Filling the dark spot: fifteen injured workers shine a light on the workers compensation system to improve it for others

摘要

Executive summary  The Creative Ministries Network (CMN) provides support to people affected by workplace injury and work-related death. Over the last fifteen years CMN has undertaken a number of projects examining the relationship between work and suicide. These earlier studies highlighted a gap in the research into work injury and compensation in relation to workers’ mental health.[1] Existing research has concentrated on examining the health and/or return-to-work outcomes of compensation processes rather than considering the impact of the process itself on workers’ health and recovery. The research has also largely been epidemiological and/or focused on particular industry settings, injury types or points in the process from injury through compensation, rehabilitation and return to work. Very little work has been undertaken on compensation systems[2] from the perspectives of injured workers. This study is intended to continue CMN’s commitment to develop a better understanding of the role played by work injury in mental health and suicidality by understanding the ways in which the Victorian WorkCover system impacts on the mental health of workers with long-term injuries. The purpose was to identify how workers might be better supported after an injury, and identify changes that compensation authorities, employers and unions can make to reduce mental distress amongst injured workers who are clients of the WorkCover system. Workers who took part in the study noted a number of positives in the current WorkCover system: The existence of a system that had provided workers with income and financial assistance with medical and other expenses related to their injury. The focus on return to work and the support provided to retrain and re-enter the workplace was seen as helpful. The capabilities of insurers’ case managers and the return-to-work co-ordinators made a difference. Where these individuals were skilled both technically and interpersonally, able to show empathy and humanity, the injured workers reported a better experience and one that enhanced their mental health and recovery. Largely positive interactions with healthcare providers. From the perspective of the workers interviewed, the study also revealed a number of problems associated with Victoria’s WorkCover system: Overall, workers experienced the system as unfair and unjust, believed it prioritised the interests of employers and failed to remedy the situation that had caused them injury in the first place. The majority of workers reported being treated disrespectfully, dismissively or without humanity by the system. Workers reported inefficiencies, errors and the complex requirements of the system combined to create a sense of being trapped in a game, where winning and disproving the worker’s version of events was the main aim. Workers were not prepared for the evidentiary and adversarial nature of the process. This took a toll on their sense of trust, as did the poor interpersonal treatment they received from WorkCover personnel and, for some, their own employers. Overall, workers struggled with the requirements of the process, especially at a time when the experience of being injured in the workplace affected their ability to function. The accumulation of these impacts left workers feeling devalued and dehumanised. Specific points in the process that appeared to have the potential for particular impact on workers’ mental health were: At the beginning, when workers were at their most anxious about whether their claim would be accepted. Attending insurers’ doctors for medical assessment and medical panels. Returning to work. Workers identified several elements of their experience as helpful in terms of managing the process and contributing to better mental health and recovery. The most valued was support they had received to engage with the process. One aspect of this is technical support, independent advice to assist them to navigate the system. But workers also stressed the importance of emotional support, someone who believed their version of events without question, someone who could see the workers’ desire to return to work and could hold onto the good worker identity of the individual. It was less important where this came from (union, family, friends, GP and psychologist were all mentioned). What was seen as vital was the person who provided the support understood what the WorkCover experience was like and could assist the worker to navigate it. This finding highlights the important issue of how the system might better utilise trained peer support workers to assist injured workers, a topic CMN is particularly keen to engage with WorkCover on. The project makes the following recommendations: Recommendation 1 Funding is sought for a pilot project to develop, trial and evaluate an intervention that utilises trained peer support workers in assisting injured workers’ recovery for life and work. Recommendation 2A course outline be developed, drawing on workers’ lived experience knowledge, for the professional development of WorkCover insurance case managers aimed at improving their ability to deal with traumatised and ill clients.  Recommendation 3That injured workers and/or their representatives are included in future relevant research reference groups and policy development processes. Recommendation 4Further research is undertaken in relation to workers’ lived experience and what supports their recovery, including interactions with the WorkCover system. This research would deliberately target workers with serious physical and psychosocial injuries but who have recovered. This research could identify what was different in the workers’ experience and how they understand their experience.  [1] Mental health’ in this report refers to the workers’ self-described experience of their own mental, emotional and psychological well-being. This definition of ‘mental health’ draws on the notion of a ‘lived experience’ knowledge base and is consistent with the conceptualisation of mental health, ill-health, distress found in the literature on mental health recovery. [2] The ‘system’ referred to throughout this report is that of Victorian WorkCover, constituted by legislation and administered by the Victorian WorkCover Authority. The system has defined roles for private insurers, employers, trade unions, health providers, workers and injured workers.