Public consultation - independent review of the Safety, Rehabilitation & Compensation Act 1988

20 December 2024

Ms Justine Ross
Workers’ Compensation Review
Workers’ Compensation Policy Branch
Safety and Industry Policy Division
Australian Government Department of Employment and Workplace Relations

Submitted online at: https://consultations.dewr.gov.au/src-act-review-consultation

Dear Ms Ross
APS response to the Public consultation - Independent review of the Safety, Rehabilitation & Compensation
Act 1988
The Australian Psychological Society (APS) welcomes the opportunity to provide a submission to the independent review of the Safety, Rehabilitation & Compensation Act 1988.
The APS is supportive of the Comcare workers’ compensation scheme and its aim to provide quality care to people who sustain a work related injury. In making this submission, the APS has reviewed the Safety,
Rehabilitation & Compensation Act and the consultation issues paper. The feedback provided has been formulated based on existing advocacy, policy positions, and feedback from APS members who are highly experienced in compensable schemes.
As with all APS work, we consider our response to this Inquiry in light of the Sustainable Development Goals
(SDGs). 1 Of relevance to the current Senate Inquiry is SDG 3: Good health and well-being that is focused on ensuring healthy lives and well-being for all at all ages. 2
Thank you again for the opportunity to respond to the current consultation. Please don’t hesitate to contact me, should any further information be required, at the APS National Office on (03) 8662 3300 or z.burgess@psychology.org.au
Yours sincerely

Dr Zena Burgess FAPS FAICD
Chief Executive Officer

1
United Nations Department of Economic and Social Affairs. (2022). Sustainable Development. https://sdgs.un.org/
2
United Nations Department of Economic and Social Affairs. (2022). Sustainable Development.
https://sdgs.un.org/goals/goal3
APS response to the Public consultation - independent review of the Safety, Rehabilitation
& Compensation Act 1988

It is well established that there has been an increase in the number of psychological injury claims within workers’ compensation schemes in Australia over recent years. The APS has long advocated for the adoption of best practice preventative processes, as well as encouraging insurers and employers to promote meaningful and purposeful work as key factors in driving positive mental health outcomes. We also consistently emphasise the importance of successful implementation and translation of best practice interventions as fundamental components of an effective workers’ compensation scheme.
The broad issues affecting an injured workers ability to return to work (RTW) and successfully engage in rehabilitation and recovery, as well as best practice methods for addressing these issues appear to be familiar to workers’ compensation schemes. We therefore consider the application of robust implementation strategies, comprehensive oversight, quality assurance processes, and effective outcome measurement as key areas to improve efficiency and operations. In light of this, the APS strongly recommends that the central focus of a review of the Comcare workers’ compensation scheme be placed on preventative policies and practices, early intervention (within days of an injury report) as well as quality-assurance mechanisms.
Many of the Terms of Reference (ToR) for this review overlap with regard to the relevant issues we wish to focus on. For this reason, rather than responding to each ToR and question specified in the issues paper, our response to this consultation will highlight key themes important to this review.
Early intervention
The benefits of early intervention are generally well known within compensable schemes. We acknowledge that
Comcare has previously partnered with Australian Public Sector agencies in an early intervention service pilot project to investigate the effectiveness of early intervention supports. We note that the reported results demonstrated an improvement to recovery and RTW.
A co-ordinated early intervention approach to managing workers’ claims is essential where there is an accepted primary or secondary psychological injury. A key purpose of early intervention is to develop initiatives that minimise the length of time it takes for workers to access psychology services and begin treatment following an injury. The focus for the worker and the scheme should be on treatment not claims evaluation and outcomes. It is critical that access to psychological intervention is a key foundation of early intervention initiatives given that the time taken to receive treatment can influence successful RTW outcomes. The APS is therefore supportive of evidence-based initiatives that increase engagement and access to psychology services and early intervention supports.
It would be well received by the community for Comcare to increase early intervention efforts and investment at all points to address and maintain the mental health of injured workers and reduce the risk of sustained work- related mental ill health. For these reasons, we recommend Comcare develop further initiatives and pilot programs that accept psychological claims and promote the use of early intervention psychological services that are trialled along with associated process and outcome evaluations. Evaluations are important to determine whether the approach is being implemented as intended, and the extent to which the approach taken is achieving the intended outcomes in the short, medium and long term. In addition, consideration needs to be given to extent to which the approach is producing worthwhile outputs and outcomes and meeting its objectives.
Examples from other schemes
When considering best practice design principles for a workers' compensation scheme, it is valuable to look at examples from other jurisdictions that have demonstrated effective approaches to early intervention, rehabilitation (including support for employees with psychological injuries), vocational support, and RTW initiatives.
WorkSafe Victoria, for instance, offers provisional payments to support individuals in their recovery and RTW, irrespective of the claim's outcome.

