Right intervention at the right

time: working with complexity,

mental health and disability in
Victorian compensation settings
Karen Sait, Health & Disability Strategy Group
4th Australasian Compensation Health Research
Forum
19 November 2014

Focus of presentation
1. Victorian compensation schemes the Transport
Accident commission (TAC), and the Victorian
Workcover Authority (VWA)
2. Complexity, mental health and disability
3. Strategy and implementation
4. Sharing learnings
5. Next steps

Systems approach
We know from national surveys that the public
consistently rate mental health as one of the top
priorities they want governments to tackle. The
work of beyondblue, SANE, Mental Health
Australia and others has ensured that mental
illness is now out of the shadows. Everyone knows
that mental ill health will affect us all one day
Professor Patrick McGorry, Executive Director Melbourne
Universitys Orygen Youth Health Research Centre

Compensation = Complexity
Research shows poorer overall outcomes of
individuals who have a compensation claim:
Barriers to treatment and recovery outcomes
due to pressures and uncertainty regarding
claim acceptance
Often compounded for those with mental health,
pain, other issues ongoing disability and
dependence

Compensation Definitions
1. Primary mental injury (no physical injury) - post
traumatic stress, nervous shock/stress (with or without
proximity to the accident or injury), adjustment disorder,
stress and related anxiety, depression
2. Secondary mental injury consequence of physical
injury and often related to pain anxiety, depression
3. Persistent Pain - constant daily pain for a period of 3
months or more- may lead to secondary mental injury
due to delay in identification/treatment; and requires
different yet complementary treatments
4. TBI/ABI (traumatic/acquired brain injury) may
have pre-existing mental health and/or other issues

The TAC and the VWA

1. No fault schemes underpinned by legislation:
Transport Accident Act 1986 legislation
Workplace Injury Rehabilitation and Compensation Act 2013 (plus
safety legislation)

2. Similar health and disability issues and shared

providers
3. Committed to efficiency and collaboration regarding
expertise, capability and resources
4. Continually strive for outcomes for injured workers
and clients through innovation and adaptation

Transport Accident Commission

Recovery and Independence
Branches. Annually:
~19,000+ new claims

Compulsory transport related personal injury

insurance

~45,000 people supported with

services and benefits

Owned by Victorian Government with

independent Board and ~800 staff.
Headquarters Geelong. Key areas:

~Road trauma estimated to cost

more than $4 billion

1. Prevention: promote road safety and

reduce accidents

Independence - 3% of new claims

and 70% of outstanding liabilities

2. Response: internal claims management treatment and benefits for people injured
in transport accidents

Victorian Workcover Authority

Primary role of regulator ~270,000
workplaces in Victoria
~3 million workers covered
~30,000 claims each year
~90% of claims musculoskeletal
~Payouts of about $1.5 billion

Owned by Victorian Government with

independent Board and ~1000 staff.
Headquarters Melbourne. Self-funded from
employer premiums. Key areas:
1. Enforcement: prevent workplace injuries
2. Prevention: OH&S and reduce injuries
3. Response: claims management by five
Agents Allianz, CGU, QBE, Gallagher
Bassett and Xchanging plus TAC for
those with catastrophic injuries

Health & Disability Strategy

Group (HDSG)
Shared TAC and VWA
service to meet corporate
objectives of both:
client outcomes;
client experience; and
scheme viability

Collaboration and partnerships:

internally and with health and disability
sectors to develop and implement new
models and strategies

Outcomes focussed:
rehabilitation and support at
reasonable and sustainable
costs - focused on return to
work, health and independence:
life back on track

Evidence and research:

internal and external health
and disability data, research,
trends, and client and
provider evaluations

Emerging Scheme Issues

Mental injury claims up from 36% to 80% ~7 years; 1
in 3 clients with physical injury and 4 of 5 pain claims
secondary
Referral post injury 12 months (median of 7 months);
more females (54%) than males (46%) and ~25% by
30 49 years
TAC clients <30% impairment who also claim some
mental injury benefits:
cost on average double their peers
3 times more likely to claim income post 12 weeks
10 times more likely to claim income for full 3 years

Snapshot Scheme Experience:

overlap of return to work, mental health, pain
(TAC Recovery Branch 2012/13)
Recovery

Ave cost per

claim per year

No
Complexities
$9K

% of claims

RTW

$79K
3%
$32K

Total ave
no. of claims
per year

$151K
2%

$36K
2%

$77K
1%

$54M

270

2%

Persistent
Pain

No
Complexities
$41M

RTW

$22M

$81K

3%

Mental
Health

54%

32%

$20K

Recovery

Total ave
cost per year

$8M

$17M
$26M
175

260

Mental
Health

4,600

2,800

210
$7M
180

$7M
85

Persistent
Pain

Service provision alarms

In 2009 our journey began:
Clients not satisfied with available options; and providers
unclear re their roles
We were:
1. Focused on outputs rather than outcomes
2. Had low expectations: return to work, health,
independence
3. Using biomedical rather than psychosocial and
interdisciplinary models - outreach and flexible services
not utilised
4. Not leveraging off contemporary public sector
5. Locked into a fee for service that often disincentivised
discharge and created dependency

