The right time for return to work: Optimising work participation for patients/clients recovering from injury or illness

Disclaimer: The following transcript has been autogenerated and may contain occasional errors or inaccuracies resulting from the automated transcription process.

Prof Steve Trumble (00:00:01):

Hello everybody and welcome to all of you who have joined us for tonight’s webinar and also the viewers who are watching the recording. At some later time, I’ll begin with an acknowledgement of country and MHPN would like to acknowledge the traditional custodians of the land, seas, and waterways across Australia upon which our webinar presenters and participants are located. We wish to pay our respects to elders past, present, and acknowledge the memories, traditions, cultures, and hopes of Aboriginal and Torres Strait Islander people. I’m on the land of Wadawurrung people on the surf coast of Victoria. My name’s Steve Trumble and I’ll be facilitating tonight. I’m a medical educator and general practitioner by clinical background, and I’m currently at Deakin University in rural Victoria. We’ve got a great panel tonight. Their bios were disseminated with webinar invitation, so I won’t go through them in detail. First of all, we have Dr. Mary Wyatt, who’s an occupational physician. And I should say that tonight’s webinar is actually supported by a group known as It Pays to Care. Now Mary, you are very involved in It Pays to Care, who are they and what do they do?

Dr Mary Wyatt (00:01:14):

Familiar with previous policy, the health benefits of good work, It Pays to Care, looks in depth at work injury schemes and how they operate and how they can help people back to work in an evidence-based way. So we’ve developed it through the College of Physicians. We’re advocating through our sister organisation, the Society of Occupational Medicine, and on Australia New Zealand Society of Occupational Medicine and Return to Work Matters, a nonprofit in this area. And we have a small team of people who are actively advocating out there, getting the messages out there in terms of the claims industry. And this year also healthcare land and employer land.

Prof Steve Trumble (00:02:00):

Well that’s great. It’s great to see a royal college being proactive in its interaction with people like that. I’m just curious though, as a physician, why are you so personally passionate about working in this area?

Dr Mary Wyatt (00:02:14):

Yeah, look, the difficulty, Steve, is that outcomes for patients are worse in compensable systems compared to the same type of injury of the same severity in non-compensable situations. And so we’re spending all this extra money which is designed to help people back to work more quickly than perhaps say that they just could access Medicare. And we have the opposite result. We’re getting worse outcomes. So as occupational physicians, these are the people we serve, this is the working or would be working population. And so it’s just crazy. We’re getting worse outcomes. So that’s why we want to see improvement. So we stop seeing our patients get into the long-term disability framework and we know that their health outcomes are significantly worse than the working workforce. So there are many reasons, but they’re the core two, health, health outcomes are worse and prolonged work disabilities really harmful for people’s health.

Prof Steve Trumble (00:03:19):

Okay, well that’s a great motivation to be involved, which is wonderful. I also love these Comcare webinars because we usually have a representative from the employer side of the table and obviously the whole dynamic is involved in getting people healthy and back to work as quickly and as happily as possible. So we’re very lucky to be joined tonight by Nancy Abdelnour who is support recovery and systems at Telstra. So welcome Nancy, what makes you passionate about working in this area?

Nancy Abdelnour (00:03:49):

Thanks, Steve. Look, I think for me people are my passion and we see the real tangible benefits of supporting people being very proactive, very deliberate with our support for people who may be presenting with a range of issues, illnesses, conditions, disability, but equally are still very valued in the organisation and are real contributors to our business. So it’s really important that we really are able to provide the right level of support, especially when it’s around return to work and return to health. And it’s an area that I’ve loved for the last 20 years and I can’t see myself doing anything different.

Prof Steve Trumble (00:04:37):

Well that’s great. Wonderful. So good to have you. So looking forward to hearing from you very shortly. But before we get on with our presentations, we need to meet one more member of the team, Dr. Lori Shore, also from Victoria and a psychologist. Lori, what leads you into this area of practise makes you passionate about doing it?

Dr Lori Shore (00:04:57):

Thanks, Steve. I think one of my main goals with my clients is always engagement, engagement and activity, engagement in social activity and engagement in anything that’s going to improve their mental health. And obviously work is one of those areas that provides for many, many of us that fulfilment, that engagement that we’re looking for. So that’s my area of interest as a psychologist and also as a member of some of the clinical panels for the compensation organisations.

Prof Steve Trumble (00:05:32):

Great. Alright, well wonderful. Have you too. It’s going to be an excellent night I’m sure. So each panellist is going to give a short discipline specific presentation and then we’ll get into the q and a part. The learning outcomes are there, I won’t read them because you can do that just as well as I can. But it’s important that you check that we’ve met those outcomes for you by the time we get to the end of the webinar and let us know through the evaluation if we’ve not achieved what you wanted us to achieve. Now, just a quick comment before we start the presentations. This webinar is an educational event. It’s not a clinical event. And so what our presenters say is not clinical advice, it’s for educational purposes only. And if any content in tonight’s webinar causes you distress, then please do seek care with your gp, your local mental health service or contact lifeline on 13 11 14. Let’s now jump into the presentations, our interdisciplinary presentations. First cab off the rank is Mary, our occupational physician. All yours Mary.

Dr Mary Wyatt (00:06:46):

Thanks Steve. So I’ll start talking a bit about the psychosocial barriers to return to work because a lot of the policy is built around as pace to care policy is built around this. So we all are impacted by psychosocial factors. We want to ask our boss for a raise and things might hold us back. What will they say? How will we ask it, et cetera. They impact all of our lives, but when we come to the whole area of return to work and work injuries, the opportunity for psychosocial barriers to interfere with things is substantially greater. First of all, it’s a difficult system for many people and that throws up all sorts of issues about how you deal with the system. Secondly, that there are many barriers introduced and many times people are stressed in relation to those barriers. So the opportunity is significantly greater.

(00:07:57):

Common barriers are passive coping in the face of distress or passive coping in the face of challenges and workplace issues, they’re the two most common psychosocial barriers. What I want you to take from this slide is that when people are assessed as having higher levels of psychosocial risk in the first week of a claim, you can see the amount of time off work there is significantly higher. In fact, it’s three times as high. And another way of explaining that is to say for every one point increase in the score, the psychosocial risk score, there’s a 4% reduction in return to work. And the particular measure psychosocial screening measure here is the short form rebo pain musculoskeletal questionnaire. So that started from New South Wales, Queensland. When they’ve surveyed people have found much the same thing in terms of duration of time off work. Thanks. Next slide.