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This allows workers and eligible volunteers to access provisional payments for reasonable treatment and services related to work-related mental injuries while awaiting a claim decision. In the event that a claim is not accepted, provisional payments can continue for up to 13 weeks, ensuring that injured workers receive ongoing support.
Similarly, WorkSafe Queensland provides a model where, during the claims assessment period, employees are generally able to access funded mental health treatment. This support includes a wide range of treatments such as GP consultations, psychology sessions, psychiatry appointments, and medication, all of which help facilitate the worker's recovery and increase their chances of successful RTW.
These examples underscore the importance of offering timely, accessible, and comprehensive support to workers, especially in the critical early stages of their recovery.
Recommendation 1:
Early intervention programs and the uptake of early intervention supports should be encouraged, both by the insurer, once a claim is made, and by employers to avoid the necessity of a claim (e.g., via EAP services).

Diagnosis of mental health conditions
We note that the Safety, Rehabilitation & Compensation Act 1988 (the SRC Act) currently allows psychologists to define and diagnose PTSD, which we support. However, we find it inconsistent that a psychologist is unable to diagnose other mental health conditions. Registered psychologists are skilled in assessing, diagnosing and treating a range of presentations related to cognition, emotion and behaviour, including mental health conditions classified in the DSM. Registered psychologists working within the scheme are well equipped to make mental injury diagnoses for the purpose of the SRC Act.
Recommendation 2:
Amend the SRC Act to permit registered psychologists to make a diagnosis in accordance with the most recent version of the DSM reflecting their scope of practice

Role of employers
Employers play a crucial role in shaping work design, organisational culture, relationships, and practices, all of which are significant factors in the prevention, management, and potential causation of work-related psychological injuries. While a preventative approach is widely regarded as best practice, it is also vital to recognise that when an injury does occur, engagement in meaningful and supportive work can significantly contribute to positive mental health outcomes.
The empowerment of employees and successful RTW are key indicators of the effectiveness of a workers' compensation scheme. However, facilitating this process becomes particularly challenging when psychological injuries are involved. Workers who feel genuinely supported and empowered by their employer, workers’ compensation scheme, and the healthcare professionals involved in their recovery are significantly more likely to achieve sustainable RTW outcomes. We emphasise the importance of providing workers with the necessary education, resources, and support, along with simplifying the claims process, as critical components of a responsive and effective workers’ compensation system.
Further, empowering and enabling workers to identify, report, and seek assistance for workplace risks related to psychological injury is of paramount importance. Despite mental health claims increasing, there appears to be a notable reluctance among workers to report psychological injuries due to concerns about potential stigmatisation and reprisals from colleagues, managers, and/or employers.
To safeguard the mental health of workers, it is crucial that employers foster an environment where workers feel empowered to seek help early and report risks for psychological injury without fear of negative consequences.
This approach creates a non-stigmatising, reciprocal process that supports both top-down and bottom-up identification of injury risks.
Equally important is the employer’s responsibility to accurately identify and promptly address risks for psychological injury in the workplace. Effective reporting requires the early detection of potential psychological risks, yet APS members have highlighted that such signs are often overlooked.

