Clinical guidelines for the diagnosis and management of work related mental health conditions

Clinical guidelines for the diagnosis and management of work related mental health conditions

Welcome to the webcast of Queensland doctors. Proudly brought to you by the Office of Industrial Relations. The focus of this webcast is to provide you with preliminary information regarding a new project being undertaken by Monash University. The Office of Industrial Relations is a proud contributor to this project to support the development of evidence based research for Queensland doctors.

Occupational injury claims relating to mental health conditions has increased by 22 per cent over the past decade. We acknowledge that GPs play a critical role in assessing, diagnosing and managing mental health conditions as well as guiding patients with workplace related mental health conditions through the injury compensation pathway. We are pleased to introduce you to Professor Danielle Mazza who will provide you with insight into Monash University's project.

The project is specifically targeted for GPs to assist you with the diagnosis and management of work related mental health problems. Thank you Professor Mazza.

Thank you for that introduction. As GPs, we are well-aware of the impact of injury on our patients. Not only are they dealing with the physical consequences of the injury, but often there are psychological consequences as well. Part of the holistic care that we provide ensures that we are also well aware of the social cost of injuries on family, the workplace, children, spouses. There may also be significant financial concerns.

The GP's role is really to provide holistic care around all of these impacts of injury. More specifically, our role is to diagnose correctly the injury that has taken place, whether that be physical or mental health injury, to monitor any medical complications that may arise as we institute a management plan, and to be aware and manage any psychosocial flags or problems, we call them "yellow flags," to ensure that we are looking out for these psychosocial consequences.

We play a coordination role, delivering the management either ourselves or in conjunction with our colleagues or physicians in allied health professions, and we assess and facilitate, importantly, return to work. The whole issue of return to work is a interesting one and one that we explored in a study that we undertook here in the Department of General Practise at Monash University in 2012. In this study, we really aimed to understand what the GP's role was in return to work, and particularly we wanted to understand how GPs issued sick certificates for injured patients. We wanted to understand also the GP's role in facilitating return to work, and what the barriers were that they encountered during this process.

We used two approaches. The first was to undertake a quantitative analysis of sickness certification practises of GPs using WorkSafe Victoria's claims data. We also undertook almost 100 interviews with GPs, injured workers, compensation agents and employers, to get insight into what was going on in this area. There were several key findings arising out of this study, and the first one was that the role of the GP in facilitating return to work was well-recognized as being critical to the patient getting back to work, by all parties. Another major finding was that workers with mental health claims had the highest rate of 'unfit for work' certificates, coupled with the fact that mental health injury claims are rising, means that there is an important issue here that needs to be addressed.

In our interviews with GPs and injured workers and the others, we found several major issues were going on. The first one was the difficulties that GPs had with mental health claims and mental health injuries. Difficulties coming to a diagnosis, understanding whether it was a primary diagnosis or a secondary diagnosis arising as a result of the original injury that had taken place, what the impact was of pre-existing illness. All of those kinds of issues around diagnosis.

There was a lot of concern about the role of independent medical examiners in relation to mental health claims, and the impact that they had on the outcomes for the patients. There was strong recognition of the stigma associated with making the mental health claim, and the impact that that stigma had on patients coming forward about mental health issues. As I mentioned earlier, the whole issue of whether the claims process actually contributed to the development of mental illness, and compounded the injury. And a lot of uncertainty about how to manage mental health claims, given their complexity, and how to approach certification in relation to return to work.

So given these issues, we are now undertaking a new project where we are developing national clinical guidelines to help GPs improve their management of patients with work-related mental health problems, and we hope that these guidelines are really going to assist GPs to provide more effective management of patients with a work-related mental health condition. The guidelines are going to go through an NHMRC approval process, and we are seeking RACGP endorsement of the guidelines. We recognise that both NHMRC approval and College of GP endorsement would be very important to the implementation of the guidelines. We will disseminate these guidelines nationally; and also creating hand-in-hand with the guidelines, an evidence-based implementation plan to ensure that the evidence actually gets out into practise.

So in developing the guidelines, we really need to be sure that we're addressing the key clinical questions that GPs have when they deal with mental health injuries. The specific areas that are going to be addressed by the guidelines are the assessment and diagnoses of these mental health injuries, helping GPs to determine whether the mental health condition has actually developed as a consequence of an injury or not, and how the development of the mental illness has occurred, whether it's a secondary issue, and helping GPs also to predict a return to work date, and encourage return to work under appropriate circumstances. Where return to the original form of work is not possible, what kind of alternative duty might they be able to recommend?

We're very keen that the guideline is going to be practical and widely implemented, and so we've used a very innovative approach to developing these key clinical questions to ensure that the guideline's going to be clinician-centered and useful. What we've done has been to interview GPs, psychiatrists, and compensation scheme workers, to get their perspective on what the critical issues are that the guidelines should address. We've used real patient case studies, and yet during our interviews for the GPs, psychiatrists and compensation scheme workers to reflect on, they have described to us the clinical dilemmas that they've faced, and we've used those as a foundation to develop our key clinical questions. Those questions are then presented to our guideline development group which consists of a multi-disciplinary panel of clinicians, content experts, consumer and policy representatives. They've helped us to formulate the key clinical questions that the guidelines will address.

We are following an NHMRC process and we've registered our intention to seek NHMRC approval, and we are currently developing the guideline in accordance with the NHMRC procedures. That involves consultation with GPs, an evidence review of systematic reviews and guidelines that helps to answer our key clinical questions, and synthesis of the available evidence into actionable recommendations. Towards the end of 2017, a draft guideline is going to be released for public consultation, and in 2018 following revision of the draft, we will submit the final draft guideline to the NHMRC for review. In 2019, we hope that the approved clinical practise guidelines will be published. We're very excited about this project, and the opportunity to enhance clinical practise and make evidence come into practise in the area of this difficult clinical issue. I look forward to letting you know in the future about our progress on this project. Thank you.

Sponsors for this initiative are: Department of Employment; ComCare; Queensland Government Office of Industrial Relations; the State Insurance Regulatory Authority; Return to Work South Australia; and WorkCover Western Australia.

To access more information on Queensland Workers' Compensation Scheme or your role in assisting workers with work related injuries, please visit our dedicated web page for doctors. Thank you for listening.

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