Work restriction for psych injury

Blog - Work restriction for psych injury

Robert Aurbach | Published: December 09, 2014

How strange. We have a lot of knowledge about work restrictions with regard to physical injury. Back injuries generally don't like sitting. Shoulder injuries generally don't like overhead lifting. You know the drill.

But when it comes to psychological injury, the understanding of GPs and other health professionals seems to get much more limited. Rest and separation seem to be the only things that get prescribed in most cases. And, there's evidence that this is a prescription for the worsening of the condition in many cases.

Stress, depression, abusive situations and anxiety all result in feelings of perceived loss of control. Being productive and earning a living are often the most powerful reinforcers of our personal sense of control over our lives. Being with the people we work with is often the most potent form of social support available to us. And this is all thrown away with the easy prescription of a bit time off.

Dame Carol Black's last visit to Australia has somehow crossed the tipping point that will allow us to seriously consider what many of us have been urging for years: reform of the standard form of medical certificate to reflect what an injured person can do safely, while removing blanket power to take someone off work. In this context, we now need to confront what restrictions or capacities will be prescribed for psychological injury.

What can a psychologically injured person do? Prescriptions to avoid the stressor for indefinite periods or change supervisory relationships can't be the answer. Aside from the unacceptable intrusion into the management function, this is little different from time off. More separation from the problem is also more separation from the reinforcements of work. The trick is to make the workplace healthy and safe, or alternatively, to create coping strategies that help the worker deal with unavoidable challenges.

Where another person is part of the problem, the interaction needs to be made safer. Notwithstanding that some people are less resilient than others, it always takes two to breakdown an interpersonal relationship. Counselling (for both sides), mediation, and innovative control of the circumstances of contact can all be of value. I recall a worker who had lost control over interruptions from someone seated in the next cubicle. A small block of wood, painted half green and half red and placed on the adjoining wall, set boundaries and returned her sense of control.

When the problem is stress, models for healthy restrictions are also readily available. Just like strategies for coping with physical strain, there are common sense things that can help. Control of the pace of work, limitations on multitasking and distractions, and addressing the timing and volume of activities – where the error rate is affected by decreased concentration – may be helpful. Minimising complex decision making, customer contact and supervisory responsibilities may also be useful strategies. Most of all, the worker should be given the opportunity for input as well, with the understanding that they are not being offered an invitation to substitute their judgment for management's regarding organisation of the work environment.

It's beyond the scope of a discussion like this to attempt to catalogue all appropriate work accommodations for psychological injury. They will vary as the personalities and challenges of our workforce vary. The time has come to start thinking about them, however, especially now that the era of the sick note is ending.