Pitfalls In Managing Psychological Injuries Dr Josie Sundin 19 March 2015
Webinar Presenter Dr Josie Sundin Dr 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 . 2
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 Depression 3
Major Depressive Disorder • Pervasively depressed mood for more than 2 weeks • Disturbed sleep, appetite, energy and motivation • Impaired cognitive function 4
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 5
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 6
PTSD • Feelings of detachment • Sense of a foreshortened future • Persistent symptoms of increased arousal • Symptoms present for more than one month. 7
Poll Question 1 What is the age bracket when psychological injuries most commonly occur? a) 18-25 b) 26-35 c) 36-45 d) 46-55 e) 55-70 provided by the Workers Compensation Regulator 8
Poll Question 1 - Answer What is the age bracket when psychological injuries most commonly occur? c) 36-45 provided by the Workers Compensation Regulator 9
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 10
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 11
State V Trait 12
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 13
One Definition of Resilience 14
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 15
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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 19
An easy solution? 20
Rehabilitation and Return to Work • Suitable Duties Plan Sui (SDP) for psychological injuries • Claims can take a long time • Must involve all treating providers in a SDP and any upgrades 21
Health benefits of Return to Work Work important but need the right support: • Medicinal • Psychiatrists • Work 22
Treatment options 23
Poll Question 3 What do you think is the percentage of return to work after a psychological injury? a) 10 – 15 % b) 15 – 30 % c) 30 – 50 % d) 50 – 75% e) 75 – 90 % 90 – 100 % f) provided by the Workers Compensation Regulator 24
Poll Question 3 - Answer What do you think is the percentage of return to work after a psychological injury? e) 75 – 90 % (specifically 84%) provided by the Workers Compensation Regulator 25
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 26
Rehabilitation and Return to Work Tips • 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 shoes 27
Questions 28
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 29
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/ 30
Return to Work Coordinator Community 31
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