(00:09:09):

And when we are doing risk screening by psychosocial risk screening tools, what we are looking for is effectively signs of distress. Now it could be all sorts of barriers. There are many, many different psychosocial barriers in terms of the workplace and some of them might be our beliefs and feelings. Some of them might be the situation we’re in. So we’ve got a lot going on at home or there are other issues at work. The supervisor’s a bit of a, so-and-so we had a bad experience with this, so we’re a bit worried about that. They were over worried about our medical condition. There’s all sorts of barriers. And what we see when we look at the three case studies is just that so Marie worried about her scan results, she’s got to care for her father. She’s not getting the best communication from her workplace. Dan is an anxious guy by nature, harder to deal with many of the issues supervisors avoiding communication and Jennifer’s a single mother with looking after three young kids. So just that extra burden of extra stress, I’ve now got to cope with this difficult thing. Thanks. Next slide.

(00:10:27):

And one of the difficulties is, is that when we don’t address psychosocial barriers, the most common reason people don’t come back to work with everyday health problems like back pain or a shoulder problem or common mental health problems is that we don’t address them early and we can all pick them up when it gets to six or nine or 12 months. But the difficulty is the longer time goes on and these barriers are not addressed, the more things are set in concrete and the more it’s harder to change things or less likely we’ll be able to change these things. So consequences of not addressing psychosocial barriers are prolonged work disability and slower return to work and higher rates of chronic pain. The longer a claim goes on, the higher the rates of secondary depression. So WorkSafe data, three years, 80% of people have a formal diagnosis of depression. That’s enormous consequences. So addressing these problems early is huge. And when we don’t address them, it’s not just the person who’s impacted, it’s their family and the consequences are for everyone. When we talk about the costs, when we talk about the better outcomes for workers, we’re also talking about reduced costs for employers because when you get people back to work earlier and better, the employers play less costs. So next slide. Thanks.

(00:11:57):

Thanks Ben. So what can we do about it? Well, the thing is we can identify these barriers. Within the first week I showed you the predictive tool. Now various claims organisations that are adopting this approach over time. So it’s coming in Queensland. Some of the private insurers have been doing it for a while. But the fundamental principles are we can pick these things up early. It doesn’t have to be a screening tool in the first week. It can be mental healthcare practitioners, it can be gps seeking to identify these barriers. So very easy to do a short form rebo. Basically a standard 10 question screening tool you can give to people with a simple explanation about just answer as the best they can. There’s no one right answer and obviously that it’s important so that you’ll use the results in understanding all of their needs and how you can best support them.

(00:12:55):

And so once you’ve done the screening, whether this is via a conversation and asking people about what’s going on, how they feel they’re coping, have they got any specific concerns about work? Do they feel their understanding, their condition and understand how to deal with it? Are they coping with their pain? So even just going through conversational questions can produce good outcomes If you are addressing those issues so early, identify the problems early as soon as you can. We recommend within the first week or two or within the first consultation or two if you are dealing with people who’ve already got a workplace injury, it fosters collaboration because we can actually talk then about the real issues. We can support the workplace to identify and address the real issues. And counsellors, psychologists or mental health professionals or those with psychosocial counselling training can really support people.

(00:13:58):

So six sessions in the systems that have enabled it is the maximum and the average has been five. It’s short term counselling that makes a difference. Thanks. Next slide Ben. So healthcare providers, we generally gps our specialists. We do a bad job of addressing psychosocial barriers as do allied health providers. So we know that if we look across systems, we look at all the research, this is difficult stuff to do. It takes time. You’ve got to have communication skills, competency in it. So it’s not always easy, but healthcare providers play a pivotal role in this, particularly mental health professionals. So adopting a biopsychosocial framework, it takes extra time. We have to think about that. We have to make consultations for people, provide positive messages about return to work, address unhelpful beliefs and foster self-management strategies, use work-focused interventions and set realistic goals and engage in effective communication.

(00:15:08):

We have lost a lot of collaboration over the years. We all work in our silos. Picking up the phone has become a hard exercise really. And so we have to think consciously about how to collaborate. Thank you. And last slide, I think creating supportive work environments. I told you before that the workplace issues are one of the most common barriers to return to work. And this is to let you know that the workplace makes the biggest difference. So if we can engage the workplace, influence the workplace, and show the workplace how to engage the worker and what to be doing and give them sensible, practical advice, then we help the workplace help the worker. So this is the slide you’ve got, the slope graph you’ve got on the right side of the slide represents when an employer is constructive with their response to an injury versus where the employer is less than constructive.

(00:16:19):

And this is the worker’s view from a survey from the return to work survey, which is done a year or two. And so this is an analysis of the survey. And so when the employer’s positive, then 87% of people are back at work when the survey’s done with a physical injury claim and if it’s a negative view for negative response or less than positive, only just above 60% back at work. So pretty solid data to say the workplace has a huge influence on whether someone comes back to work or not. So we want to foster workplaces understanding that everyone talks about the role of the GP and GP certification, GP unfit for work certificates, but really the juice of changing things is in that workplace employee relationship. And I think that was my last slide.

Prof Steve Trumble (00:17:09):

It is indeed. Thanks Mary. Such good sense. And funnily enough, the very first question we’ve been asked through the system by Sandra does ask that question about what happens when the workplace is a large part of the problem. So we’ll come to that in the discussion. But before we get there, let’s hear from Lori Shore about the psychologist’s perspective. Thanks Lori.

Dr Lori Shore (00:17:32):

Thanks Steve. If we can move on to the next slide. So just before I started I just wanted to give a brief background on me just to help provide context to my personal perspective on return to work. Not only am I clinical psychologist, I have a small practise in the western suburbs of Melbourne. I predominantly work with clients with persistent pain and other chronic health conditions. I also work with patients at one of the major hospitals in Melbourne in a similar area and I’m a clinical consultant to a number of compensation organisations. So what that means in practise is that I talk to a lot of psychologists who are treating injured workers and when it comes to return to work for those injured workers, what I see is that we as clinical psychologists, psychologists generally mental health workers, social workers, anyone who is working with that mental health side of things, we are in a unique position to assess the client’s ability to return to work.

