Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697643057580.pdf (Australia)
The Australian Society of Rehabilitation Counsellors Ltd (ASORC) Submission to The Senate Education and Employment References Committee into The role of Commonwealth, State and Territory Governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers June 2018 Committee Secretary Senate Education and Employment Committees PO Box 6100 Parliament House Canberra ACT 2600 Emailed to: eec.sen@aph.gov.au PO Box H189 Hurlstone Park NSW 2193 Telephone: 1800 643 155 E-mail: admin@asorc.org.au www.asorc.org.au ABN 81 442 528 153 ACN 616 971 138 The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 36 Table of Contents Executive Summary ...................................................................................................................... 3 Introduction ................................................................................................................................... 4 Terms of Reference A: The nature and underlying causes of mental health conditions experienced by first responders, emergency service workers and volunteers; ................................................... 5 Terms of Reference B: Research identifying linkages between first responder and emergency service occupations, and the incidence of mental health conditions; ............................................. 5 Terms of Reference C: Management of mental health conditions in first responder and emergency services organisations, factors that may impede adequate management of mental health within the workplace and opportunities for improvement ............................................................................... 5 Terms of Reference D: Any other related matters ......................................................................... 9 Bibliography/References ............................................................................................................. 10 ASORC Submission to The Senate Education and Employment Committees – into the role of Commonwealth, State and Territory Governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers June 2018 2 The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 36 Executive Summary ASORC supports the current inquiry into the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers.
We welcome and support the goal of preventing, minimising and assisting the recovery of people contributing to our community as first responders.

Mental health is mutli-faceted and complex, especially when the condition arises out of exposure to traumatic experience within the workplace.

Prevention and risk mitigation, coupled with early, appropriate response and support can positively impact long-term outcomes for people.
Every step, from early onset of symptoms, through any claims determination process, to recovery and return to work, elicits layers of complexity.

Therefore, it is critical that those navigating Return to Work processes, fully understand these issues.

Rehabilitation Counsellors are often best placed for this critical role, with competencies and skills to interpret psychological function and how this articulates to duties at work.

In addition, they are competent educators on mental health.
Rehabilitation Counsellors can help explain the rationale for workplace modifications, without the confidentiality conflicts that other health practitioners (e.g.

General Practitioners) may perceive.

We strongly advocate for nomination of Rehabilitation Counsellors in return to work roles for front line responders, particularly those with mental health concerns.
In this submission we have addressed Terms of Reference C (parts ii, iii and iv), we have not addressed Terms of Reference A, B and D. ASORC Submission to The Senate Education and Employment Committees – into the role of Commonwealth, State and Territory Governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers June 2018 3 The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 36 Introduction The Australian Society of Rehabilitation Counsellors Ltd (ASORC) thanks the Education and Employment References Committee for its inquiry into the mental health of first responders.
Below is an overview of ASORC’s role, structure and focus to provide the review team with context.

ASORC is the peak professional body representing rehabilitation counsellors throughout Australasia.

Established in 1976, ASORC is a non-party political, non-sectarian and not for profit organisation.

ASORC’s mission is to promote the profession of rehabilitation counselling and to foster the professional capability of members.
ASORC provides:  A long standing and respected voice for the profession (over 40 years since inception);  Resources, education, mentoring and supervision necessary for members to achieve career advancement and enhanced credibility in the profession and in the community;  A robust set of core competencies and code of ethics;  Access to latest research and academic commentary through the ASORC ® Journal (AJRC);  Access to a network of similarly skilled and minded professionals across Australia.
Rehabilitation Counsellors are Allied Health Professionals who work within a counselling and case management framework to assist people who are experiencing disability, a health condition or social disadvantage to participate in employment or education, or to live independently and access services in the community.

It is important to note that the occupation of Rehabilitation Counsellors should not be confused with Rehabilitation Consultants.
Rehabilitation Counsellors belong to the specific allied health profession of Rehabilitation Counselling, whilst Rehabilitation Consultant is a generic title that covers a range of professionals and non-professionals.

Rehabilitation Counselling is an independent allied health profession that has been recognised in Australia since the mid-1970s and internationally since the 1950s.
University courses in Rehabilitation Counselling commenced at Sydney University in 1974 and are now delivered at multiple universities across Australia.

The Heads of Worker’s Compensation Authorities (HWCA), to which the majority of Worker’s Compensation schemes in Australia and New Zealand are bound, lists ten health and allied health professions that meet the requirements for delivering return-to-work services.

