GPs struggle to manage patients with work-related mental health problems

Doctors face many challenges when managing work-related mental health problems, leading some to counsel patients against pursuing basic labour rights because it may prove detrimental to their mental health, the General Practitioner (GP) Return to Work study has found.

The study examined the GP’s role in facilitating return to work after injury, arguing that some GPs find dealing with the workers compensation system so onerous and difficult that they are reluctant to follow through with some claims.

The study results are based on interviews with 93 GPs, injured patients, compensation scheme personnel and employers as well as an analysis of 125,000 compensation claims issued by around 10,000 GPs.

One doctor in the study said his instinctive response to the many patients who wanted to pursue worker’s compensation for stress, anxiety, depression and other work related sickness was to dissuade them.

“When people come and ask me, that they perceive they’re being bullied at work and say, “I’m going to put in a Workcover claim,” I say, “Well just be careful because you have every right to, if you feel that you’ve been hard done by, but it’s going to be a dog fight.”

This response was typical of the GPs interviewed.

GPs reported difficulties with the initial assessment and diagnosis of mental health injuries (as opposed to some easily diagnosable physical injuries such as fractures and lacerations). In 96% of initial sickness certificates issued for work-related mental health problems, GPs classified patients as “unfit for work”.

GPs also reported conflicting medical opinions among clinicians about the difference between mental illnesses developed as a result of work-related stress and pre-existing mental illness secondary to work. This has a flow-on effect to workers compensation claims, as many schemes will only cover mental illness that arises as a consequence of work.

The strong stigma associated with making a work-related mental health claim also makes patients reluctant to seek help from psychiatrists and psychologists. They fear this health record will limit future employment prospects. GPs often have to juggle protecting their patients’ private health information alongside employers’ and insurance agents’ requests for further details.

The study also found, while patients might initially present with physical injuries, the complexity of the compensation system can create such a degree of stress that secondary mental illness may develop as a result of dealing with the system.

In other cases, chronic pain from physical injuries can lead to dependency on opioids and long periods of time off work, a vicious cycle that can also increase patient’s vulnerability to mental illness.

GPs in the study reported insufficient remuneration for hours of overtime, reams of paperwork, the threat of legal subpoenas and lost income due to court appearances. It is therefore unsurprising that an increasing number of GPs are reluctant to treat such patients and are more likely to refer them elsewhere.

Despite the problems uncovered in this study, over the past ten years there has been a 22% rise in work-related mental health claims. This is a worrying trend because strong evidence demonstrates that if a patient is off work for more than six months, their risk of depression and long-term disability is significantly increased. The costs of this long-term ‘worklessness’ is to the economic tune of approximately $5 billion per year and the social discords of failed marriages, family conflict, increased suicide ideation, and financial crisis.

Compensation insurers have responded by providing GPs with specific and targeted information on how the compensation system works and clinical education and training on assessment and management for work-related mental health problems. But this is tackling only one side of the problem. Fundamental reforms within the compensation system is also urgently needed.

This study will inform the development of clinical guidelines to help GPs to look after patients with work-related mental health problems and help them return to work as soon as it is safe to do so.