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Additionally, participation in mental health training programs can greatly benefit individuals by enhancing their skills and knowledge while improving their overall well-being and psychological health. Such programs foster psychosocial benefits like increased social support and a sense of control, both of which are instrumental in boosting self-efficacy and self-esteem. These factors not only promote psychological well-being and prevent depression but also increase employability, thereby contributing to a more resilient and productive workforce.
Recommendation 3.
Ensure the current review focuses on systematic reform to empower injured workers through the provision of genuine support from the Comcare workers’ compensation scheme, employers and the healthcare professionals involved in their recovery.
Recommendation 4.
Incentivise employers to identify and address risks of psychological injury in the workplace and to provide mental health training for workers and managers.

Occupational and return to work assistance

RTW programs need to consider whether an injured worker is able to return to the same environment and whether this will be helpful in their recovery. If not, there may be a need to identify an alternative work location or work rotation.
Improved occupational and RTW assistance is critical for injured workers across Australia. There are generally four broad possible RTW outcomes:
• Returning to the same job with the same employer or organisation;
• Returning to a different job with the same employer or organisation;
• Returning to the same job with a different employer or organisation; and
• Returning to a different job with a different employer or organisation.

While many workers may possess the capacity to RTW, there are circumstances in which it is not feasible for them to do so within the same role or with the same employer. In such instances, access to appropriate healthcare professionals becomes essential in supporting workers' RTW and improving the effectiveness of RTW programs.
It is also imperative to review and remove any system limitations that may impede these outcomes. Additionally, there is a pressing need to design and commit to sustained RTW arrangements that foster workplace harmony.
Many APS members have observed that failed RTW attempts often stem from managerial indifference or, in some cases, near-hostility toward workers returning to the workplace.
An injured worker’s resilience can be positively impacted by psychological treatment. However, it can be negatively impacted by factors such as how the worker is managed in the workplace by their employer and how they are treated by peers (i.e., the presence of stigma). Workplace training is essential for managers to appropriately respond to psychological vulnerability in employees and the successful transition of injured workers back into the workplace.
Recommendation 5.
Improve the effectiveness of return-to-work programs by enabling enough flexibility to ensure the availability of the most effective option.
Recommendation 6.
Foster workplace harmony through legislative arrangements that support injured workers to avoid stigmatisation
(e.g., incentives for managers and employers to undertake appropriate training and/or measures to ensure prohibition of stigmatising practices in the workplace).

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Treatment interventions

Ensuring competent treatment interventions is essential for the effective management of psychological injuries in the workplace. A robust workers’ compensation scheme must proactively focus on several key areas to enhance the support provided to injured workers.
• Firstly, it is crucial to strengthen the capacity of employer wellbeing services to help workers effectively
manage reactions to workplace stressors, thereby preventing the occurrence / onset of psychological
injuries.
• Secondly, improving access to registered health providers and programs with proven expertise in addressing
the unique needs of both employers and injured workers is paramount.
• Finally, fostering collaboration between employers, employing organisations, compensation authorities, and
professional advisory bodies is necessary to address the current gaps in the uptake of evidence-based
restorative interventions and treatment.

