OPINION | Superannuation funds, group insurers, case managers, employers and treating practitioners need to come together to share expertise and information, working collectively to ensure that those on claim receive the best result possible.

During 23 years in the United Kingdom Armed Forces I was deployed, as a psychiatrist and researcher, to a number of hostile environments including Afghanistan and Iraq. Throughout my career, as both practitioner and academic, I have seen time and again the benefits that flow from collective effort to increase the focus on prevention and early intervention.

In June 2017, I took on a new role working with life insurance specialist TAL and its partners, such as First State Super and the NSW Police Force. The experience of supporting these organisations in their efforts to drive best practice management of traumatic stress has given me a tremendous insight into how improvements can be made across the insurance and health landscape in Australia.

Seeking help early always results in less severe and more manageable difficulties for those suffering from traumatic stress disorders. That’s why my first recommendation will always be that employers – especially trauma-exposed organisations such as the emergency services or medical institutions – implement programs to foster the prevention and early detection of traumatic stress.

In the UK, many emergency services organisations make use of TRiM (Trauma Risk Management), a highly researched and structured peer support system that proactively checks on the mental health of trauma-exposed employees and ensures that those in need of professional care get it. In my experience, many opportunities for successful early intervention in a claim are missed because programs like TRiM are not in place.

Of course, this is not always the case.

Some trauma-related mental disorders may develop insidiously over long periods of time and can therefore be challenging to identify early on. As such, case managers should be armed to help those suffering from traumatic stress-related illnesses as best they can.

Best practice

For someone on claim to get the best result possible, strong communication skills are needed to ensure effective co-ordination across the different organisations involved. The treating doctor, insurer and employer must all work together. By sharing resources, information and expertise, they will be better equipped to explore all the options available to the person on claim.

Case managers should also be on top of best practice treatment and reflect it in their dealings with those suffering traumatic stress. For instance, referring sufferers to multiple specialists for disability assessments is usually counter-productive unless there is a clear need to do so. And should it become clear that someone is not going to return to work quickly – generally recommended as soon as possible – case managers should be able to identify which healthcare providers adhere to established treatment guidelines. Off piste initial treatment of post traumatic stress disorder (PTSD) is to be avoided.

Australia has excellent PTSD treatment guidelines produced by Phoenix Australia (the Centre for Posttraumatic Mental Health). Unfortunately, in my experience, not all healthcare professionals make use of them.

Despite the wealth of evidence about effective treatment, some healthcare providers overly rely on medication and fail to use evidence-based psychological interventions – in particular, trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) – which have proven to improve the health of people  with PTSD. Case managers can play an important role for those on claim by encouraging consultation with practitioners who make extensive use of these guidelines.

Reducing stigma

The benefits of such an approach may take a long time to flow through but the effort is certainly worthwhile – not only
for people on claim, but for society as a whole. Every person who returns to work or recovers after suffering from a traumatic stress-related illness will change the attitudes of those around them and help to reduce the stigma of poor mental health.

We are a long way from achieving parity of esteem – where depression and PTSD are afforded the same day-to-day professionalism and quality of care as broken limbs – but the more we become accustomed to dealing successfully with mental illness, the closer we get.

Professor Neil Greenberg (BM, BSc, MMedSc, FHEA, MFMLM, DOccMed, MInstLM, MEWI, MFFLM, MD, FRCPsych) is an academic psychiatrist based at King’s College, London, UK.

If you work in the group insurance sector and would like to learn more about emerging best practice consider attending the upcoming Conexus Financial Group Insurance Summit, of which TAL Australia is a platinum sponsor. For more information about the event, to be held in Sydney on August 29, visit the website or contact Emma Brodie via emma.brodie@conexusfinancial.com.au or +61 2 9227 5708. 

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