Research and listening

External advisory think tank of experts
Foundation piece Mental Health Framework
Researched best practice mental health, pain,
disability and complexity models and options
Reviewed internal processes, tools, staff
capability and most importantly communicated,
consulted, and reviewed
Endorsed joint Board TAC/VWA Strategy
2010/2011
Commenced implementation in 2011/2012

Mental Health Strategy

3 5 Years
Vision: TAC clients and injured workers with mental injuries or at risk, have
access to the right intervention at the right time to enable
return to work, health and independence

Claims capability

Client capability

Provider capability

Intervention
options

Improve staff
capability to manage
mental injury and
pain claims, with a
focus on identifying
clients at risk earlier,
and integrating with
claims management
processes

Empower clients to
take control of their
journey through
facilitating awareness
and self-management

Develop the
capability of
providers to
effectively work with
TAC clients and
injured workers

Expand the range of

evidence-based
services available to
clients based on a
stepped care
approach

Enablers: Research/Partnerships/Data
Mental Health Framework

Key initiatives
Achievements to date
Claims
capability
Client
capability

Provider
capability

New
Intervention
options

Information, resources, training and tools

Model of stepped interventions
Screening process based on current TAC Longitudinal Study
Purpose designed service catalogue

Information sheets and links to national e-therapy services

Provider capability framework
New partnerships for example community managed mental
health sector
Disability Service Reform Working Group and Primary Care
Advisory Group

Psychosocial outreach services

Intensive outreach Services
Peer support
Partnership with Austin Health re PTSD program

Psychosocial outreach support

Community managed mental health sector is a valued
component of a modern system based on recovery
principles, care coordination and community connections
Implemented within TAC early 2014 - 36 referrals to date
Example of a client outcome:
Prior to receiving outreach services unable to use public transport or
attend community activities due to anxiety and panic attacks post
transport accident. After engagement with the local outreach service,
this client now has strategies to deal with her anxiety and has overcome
her fear of using public transport. She has reconnected with family,
friends and attending health appointments and community activities
independently.

Screening process
Research also indicates early intervention leads to better outcomes.
The screening process draws on research from the TAC Longitudinal
Study and is a two-stage process for new clients:
Initial screen identifies clients most likely in need of assistance and
screens out about 60% of clients (0-3 months post-accident)
Second screen validates the first screen for remaining 40% and
provides a pathway to the most appropriate services and actions (3-5
months post-accident)
Initial
Screen

Client risk of mental health or pain issues

Low 60%

Med 20%

High 20%

(at the first call)

Second
Screen

Low ~8% / Med ~12% / High ~12% / Severe ~8%

(~3 months post

accident)

Information /
Supports

Range of treatment, referral, support

options

Return on Investment
Undertaken significant work that demonstrates
early and positive outcomes:
1. Improved scheme viability
2. Potential common law benefits
3. Contribution to improved client outcomes
4. Improved client experience

Key Learnings
Positives of note

Lessons to note

1. Paradigm shift for clients and providers

2. Claims capability and new intervention
options positively impacted staff
3. Gave rise to champions at all levels
4. New data set on mental injury and pain
5. Screening process and new support
options to better meet client needs
6. Potential to reduce common law due to
earlier identification of claims at risk
7. Screening process may inform and
influence NDIA models for clients with
psychosocial needs and/or psychiatric
disability

1. Compensation system is not a health

system competing demands
2. Collaboration is challenging - find ways
to work and complement strengths
3. Earlier focus on change management
4. Amount of resources and input required
5. Priorities shift and staff moveremain
optimistic and constantly communicate
6. Screening tool is only a tool - capability
of claims managers is critical
7. Screening may identify increase in
numbers of clients at risk and initially
increase liability costs - need to be
upfront
8. MOST IMPORTANTLY there are many
benefits in shifting from a model of
compliance to a culture of care and
trust with assurance

Next Steps
1. Embed, evaluate and refine the screening process
2. Implement psychosocial outreach and e-therapy
within VWA and develop targeted approaches
3. Expand client self-management
4. Collaborate with GPs on pain and mental health
issues for compensable clients and link to our
other initiatives for example, the health benefits
of safe work
5. Review high risk pharmaceutical use
6. Standardise multi-disciplinary pain services
7. Continue to develop new partnerships and
models for compensable clients

Further Information
Victorian WorkCover Authority (VWA)
vwa.vic.gov.au
Phone: 1800 136 089
Transport Accident Commission (TAC)
tac.vic.gov.au
Phone: 1300 654 329
Provider Feedback
Hdsg_provider_support@tac.vic.gov.au