(00:18:30):

Firstly because generally we spend more time, more often with clients than any of the other clients’ treat us. And our training teaches us to set smart goals with our clients that have a focus on that symptomatic side and that functional side, which I’ll come back to. And we’ve regularly assess progress towards those goals. We’re also often thinking holistically about our clients through biopsychosocial lens. And as Mary pointed out earlier, this is not always the case with other treaters. And finally, we look at the aspects that affect a client’s return to work. The Monash University identified some personal factors that can affect the client’s return to work, degree of pain, catastrophizing, fear avoidance, self-efficacy. Mary pointed that one out as well. Positive recovery expectations and perceived workability. These are all things we work on with our clients every day in therapy. Next slide please.

(00:19:32):

So when is the right time for our clients to return to work? Although in my home state of Victoria, psychologists aren’t allowed to write certificates of capacity for clients. More and more GPs and occupational rehab providers are relying on us to provide advice on the client’s psychological capacity to return to work. Therefore, assessment of capacity to return to work has to be something that needs to be considered in our treatment planning for any injured workers. So where do we start assessing and monitoring the client’s diagnosis? This is our bread and butter, this is what we do, any pain symptomatology and we also want an understanding of the severity of the mental health injury, but also any pain, questioning and monitoring of our client’s functioning. I regularly ask my clients about their sleeping, eating, socialising, exercising habits. And these are just conversation pieces. Again, as Mary pointed out.

(00:20:28):

And I also pose the question, what does a normal day look like to you? And although I won’t go right into it on the next slide, I’ve included a table by occupational psychiatrist, Dielle Felman. That really helps us to think about the areas we need to be focusing on when we look at assessing functioning. And then there’s the obvious client’s capacity to meet the organisational requirements. Things like can they actually turn up to work? Can they perform to the efficiency standards required? And finally, in terms of this, we need to make our own judgement call and it is our judgement call. Often GPs do rely on us. I speak to psychologists all the time who are saying, the GP is actually relying on me to make the decision. How do I do that about when returning to work is actually going to be helpful to the client’s progress versus when it’s actually going to cause some sort of major setback. Finally, capacity assessment also includes reviewing the client’s toolkits of coping strategies that will equip them to manage any potential triggers in the workplace. So what do they have in their toolkit and what do they have to deal with all those What if scenarios that might come up.

(00:21:43):

Next slide please. This is the table I mentioned and I’ll point you to the YouTube clip noted at the bottom because that really goes into further explanation. It’s a nice little, I think it’s about five minutes video that really talks about functional assessment of mental health injuries, mental health concerns. Next slide please. So let’s just take a quick look at these case studies in my mind. Both Marie and Jennifer require further assessment and potential treatment before return to work. Neither appear to have had any treatment with both being advised to rest, although there’s probably some functional ability as they both have unavoidable caring responsibilities. In Marie’s case, there’s the inevitable fear avoidance that requires a greater approach to increasing confidence and conditioning. And with the right treatment, we’d really be hopeful for her to return to work to a sustainable return to work in about two months.

(00:22:48):

And that’s a point there because both of these injured workers appear to be headed for potentially an unsustainable return to work. And in Jennifer’s case, look, there’s just, from my perspective, there’s too many unknowns at this stage. And contact with other treaters is required to understand any physical limitations and any plan for any further diagnostics or surgery or building up of conditioning the psychology treatment, the psychology treatment plan, and any return to work goals need to be guided by this. So both these cases also require supporting the client to engage with the employer and also from our perspective engaging in those return to work discussions. Next slide please.

(00:23:36):

Dan, on the other hand, is already at work but appears to be supported in a boom bust situation. These are two of my favourite little graphs on the side here. They’re often related to pain and fatigue, but I think they can also, and I often use them also for mood in terms of grading anything up, grading up activity, grading up engagement. So Dan appears to be supported in a boom bust situation. He’s functioning some of the time but not others. And his symptomatology is equally variable here. I’d be looking at encouraging Dan and his or to provider to consider some regular work hours by either attempting to maintain full-time work or reducing to regular part-time hours in the short term, and then building back up to full-time work so that he actually disengages from this perform rest cycle or the boom bust cycle that he appears to be in at the moment that is probably playing a role in maintaining his low mood. And that’s really it from me. If I go onto the next slide, I just want to say, and probably just reiterating some of what Mary’s already said, early intervention, active treatment and ongoing assessment are fundamental to a client’s capacity to return to work. And I think we as psychologists, as I said, as social workers, as mental health workers, I’m really in that ideal position to assist our clients with this.

Prof Steve Trumble (00:25:06):

Absolutely. As a gp, I couldn’t agree more that any GP who doesn’t take advice from the psychologist or the other member of the team on when somebody is ready to go back to work from a mental health perspective is not doing a good job. In the same way we would look to a neurosurgeon or a physio for advice on musculoskeletal problems. You got few people are the real experts in this and the GP should be not signing off on somebody’s return to work until they’ve had the best advice. I just wanted to pick up on a comment that Nelson’s made in the chat. I’ve had the luck of having a boss with lived experience. Honestly now it feels like my second home love heart, which is great. Not everybody’s experience I’ve also seen in the chat, which we’ll come to. But before we get there, Nancy, let’s hear your presentation. Thanks very much.

Nancy Abdelnour (00:25:57):

Thanks Steve. So I guess before I get into my thoughts on these case studies, I just wanted to sort of preface this by talking a little bit about what Telstra does from a return to work and a health management perspective. So we have an equity of access to support when it comes to return to work services here at Telstra. In essence, what that means is that anyone who requires support because of an injury, illness, disability returning from a surgery or whatever may be going on for them is able to access this support and it’s irrespective of causation and irrespective of compensability. So we don’t factor those things in when we think about what a person may need to support them to remain at work or return to work. So I’ve provided context and an explanation, if you will, on these case studies, on what we would do here at Telstra.

(00:26:54):

And this would be irrespective of whether there was a compensation claim on foot or not. So what I would say with Marie’s story similar to what’s been pointed out by Lori and Mary is the real value and importance of that connection and that communication and that engagement with the worker leaving workers to take leave extended periods of leave. It’s not a HR issue, it’s a workplace return to work issue more so than anything else. So maintaining those connections with your employee is really critical. And I think it’s sometimes hard because sometimes treaters or perhaps the worker might be a bit cynical of as to why their manager wants to speak to them or why are they reaching out and what’s behind it. Is there an agenda? But I guess the truth of the matter in many cases, and I can certainly speak for what we do at Telstra, is that we genuinely care.

