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GP Guide for Patients Bullied at Work

What is workplace bullying?

Workplace bullying is characterised by persistent and repeated negative behaviour directed at a worker that creates a risk to health and safety.

What is not bullying

At times people may feel that their working life is unpleasant and that they are being inappropriately treated, but feeling upset or undervalued at work does not mean an individual is being bullied at work. Dissatisfaction or grievances with organisational and management practices or poor management practice on their own are not workplace bullying.

What is my role as the GP for a patient reporting bullying?

GPs are often the first point of contact and it is important to acknowledge that GPs have a role in assessing and treating the mental health of patients reporting workplace bullying.

The consultation

  • Take a full history – including the details of the workplace stressor/s identified or allegations raised by the patient
    • Duration of exposure, frequency, severity, type of behaviours allegedly exposed to, triggers for the behaviours
    • Broader work issues including performance, attendance, behaviour, relationships at work.
  • Provide time – encourage your patient to book appropriate length consults.
  • Where issues are workplace based rather than medical, encourage your patient to explore avenues to address the issues. It is important not to medicalise workplace issues - this can impact your patient's ability to recover and return to work.
  • Provide support and potential referral sources, expectations for recovery, goal setting/ timeframes early on.

For more information about Work-related stress go to www.worksafe.vic.gov.au .

Treatment

  • Assessment and treatment focus should be on function rather than symptoms – focus on what your patient can do.
  • If your patient's condition requires mental health treatment, consider using Medicare's GP Mental Health Treatment Plans. It can take time for your patient to have a workers compensation claim assessed, but they can access 'Medicare reimbursement for Psychological management with a psychologist' or psychiatrist straight away (these can be billed privately if a claim is accepted). The key is early intervention and support to start the recovery now.
  • It is very important that psychology services use exposure-based techniques, focus on building coping skills and do not reinforce avoidance behaviour.
  • There is strong evidence that the earlier an injured person is able to return to good work, the better their health outcomes, including mental health conditions.1

Providing a Certificate of Capacity

  • Bullying is not a medical diagnosis. Bullying may in some instances lead to a clinical mental health condition and it is this diagnosis which should be noted on the Certificate of Capacity.
  • If there is no clinical diagnosis you should consider whether it is appropriate to complete a Certificate of Capacity or other medical certificate.
  • The provision of a Certificate of Capacity is not considered evidence of the injury resulting out of a workplace accident or incident. The decision to determine the cause of injury as work related is made by the approved Insurance Agent.

Determining Capacity

  • Mental health conditions do not usually equate to total incapacity for all work in any workplace.
  • Emphasise the importance of returning to normal structure and routine, including a return to work, from the first consultation.
  • Focus on function not symptoms – apply the same approach to certification as you would for a physical injury – What can the patient do?

Assessing Work Capacity in Psychological Injury

Symptoms are secondary: functioning is what matters. Has there been changes in

  • Cognitive & concentration: Can your patient read newspapers? Watch television? Read a book? Respond to e-mails, Facebook, other social media? Basic activities of daily living: Has there been any impact on their routine? Cooking, cleaning, shopping, management of children/school?; other activities?
  • Social interaction: Has their day-to-day engagement with family and friends changes?, Interaction with work colleagues?; engagement in out of home activities - nature & frequency etc.?
  • Sleep: How much continuous sleep before waking? How are they sleeping overall?
  • Exercise: Are they regularly walking? What other activity?
  • Vitality/Energy: Do they require rest during the day? Rest after significant activity?
  • Coping: Is there substance use? Avoidance behaviours?
  • Work engagement: Identify specific barriers; problem solve/exposure to work.

Dr Peter Cotton, Clinical Psychologist

What workplace adjustments are reasonable to request?

  • As a GP your role is to certify capacity, not to identify alternative duties – this is the employer's obligation.
  • Workplace adjustments GPs can recommend for patients should focus on psychological safety and may include:
    • Reduced exposure to specific stressors within a workplace e.g. reporting to another manager for the short term
    • Alteration to work hours/days (if a graduated return to work is required)
    • Restriction on driving (vehicles, forklifts etc.) if medications may compromise safety.

Resources for GPs and patients

  • WorkSafe Advisory service toll-free on 1800 136 089, or email info@worksafe.vic.gov.au can provide information on bullying and how to prevent it, advice on how to raise the issue of bullying in your workplace or refer the matter to an inspector (where appropriate).
  • Go to http://worksafe.vic.gov.au for further information, including:
  • Employer - HR Manager/ RTW Coordinator/ OHS Representative.
  • Your patient's WorkSafe insurance Agent for any claim related queries.

Further GP resources

Acknowledgements

This information was prepared by: WorkSafe Clinical Panelists Dr Roya Dabestani, GP and Dr Peter Cotton, Clinical and Organisational Psychologist.


1 The Royal Australasian College of Physicians, Australasian Faculty of Occupational and Environmental Medicine Position Statement on Realising the Health Benefits Work, Sydney 2015