Diagnosing and managing work-related mental health conditions in general practice – new Australian Clinical Practice Guidelines

Problem

Mental health conditions are among the leading causes of long term work incapacity and absenteeism. General practitioners (GPs) are almost always involved in diagnosing and managing patients with work-related mental health conditions. However, GPs face clinical challenges that hinder their ability to provide optimal care to these patients and have requested advice to assist them to address these challenges. We aimed to develop an Australian clinical guideline to assist GPs with diagnosing and managing patients with work-related mental health conditions.

Approach

The guideline was developed according to Australian National Health and Medical Research Council standards. First, clinical questions were based on clinical dilemmas faced in practice. Next, a systematic review of the literature was undertaken for each question. Then, the body of evidence for each question was graded according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). A draft guideline was developed by a multidisciplinary Guideline Development Group, and was made available for public consultation between January and March 2018. Finally, the guideline was revised following the consultation and was assessed by independent methodologists and content experts prior to receiving NHMRC approval and RACGP and ACRRM endorsement.

Findings

Eleven evidence-based recommendations and 19 statements based on consensus provide advice on the diagnosis and management of work-related mental health conditions in general practice, specifically regarding:

• tools to assist diagnosis and assessment of severity of a mental health condition

• assessing if a patient is developing a comorbid or secondary mental health condition

• assessing if the mental health condition has arisen from work

• conveying a diagnosis of a mental health condition to a patient

• undertaking effective management of the condition to improve personal recovery

• considering if the patient can work in some capacity

• communicating with the patient’s workplace

• managing mental health conditions with comorbid substance misuse

• considering why a patient’s mental health condition is not improving

• managing a patient whose mental health condition is not improving

This guideline will enhance care and improve health outcomes by encouraging

• utilisation of appropriate tools to assist the diagnosis and assess the severity of mental health conditions

• the assessment of factors that can lead to the development of a mental health condition

• more comprehensive clinical assessments

• the use of existing high-quality guidelines to inform the clinical management of mental health conditions

• consideration of a patient’s work capacity

• appropriate communication with workplace

• collaboration with other health professionals.

Consequences

This guideline is the first to address the clinical complexities associated with diagnosing and managing work-related mental health conditions in general practice. This guideline will provide GPs with the best available evidence, to assist in diagnosing and managing patients with work-related mental health conditions. Implementation of the guideline will be facilitated through tailored implementation activities.