November 21, 2024 • 28 mins
Stigma can play a large part in increasing the suffering of an injured or sick person. Often they feel like they are being judged, or letting the side down, and when they do return to work, will they be treated the same way.
In this episode Dr Caroline Howe speaks to Libi Stone - Occupational Rehabilitation Leader and Senior Rehabilitation Consultant - in a wide ranging conversation encompassing stigma, the role of anxiety, how the medical heirarchy and Case Managers help (and sometimes don't) in Workers Compensation, plus how to combat stigma, regain your confidence and see through to the other side.
They are joined by members of the My Social Support Network who share their experiences with stigma.
See omnystudio.com/listener for privacy information.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
S1 (00:01):
Hello and welcome to the My Social Support Network podcast,
a series to guide you along the path to recovery
while on workers compensation. In this series, we will answer
questions from you and provide information from experts and people
with lived experience currently going through worker's compensation and those
who have made their way to the other side. Through
these interactions, we'll be giving you tools, advice, but most importantly,
(00:24):
encouragement on what can be a stressful time when you're
also recovering from an injury sustained in your workplace.
S2 (00:30):
Often, stigma lives inside our head, so if you're prone
to anxiety or if you suffer from anxiety, the experience
and the thought about what you're going to experience are
often very different.
S3 (00:40):
Today we have the beautiful opportunity to talk to Libby Stone.
She's a senior rehab consultant. She has worked in injury management,
returned to work and vocational rehab. We're going to talk
to Libby today about how someone with an injury could
really try and think differently about the stigma of having
an injury and most importantly, for an employer out there,
all of the incredible opportunities in taking on someone with
(01:04):
an injury, because there are so few things that you
really need to be scared of because we're all working
together to get people back to work. Libby, thank you
so much for coming on to my Social Support Network
podcast today. I'm very excited to be able to have
this discussion with you. And one of the things that
I really wanted to be able to talk to you about,
and I know that it is such an important topic
for people with an injury, is the whole idea of stigma.
(01:28):
What's so interesting is that if I look back over time,
if I'm looking at gender inequality or sexual orientation, there
are lots of other big areas in life where we
have now been able to transcend a level of stigma.
And yet when we look at worker's compensation, that level
of stigma is static.
S2 (01:48):
Yes. That's true. Caroline. That's really true. Actually, it's interesting
you say that. I wonder where that comes from. I
guess you have to think about who the drivers are
and who's talking about worse compensation and all of that
kind of stuff. And we as health professionals working in
the area, we think about that. Then on the flip side,
you have this very commercial space that sits alongside of
(02:10):
what we do, and I wonder if that voice is louder.
S3 (02:12):
Stigma is a set of negative and unfair beliefs that
a society or group of people have about something. So
when we're talking about, I feel that they have stigmatized me.
I can't assume that I'm being stigmatized by other people.
(02:34):
That's probably an automatic thought that I'm having, which may
or may not be true. And I'm hazarding a bit
of a guess that that then falls into the bullying
and harassment and a different thing. It's not necessarily stigma,
but it actually falls into a part of policy that
is also not right. But there's an employer fear, what
(02:54):
am I going to do? How do I talk to
that person and coming back? They've got a psychological injury.
How do I not break them? How did I break them?
There's that component. But then you've actually got the scheme
and the case managers. And most of the time, if
I have a look, we have an average age of
our injured worker is around 50 years old. Yep. The
average age of a case manager is 10 to 15
(03:17):
years younger, 20 years younger than that. And there is
this stigma from the case managers as well. So I'm
a case manager having to now work with the person
who I've now put into a box.
S2 (03:29):
And I mean, and I guess also the turnover in
those larger organisations. And I think at one stage a
couple of years ago, one of the larger agents had
more than 50% of their whole staff working as case
managers with less than two years experience. So you've got
the old dogs, new tricks to the to the younger guys,
but they're turning over really quickly, so you're losing that
(03:52):
knowledge hand over fist.
S3 (03:54):
In your opinion, is stigma related to anxiety?
S2 (03:59):
Yes. Often stigma lives inside our head because you might
walk out the door and think that person is looking
at me because I've got blonde hair and they've got
a certain perception of what that means for you as
a person, but do they really think that? I'm not
really sure. So if you're prone to anxiety or if
you suffer from anxiety, those social conventions that you may
(04:21):
know of, um, or that you've seen or you've experienced
can certainly play on that anxiety and make it much
worse for you, because we don't know what's in other
people's heads. The experience and the thought about what you're
going to experience are often very different.
S3 (04:37):
How do we then go about managing those experiences of
stigma inside the person with the injury first?
S2 (04:47):
That's a good question. I think the most important thing
is to gain an understanding of what their feelings are
about the situation they're in. So one of the things
that I find and have found over my career is
that going in and jumping into an assessment, for example,
because the insurer said so isn't always a very positive
(05:08):
experience for anybody. And I think providing some clarity and
context around why you're doing what you're doing and then
allowing your client to express what their concerns are really
gives you a sense of how they're feeling about their
position in the system itself, because that's what's important. You know,
(05:31):
do they feel like they have control? You know, is
that important to them, or do they just want someone
to tell them what to do and how to get
through this? You have to really have a really strong
understanding of what their perception of other people's perception of
them is.
S3 (05:45):
How do you then manage that stigma for employers? Because
you can have someone who is now able to manage
and now the employer.
S2 (05:54):
Employers can be very warm and fuzzy and that's really lovely.