(00:27:51):

We actually want to know how they’re going. We want to know how they’re recovering, what their treatment’s been like, what’s working, what’s not working, but more importantly, what does that communication with them mean for them? Is it helping? Is it beneficial? Is it aiding in their recovery or is it actually getting in the way? So it’s really trying to set some ground rules around that and actually understand what does good support look like for them. And certainly in Marie’s case, what does she need to enable her to focus on her rehab and her recovery and a safe and sustainable return to work? Often what our health management consultants are doing are they’re, they’re upskilling the leader, they’re coaching the leader to have those health-based conversations. They are trying to build confidence in those leaders. If they’ve not had to do that before, it can be a little bit daunting.

(00:28:40):

So they’re really trying to step them through how to have that conversation in a empathetic and constructive way that is perceived in the right way by their employee. And really what they’re trying to elicit is information as to whether Marie’s physically and mentally safe to come back to work. Is it beneficial for her to come back to work? When is it not beneficial for her to come back to work? What would the supports look like? What would those modifications in the workplace look like? And really helping Marie understand and certainly her treating practitioners or psychologists understand that there are lots of options available for workers if and when they’re ready to return to work and really setting them up for success is a really key message that we’re trying to impart when we’re having those conversations. Next slide please.

(00:29:37):

So Dan’s story is an interesting one because he has disclosed to his manager that he’s got a preexisting mental health condition, which is obviously impacting him at work, it’s impacting his performance in his attendance and really the manager has a unique opportunity if you like, to really understand a little bit more about what’s going on for Dan and how his condition is impacting him and what’s unique about his symptoms and how he’s managing. What does this relapse mean for him? It sounds like he’s had difficulties in the past, he’s been okay and then he’s had some setbacks. So it’s really trying to build a better understanding so that the right supports can be put in place and not jump to conclusions or make assumptions as to what Dan can do or can’t do while he’s going through treatment. And it’s really just to encourage Dan to also explore those very same questions that the employer may have with his psychologist.

(00:30:41):

So in these instances when people do have some supports around them, we like to empower them to have those conversations with their practitioners rather than us taking the lead in that space. And that’s really to ensure that we understand what might be beneficial for Dan with supporting him to remain at work, but also what the guardrails might be like. So if there are particular work pressures or expectations or deadlines or could be work targets or deliverables and that just may not be conducive to him right now and his current treatment regime, it’s best that we know that so we can tailor work and we can make those modifications that are meaningful and beneficial for where he might be at from a recovery and a rehabilitation standpoint. Next slide please.

(00:31:36):

So with Jennifer’s story, one of the things that really stood out to me was I guess the level of uncertainty that we would have as an employer in understanding what her real condition is. We didn’t really have a clear diagnosis, the prognosis seemed poor, the treatment plan was a little bit unclear. So from an employer standpoint, it may come across like we’re asking all these questions because we are wanting to know things that for some people they think that maybe it’s not our place to know that. But again, when we look at the context of the benefits of work and what a workplace can actually do to support someone and compliment their rehab and recovery, it makes sense for us to actually want to understand more of Jennifer’s circumstances and situations and also considering what that home environment might be like for Jennifer that may be also inhibiting her rehab and recovery.

(00:32:33):

So looking at it from a biopsychosocial perspective is really critical as well. In some instances we hear from workers saying, it’s actually better for me to be at work than to be at home because here at work I get a break, it’s structured, I know what I’m doing. Whereas sometimes the home environment can be really chaotic and really challenging for people, especially if they’re trying to recover from a serious illness. So really what we’re trying to do is develop a holistic model or a care programme that really incorporates Jennifer’s rehab and treatment needs as well as what she could potentially be doing in a workplace that is going to further support her overall recovery and achieve a real sustainable outcome. Again, working with leaders, making sure that they understand how to have those conversations and coaching them through that and providing with them with tools and tips in which things that they can say they should say and certainly things that they shouldn’t say to really guide them through those conversations and empower them to really front into what might be a challenging conversation with a worker.

(00:33:40):

But one that is really important to have because ultimately that engagement, that connection, that level of care and support that we provide people as Mary called out earlier in her slides, can be really the key difference between a successful return to work or an unsuccessful return to work. So I think employers play a really, really important role in the overall recovery journey that an employee may have. And we don’t always get it right. And I’m sure there are people who’ve worked with clients who say their employer is really difficult or isn’t showing the same level of care and compassion that they should, but for the most part the employers who I speak to and certainly what we do here at Telstra comes from a place of care first and foremost because we are committed to making sure our people make that safe and sustainable return to work. And that’s all from me. Over to you Steve.

Prof Steve Trumble (00:34:40):

Thanks so much Nancy. And all three of you have touched on topics that people want to talk about in the questions. So just to remind people, if you want to ask a question more formally than through the chat, please do hover your mouse over the video panel and click the three dots in the bottom right hand corner and then click on ask a question and we’ll get the questions going. In fact, we’ll get the questions going right now. Immediately EZ is out of the box asking a question, which I think is hugely important. A lot of injured workers report inappropriate requests from return to work providers for a job that is perceived as inappropriate compared to the person’s pre-injury job. Therefore some injured workers considerate, disrespectful and a kind of humiliation. And I must say if one more of my patients get told they can be a school crossing supervisor or a car park attendant, for me it’s school crossing supervision has got to be one of the most stressful jobs on the planet. But anyway, that’s another point. I’m just wondering, Mary, are you happy to comment on this issue about workers perceiving that a job that they’re offered which doesn’t really meet what they’re interested in is perhaps a humiliation?

Dr Mary Wyatt (00:35:51):

Yeah, thanks Steve. It is difficult finding appropriate duties for people, particularly if they’ve been off work for a while and particularly in some work environments. I think it provides an opportunity to focus more on the prevention side of things. So one of the problems we have is that people feel that the system’s taken over so they have to do all these things, they have to get a certificate each month, they have to have this treatment, they have to fill out that form so it becomes a world of being told what to do and it can just feel like it gradually slips that way. And people then are at the behest of the system. They’re dependent on what the system is going to do. And there’s an opportunity here to really think early about duties and encourage the worker to think, I mean we do see this quite frequently from rehabilitation providers.

