We now have clear evidence that system approaches which address modifiable psychosocial determinants of health can achieve substantial improvements in work disability and its associated costs, in the region of 20- 40%.
The biopsychosocial model of healthcare recognises that health is influenced by biological, psychological and social factors. The biopsychosocial approach acknowledges that each of these three components may present barriers to, as well as enablers of, recovery, and that there are interrelationships between the components.
In workers’ compensation, biopsychosocial influences emerge in the domains of scheme regulation, case management, the workplace and healthcare, and within individual injured workers. As examples:
- Scheme factors, such as delays and disputes, perceptions of fairness and bureaucratic processes, can result in reduced motivation and distress in an individual worker, leading to poorer recovery and delayed return to work.
- An employer’s response to injury has a notable bearing on whether someone resumes their role: the nature of workplace encounters, levels of supervisor support, workplace culture before and after the injury, and attitudes of co-workers all make a meaningful difference to wellbeing and recovery.
Individual factors such as poor or passive coping, unhelpful beliefs about pain and injury, poor recovery expectations, adverse life experiences, anxiety and mood disorders can all contribute to delayed recovery and return to work. Importantly, however, many of these biopsychosocial factors are modifiable.
A wealth of evidence suggests many scheme and workplace barriers can be lowered by modifying the way systems and workplaces interact with injured workers. Barriers arise because of unhelpful relationships, cultures, processes, and system characteristics, including in systems intended to help.
Workers with personal psychosocial barriers to recovery can benefit from individually focused interventions, such as programs designed to improve self-efficacy. Support for individuals can assist them to identify and deal with their own barriers to recovery. Workers asked about biopsychosocial factors, and supported to address these factors, express satisfaction with the care they receive and have reduced work disability.
To ensure a biopsychosocial approach is effectively implemented, there is a need to:
- ensure scheme cultures, systems and processes do not create unnecessary barriers to recovery, but instead encourage positive psychosocial factors (those known to assist recovery and RTW) whilst reducing negative psychosocial factors (those known to slow recovery and RTW).
- systematically capture psychosocial information for individual claims and proactively manage psychosocial risk by providing claimants, workplaces and healthcare practitioners with timely support according to need.