Pitfalls In Managing Psychological Injuries Dr Josie Sundin 19 - - PowerPoint PPT Presentation

Dr Josie Sundin

19 March 2015

Pitfalls In Managing Psychological Injuries

Webinar Presenter

Dr Josie Sundin

Dr Sundin will provide a snapshot

• f

common work related psychological injuries, as well as tips on identifying potential pitfalls in managing these and

• ptimising

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/
• ccupational 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

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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 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

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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

21 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 shoes

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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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