The complexities of diagnosing and managing work related mental health conditions in general practice: Views from GPs, psychiatrists and compensation scheme workers
Problem
The incidence of people with work-related mental health conditions is increasing. Most patients with these conditions seek care from a General Practitioner (GP). However, GPs report challenges when caring for these patients. We sought to describe the key clinical challenges associated with the diagnosis and management of work-related mental health conditions in general practice.
Approach
We adopted a qualitative approach. Semi-structured, telephone interviews were undertaken with 25 GPs, 8 compensation scheme workers and 5 psychiatrists across Australia. Interviews were based on reflections of two case vignettes. The first vignette focussed on a patient that had experienced workplace bullying and developed a primary work-related mental health condition and the second related to a patient who sustained a physical injury at work and later developed a secondary mental health condition. Thematic techniques were used to analyse the data.
Findings
Four major themes were identified: 1) Diagnostic challenges: ensuring diagnostic accuracy and difficulty in determining the work-relatedness of a patient’s condition; 2) Management: dealing with patient attitudes concerning return to work, determining when referral to a mental health service specialist is appropriate, and addressing the implications of managing mental health conditions through a claims process 3) Variations in perceptions of a GPs role: including clinical responsibilities, a GPs role in certification and the compensation scheme process, and communicating with other health professionals and compensation scheme personnel. 4) Lack of knowledge and understanding of the compensation scheme system.
Consequences
GPs face a number of significant challenges in diagnosing and managing patients with work-related mental health conditions. The findings of this study were used to formulate key clinical questions that have been addressed by a new evidence based clinical practice guideline. This guideline will be endorsed by the Australian National Health and Medical Research Council and released in late 2018.