One of these is the profession of Rehabilitation Counselling.
Rehabilitation Counsellors:  belong to a professional body – ASORC being the peak professional body  have fulfilled specific tertiary academic requirements,  possess well defined professional competencies  are qualified to deliver a wide range of services to support individuals to achieve the health benefits of good work across a wide range of sectors, including personal injury schemes, the NDIS, long-time unemployed, individuals with cancer and other debilitating illnesses, people with hearing loss and refugees.
 are bound by a specific Code of Ethics.
In this submission we have addressed Terms of Reference C (parts ii,iii and iv), we have not addressed Terms of Reference A, B and D. ASORC Submission to The Senate Education and Employment Committees – into the role of Commonwealth, State and Territory Governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers June 2018 4 The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 36 Terms of Reference A: The nature and underlying causes of mental health conditions experienced by first responders, emergency service workers and volunteers; No comment Terms of Reference B: Research identifying linkages between first responder and emergency service occupations, and the incidence of mental health conditions; No comment Terms of Reference C: Management of mental health conditions in first responder and emergency services organisations, factors that may impede adequate management of mental health within the workplace and opportunities for improvement Including: i) reporting of mental health conditions No comment ii) specialised occupational mental health support and treatment services In conjunction with comments related to Terms of Reference C, part V noted below, we would advocate for the use of expertise of Rehabilitation Counsellors to specifically support the following guidelines published in the Expert Guidelines: Diagnosis and treatment of post-traumatic stress disorder in Emergency service workers.
Specifically, Rehabilitation Counsellors can support the expert guideline goals in relation to:  Guideline 18 – Development of an agreed set of treatment goals, prior to the commencement of treatment which is inclusive of consideration of occupational recovery.

 Guideline 19 – Assessment, monitoring and review and onward referral for treatment where appropriate.
 Guideline 40 – Ensuring occupational recovery is considered from the beginning of treatment with options including, remaining at, or returning to work with work capacity being an aim of treatment.

 Guideline 41 – Focusing rehabilitation on the expectation that most emergency workers (with PTSD) can benefit from appropriate treatment which may include the extended use of modified duties to lessen the risk of recurrence or intensification of subsyndromal symptoms.
 Guideline 42 – Assisting employers to maintain regular supportive contact with an emergency worker who is away from work due to PTSD.

Regular, supportive contact is important during all stages of an episode of sickness absence.

 Guideline 43 – Applying an integrated approach to return to work / recovery programs, with regular supportive contact between the worker, the workplace and the treating clinicians.
 Guideline 44 – Promoting, where suitable, modified duties and/or partial return to work to aid recovery and reducing the risk of long-term sickness absence.

 Guideline 45 & 50 – Develop, plan and obtaining agreement for meaningful, non- stigmatizing return to work programs in consultation with the worker, treating clinicians and the relevant occupational health / rehabilitation coordinator.
5 ASORC Submission to The Senate Education and Employment Committees – into the role of Commonwealth, State and Territory Governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers June 2018 The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 36  Guideline 46 & 52 – Provide a central, knowledgeable and informed individual to liaise with the worker, employer and treatment providers to promote and help plan, monitor and review recovery and rehabilitation.
 Guideline 47 - Provide work-focused interventions, such as work-focused exposure therapy, in addition to standard symptom-focused treatment.

 Guideline 48 – Support psychological therapies in relation to direct work-related triggers and work-specific anxieties as part of any graded exposure treatment.

 Guideline 49 – Identify and plan strategies to manage barriers preventing return to work and recovery.
 Guideline 51 – Assess workplace duties with regards to functional capacity in line with medical certification.

 Guideline 53 – Ensure prior to permanent cessation of employment, employers have considered trials of evidence-based treatments, return to work programs and alternate options within the employing organisation in line with hierarchy of options.

Including, redeployment rehabilitation services for workers who are unable to continue with their pre-injury / illness employment.
iii) workers’ compensation Please refer to comments above in (ii) which would apply to the workers compensation process.

iv) workplace culture and management practices No comment v) occupational function and return-to-work arrangements Rehabilitation Counsellors are specialist allied health professionals within the areas of occupational function and return to work arrangements.
Rehabilitation Counsellors work both preventatively and reactively within the context of workplace injury, illness and disability; however, a majority of our work is focused within the context of return-to -work (RTW) arrangements and as a such, the focus of our response will relate to reactive management.

Factors likely to impede occupational function and RTW arrangements in relation to mental health conditions within the workplace are complex.
More so in workplaces where the very nature of the work is intrinsically multifaceted.