(00:36:57):

They’ve provided with a limited pool of suit, a pool of funds, they’ve got to do a vocational assessment. It really, it’s hard to get the time and nuances into it. So you really bringing out the richness, actually counselling where you’re really understanding people’s needs and their input and motivations takes quite a bit longer than a sort of work capacity vocational assessment where and it’s often those that describe the output as you talk about Steve, the school crossing supervisor or the car park attendant. So developing a list of alternate duties is challenging, but it is much better if the person themselves identifies opportunities. So whether it’s return to work duties and they’re realistic or whether it’s a long-term change in career or a different job option, encourage the person themselves to get ahead of the curve and think about what might work for them and really offer suggestions. Now there have to be certain parameters and it’ll depend on each system, but some they’ll allow short retraining periods. So be pragmatic and encourage people to think about their options.

Prof Steve Trumble (00:38:12):

Okay, thanks for that. What about from the employer’s perspective, Nancy? How would a corporation like Telstra try to make sure that what’s offered actually is going to enrich the person?

Nancy Abdelnour (00:38:23):

Yeah, it’s a really, really important Steve and once upon a time it was reasonable to cobble up duties and present them as being meaningful and appropriate from a return work perspective. We’ve come a long way since then and really what we’re trying to do is find ways to upskill where it’s appropriate to do so. If a person can no longer be on the tools because of a physical injury, it’s really important to identify what transferable skills they currently have and how does that translate into real meaningful work and potential permanent new roles or new opportunities within Telstra. We’ve taken people who’ve never worked on a computer and never used a piece of technology, been out in the field to working in back of house tech support roles using their knowledge and expertise differently by giving them different opportunities and training them and supporting them and coaching them and helping in some respects manage their anxiety to an extent and supporting them through that because change is hard, but also there are so many possibilities if we really help people step through what that might look like for them. And of course we only succeed in doing that when we have the treaters on board and that collaboration to get to that end result. We can never do it on our own. So that’s what my message would be there. It takes a full team and everybody engaged to do this

Prof Steve Trumble (00:39:52):

And Helen’s asked for a little bit more on the safety of those return to work options. I think from what you are saying, you’ve got to make sure that what you’re offering will actually do good rather than do harm

Nancy Abdelnour (00:40:01):

Obviously. Absolutely. Yep. Absolutely.

Prof Steve Trumble (00:40:04):

Alright, what about your perspective, Lori, have you got thoughts on that?

Dr Lori Shore (00:40:11):

Sorry, just briefly. I think just the part that I’d like to add to it is I think it is case specific. I think alternative duties are really helpful when they’re stepped and if someone can see that there’s actually a starting point to return to work and then maybe there’s something else and something else. I think that’s obviously a different case to someone who is put in, as Steve said, a crossing supervisor and perhaps they were a lawyer, I’m not sure. But I think that was the sort of the example we were thinking about. And I also think that obviously from the person’s perspective, the worker’s perspective, it’s very case specific as well. I mean I’ve had a very senior police officer who went back to work in a data entry reposition and he’s quite happy with that for the moment, but he’s quite happy with that. So I think it’s really very, very case specific and depending on for the person in terms of the person themselves, but also whether it’s a stepped approach to return to work.

Prof Steve Trumble (00:41:20):

Right. Thanks for that. Now the next one, I’m binding together about a dozen questions about when the workplace is a large part of the problem and I’ve picked up on Lynette’s question where she said that when is it advisable for a worker to stay or to leave a workplace when there’s bullying in the workplace and interpersonal power and balance between the worker and their supervisor? Is that something I’m thinking maybe Nancy from the employees when it is

Nancy Abdelnour (00:41:48):

Yeah,

Prof Steve Trumble (00:41:49):

You can intervene with and then Mary, your thoughts.

Nancy Abdelnour (00:41:52):

Yeah, look, I think from an employer’s perspective it’s really important that the employee along with their treaters are given a platform to put forward what those issues, concerns, barriers might look like when there is a disconnection in information and communication or limited communication from employees and their treaters around what those barriers are. The employers left trying to fill in the gaps themselves. And often that’s really the challenge and the problem that we find we leaders who will make assumptions that, oh, the reason why they don’t want to come back to work is because they’re on compensation now, so that’s the last thing they want to do. And that’s actually could be no further from the truth. Being able to really understand what those barriers are, what those interpersonal conflicts and issues actually mean for that employee can really enable people, for example in my area, the health management team, HR and so on, to really get in and intervene at the right time to be pragmatic and solution focused with what a real return to work could look like when those interpersonal conflicts and bullying issues present. So it’s not a matter of well that problem exists, therefore they can never go back there. I’d like to think that with the right communication, the right engagement, the right support, and in a safe and appropriate manner, if things can be discussed and worked through that you’d give that a go before considering potentially completely moving on or leaving that employer.

Prof Steve Trumble (00:43:30):

Okay, well that’s important. What about from the medical point of view, Mary? The other side of the desk,

Dr Mary Wyatt (00:43:37):

I think I’m probably still going to talk about from the workplace perspective perspective of the workplace, a few things. So one is that super friend have been looking at workplace data for many years, 10 years now, and there’s actually been a reduction of bullying talked about in the workplace that workers report in the workplace. This is non-AI data, it’s survey data, but despite that we’ve seen an increase in number of claims. So there’s a disconnect there. Don’t know enough about what that means, but there’s a disconnect there. Second thing to say is that not all workplaces like Telstra, and unfortunately when people report bullying at work, it is often not dealt with in a constructive way. And so it’s often as not or more often that it’s the person who reports the bullying that leaves the workplace. And that’s what my psychiatry colleagues tell me.

(00:44:44):

Now, I don’t have data on that, but that’s what they tell me. So it is difficult. I don’t think we can say when is the right time? People should step away from work. It depends on many things, particularly the potential for the situation to get worse before it gets better. So I think it’s an individual conversation with each person and it depends what the state of their mental wellbeing is. I’ve dealt with people you can just see the path forward for them is negative, the workplace isn’t going to listen and use it constructively. And so you can tell people in that situation, I think the way things are going, it’s a downhill journey for you, but they’ve got to make their own mind up. You can advise people, they have to make their own mind up. The ramifications are significant, particularly in terms of their income.