But the reality is there is a commercial component to
managing a return to work that we cannot ignore as
a health professional. It's not a natural place for us
to sit. I think there's very few of us that
are comfortable with that, because that's really a driver for
particularly small business owners. And the cost of doing business
(06:16):
sometimes is managing these types of return to work. So
there's a lot of fear with employers. A lot of
the time, and I'm talking your small to medium here,
I'm not talking big business because I think that that
that sort of fits into its own category. But in
terms of managing employers expectations and allaying their fears, it's
about providing something in the currency that they understand. I
(06:39):
find one of the things that's really helpful is to
make sure that they're aware that this their person or
the injured person that we're putting into their Organization is
medically signed off to go ahead and do that job
because doctors, whether we like it or not, have a
lot of sway. And what they say really means something
to people. And if you can go in with all
(07:01):
the right medical information and explain that this is the
situation and also give them some support in terms of, okay,
we can we can call you Libby if something goes
wrong and they know that they're supported, it's going to
help ease the way through that. But we do have
to rely on the white coat factor. It's just a
factor of life. One of the things that I always
say to my clients when I first meet them is that,
(07:22):
you know, we're here to talk about your options in
terms of your return to work. If you're a painter
and you want to go back to work as a
brain surgeon, I can't help you. And then that leads
me into the conversation around the return to work hierarchy.
So really, what that looks like is that the legislation
is written to kind of make your return to work, um,
(07:43):
a process whereby you're grabbing onto the lowest hanging fruit.
So their first point of call is to return to
your same job with your same employer. Right. If that
doesn't work out for whatever reason, whether the job is
no longer there or as an injured person, you can't
go back and do the functional requirements of that work,
then so be it. The next part of the hierarchy
(08:03):
is same employer, similar job, right. So something similar. You
might be working at the front desk. And for whatever
reason you've had an injury that precludes you from working
with the public. They might find you a spot in
the in the back office. Same with that same vein.
The next step on the hierarchy is same employer, different job.
(08:24):
So that's pretty self-explanatory, right? The next part of the
hierarchy is different. It's when we change from what we
would call the industry from the same employer services to
the new employer services.
S3 (08:35):
And this is where the doctor is really important because
the doctor up until this point, and I think this
is good for doctors because they often don't do worker's
comp as well, that they are the first three components.
Same job, similar job, different job with the same employer.
And once that's exhausted, the doctor themselves actually has to
(08:55):
say this is requiring a new employer goal because otherwise
all of us around wait until it's on the medical certificate.
S2 (09:03):
Absolutely. And that's the thing too, about, I think the
difference between a good consultant and a mediocre consultant is
being able to recognize that before the doctor has to,
because you can go from a same employer to a
new employer immediately. Right. And there's no reason you can't
do that as as a doctor, you can't you can
certify that immediately. There is if you if your belief
(09:25):
in your medical opinion is that that person can't go
back to that role, then that's perfectly okay to say
that as rehab counselors and Caroline, you'd appreciate this. We
often get workers when they have been through the absolute wringer,
and you can see that it was just totally unnecessary
because this process could have started six, 612 months ago
because no one had the insight to say, listen, we're
(09:48):
just going to move away from this right now. Because again,
going back to the white coat and the doctor, they
really are the linchpin in terms of managing someone's return
to work. And that can be a really good thing,
or it can be a really bad thing depending on
what day it is. And doctors, again, are like you said,
they don't understand that process. So part of what we
do is not just to advocate for our injured workers,
(10:10):
but advocate for the doctors who they're seeing as well,
and making sure they have a good understanding of what
it is that we're trying to achieve. We're not just
trying to shove their patient back to work. We're actually
trying to work with everyone to make sure that whatever
it is they do, it's appropriate and sustainable and can
be long lasting for them.
S3 (10:30):
And again, stigma rears its head because if we're talking
about that move from same employer to different employer, there's
a lot of stigma around that. It is driven by
a very strong financial component for the employers. But if
it's the best thing for the person with the injury,
specifically for psychological injury, in 96% of the people that
(10:52):
we see, it's due to bullying and harassment. I know
that there are 16 different psychosocial hazards, 96% bullying and harassment.
And the problem is that that means that the social
condition at work has led to that point. Now, in
a big employer, you've got the opportunity to maybe look
at different jobs with the same employer, but you've also.
S2 (11:13):
Got access to eaps. For example, in a large employer, too,
you certainly have a bigger focus on broader social, social issues.
And that is really important.
S3 (11:24):
When we're talking about that move from same to new,
because there's a lot that's going on, you know, and
the return to work hierarchy for new employer is the same.
But with the new employer.
S2 (11:35):
Yes, exactly. Exactly.
S3 (11:37):
So it's same job with a new employer. Similar job.
New employer. Different job. Different employer. So there are six
different levels. If people are more happy to put in
a claim to say I have a psychological injury, then
it would also be great for people to go and
now I need to look for a different job. Now
I can already feel the backlash with this because an
(11:59):
injured worker will say, why would I need to go
and find a new job? And that's a very, very
valid discussion. But oftentimes in a small business, there just
isn't the breadth of positions, which is why moving forward
and just getting on with your life from a mental
health perspective is actually better. It doesn't though. Stop the stigma.
So if you are, then we've had the the injury.
(12:21):
We've gone through the return to work hierarchy. We're now
at that point where we've found something that we'd like
to go to that's new. How would you approach that
conversation with the new employer to promote that? We have
someone with an injury. Psychological injury. Coming to work to
manage the stigma around that. And are there any programs
(12:43):
that could we could also capitalize on that might be available?
And we are talking specifically in New South Wales here
for the purposes of this conversation.
S2 (12:52):
Well, it's interesting, I recently had a client and took
it upon herself to find alternative work, and when she
did that, the biggest problem was that she couldn't exit
from her current employer to take on this secondment role.
And she said to me, I do not want you
involved at all, um, and took it upon herself to
organise it all. So it sort of took us back
to what you were saying earlier, Caroline, about, well, we
(13:13):
can't help if we're not involved. So being involved is
really positive, and it really helps us to just make
sure that process is quite smooth. Approaching employers is tricky. Um,
and often we'll find that you'll know as soon as
you pick up the phone if they're going to be
open to potentially having a conversation about employing someone who's injured.
