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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