Prof Steve Trumble (00:45:34):

Absolutely. And that’s often what it’s about. I mean people have to, and there’s been a number of questions, in fact, we’ll get to one in just a moment. But before we go there, before we get to the financial secondary gap, well secondary gain sounds pejorative, but anyway, Lori, before I flap my gums, much more to your thoughts about the bullying.

Dr Lori Shore (00:45:55):

Yeah, look, I think my take on this is that I see it much like any relationship and we often think about do they stay or do they go and actually there’s four options. One is if they’re already at work, do they stay and nothing changes? Two is do they stay and make things worse? Three, do they stay and do what they can to make change either to themselves, to their environment, whatever else. And if none of those things are going to be optional and you can see why some of them wouldn’t be, then they leave. Generally in our area we’re working on number three, if it’s going back to work or if it’s staying at work, what can they do to either change the way they see things or the way they interact, the way they have move in their environment, whatever that is. And when that doesn’t work, then generally it’s that they leave. But I think just having some broader discussions around the options is helpful with the worker than just do they stay or do they go?

Prof Steve Trumble (00:47:00):

Yeah, absolutely. So Mary’s rose the issue about people’s need. In fact it was in the cases about needing to continue to provide for a family, but there is a question, and I’m again bundling a number together and putting this one under Joan’s question, what are some ways to address secondary gain? Some clients may fear to be truthful in their sessions that are paid for by the insurer, and if they say they’re feeling better, then they’re worried the funding’s going to stop for those sessions. So quite a part, we’re not talking about making money out of the claim, we’re talking about people getting benefit from their sessions. But that catch 22, dare I say, of if you say you’re getting better, they stop. Who’s got a thought on that? We’re frozen, hang on. No,

Dr Mary Wyatt (00:47:52):

No, Lori, you’d be good for that, wouldn’t you? I was keeping quiet there,

Prof Steve Trumble (00:47:58):

But how do you deal with that, Lori? Your services must stop at some stage. How do you work with the person to be able to tell you truthfully what’s going on?

Dr Lori Shore (00:48:07):

Yeah, and I know I think that look, that comes down to the therapeutic relationship, but I also think that our role as mental health workers is to maintain those communications so that we know what’s going on around the worker. So it may not be that we’re talking to the employer normally I don’t talk to the employer, but I’ll often have conversations with if there’s an occupational rehab provider or with the agent themselves. So what’s going on around the person and having those communications is really important to be saying actually this is what they need. And look, I’d like to think, and I know that over the years that the compensation world has had a bad rap and rightly so, but I’d like to think that things are changing a little bit and that we, and I was actually going to point this out a bit earlier, that I think we again, as treaters need to step up to that we need to be able to say this is what we think is going on.

(00:49:17):

We need to be able to say this is how we’re supporting the worker and we need to continue to support the worker on a return to work for so many months after they’ve returned to work, whatever that is. So I think that we are often a little perhaps reticent to, and I’m not talking about advocating, I’m talking about presenting what’s going on for our client, our worker, and for example that, sorry, I don’t want to derail this one, Steve, but that example about the return to work, I think we were just talking about it before the return to work question and we can ask for things like a transferable skills analysis so that they aren’t necessarily placed in jobs that they’re just not skilled for or don’t want to do. We can ask to provide input to that sort of stuff. I don’t think we always do, but we can do that as well. So I think

Prof Steve Trumble (00:50:21):

Lisa has picked up on a point you were talking about the fact that we obviously hear a lot from the client side of it, but not a lot from the employer’s side. Lisa said, do treat us fine that they only get the version of events from the injured worker and don’t necessarily get informed about the workplace version or side of things to assist with making a more rounded or informed approach. What do our panel think about that? I mean you said we can’t advocate gps get passionately advocating for their patient. That’s really what motivates us, but not appropriate. How do we get a balanced story? What are people’s thoughts on that?

Nancy Abdelnour (00:50:59):

Steve, if I may add that I personally, we love hearing from treaters. I mean to get five, 10 minutes with a treater just to talk to them about the employer’s perspective or concerns or challenges that we may be facing with supporting their patient or our employee to return to work can really set up the pathway for success when it comes to return to work by just being a bit more aware or educated or insightful in terms of what might be going on from a treatment perspective, but also what we could be doing from an employer’s perspective. Personally, I don’t see how you can approach it without that collaborative effort from all parties involved. And whilst it may seem a bit odd that a treater doesn’t necessarily hear from the employer, my question to the treaters is why not? What stops a treater from wanting to make that connection, whether it’s through the OC rehab provider or the insurer to create this multidisciplinary approach almost to a patient and their care and rehab and return to work if we’re all on the same team, if we’re all working towards the same outcome.

Prof Steve Trumble (00:52:24):

It was interesting to see in the chat room, somebody made a comment about silence from the employer being interpreted as not caring and being dismissive, whereas the employers are saying, no, we just don’t want to put pressure on the person. So it’s just like any relationship, isn’t it getting the communication right. So important apparently from what I recall

Nancy Abdelnour (00:52:45):

And often from a mental health perspective, there is a fear. The employer thinks they’re going to make things worse. So if I speak to them, they’re going to get even more upset. And if something happens that’s on me and there is that general concern and anxiety around if I say the wrong thing, it will make the situation worse. So they say nothing

Prof Steve Trumble (00:53:04):

At the same time the employer is saying, but you never call. So it’s very hard. Mary, what are your thoughts?

Dr Mary Wyatt (00:53:09):

Yeah, look, that’s a really common issue. It’s only a minority of people, but it’s an issue. We see semi-regularly. People will come to it from their own perspective. How much has actually been said in the way they translated how much has happened in the way they translate it. They come to it with their own perspective, which can slam things. And also sometimes they’re not fully aware of things. So you might say, well what about going back to work on duties? And they might say the employer doesn’t have any. That’s a common one, but often the person doesn’t actually understand what the employer can and will offer. So having that separate advice from the employer can really be helpful in that situation. For an example, sometimes I’ll do fitness for duty assessments as a specialist and when someone comes in for their presentation, they say, oh no, this is not happening or that’s not happening. And you’ve got that in black and white from the employer. If you don’t have it clearly, then often you’ll get different stories and you won’t know what to deal with the situation. So that’s a situation where the employer’s facts really can make a big difference.