I do stacks and stacks of labour market analysis, and
(13:36):
sometimes you'll get hung up on straight away. Other times
people are really happy to have a chat. And when
you find an employer like that, it's really great to
talk to them because they will be happy to listen
to what you've got going on. One of the things
that's really important is making sure that when you're speaking
to employers, that you talk to them about the fact
(13:57):
that we have someone who fits the bill in terms
of their experience, their qualifications and all that kind of stuff,
and being upfront about, okay, this is the sum of
the exceptions that we might need to make. We can
offer programs like you said, Caroline, in terms of easing
the way through that path. So one of them is
the work trial programme, which is okay. It's really great
for people who have been out of the workforce for
(14:20):
quite some time, who don't have a lot of confidence
in their own abilities, and it's also a soft entry
into an employer. So what that looks like, it's basically
like school experience. You know, when you did work experience
when you were at school. So it's it's like they
get to have the experience with the support of a
very supportive employer who will make exceptions for them as required.
The employer doesn't have any kind of financial interests. There's
(14:45):
no risk for them having a claim put in against them.
Sarah makes sure of that with one of these programs,
and it really does help to get the worker really
re-engage with the world of work. It's really great. The
next step on from that, and this is one of
the other programs that has more bang for your buck,
I suppose, as an employer, in terms of taking someone
(15:07):
on who does have a workplace injury, it's called the
job cover placement program. It's pretty underutilized as far as
I'm aware. People aren't great at engaging the program, but
essentially the worker can come into an employment situation with
a new employer and any injury will be covered under
their previous claim. The wages associated with having this worker
(15:31):
on board are deleted from the employer's premium calculation, which
in turn brings down your premium that you're paying on
a yearly basis. And the other thing is, and this
is huge, you can be reimbursed as an employer for
up to $28,000 per year for having these guys on
board as paid employees. So those are great hooks in
(15:53):
terms of providing a way to change the culture in
an employer, right. Because this might be the first time
that they've put someone on who does have an injury.
They can do it in a way that's safe or
that they perceive as safe, because a they're not going
to get hit with a new claim, and b anything
that happens is attributed back to the old claim, but
(16:13):
they also are then being paid to have these people on,
and the benefit of them having people on who are
in the throes of a worker's compensation claim means that
that stigma can then be diluted inside of that employer,
because they're going to see the outcome of someone coming
on board. That's generally going to be a positive one, right?
(16:33):
Because they're already being supported. So that's really important. And
there's some really good programs in and around that.
S3 (16:39):
And the injured worker provided that they're working more than
15 hours and earning over a certain amount, they then
go back up to the 95% of wages, even though
they might be earning considerably less. So it's a win
win win all around.
S2 (16:55):
Absolutely. I think it's a really great program and as
I said, quite underused.
S3 (16:59):
You know, you can imagine as a small business the
value of that so hard as a small business to
take someone on and then carry those wages and then
you're not sure having worked in disability for a long time,
once a person with any of those obstacles makes that
decision to go back, you're talking about a person who
is now fighting for their life back, and they are
(17:21):
an incredible asset to a team.
S2 (17:23):
Yes, absolutely. It's like busy mothers, for example, right? You
want something done, give it to a busy mum to
do because they will get it done. You give it
to someone who really wants to do it and has
been given an opportunity despite the obstacles that they've come
up against, and you're going to see some terrific results.
S3 (17:40):
And that's where the frustration around stigma is because we've
still got personal stigma. They won't want me. How do
I know that I'm not going to get injured again?
What we're trying to say is in utilizing some of
the programs that are out there, and these are regulator
funded programs, but then it's up to that third party,
which is the rehab provider or the individual embracing and going,
(18:01):
look at all these great things. If you hire me,
then these are all of the benefits to you.
S2 (18:05):
Yeah, absolutely. I think so in terms of stigma and
and changing the way people think, what you're doing here
with the MSN podcast is really important work, because it
gives a voice to the positive experiences that people can have.
S4 (18:20):
I don't think we're going to ever get rid of
the stigma attached to it until we get rid of
the old school mentality. Like, for example, the GM of
operations at my workplace said in a meeting with subordinates
and other colleagues that a particular gentleman at work wasn't depressed.
He's just sad that he failed at life. He's got
(18:42):
no mental health qualification to even make that judgement. But
you've got people like this that still exist in senior roles,
who have a lot of say about where people go
for returning to work, creating. It's not just stigma, they
actually causation of a lot of these claims, you know,
suck it up, Princess. Or, you know, those sorts of remarks.
S3 (19:02):
If I am the person and I do feel like
I have failed at life, I will be depressed. Is
it a mental illness or is it a psychological injury?
And I guess that then goes into that discussion around
illness and disorder. As I understand it, for a psychological injury,
the idea is if you take the cause away, then
(19:26):
you should get better. And that's how the scheme looks
at it. But if it is a permanent change, then
it becomes an illness and no longer is it an injury. However,
just because you have been diagnosed with schizophrenia doesn't mean
that you're going to get a mental injury at work.
If the conditions are right and your medication is right
(19:48):
and all of those things, people are supportive. A person
shouldn't go to work and come away with any kind
of injury or exacerbation of pre-existing illness.
S2 (19:58):
That's exactly.
S3 (19:59):
Right. Therefore, it doesn't matter if I've got a pre-existing
diagnosis of depression or the many diagnoses that are in.
S2 (20:07):
Fact, what it should do is raise issues with the
way that the company is managing their sites. Because if
if I've got a pre-existing condition and I come and,
you know, I'm coping fine, and then all of a
sudden things change with respect to my pre-existing condition, what's
going on there in that environment that is causing those problems?
S4 (20:27):
The stigma for me was before I put the claim
in working in middle management all my life, trying to
protect the business from site claims and doing things as,
you know, as gently, gently as possible with performance management
and and things like that with staff and colleagues. And
if I didn't have the stigma that I had, I
probably would have put a claim in earlier and I
(20:48):
would have probably been back to work already. But because
I held off because of the stigma, I'm now in
a worse position.