Ultimately, the management of mental health within the workplace needs to be made on a case by case decision, with the knowledge that for first responders, extended leave of absence reduces the likelihood of successful return to work (Mazza, 2018; Good practice framework for mental health and wellbeing in first responder organisations, Heads Up).
There are numerous factors which may impede adequate management and recovery of mental health conditions in the workplace.

These may include: Medical/ Treatment  Ineffective treatment modalities/ approaches for the individual patient;  Failure to identify and address early indicators of mental health decline;  Presence of comorbidities, which complicate the recovery and/ or higher severity of condition(s);  Unintentional reinforcing messages that work is dangerous, e.g.
prolonged certification of incapacity;  Quality and consistency in approach of medical treatment (i.e.
where there are multiple medical professionals, multiple diagnoses and various modalities of treatments recommended);  Limits of confidentiality with medical practitioners and perceptions of a limited ability to liaise with employers for the purpose of RTW success; 6 ASORC Submission to The Senate Education and Employment Committees – into the role of Commonwealth, State and Territory Governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers June 2018 The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 36  Quality and consistency of allied health treatment services (e.g.
Psychologist, Social Worker, Rehabilitation Counsellor);  Limited funding for often long-term treatment recommendations, and  Slow, more gradual recovery progress than anticipated.
Workplace  Poor supervisor support, behaviour and leadership;  Time in service (cumulative stressors (Haugen et al., 2012));  Perceived injustice including; o a sense of having had to endure any precipitating issues for long periods of time before being addressed or accepted; feeling as if there has been no adverse consequences where blame is assigned; feeling that people do not believe them; feeling as though they have to prove that they are psychologically unwell, and o o o o any protracted claims handling processes.
 Poor workplace culture including; o poor acceptance / knowledge of mental health conditions (Pomaki, et al., 2010); o poor workplace social support; o poor systems to assist with return to work, and o inter-relational difficulties.
 General job / organisational stressors including poor job design and type of intensity of critical incident stressors (Haugen et al., 2012);  Lack of suitable alternate duties;  Failure of occupational bonding, this refers to the bond between workers, employers and employment systems (Shrey, 1997);  Failure to return to work;  Diminished trust and failure to address this in treatment;  Inadequate RTW assessment, planning, preparation and monitoring, resulting in initial RTW failure.
Health Behaviours  Poor adherence to pharmacological or other treatments;  Poor Sleep hygiene;  Reliance on maladaptive coping strategies.

Patient/ Personal Factors  Ambivalence;  Personal /previous experiences or triggers;  Expectations of others;  Feeling that their emotions have been devalued;  Low self-efficacy;   Stressful life factors outside of work;  Fear of unemployment, and  External Locus of control.
Increased financial concerns; Opportunities for improvement We suggest that return to work occurs as soon as practicable whilst acknowledging that this must occur with a balance of symptom management and avoiding reinforcement of the belief that work is bad for the patient and should be avoided.

This is supported in the good practice framework for mental health and wellbeing in first responder organisations developed by Beyond Blue and Heads Up.
ASORC Submission to The Senate Education and Employment Committees – into the role of Commonwealth, State and Territory Governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers June 2018 7 The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 36 There is a growing body of literature confirming the health benefits of good work and the benefits of engaging in disability prevention (The Royal Australasian College of Physicians and the Australasian Faculty of Occupational and Environmental Medicine, 2013; American College of Occupational and Environmental Medicine, 2006).
Preventative education and ensuring that workers’ adequately understand any mental health diagnosis are essential elements in managing mental health concerns in a workplace.

We support this but would like to add that there should be adequate psychoeducation, in terms of recovery and the importance of maintaining activities of daily living, including work.
If we consider the common mental health condition anxiety, which often forms part of a diagnosis when a mental health condition arises out of a workplace injury, (either as part of the primary diagnosis or as a comorbidity), many psychological treatment approaches or management tools are directed towards graded exposure/ or developing strategies to help manage the physiological manifestation which occur with anxiety.
Some commonly prescribed psychological treatments are aimed at removing the threat value of stimuli and discourage avoidance.

In the case of first responders, it can be difficult to gradually expose a worker to their pre-illness role and as such, many workers with diagnosed mental health concerns remain absent from the workforce to ‘recover’ and remove the triggering stimulus.
However, extended periods of time away from work may inadvertently confirm the belief that work is dangerous and should be avoided by the patient.

The longer the period of incapacity the more difficult it can be to challenge this belief.

