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Mental health recovery and support action plan
1. Background
Within the NSW Compulsory Third Party (CTP) and Workers Compensation (WC) schemes, there is substantial evidence that people making psychological injury claims take much longer to return to work, have slower recovery trajectories, report poorer claims experiences, and have more costly claims when compared to physical injury claims1. These trends are not unique to NSW and have been observed in other Australian States and internationally.2
In response to these trends, SIRA commissioned Monash University to conduct a multi-stage intervention mapping project in 2019 (Monash Project). The project design included a review of existing strategies and research, followed by in-depth stakeholder interviews and surveys. This approach enabled gathering of significant insights from scheme participants and assisted in identifying the issues that resulted in poorer outcomes for people with psychological injury claims.
The final report synthesised evidence from the literature and scheme stakeholders, and led to recommendations under four focus areas:
- Addressing barriers and facilitators to effective care with the employer and the workplace, healthcare providers and insurance case managers. Key opportunities include increasing mental health literacy, reducing complexity and filling the gap in relation to tools, resources, and implementation.
- Developing a model of care. A model of care broadly defines the way health services are delivered. It outlines best practice care and services for a person. A well-defined model of care for people with psychological injury within Australian injury compensation schemes would fill a gap in implementation science. Such a model could support the three key principles identified in the Monash project:
- tailored, person-specific treatment and management
- the importance of early action
- multi-stakeholder approaches
- Addressing the evidence gap. There are a range of opportunities to support in the development, and translation of evidence. From short-term recommendations that enable easier access to peer reviewed materials focussed on early intervention and management, to ongoing investment in research and practice-based evidence.
- Transformation infrastructure. Support structures will need to be established to help realise these opportunities. This could include establishing an advisory group of people with lived experience of psychological injury, employers with demonstrated expertise in stay at work and return to work strategies for employees with psychological injuries, suitably experienced healthcare providers and insurers and self-insurers.
All the reports from the Monash Project are available on the SIRA website.
Further to the Monash project, in 2020 SIRA commenced an Australian first study, the Regulatory Measurement of Customer Experience and Outcomes Study (Customer Outcomes Study), to measure customer experience, health and social outcomes across workers compensation and compulsory third-party motor vehicle schemes. The first component of the study was a baseline survey focused on customer experience with insurers, trust in the schemes, perceptions of justice, return to work and other activities, and health and social outcomes. Mental health was reported as an issue across both schemes with one quarter of people with a CTP claim (25%) and one in five (19%) people with a worker’s compensation claim assessed as having a probable serious mental illness.
People reporting poor mental health were more likely to report poorer results, including in relation to customer experience, trust, return to work and activities, and self-reported health and social outcomes.3
Further reading is available in the Customer experience research report.
2. Mental Health Recovery & Support Strategic Action Plan
The mental health recovery and support strategic action plan (the action plan) has been developed as the first step toward an integrated, long-term approach to enabling better mental health and psychological injury outcomes for scheme participants and is guided by the four focus areas identified in the Monash Project. The action plan includes long term goals, guiding principles and a high-level indicative timeline for delivering priority initiatives under each focus area.
The action plan has been guided by several inputs including but not limited to:
- The Psychological Injury Intervention Mapping Projects recommendations (2021)
- SIRA’s Regulatory Measurement of Customer Experience and Outcomes Study (2020)
- Productivity Commission final report for its inquiry into mental health (2020)
- The impact of COVID-19 and bushfires on mental health (2019-2021)
- Data collected by SIRA from the NSW CTP and Workers Compensation schemes
2.1. A focus on mental health and psychological injury
While responding to health outcomes relating to psychological injury in the schemes was the primary focus when commissioning the Monash Project in 2019, it is now clear following the results of the Customer Outcomes Study that this focus should be expanded.
To acknowledge this, SIRA has expanded the scope of the action plan to include a holistic focus on mental health recovery and support, in addition to psychological injury. This approach acknowledges that mental health issues often go undiagnosed and will enable identification and mitigation of factors that lead to poorer health and recovery outcomes for scheme participants.
3. Long Term Goals
Two long term goals have been developed to guide the action plan. These goals are aligned to SIRA’s strategic goals (https://www.sira.nsw.gov.au/corporate-information/about-us).
3.1 Optimal outcomes for people: Better mental health outcomes for people in schemes
The Customer Outcome Study (Social Research Centre, 2020) found that people with higher levels of distress were more likely to report poorer outcomes in relation to customer experience, trust, return to work and activities, and self-reported health and social outcomes.
A focus on person centred, needs based, outcome focussed approaches will support cultural change within the scheme ecosystems.
3.2 Sustainable Schemes: Delivering interventions that drive efficiency while maintaining efficacy
Across the workers compensation and compulsory third-party schemes, psychological injury claims are rising, cost more and are longer in duration (Gray, SE et al, 2019). SIRA wants to better understand the drivers of this scheme behaviour and develop value-based practices which support better health outcomes, and more sustainable schemes
4. Guiding Principles
To achieve the long-term goals of scheme sustainability and optimal outcomes for people, three guiding principles have been identified. These principles will guide the development of initiatives.
4.1 Customer-focus
Designing and implementing interventions that focus on tailored, person specific supports for scheme participants.
Examples of customer focus in practice:
- Co-designing initiatives with scheme participants
- Driving culture change within schemes
4.2 Value Based
Value-based approaches will ensure that SIRA is responding to mental health recovery and support needs within the schemes using interventions that work.