S2 (20:54):
Yeah. And it's interesting. Is it because I also think
that there's different levels of stigma associated with the type
of injury that you might have, or illness or whatever
it might be that's across the board. That's not just
in relation to worker's compensation, I don't think, because say,
for example, um, there is far more stigma attached to
being diagnosed with a psychological illness as there is to
(21:16):
being diagnosed with cancer, for example. Right? You don't have
the same stigma and stigma attached to that. They're both
very confronting and often very drawn out process in terms
of your recovery. But one is accepted with open arms
and one isn't.
S4 (21:32):
It's just polar opposites to what you would expect it
to be like. You have the stigma on yourself that
you know your high expectations. You should be back to
work by now. Why aren't you? Why can't you handle
simple social situations or, you know, tiny changes to plans?
You know, like all those sorts of things. But then
you've got the stigma around you from your colleagues who think, oh,
you know, are they bludging or people trying to discredit
(21:54):
you or whatever the case is? But like you said,
physical and visible or not visible at all. I really
think a physical injury in the workers compensation scheme probably
attracts less stigma, because you can see someone who's got
a cast on their arm or their leg or back injury,
who's actually in physical pain and visible pain. From an
(22:16):
emotional perspective, the only time you really see someone going
through that is if they're having an emotional response. It's
very clear from an emotional versus a physical perspective that
the stigma changes.
S3 (22:27):
If you are talking to the person with the injury
and you wanted to give them three tips about trying
to not feel that fear of stigma and be able
to have a conversation with the employer, what would you recommend?
What are the tools that we can give someone with
an injury to feel brave enough to not carry that
(22:50):
fear of they won't want me, they're going to treat
me the same way. How am I going to do this?
S2 (22:54):
Okay, so I guess the first thing would be to
just be sure that you're aware that the work that
we're seeking for them is safe. That's why we go
through the assessment process. That's why we do all of
these things. It's why we meet with you, doctor, and
making sure they're part of that process as well. So
they're engaged. You know, they're in the driver's seat essentially.
(23:16):
The second thing I would say is that when they're
getting through to the interview stage. For example, ask questions.
You know, ask questions of your potential new employer. How
do you support your workers? What happens if things get
too stressful? How do you reallocate work? You know, how
do you make sure that your staff are okay? And
I would also be asking questions about what's the culture
(23:38):
like when you're in in that interview situation, you're interviewing
them as well. If you don't get a good feeling
about it, that's okay. Maybe it's not the right place
for you. All right. And I think that giving people
an opportunity to have a really good understanding of that
and placing that control with them, provides them with the
(23:59):
confidence to be able to walk forward through this process
as well. They're interviewing you, but you're interviewing them too.
It's really important to remember and look, and I guess
there's a third thing. It goes without saying, making sure
that everyone is aware of the benefits of the programs
that we discussed earlier. But I think that that that
comes a distant third.
S3 (24:18):
I love that. Love love love love love love that.
Because people feel so disempowered and the whole scheme is
written for the the person with the injury. It truly is.
It doesn't feel like it when they send those section
77 of the level B and blah blah blah, stupid
letters like dumb dumb letters. And before the injury happened.
(24:41):
So would you have picked the job in the first place?
Is it a job you want to go for? Second?
Would you sit there at an interview thinking before the injury?
Would you go hang on a minute? What are you
offering me? You're taking my time for this amount of money.
So what do I get out of it? You would
be asking questions. And the third thing is, whilst you're
(25:01):
still in the workers comp scheme, you've got that protection.
Someone's paying your wages. You don't lose it just because
you go to an interview. You don't lose it just
because you start the job. It's allowed to all fall over.
And then you can go back to start with your
case manager or your rehab provider and go, Didn't work.
And then you can start again. It's not absolutely absolute.
I've got a job and now everything falls over and
(25:23):
it can feel like that. But that's not the case.
And I think that's really important for people to remember.
And if you can empower people with the injury, I
think that stigma starts to break down. Absolutely.
S2 (25:33):
Because the only stigma you can control is the one
in your own head, right? The first job you get
as part of this process doesn't have to be your
end game. It's not forever, right? And take a bit
of pressure off yourself. You know, one of my favorite
things to say is that it's so much easier to
get a job when you have a job. I don't
know why. It's probably the stigma attached with being unemployed, right? Like, right.
(25:56):
And you're not.
S3 (25:56):
Desperate because I'm not going, oh my god, oh my God,
oh my God. My wages are about to end. I
need to do this. Here's one more thing get the
job well before the claim is in the death throes.
Absolutely gets too late. At least if you try, then
we can do something about it. Oh, I need another
course you can try. That didn't work. Let's reset. Try.
We can. We can put in structures in place to
(26:18):
support it. But if you wait till the end, until
that work, when that work capacity decision comes down, or
you're at 220 weeks and you know you've got 40
weeks left, it's so hard.
S2 (26:28):
And then that's when you start to take a dive.
And that comes back to staying motivated and getting ready
to return to work, and having your health team work
together to give you the opportunity to to look at
work and taking some control. And it does come back
to that control and making sure that you're there in
the box seat.
S3 (26:46):
We want to say thank you to Libby Stone, who
joined us. She comes to us with a wealth of information,
and we were able to really unpack obstacles that are
created with our perceptions of stigma. It is a problem
and an obstacle for a person with an injury in
getting back to work, as well as it is that
fear that's created for the employers in taking on someone
(27:08):
with an injury. We hope that today's episode has been
helpful for you If you want to contact us and
get some more information or be part of the podcast,
then let us know. Follow us on our socials. Be
part of this ever growing community of people with injuries,
illness or disability. We are my social support network. We
are your best. Tomorrow begins today. Well, you've been listening.
S1 (27:29):
You may have found some of these concepts challenging, so
if you are needing help, please reach out to the
police or the ambulance on 000 lifeline on 13 1114.