Prof Steve Trumble (00:54:32):

Thanks so much for that comment. Lori, did you want to add anything to that or, okay, it was funny as you were talking, Mary, in allowing for the delay, which is there in case one of you drops a word or whatever, there was a comment in the chat box just at that time about small employees not having a lot of choice often now Telstra is massive, but what about small employees that can’t offer a lot of return to work options? Somebody said, and I’m colliding lighting. Lynette and Claire, I think here, Leanne and Claire with a question about what happens if you have returned to work with a small employer, not of other choices, or the person has to go and find a job with somebody else while they’re still unwell because their original employer doesn’t have jobs. How do we approach that? What are people’s thoughts?

Nancy Abdelnour (00:55:27):

If it’s the question as to what to say to a new prospective employer,

Prof Steve Trumble (00:55:32):

Well I guess it’s what does the employee have to say what a prospective new employer, whether the existing employer can do anything to facilitate the transfer office

Nancy Abdelnour (00:55:44):

And look, that can happen. So there are various programmes where if there is an arrangement for an employer to pick up an employee on a work trial, they typically call them a work trial basis. So usually there is some level of communication and understanding about the employee’s return to work status or their injury or their recovery. And in some scenarios, Steve, we also know that employees want to start fresh. They want to move on to a new employer and perhaps put what was a really difficult experience and time behind them. And often they’ll come and ask us questions as to what should I say if they ask me if I have an injury or if I have a work cover claim. And often we are there to give them obviously some practical guidance. But the reality is a new prospective employer cannot discriminate against someone who does have an injury, illness or disability.

(00:56:48):

And really what the focus should be on is their capacity and their abilities. What can they do? What can they offer this perspective employer? And really shaping the conversation in a positive frame that really highlights their skills and capability and what they’ve got to offer as opposed to focusing on the negative and focusing on the things that they’re still working through. And really that’s for them to work through with their treater and obviously within good reason. And obviously making sure that their treaters are on board with this new role or new job opportunity that they’re not doing something that again is going to hamper their recovery. But really making sure that like anyone going for an interview, they’re presenting themselves in the most appropriate, honest and positive way.

Prof Steve Trumble (00:57:32):

Great, thanks. Thoughts from Lori or Mary about what Nancy said on this topic?

Dr Lori Shore (00:57:38):

I might just jump in.

(00:57:43):

I might just jump in from a treatises perspective that one of the things from a very, the practical side of things is just to get in contact with the insurer and often they’ll have contacts. I think Telstra’s obviously slightly different because a big organisation, but those smaller ones, they’re going to be much, much more difficult. And the insurer will often have occupational rehab providers. They can refer them to, as I said before, they can do transferable skills analysis, those sorts of things. So there is support out there. We often just dunno where to look. And that’s certainly one of the practical things that we can do as treaters.

Prof Steve Trumble (00:58:23):

Thanks Mary. Thoughts from you?

Dr Mary Wyatt (00:58:25):

I don’t think I’ve got a lot of stuff to add to that. Been well covered.

Prof Steve Trumble (00:58:29):

Okay. Well let’s look at a question then from Connor, which takes us in a bit of a d and m. HPN is all about working with the large team of people who can contribute to mental wellness and questions asked about the services of an exercise physiologist is one example, I guess of another practitioner who could be useful. And this is to support them with maintaining a healthy routine, increased exposure to social and meaningful activities. Do you use other practitioners more broadly to try to help people return to work and be, well, Nancy looks like you’ve come off mute. That’s always a good sign.

Nancy Abdelnour (00:59:07):

Look, we work with a broad range of treaters and this is in the compensable and non-compensable space. But ultimately if there is a treater that is working to support that patient or that employee with a safe and sustainable return to work, and they might have a particular focus in terms of an exercise programme or building on physical restoration or improving function, and if they’ve got a psychologist or another practitioners that’s working on the mental health side, so long as there isn’t confusion and an unnecessary overlap, we absolutely would encourage that multidisciplinary nature and approach to support people.

Prof Steve Trumble (00:59:54):

Right. Thanks so much.

Dr Mary Wyatt (00:59:57):

And just to support that, I mean there’s evidence base for it, but also we know that people when they’re languishing because their life is disrupted, particularly if they’re off work, they lose a lot of fitness, that lack of activity contributes to further mental health problems. So absolutely, it’s a great thing. It’s a great approach.

Dr Lori Shore (01:00:20):

And again, just from a treatment perspective, that stepped approach an exercise physiologist is a good first step before say going on to say a gym swim programme in terms of getting, because often exercise physiologist, not always, but often they’ll actually, if we’ve got someone who isn’t leaving their house, they’ll come to their house and then the next stage is then getting them out to a gym sort of swim programme. So it’s a good stepped programme as well.

Prof Steve Trumble (01:00:46):

Great. Well thank you all so much. We’ve got a lot more questions to ask, but we’re running out of time. Some questions have been very specific, we haven’t answered those. This is not the place for those we’ve tried to keep to broader questions which are of interest to the broader group. So thank you for the questions you’ve submitted and also to the people to our team who’ve responded. We do notice, want to hear from each of our presenters just a short wrap up about what are the key principles that represent best practise in this area. And we’ll work through the list we had before starting with you, Mary.

Dr Mary Wyatt (01:01:23):

Thanks Steve. I would say key things are working with the person who’s had the injury in a way that empowers them. That word empower is a bit of a sort of love hate word. It does have meaning, but it really is important to help people feel they have agency and making decisions that are appropriate for their lives standing, what is the different trajectories they might take? So encouraging people to take ownership to be active in their own care. And then the second key message is to support them from a psychosocial perspective. We didn’t go into deep depth on that for mental health cases, but it is just as important for mental health cases. We don’t have an easy screening tool, but delving into psychosocial and helping people overcome those as my second and last key message.

Prof Steve Trumble (01:02:26):

Thank you so much. And I think we should go to Lori for your thoughts about what represents best practise principles of best practise.

Dr Lori Shore (01:02:36):

Thanks Steve. I mentioned it before, but I think for me it’s that early intervention, active treatment and ongoing assessment that’s fundamental to developing and ensuring a client’s capacity to return to work. And my background has been in multidisciplinary pain clinics for some time, and I think just that talking to other treaters, making sure we have a holistic understanding of the client, the worker, and talking to other treaters, talking to the insurer if we need to, talking the occupational rehab provider and as Nancy said, talking where it’s appropriate to the employer as well.

