmare, flashbacks or intrusive recollections

• There is a sense of reliving the experience or of the experience recurring

• Associated patterns of avoidance

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PTSD

• Feelings of detachment

• Sense of a foreshortened future

• Persistent symptoms of increased arousal

• Symptoms present for more than one month.

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Poll Question 1

a) 18-25

b) 26-35

c) 36-45

d) 46-55

e) 55-70

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What is the age bracket when

psychological injuries most

commonly occur?

provided by the Workers Compensation Regulator

Poll Question 1 - Answer

c) 36-45

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What is the age bracket when

psychological injuries most

commonly occur?

provided by the Workers Compensation Regulator

Definition of Personality

• Personality refers to a persons unique

enduring, deeply engrained qualities.

• Shown through a persons patterns of

behaviour, in the way they relate to the

world, and the way they perceive

themselves and others within that world

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Always Remember:

• Incapacity, pain, frustration and confusion all cause feelings of distress

• The less resilient an individual is… the more exaggerated that distress will be.

• Stress will exaggerate existing personality characteristics

• Never assume you are understood, stressed people hear and understand less

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State V Trait

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Resilience

• A behavioural adaptive process, not an individual characteristic

• Best understood as an interaction between the individual and

their environment

• Refers to a persons capacity to cope with stress and adversity

• Improved by processes that promote well being and protect

against overwhelming risk factors

• Resilience occurs when there are cumulative protective factors

e.g. family, community or work support, good social policy

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One Definition of Resilience

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Challenging Personality Types

• Paranoid: can hold longstanding grudges, tend to hypervigilance,

prone to being tense, secretive, litigious, and angry

• Anti-social/ narcisstic: reduced empathy and remorse, prone to

impulsivity and irresponsibility, exploitative, hyper-sensitive to criticism

• Histrionic: Exaggerated emotions, seductive, demanding, stormy inter-

personal relationships

• Obsessional: prone to be rigid, rules bound, can be cold, judgemental

and highly controlling

• Passive-aggressive: Resistant, stubborn, can seem sulky and

resentful, prone to blame others

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Poll Question 2

What is the average time length of time off

work for an injured worker with a

psychological condition?

a) 50 days lost

b) 100 days lost

c) 150 days lost

d) 200 days lost

e) 250 days lost

provided by the Workers Compensation Regulator

Poll Question 2 - Answer

What is the average time length of time off

work for an injured worker with a

psychological condition?

c) 150 days lost

provided by the Workers Compensation Regulator

Challenges

• EXPECTATIONS: YOURS, THEIRS and OTHERS

• PREJUDICES: YOURS, THEIRS and OTHERS

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An easy solution?

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Rehabilitation and Return to Work

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Sui• Suitable Duties Plan

(SDP) for psychological

injuries

• Claims can take a long

time

• Must involve all treating

providers in a SDP and

any upgrades

Health benefits of Return to Work

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Work important but need

the right support:

•Medicinal

•Psychiatrists

•Work

Treatment options

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Poll Question 3

a) 10 – 15 %

b) 15 – 30 %

c) 30 – 50 %

d) 50 – 75%

e) 75 – 90 %

f) 90 – 100 %

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What do you think is the percentage of return to work

after a psychological injury?

provided by the Workers Compensation Regulator

Poll Question 3 - Answer

e) 75 – 90 % (specifically 84%)

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What do you think is the percentage of return to work

after a psychological injury?

provided by the Workers Compensation Regulator

Rehabilitation and Return to Work Tips

• Pre-existing conditions can be re-triggered by new injuries

• The better you can manage the worker’s anger the better the claim will progress

• Try to resist assuming malingering when a claim goes longer than expected

• Try to contextualize the stressors to better understand the worker’s perspective

• Understand that most doctor’s tend to see themselves as their patients advocates and that few doctors understand the rehabilitation legislation or philosophy

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• Suitable Duties Plan must be collaborative

sign off

• Ok to ask to attend the end of an

appointment with employee

• Sometimes good to have external provider

monitoring if outside of your RTWC skill

level

• Patient and Understanding

• Walk in their shoes27

Rehabilitation and Return to Work Tips

Questions

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Resources

• Visit www.worksafe.qld.gov.au– People at Work project

– Work-related stress tip sheets

– Resolve at Work rehabilitation providers

• Phone Info-line 1300 369 915

• Sign up for free eBulletin subscription

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Resources Continued

• Beyondblue

http://www.beyondblue.org.au/

• Headspace

http://www.headspace.org.au/

• Black Dog Institute

http://www.blackdoginstitute.org.au/

• SANE Australia

http://www.sane.org/

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Return to Work Coordinator Community

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