That's 13 1114 Beyondblue on one 302 24636. That's 1300 224 636.
(27:51):
The 24 hour mental health access line, which is one
800 015, double one. That's one 800 015, double one.
And if you think you could benefit from some legal advice,
reach out to the Iro who can recommend some lawyers
or someone to help you with your current legal case.
Thank you for joining us and we'll be back next time.
Hello and welcome to the My Social Support Network podcast,
a series to guide you along the path to recovery
while on workers compensation. In this series, we will answer
questions from you and provide information from experts and people
with lived experience currently going through worker's compensation and those
who have made their way to the other side. Through
these interactions, we'll be giving you tools, advice, but most importantly,
(00:24):
encouragement on what can be a stressful time when you're
also recovering from an injury sustained in your workplace.
S2 (00:30):
Often, stigma lives inside our head, so if you're prone
to anxiety or if you suffer from anxiety, the experience
and the thought about what you're going to experience are
often very different.
S3 (00:40):
Today we have the beautiful opportunity to talk to Libby Stone.
She's a senior rehab consultant. She has worked in injury management,
returned to work and vocational rehab. We're going to talk
to Libby today about how someone with an injury could
really try and think differently about the stigma of having
an injury and most importantly, for an employer out there,
all of the incredible opportunities in taking on someone with
(01:04):
an injury, because there are so few things that you
really need to be scared of because we're all working
together to get people back to work. Libby, thank you
so much for coming on to my Social Support Network
podcast today. I'm very excited to be able to have
this discussion with you. And one of the things that
I really wanted to be able to talk to you about,
and I know that it is such an important topic
for people with an injury, is the whole idea of stigma.
(01:28):
What's so interesting is that if I look back over time,
if I'm looking at gender inequality or sexual orientation, there
are lots of other big areas in life where we
have now been able to transcend a level of stigma.
And yet when we look at worker's compensation, that level
of stigma is static.
S2 (01:48):
Yes. That's true. Caroline. That's really true. Actually, it's interesting
you say that. I wonder where that comes from. I
guess you have to think about who the drivers are
and who's talking about worse compensation and all of that
kind of stuff. And we as health professionals working in
the area, we think about that. Then on the flip side,
you have this very commercial space that sits alongside of
(02:10):
what we do, and I wonder if that voice is louder.
S3 (02:12):
Stigma is a set of negative and unfair beliefs that
a society or group of people have about something. So
when we're talking about, I feel that they have stigmatized me.
I can't assume that I'm being stigmatized by other people.
(02:34):
That's probably an automatic thought that I'm having, which may
or may not be true. And I'm hazarding a bit
of a guess that that then falls into the bullying
and harassment and a different thing. It's not necessarily stigma,
but it actually falls into a part of policy that
is also not right. But there's an employer fear, what
(02:54):
am I going to do? How do I talk to
that person and coming back? They've got a psychological injury.
How do I not break them? How did I break them?
There's that component. But then you've actually got the scheme
and the case managers. And most of the time, if
I have a look, we have an average age of
our injured worker is around 50 years old. Yep. The
average age of a case manager is 10 to 15
(03:17):
years younger, 20 years younger than that. And there is
this stigma from the case managers as well. So I'm
a case manager having to now work with the person
who I've now put into a box.
S2 (03:29):
And I mean, and I guess also the turnover in
those larger organisations. And I think at one stage a
couple of years ago, one of the larger agents had
more than 50% of their whole staff working as case
managers with less than two years experience. So you've got
the old dogs, new tricks to the to the younger guys,
but they're turning over really quickly, so you're losing that
(03:52):
knowledge hand over fist.
S3 (03:54):
In your opinion, is stigma related to anxiety?
S2 (03:59):
Yes. Often stigma lives inside our head because you might
walk out the door and think that person is looking
at me because I've got blonde hair and they've got
a certain perception of what that means for you as
a person, but do they really think that? I'm not
really sure. So if you're prone to anxiety or if
you suffer from anxiety, those social conventions that you may
(04:21):
know of, um, or that you've seen or you've experienced
can certainly play on that anxiety and make it much
worse for you, because we don't know what's in other
people's heads. The experience and the thought about what you're
going to experience are often very different.
S3 (04:37):
How do we then go about managing those experiences of
stigma inside the person with the injury first?
S2 (04:47):
That's a good question. I think the most important thing
is to gain an understanding of what their feelings are
about the situation they're in. So one of the things
that I find and have found over my career is
that going in and jumping into an assessment, for example,
because the insurer said so isn't always a very positive
(05:08):
experience for anybody. And I think providing some clarity and
context around why you're doing what you're doing and then
allowing your client to express what their concerns are really
gives you a sense of how they're feeling about their
position in the system itself, because that's what's important. You know,
(05:31):
do they feel like they have control? You know, is
that important to them, or do they just want someone
to tell them what to do and how to get
through this? You have to really have a really strong
understanding of what their perception of other people's perception of
them is.
S3 (05:45):
How do you then manage that stigma for employers? Because
you can have someone who is now able to manage
and now the employer.
S2 (05:54):
Employers can be very warm and fuzzy and that's really lovely.
But the reality is there is a commercial component to
managing a return to work that we cannot ignore as
a health professional. It's not a natural place for us
to sit. I think there's very few of us that
are comfortable with that, because that's really a driver for
particularly small business owners. And the cost of doing business
(06:16):
sometimes is managing these types of return to work. So
there's a lot of fear with employers. A lot of
the time, and I'm talking your small to medium here,
I'm not talking big business because I think that that
that sort of fits into its own category. But in
terms of managing employers expectations and allaying their fears, it's
about providing something in the currency that they understand. I
(06:39):
find one of the things that's really helpful is to
make sure that they're aware that this their person or
the injured person that we're putting into their Organization is
medically signed off to go ahead and do that job
because doctors, whether we like it or not, have a
lot of sway. And what they say really means something
to people. And if you can go in with all
(07:01):
the right medical information and explain that this is the
situation and also give them some support in terms of, okay,
we can we can call you Libby if something goes
wrong and they know that they're supported, it's going to
help ease the way through that. But we do have
to rely on the white coat factor. It's just a
factor of life. One of the things that I always
say to my clients when I first meet them is that,
(07:22):
you know, we're here to talk about your options in
terms of your return to work. If you're a painter
and you want to go back to work as a
brain surgeon, I can't help you. And then that leads
me into the conversation around the return to work hierarchy.