It is critical that workers experiencing a psychological injury have access to psychological interventions delivered by expert providers. Inconsistencies in the application of best practice psychological interventions can adversely affect recovery and RTW outcomes. This highlights the critical need for system oversight to ensure that evidence- based interventions are consistently delivered, ultimately improving recovery and RTW outcomes for injured workers.
Workers' compensation schemes bear the responsibility for such oversight, and need to ensure robust evaluation, including regular review of treatment outcomes. Policies and practice need to support evidence- based treatment for psychological injuries (e.g., through assessment procedures and psychological management plans/treatment request forms). Further, Comcare need to provide incentives to encourage providers to engage in peer consultation and review. While psychologists undertake regular supervision as a requirement of their ongoing registration, we are recommending financial support to ensure this occurs within the context of the
Comcare workers’ compensation scheme. For these improvements to be effective, it is essential that employers, workers’ compensation schemes, employing organisations, and professional bodies collaborate closely in a coordinated effort to advance best practice in treatment and intervention.
Recommendation 7:
Implement measures to ensure effective, evidence-based treatment of injured workers through integrated regular review and evaluation to promote evidence-based practice.
Recommendation 8:
Provide financial incentives for peer consultation and review.

Psychological workforce challenges
The APS does not currently have access to data regarding whether there are enough psychology providers’ ability to meet the needs of injured workers within the Comcare workers’ compensation scheme. However, our members have consistently raised issues regarding a shortage of providers within compensable schemes. A key barrier for psychology providers is the low fee rate offered by compensable schemes, as compared to the fees psychologist can attract under Better Access or through clients with private health insurance.
We note that the current Comcare fees for psychologists within the scheme are $253.20 for an initial and subsequent consultation (46 to 60 minutes), which we consider appropriate in comparison to other compensable schemes in Australia. APS members (particularly more experienced psychologists, or those with additional training) have reported that they are often discouraged from participating in compensable schemes with low rates. That is, low rates pose a risk to the provision of quality psychological care and treatment to injured workers.

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A high quality and robust scheme would ensure that fees reflect the provision of gold standard psychological interventions for injured workers.

Recommendation 9:
Monitor and update fee schedules regularly and utilise legislative mechanisms to ensure fees are competitive and attract quality psychological interventions and treatment for injured workers.

Complex psychological claims
Complex psychological claims involve primary or secondary psychological injuries often linked to stress or traumatic stress. Workplace injuries become particularly complex when accompanied by a range of critical factors, such as:
1. Chronic pain directly attributable to the causal event, especially when exacerbated by inappropriate
workplace practices.
2. Delays in insurer approval of best-practice interventions for accepted conditions, including treatments
ranging from allied health services to surgical procedures; and
3. The nature of employment held by the injured worker.

Professions such as first responders, child protection workers, mental health professionals, emergency department staff, fire personnel, and various white-collar occupations are disproportionately represented in complex claims. The nature of the event leading to the injury, the worker’s perception of their employer’s support, and the prevailing organisational climate both before and after the injury also contribute to the complexity. Furthermore, misconceptions held by claims agents regarding mental health can further complicate the situation.
These characteristics can foster a profound sense of injustice, driving anger and psychological distress in injured workers. For example, injured workers may feel wronged by the event itself, questioning who is responsible for the harm and who failed to meet their needs in the aftermath of an injury they neither sought nor caused. This overwhelming sense of injustice and the need for restorative justice are particularly prevalent in vocations exposed to trauma, such as first responders. For workers’ compensation schemes to function optimally, claims must be assessed for their potential complexity from the outset. The issues raised in this submission underscore the importance of addressing key principles that are essential for effectively managing workers’ compensation claims.
Recommendation 10:
Assess workers’ compensation claims for their potential complexity from the outset with due consideration being afforded to the critical factors impacting the potential complexity of an injury.

The APS is grateful for the opportunity to participate in this important review. We acknowledge that claims related to psychological injury are becoming an increasing concern within the Comcare workers’ compensation scheme and consider this review a pivotal opportunity to shape a more effective and responsive system. We emphasise that any recommendations arising from this review will only effectively address the inherent systemic issues if they are implemented in a comprehensive manner and supported by all relevant stakeholders. The APS is keen to continuing to engage with Comcare to support future initiatives, including the development of early intervention programs, and policy and research strategies aimed at addressing gaps in knowledge, practice, and other challenges across the scheme, with the ultimate goal of better supporting injured workers in their recovery and return to work.

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