Therefore, we suggest that it is imperative that goal-oriented therapies be employed by clinicians in order to prevent long term disability and worklessness.
Much like medical practitioners educate their patients as to their diagnosis, we believe that this education should extend to patient’s recovery for all activities, including returning to work in a timely and safe manner.
A qualified Rehabilitation Counsellor (see https://www.asorc.org.au/aboutus/rehab-counsellors- and-rehab-consultants) assisting in return to work (RTW) arrangements should be utilised where necessary to assist the worker, workplace and treating health practitioners with:  psychoeducation, in terms of recovery and the importance of maintaining activities of daily living, including work;  supporting adherence to medical and other recommended treatment regimens;  identification of suitable duties preferably within the pre-injury employer (Pomaki, et al., 2010); return to work, and where this is not possible initially, arranging suitable work placement for the purpose of: o Graded exposure to work relationships / situations o Opportunities to practice treatment management techniques  Note: This strategy should be monitored closely and return to pre-injury employment should be implemented as soon as practicable (i.e.
ensuring that it is safe, durable and sustainable);  assisting the worker with helpful ‘patient centred’ strategies to manage return to work obstacles, as required;  education for employers, as necessary, on what is required from them;  management of relationships between the stakeholders;  assistance with complex communications, as required, and  acknowledge the unique nature of the work first responders undertake as part of any recovery process.
Currently, in various states within Australia, return to work coordinators may undertake this type of role, however, the quality of services provided vary according to the qualification and skills of the person managing the RTW process.

For example, in some states in Australia, employers are required to have a trained return to work coordinator as a representative of the employer.

This involves completing training consisting of between 2- 9 days.
ASORC Submission to The Senate Education and Employment Committees – into the role of Commonwealth, State and Territory Governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers June 2018 8 The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 36 Whereas, we believe that an allied health trained return to work professional is required for the complexity of work related to first responders.
These professionals are usually referred to as a Workplace Rehabilitation Provider (WRP, see the Nationally Consistent Approval Framework for Workplace Rehabilitation Providers for more information) Shaw et al.

(2008) make it clear that RTW professionals should be appropriately trained in line with 6 core competencies of RTW.
These core competencies and skills are consistent with the skills and competencies of ASORC qualified Rehabilitation Counsellors (https://www.asorc.org.au/resources/asorc-core- competencies).

We strongly believe that the intrinsic value proposition that Rehabilitation Counsellors offer is their underpinning competencies in behavioural science and ability to apply a biopsychosocial approach to return to work.
As such, Rehabilitation Counsellors are ideally-suited to working within a mental health context and with first responders.
Intrinsically, Rehabilitation Counsellors understand the principles underpinning injury management including:  Early intervention;  Occupational bonding;  Person centred;  Respect and dignity;  Comprehensive and coordinated services;  Understanding the personal impact of injury and disability;  Trying to reduce adversarial issues;  Goal oriented rehabilitation services;  Mediation – if appropriate;  Engagement of the stakeholders.
(American College of Occupational and Environmental Medicine, 2006; Attridge & Wallace, 2010; Australian Human Rights Commission, 2018; Nicholas, 2017; Pomaki, et al., 2010; Shaw, Hong, Pransky, & Loisel, 2008; Shrey , 1997; Sullivan, Scott, & Trost, 2012; The Heads of Workers' Compensation Authorities, 2018).
vi) collaboration between first responder and emergency services organisations No comment vii) post-retirement mental health support services, and No comment viii) resource allocation No comment Terms of Reference D: Any other related matters No comment ASORC Submission to The Senate Education and Employment Committees – into the role of Commonwealth, State and Territory Governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers June 2018 9 The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 36 Bibliography/References American College of Occupational and Environmental Medicine.
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Retrieved from https://blackdoginstitute.org.au/docs/default- source/research/expert-guidelines---diagnosis-and-treatment-of-post-traumatic-stress-disorder- in-emergency-service-workers.pdf Good Practice Framework for Mental Health and Wellbeing in First Responder Organisations.

Retireved form https://www.headsup.org.au/healthy-workplaces/for-police-and- emergency-services Haugen, P. T., Evces, M., & Weiss, D. s. (2012) Treating posttraumatic stress disroder in first responders: A systematic review.
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ASORC Submission to The Senate Education and Employment Committees – into the role of Commonwealth, State and Territory Governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers June 2018 10 The high rates of mental health conditions experienced by first responders, emergency service workers and volunteersSubmission 36