So really, what that looks like is that the legislation
is written to kind of make your return to work, um,
(07:43):
a process whereby you're grabbing onto the lowest hanging fruit.
So their first point of call is to return to
your same job with your same employer. Right. If that
doesn't work out for whatever reason, whether the job is
no longer there or as an injured person, you can't
go back and do the functional requirements of that work,
then so be it. The next part of the hierarchy
(08:03):
is same employer, similar job, right. So something similar. You
might be working at the front desk. And for whatever
reason you've had an injury that precludes you from working
with the public. They might find you a spot in
the in the back office. Same with that same vein.
The next step on the hierarchy is same employer, different job.
(08:24):
So that's pretty self-explanatory, right? The next part of the
hierarchy is different. It's when we change from what we
would call the industry from the same employer services to
the new employer services.
S3 (08:35):
And this is where the doctor is really important because
the doctor up until this point, and I think this
is good for doctors because they often don't do worker's
comp as well, that they are the first three components.
Same job, similar job, different job with the same employer.
And once that's exhausted, the doctor themselves actually has to
(08:55):
say this is requiring a new employer goal because otherwise
all of us around wait until it's on the medical certificate.
S2 (09:03):
Absolutely. And that's the thing too, about, I think the
difference between a good consultant and a mediocre consultant is
being able to recognize that before the doctor has to,
because you can go from a same employer to a
new employer immediately. Right. And there's no reason you can't
do that as as a doctor, you can't you can
certify that immediately. There is if you if your belief
(09:25):
in your medical opinion is that that person can't go
back to that role, then that's perfectly okay to say
that as rehab counselors and Caroline, you'd appreciate this. We
often get workers when they have been through the absolute wringer,
and you can see that it was just totally unnecessary
because this process could have started six, 612 months ago
because no one had the insight to say, listen, we're
(09:48):
just going to move away from this right now. Because again,
going back to the white coat and the doctor, they
really are the linchpin in terms of managing someone's return
to work. And that can be a really good thing,
or it can be a really bad thing depending on
what day it is. And doctors, again, are like you said,
they don't understand that process. So part of what we
do is not just to advocate for our injured workers,
(10:10):
but advocate for the doctors who they're seeing as well,
and making sure they have a good understanding of what
it is that we're trying to achieve. We're not just
trying to shove their patient back to work. We're actually
trying to work with everyone to make sure that whatever
it is they do, it's appropriate and sustainable and can
be long lasting for them.
S3 (10:30):
And again, stigma rears its head because if we're talking
about that move from same employer to different employer, there's
a lot of stigma around that. It is driven by
a very strong financial component for the employers. But if
it's the best thing for the person with the injury,
specifically for psychological injury, in 96% of the people that
(10:52):
we see, it's due to bullying and harassment. I know
that there are 16 different psychosocial hazards, 96% bullying and harassment.
And the problem is that that means that the social
condition at work has led to that point. Now, in
a big employer, you've got the opportunity to maybe look
at different jobs with the same employer, but you've also.
S2 (11:13):
Got access to eaps. For example, in a large employer, too,
you certainly have a bigger focus on broader social, social issues.
And that is really important.
S3 (11:24):
When we're talking about that move from same to new,
because there's a lot that's going on, you know, and
the return to work hierarchy for new employer is the same.
But with the new employer.
S2 (11:35):
Yes, exactly. Exactly.
S3 (11:37):
So it's same job with a new employer. Similar job.
New employer. Different job. Different employer. So there are six
different levels. If people are more happy to put in
a claim to say I have a psychological injury, then
it would also be great for people to go and
now I need to look for a different job. Now
I can already feel the backlash with this because an
(11:59):
injured worker will say, why would I need to go
and find a new job? And that's a very, very
valid discussion. But oftentimes in a small business, there just
isn't the breadth of positions, which is why moving forward
and just getting on with your life from a mental
health perspective is actually better. It doesn't though. Stop the stigma.
So if you are, then we've had the the injury.
(12:21):
We've gone through the return to work hierarchy. We're now
at that point where we've found something that we'd like
to go to that's new. How would you approach that
conversation with the new employer to promote that? We have
someone with an injury. Psychological injury. Coming to work to
manage the stigma around that. And are there any programs
(12:43):
that could we could also capitalize on that might be available?
And we are talking specifically in New South Wales here
for the purposes of this conversation.
S2 (12:52):
Well, it's interesting, I recently had a client and took
it upon herself to find alternative work, and when she
did that, the biggest problem was that she couldn't exit
from her current employer to take on this secondment role.
And she said to me, I do not want you
involved at all, um, and took it upon herself to
organise it all. So it sort of took us back
to what you were saying earlier, Caroline, about, well, we
(13:13):
can't help if we're not involved. So being involved is
really positive, and it really helps us to just make
sure that process is quite smooth. Approaching employers is tricky. Um,
and often we'll find that you'll know as soon as
you pick up the phone if they're going to be
open to potentially having a conversation about employing someone who's injured.
