World-first guideline for work-related mental health conditions

Doug Hendrie

14/03/2019 4:13:57 PM

People experiencing work-related mental health issues take up to three times longer to return to work than those with physical injuries.

Dr Ron McCoy
RACGP Education Strategy Senior Advisor Dr Ron McCoy launched the guideline at Monash University.

While some 7500 Australians successfully make compensation claims for mental health work injuries, the actual number is estimated to be 30 times higher – around 225,000 per year – since most do not seek or receive compensation.
It is for this reason that Professor Danielle Mazza, who heads the Monash University Department of General Practice, led a team to produce world-first guideline designed to help GPs manage these particularly complex presentations.
‘GPs are the first-line providers of care for the growing number of patients with work-related mental health conditions, and have called for evidence to support them in managing these patients,’ she said.
‘These guidelines aim to do just that.’
RACGP President Dr Harry Nespolon said GPs have long called for guidance in this area.
‘[GPs play a key role in] shaping a patient’s recovery from the point of diagnosis, getting access to allied or specialist care and even determining when they can return to work and in what capacity,’ he said.
The Clinical guideline for the diagnosis and management of work-related mental health conditions in general practice provides evidence-based recommendations to help GPs manage this patient cohort.
The RACGP and the Australian College of Rural and Remote Medicine (ACRRM) have both endorsed the guideline, with approval from the National Health and Medical Research Council.
Workers with mental health injuries are known to be at higher risk of comorbidities such as high blood pressure, smoking, pain issues, and conflict at home. Mental health injuries are second only to musculoskeletal disorders among work-related injuries.
GPs are more likely to certify workers with a mental health condition as unfit for work compared to those with a physical injury.

Professor Danielle Mazza called GPs the ‘first-line providers of care’ for people experiencing work-related mental health issues. 

Professor Mazza told newsGP a key consideration for the GPs she and her team consulted was assessing whether the workplace itself had caused the mental health issue.
‘If it’s arising out of bullying or stress in the workplace, these issues need to be addressed if a patient is to return to work,’ she said.
‘One of the questions GPs asked us to look at was, can the patient work in some capacity?
‘The recommendations we derived there were that you’ve got to look at patient factors – and also workplace factors, to find out what the workplace is like, whether there’s conflict with a supervisor, and what ongoing stresses there may be.’
Professor Mazza believes these patients require special care, as there is a risk of the mental health issue becoming a chronic condition.
‘If they aren’t recovering, look for reasons why and try and address those,’ she said.
‘Our guidelines are based on the premise that good and safe work is beneficial for health, so our aims are around patient recovery and return to work.
‘These guidelines are very GP-focused and implementation-focused. As a practising GP, I know there are a zillion guidelines for every possible condition. Everything has been looked at with an implementation lens, so it’s easy to apply in a GP setting.’
RACGP Education Strategy Senior Advisor Dr Ron McCoy launched the guideline at Monash University. He told the audience he welcomed the new resource, which tackles key clinical challenges for GPs.
‘Until now, there has been no clear instruction or advice to GPs about the appropriateness of instruments for diagnosing or assessing the severity of mental health conditions or how to determine the work-relatedness of a condition,’ he said. 
‘The resulting ambiguity can result in delays with the mental health claims process, in instances contributing to disagreements between clinicians and compensation scheme staff.  
‘Until now, GPs also received no evidence-based guidance about how to determine the capability of a patient to return to work or how to approach the development of comorbid mental health conditions in those with a physical injury, or what to do if a patients wasn’t improving.’
‘This guideline changes all that. This guideline is the first clinical resource, internationally, to provide evidence-based guidance to GPs about the diagnosis and management of mental health conditions that have arisen as a result of workplace injury.’

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A.Prof Vicki Kotsirilos, AM   15/03/2019 6:20:11 AM

Congratulations Monash University and Professor Danielle Mazza

Dr Mahavir Prasad Gupta   15/03/2019 6:32:25 AM

This sounds very useful. I would like a copy of guidelines if possible.

newsGP   15/03/2019 11:11:58 AM

Thanks for your comment, Dr Gupta.

The guideline is available at

Vivienne Sandrini   8/04/2019 12:55:21 PM

I am a Physio and work as a Rehab case manager at Dept of Health CAnberra , and would like a copy of the guidelines as a reference- I often liase with GP's