Examples of value based mental health care in practice:
- Needs based and outcomes focused
- Health outcomes that matter to patients
- Person centred approaches
- Harm minimisation
- Addressing mental health stigma
- Improving effectiveness and efficiency of care
4.3 Evidence driven
A focus on leveraging proven approaches and contributing to the evidence base through strong evaluation approaches will reduce the use of outdated or ineffective practices and will improve mental health outcomes for people within the schemes.
Examples of being evidence driven:
- Building the evidence and knowledge base
- Translating research into easy to apply tools and resources
- Using existing data better
- Using lived experience insights
5. Priority initiatives
In response to the Monash Project recommendations synthesised from existing literature and stakeholder feedback across 2019 and 2020, SIRA conducted a gap analysis to identify initiatives currently underway as well as opportunities to strengthen the response to mental health recovery and support across the four domains.
The action plan is separated into four domains, representing the four recommendations from the Monash Project. Relevant mental health initiatives currently underway or planned are listed under the most relevant domain. These initiatives are separated into short, medium, and long-term (Horizon 1, 2 and 3 respectively).
SIRA will continue to review the action plan to ensure its fit for purpose and will continue to engage broadly on the development of the initiatives, as well as on the strategic approach.
Short Term | Medium Term | Long Term |
|---|---|---|
| Domain: Addressing the evidence gap | ||
Enable access to evidence Development of an information portal to enable access to peer reviewed materials with a focus on early intervention and management. Partner and evaluate Evaluation of Recovery Boost Grant Projects. The grant program has focussed on building the evidence base relating to workplace mental health recovery through academic research and practice-based evidence. The evaluation of the program will determine future investment approaches in practice-based evidence. | Enable evidence development Development of pipeline of research to support evidence base development, supported by the Customer Outcome Study results. Ongoing integration of feedback from the Customer Outcome Study. Review and renewal of research pipeline. | Evidence translation Publication of commissioned research along with plans for evidence translation. Ongoing integration of feedback from the Customer Outcome Study. |
| Domain: Barriers to effective care | ||
Expectation setting: Implementation of standards of practice for claims handling. This will include the implementation of the Workers Compensation Standard of Practice 33, along with related activities in the CTP scheme. Risk screening and triage standards. Initiative to support insurers to achieve best practice claims triage and screening to enable early detection of support needs. Supervision and monitoring: Claims and injury management assurance program. The program will provide data to support gap analyses which will determine future initiatives and regulatory activities. Building capability: Commence engagement with scheme stakeholders (scheme participants, employers, insurer case managers and healthcare providers) to determine priority areas for development of resources, tools, and educational materials. | Expectation setting: Review and evaluation of triage and risk screening initiative/s. Supervision and monitoring: Audit effectiveness and performance following claims and injury management assurance program. Monitor and test effectiveness of standards of practice for claims handling. Consider revisions. Building capability: Continue engagement with scheme stakeholders (scheme participants, employers, insurer case managers and healthcare providers) to review progress and determine priority areas for development of resources, tools, and educational materials. | Supervision and monitoring: Continue to monitor and test effectiveness of standards of practice for claims handling. Consider revisions. Building capability: Continue engagement with scheme stakeholders (scheme participants, employers, insurer case managers and healthcare providers) to review progress and determine priority areas for development of resources, tools, and educational materials. |
| Domain: Model of care | ||
Initiate a project to explore model of care development, tailored to address specific needs. SIRA will build project management and governance structures to support the project and engage key stakeholders in this stage. | Conduct diagnostic and solution design for Model of Care. This will include establishing a clear picture of what ideal management of psychological injury looks like. This step will entail consultation with employers, health care providers and insurers to design a solution that can be tested and refined as needed. | Pilot model of care. A pilot will be conducted to determine the effectiveness of the model of care, as well as support the relevant scheme systems in executing changes needed to sustain the model of care. |
| Domain: Transformational infrastructure | ||
Defining, designing, and building supportive infrastructure. SIRA will explore how to best leverage existing connections and advisory groups while designing the infrastructure needed to support in the development and implementation of the activities within domains 1, 2 and 3. The advisory group will provide input to design of resources and advise on dissemination strategies. | Evaluating effectiveness of infrastructure. SIRA will evaluate the effectiveness of the infrastructure developed annually, and in the long term will re-define and design based on the future needs. | |
7. Next Steps: Implementing the action plan
SIRA will consult with scheme participants as we work to implement the components of this plan as well as to develop a long-term strategic plan to enable better recovery outcomes and to ensure scheme viability.
You can register to the SIRA Bulletin to stay informed about opportunities to participate in the development of the projects and initiatives.
8. Glossary of Key Terms
Mental Health: a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to contribute to his or her community (WHO, 2018)
Mental health issues: A mental health issue interferes with a person’s cognitive, emotional, or social abilities. There are different types of mental health issues and each of these can occur with a varying degree of severity. (WA MHC 2021).
Psychological Injury: Psychological injury or mental injury includes a range of cognitive, emotional, and behavioural symptoms that interfere with an individual's life and can significantly affect how they feel, think, behave, and interact with others. Psychological injury may include such disorders as depression, anxiety, or post-traumatic stress disorder. (SafeWork AUS)
Person-centred/Customer Focused: Person-centred care is a way of thinking and doing things that sees the people using health and social services as equal partners in planning, developing, and monitoring care to make sure it meets their needs. Person-centred care is widely recognised as a foundation for safe, high-quality care.
People with lived experience: People with lived experience is used to refer to people who have experienced a mental health issue personally, or as a carer.