I do stacks and stacks of labour market analysis, and
(13:36):
sometimes you'll get hung up on straight away. Other times
people are really happy to have a chat. And when
you find an employer like that, it's really great to
talk to them because they will be happy to listen
to what you've got going on. One of the things
that's really important is making sure that when you're speaking
to employers, that you talk to them about the fact
(13:57):
that we have someone who fits the bill in terms
of their experience, their qualifications and all that kind of stuff,
and being upfront about, okay, this is the sum of
the exceptions that we might need to make. We can
offer programs like you said, Caroline, in terms of easing
the way through that path. So one of them is
the work trial programme, which is okay. It's really great
for people who have been out of the workforce for
(14:20):
quite some time, who don't have a lot of confidence
in their own abilities, and it's also a soft entry
into an employer. So what that looks like, it's basically
like school experience. You know, when you did work experience
when you were at school. So it's it's like they
get to have the experience with the support of a
very supportive employer who will make exceptions for them as required.
The employer doesn't have any kind of financial interests. There's
(14:45):
no risk for them having a claim put in against them.
Sarah makes sure of that with one of these programs,
and it really does help to get the worker really
re-engage with the world of work. It's really great. The
next step on from that, and this is one of
the other programs that has more bang for your buck,
I suppose, as an employer, in terms of taking someone
(15:07):
on who does have a workplace injury, it's called the
job cover placement program. It's pretty underutilized as far as
I'm aware. People aren't great at engaging the program, but
essentially the worker can come into an employment situation with
a new employer and any injury will be covered under
their previous claim. The wages associated with having this worker
(15:31):
on board are deleted from the employer's premium calculation, which
in turn brings down your premium that you're paying on
a yearly basis. And the other thing is, and this
is huge, you can be reimbursed as an employer for
up to $28,000 per year for having these guys on
board as paid employees. So those are great hooks in
(15:53):
terms of providing a way to change the culture in
an employer, right. Because this might be the first time
that they've put someone on who does have an injury.
They can do it in a way that's safe or
that they perceive as safe, because a they're not going
to get hit with a new claim, and b anything
that happens is attributed back to the old claim, but
(16:13):
they also are then being paid to have these people on,
and the benefit of them having people on who are
in the throes of a worker's compensation claim means that
that stigma can then be diluted inside of that employer,
because they're going to see the outcome of someone coming
on board. That's generally going to be a positive one, right?
(16:33):
Because they're already being supported. So that's really important. And
there's some really good programs in and around that.
S3 (16:39):
And the injured worker provided that they're working more than
15 hours and earning over a certain amount, they then
go back up to the 95% of wages, even though
they might be earning considerably less. So it's a win
win win all around.
S2 (16:55):
Absolutely. I think it's a really great program and as
I said, quite underused.
S3 (16:59):
You know, you can imagine as a small business the
value of that so hard as a small business to
take someone on and then carry those wages and then
you're not sure having worked in disability for a long time,
once a person with any of those obstacles makes that
decision to go back, you're talking about a person who
is now fighting for their life back, and they are
(17:21):
an incredible asset to a team.
S2 (17:23):
Yes, absolutely. It's like busy mothers, for example, right? You
want something done, give it to a busy mum to
do because they will get it done. You give it
to someone who really wants to do it and has
been given an opportunity despite the obstacles that they've come
up against, and you're going to see some terrific results.
S3 (17:40):
And that's where the frustration around stigma is because we've
still got personal stigma. They won't want me. How do
I know that I'm not going to get injured again?
What we're trying to say is in utilizing some of
the programs that are out there, and these are regulator
funded programs, but then it's up to that third party,
which is the rehab provider or the individual embracing and going,
(18:01):
look at all these great things. If you hire me,
then these are all of the benefits to you.
S2 (18:05):
Yeah, absolutely. I think so in terms of stigma and
and changing the way people think, what you're doing here
with the MSN podcast is really important work, because it
gives a voice to the positive experiences that people can have.
S4 (18:20):
I don't think we're going to ever get rid of
the stigma attached to it until we get rid of
the old school mentality. Like, for example, the GM of
operations at my workplace said in a meeting with subordinates
and other colleagues that a particular gentleman at work wasn't depressed.
He's just sad that he failed at life. He's got
(18:42):
no mental health qualification to even make that judgement. But
you've got people like this that still exist in senior roles,
who have a lot of say about where people go
for returning to work, creating. It's not just stigma, they
actually causation of a lot of these claims, you know,
suck it up, Princess. Or, you know, those sorts of remarks.
S3 (19:02):
If I am the person and I do feel like
I have failed at life, I will be depressed. Is
it a mental illness or is it a psychological injury?
And I guess that then goes into that discussion around
illness and disorder. As I understand it, for a psychological injury,
the idea is if you take the cause away, then
(19:26):
you should get better. And that's how the scheme looks
at it. But if it is a permanent change, then
it becomes an illness and no longer is it an injury. However,
just because you have been diagnosed with schizophrenia doesn't mean
that you're going to get a mental injury at work.
If the conditions are right and your medication is right
(19:48):
and all of those things, people are supportive. A person
shouldn't go to work and come away with any kind
of injury or exacerbation of pre-existing illness.
S2 (19:58):
That's exactly.
S3 (19:59):
Right. Therefore, it doesn't matter if I've got a pre-existing
diagnosis of depression or the many diagnoses that are in.
S2 (20:07):
Fact, what it should do is raise issues with the
way that the company is managing their sites. Because if
if I've got a pre-existing condition and I come and,
you know, I'm coping fine, and then all of a
sudden things change with respect to my pre-existing condition, what's
going on there in that environment that is causing those problems?
S4 (20:27):
The stigma for me was before I put the claim
in working in middle management all my life, trying to
protect the business from site claims and doing things as,
you know, as gently, gently as possible with performance management
and and things like that with staff and colleagues. And
if I didn't have the stigma that I had, I
probably would have put a claim in earlier and I
(20:48):
would have probably been back to work already. But because
I held off because of the stigma, I'm now in
a worse position.
S2 (20:54):
Yeah. And it's interesting. Is it because I also think
that there's different levels of stigma associated with the type
of injury that you might have, or illness or whatever
it might be that's across the board. That's not just
in relation to worker's compensation, I don't think, because say,
for example, um, there is far more stigma attached to
being diagnosed with a psychological illness as there is to
(21:16):
being diagnosed with cancer, for example. Right? You don't have
the same stigma and stigma attached to that. They're both
very confronting and often very drawn out process in terms
of your recovery. But one is accepted with open arms
and one isn't.