Prof Steve Trumble (01:03:25):

Thanks Lori.

Dr Lori Shore (01:03:26):

Lots of talking.

Prof Steve Trumble (01:03:27):

Absolutely. No, it’s all about talking. Nancy, what are your thoughts?

Nancy Abdelnour (01:03:33):

Look, I think I echo the same sentiments that early intervention is key. Early communication and engagement with all appropriate stakeholders is really necessary. The employer is a key and critical stakeholder just like the treating practitioners are. And really making sure that we are communicating and understanding what those goals are, what those rehab and return to work goals could look like and working towards them. And if we’re all doing that, we’re all pulling in the same direction, that typically does lead to a better outcome for all.

Prof Steve Trumble (01:04:09):

Great. Well you’ve all kept incredibly well to time, which means we’re a little bit early, so I’m going to throw in a more questions, questions without notice. And in fact, this one’s from Jennifer and it’s picking up on Lori’s four options. And she said, isn’t there a fifth option that there are changes in the workplace? And I guess that’s probably going to come back. I can see Mitch nodding. I can see Nancy about to lose her connection. What do we do as clinicians when we can see the problem actually is in the workplace? Can we advocate for there being changes in the place that our area?

Dr Lori Shore (01:04:51):

It’s a tricky,

Prof Steve Trumble (01:04:51):

Sorry, you’re up.

Dr Lori Shore (01:04:52):

Yeah. Yes, I’ve got my unmute off. Yeah, look, it is a tricky balance, isn’t it? I think as treat as we always have to be really clear about that sort of what we can control and what we can’t control. And for me it’s not necessarily give up strategy, but it is about what sort of influence can you have and when you don’t have that influence and nothing’s changing, then probably as treaters we have to be very circumspect about whether the person goes back. I think I’ve seen time and time again, the worker and the treater getting hooked into things have got to change in the workplace. We don’t really have control over that. So I think it’s a bit of a trap and it can keep the worker trapped as well.

Prof Steve Trumble (01:05:47):

Okay. Well before we come to the employer, Mary, what are your thoughts about that question?

Dr Mary Wyatt (01:05:54):

Absolutely, but I’ve forgotten the question.

Prof Steve Trumble (01:05:58):

It’s about whether we can influence changes in the workplace if that where the problem is we can so much with our client, what can we do to influence change in the workplace if that’s where it’s needed?

Dr Mary Wyatt (01:06:09):

I was so busy thinking about my great answer. I’ve forgotten the question. Thanks Steve. Absolutely. Look, I think we forget as doctors and other health providers how much influence we can have. And so I think educating the workplace about how they can support workers is a really important role. Probably a really important role as a treating specialist because we can perhaps

Prof Steve Trumble (01:06:41):

We’ve lost your, yeah,

Dr Mary Wyatt (01:06:42):

Sorry, I sat on the mute button on the speaker thing.

Prof Steve Trumble (01:06:47):

Okay. That’s a first. Well done.

Dr Mary Wyatt (01:06:50):

Good. So yeah, we can do a lot to influence the workplace. Not always, but absolutely we need to teach the employers what they can do to help people, obviously in a diplomatic way, but we can and should be influencing workplaces.

Prof Steve Trumble (01:07:07):

Great. Alright. Thank you so much, Nancy, over to you.

Nancy Abdelnour (01:07:11):

Look, I think that it’s always important to really have open and honest conversations with a workplace, with a manager about what’s working and what’s not working. And I think really it’s around defining what does that change actually mean? What does that look like in practise? If we’re talking about, well, I don’t want to work that shift anymore because I don’t want to work with that person or I don’t want to do those tasks anymore, I don’t like doing them. There are things which really can be quite reasonable and appropriate to work through. And then there are things that might actually fall outside the scope of what that return to work might look like or might actually fall outside of scope from what that employer can support operationally as well. So I think that does need to, I preface that by saying there’s no question that shouldn’t be asked or things that shouldn’t be considered in a scenario where a worker is really having a difficult time, but also they need to understand the landscape and the parameters in which we’re all trying to work within. And some things are doable and some things are just not.

Prof Steve Trumble (01:08:19):

Yep, absolutely. Well, thank you all so much and for stepping up again when I mucked up the timing and had to go back to more questions, but I think we’ve heard some really good information. There’s been lots of excellent chat in the box as well with people sharing ideas and thoughts. I saw a shout out to the paper by Dielle Felman that was referenced there. Dielle’s, psychiatrists’ expertise, an alumna of the MHPN webinars and she’s just fabulous. Good information in that as a resource from tonight as well. So plenty to do going on from here and you can see the resources and further reading box there. Just a few things to cover off before we finish up, so please don’t leave us before we do. There’s another webinar coming up on the 12th of November, which is on supporting the mental health of children living in out-of-home care, which is enormously important, so please make sure you attend that one if that’s your area of expertise.

(01:09:19):

I would like to acknowledge this is my last webinar, so I’d like to pay particular thanks to the whole team led by Julie Middleton for nearly 10 years. Ben and Jamie on the technical side, and Julie’s in the chat room if you’d like to wish her well. So thank you to everybody at MHPN for making my time in these webinars so enjoyable. We have the latest podcast release, the third of four episodes relating to clients and settings released last week and produced in partnership with ANZCATA, the creative arts therapists, please search Mental Health in Focus in your preferred podcast app. MHPN does support more than 300 networks where mental health practitioners meet online and in-person to engage in free interdisciplinary networking, peer support, and CPD. If you’re interested in finding out more, then please go to the MHPN website. You will be receiving statements of attendance in about a week along with the recording from tonight and the resources as well.

(01:10:19):

Before you go, please do make sure you complete the exit survey to give us feedback to always improve these webinars and just make sure you click on the button below the video panel to do that. So thank you so much to all the people listening for being here tonight and obviously to our panel tonight and for the fabulous team that make these webinars work. Before I close, I would like to acknowledge the lived experience of people and carers who have lived with mental illness in the past and those who continue to live with mental illness in the present. Thank you all so much for your participation this evening and I wish you well. Goodnight.