S4 (21:32):
It's just polar opposites to what you would expect it
to be like. You have the stigma on yourself that
you know your high expectations. You should be back to
work by now. Why aren't you? Why can't you handle
simple social situations or, you know, tiny changes to plans?
You know, like all those sorts of things. But then
you've got the stigma around you from your colleagues who think, oh,
you know, are they bludging or people trying to discredit
(21:54):
you or whatever the case is? But like you said,
physical and visible or not visible at all. I really
think a physical injury in the workers compensation scheme probably
attracts less stigma, because you can see someone who's got
a cast on their arm or their leg or back injury,
who's actually in physical pain and visible pain. From an
(22:16):
emotional perspective, the only time you really see someone going
through that is if they're having an emotional response. It's
very clear from an emotional versus a physical perspective that
the stigma changes.
S3 (22:27):
If you are talking to the person with the injury
and you wanted to give them three tips about trying
to not feel that fear of stigma and be able
to have a conversation with the employer, what would you recommend?
What are the tools that we can give someone with
an injury to feel brave enough to not carry that
(22:50):
fear of they won't want me, they're going to treat
me the same way. How am I going to do this?
S2 (22:54):
Okay, so I guess the first thing would be to
just be sure that you're aware that the work that
we're seeking for them is safe. That's why we go
through the assessment process. That's why we do all of
these things. It's why we meet with you, doctor, and
making sure they're part of that process as well. So
they're engaged. You know, they're in the driver's seat essentially.
(23:16):
The second thing I would say is that when they're
getting through to the interview stage. For example, ask questions.
You know, ask questions of your potential new employer. How
do you support your workers? What happens if things get
too stressful? How do you reallocate work? You know, how
do you make sure that your staff are okay? And
I would also be asking questions about what's the culture
(23:38):
like when you're in in that interview situation, you're interviewing
them as well. If you don't get a good feeling
about it, that's okay. Maybe it's not the right place
for you. All right. And I think that giving people
an opportunity to have a really good understanding of that
and placing that control with them, provides them with the
(23:59):
confidence to be able to walk forward through this process
as well. They're interviewing you, but you're interviewing them too.
It's really important to remember and look, and I guess
there's a third thing. It goes without saying, making sure
that everyone is aware of the benefits of the programs
that we discussed earlier. But I think that that that
comes a distant third.
S3 (24:18):
I love that. Love love love love love love that.
Because people feel so disempowered and the whole scheme is
written for the the person with the injury. It truly is.
It doesn't feel like it when they send those section
77 of the level B and blah blah blah, stupid
letters like dumb dumb letters. And before the injury happened.
(24:41):
So would you have picked the job in the first place?
Is it a job you want to go for? Second?
Would you sit there at an interview thinking before the injury?
Would you go hang on a minute? What are you
offering me? You're taking my time for this amount of money.
So what do I get out of it? You would
be asking questions. And the third thing is, whilst you're
(25:01):
still in the workers comp scheme, you've got that protection.
Someone's paying your wages. You don't lose it just because
you go to an interview. You don't lose it just
because you start the job. It's allowed to all fall over.
And then you can go back to start with your
case manager or your rehab provider and go, Didn't work.
And then you can start again. It's not absolutely absolute.
I've got a job and now everything falls over and
(25:23):
it can feel like that. But that's not the case.
And I think that's really important for people to remember.
And if you can empower people with the injury, I
think that stigma starts to break down. Absolutely.
S2 (25:33):
Because the only stigma you can control is the one
in your own head, right? The first job you get
as part of this process doesn't have to be your
end game. It's not forever, right? And take a bit
of pressure off yourself. You know, one of my favorite
things to say is that it's so much easier to
get a job when you have a job. I don't
know why. It's probably the stigma attached with being unemployed, right? Like, right.
(25:56):
And you're not.
S3 (25:56):
Desperate because I'm not going, oh my god, oh my God,
oh my God. My wages are about to end. I
need to do this. Here's one more thing get the
job well before the claim is in the death throes.
Absolutely gets too late. At least if you try, then
we can do something about it. Oh, I need another
course you can try. That didn't work. Let's reset. Try.
We can. We can put in structures in place to
(26:18):
support it. But if you wait till the end, until
that work, when that work capacity decision comes down, or
you're at 220 weeks and you know you've got 40
weeks left, it's so hard.
S2 (26:28):
And then that's when you start to take a dive.
And that comes back to staying motivated and getting ready
to return to work, and having your health team work
together to give you the opportunity to to look at
work and taking some control. And it does come back
to that control and making sure that you're there in
the box seat.
S3 (26:46):
We want to say thank you to Libby Stone, who
joined us. She comes to us with a wealth of information,
and we were able to really unpack obstacles that are
created with our perceptions of stigma. It is a problem
and an obstacle for a person with an injury in
getting back to work, as well as it is that
fear that's created for the employers in taking on someone
(27:08):
with an injury. We hope that today's episode has been
helpful for you If you want to contact us and
get some more information or be part of the podcast,
then let us know. Follow us on our socials. Be
part of this ever growing community of people with injuries,
illness or disability. We are my social support network. We
are your best. Tomorrow begins today. Well, you've been listening.
S1 (27:29):
You may have found some of these concepts challenging, so
if you are needing help, please reach out to the
police or the ambulance on 000 lifeline on 13 1114.
That's 13 1114 Beyondblue on one 302 24636. That's 1300 224 636.
(27:51):
The 24 hour mental health access line, which is one
800 015, double one. That's one 800 015, double one.
And if you think you could benefit from some legal advice,
reach out to the Iro who can recommend some lawyers
or someone to help you with your current legal case.
Thank you for joining us and we'll be back next time.
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