Mental health occupational therapy services policy

Background

Occupational Therapy Australia (OTA) mental health endorsed occupational therapists have specific experience in evidence-based management of mental health conditions. The OTA Mental Health Endorsement program, previously known as BAMH (Better Access to Mental Health) endorsement, is built on the foundations of the OTA Mental Health Capability Framework.

Mental health occupational therapists (OTs) provide focused psychological strategy services and form collaborative relationships with general practitioners (GPs), psychiatrists, clinical psychologists, psychologists, and social workers. The collaboration aims to coordinate team-based mental health care for their clients.

Mental health OTs draw on, and are trained in, occupational therapy-specific tools and approaches, as well as the psychological techniques used by other mental health professionals. They work across the spectrum of mental illness, providing early intervention, prevention, and treatment services to people with mild, moderate and severe mental health conditions. They deliver services to people with relatively common conditions such as anxiety disorders, as well as more severe conditions which require targeted interventions, such as psychosis and trauma-related disorders.

This policy outlines guidelines for the provision of mental health occupational therapy services under the Victorian workers compensation scheme (WorkCover).

This policy must be read together with the following:

What WorkSafe will pay for

What WorkSafe will pay for

WorkSafe (either directly or through one of its authorised agents) can pay the reasonable costs of mental health occupational therapy services that are:

• required as a result of a work-related injury or illness
• performed by a clinician registered by WorkSafe to provide OTA mental health endorsed occupational therapy services
• clinically justifiable, safe, and effective
• for a clear rehabilitative purpose, and are not for non-work-related injury rehabilitative purposes
• likely to achieve or maintain a measurable functional improvement
• likely to achieve progress towards functional independence, participation, and self-management

The agent will periodically review an injured worker's entitlement to mental health occupational therapy services to ensure treatment and services are reasonably applicable to the work related injury and/or illness, and payable under the WorkCover scheme.

What WorkSafe will not pay for

WorkSafe or an agent will not pay for:

• treatment or services for a person other than the injured worker
• treatment or services provided by a treating healthcare provider (THP) not registered and approved to provide mental health occupational therapy services under the WorkCover scheme
• more than one initial consultation by the same provider or clinic unless exceptional circumstances apply, (e.g. hospital admission, or significant time has passed since the injured worker last received treatment)
• more than one consultation per day for the same injured worker
• fees associated with cancellation or non-attendance
• treatment or services provided outside the Australia without prior written approval from the agent
• treatment, services, prostheses, or equipment where there is no National Health and Medical Research Council level 1, or level 2 evidence of safety and efficacy

Mental health occupational therapist eligibility criteria

To be eligible to register as a mental health endorsed occupational therapist with WorkSafe, applicants must:

• be registered with the Occupational Therapy Board of Australia without any current restrictions on practice
• be endorsed by Occupational Therapy Australia and registered with Medicare to deliver focused psychological strategies under the OTA Mental Health Endorsement Program
• be registered with WorkSafe to provide services as an occupational therapist
• complete 10 hours of relevant continuing professional development annually
• have signed a declaration committing to provide mental health occupational therapy services in line with the Clinical Framework and related Service Standards

Occupational therapists who do not hold mental health endorsement, but show appropriate skills in this field, should refer to the applicable occupational therapy policy and fee schedule for relevant service provision information.

Service Standards

These Service Standards must be read together with the Mental Health Occupational Therapist Services Declaration. Mental health occupational therapists who do not comply with the service standards may have their WorkSafe registration withdrawn.

The role of a mental health occupational therapist

A mental health occupational therapist provides client-centred, goal orientated directed treatment to injured workers. Treatment must be consistent with the Clinical Framework, with a focus on return to health, achieving independence and return to work.

A mental health occupational therapist's treatment must adopt the following principles:

• measure and/or demonstrate the effectiveness of treatment
• adopt a biopsychosocial approach
• empower the injured worker to manage their injury
• implement goals focused on optimising function, participation, and return to work
• base treatment on best available research and evidence

Reporting and communication

After treatment has commenced, the mental health occupational therapist must submit an Allied Health Recovery Management Plan (AHRMP) to the agent by the fifth consultation.

The mental health occupational therapist must work with WorkSafe and its Clinical Panel to ensure treatment adheres to the Clinical Framework, Service Standards and Declaration.

WorkSafe registered mental health occupational therapists are also expected to communicate and collaborate with other parties involved in the worker's support team to facilitate continuity of care and return to work.

Return to Work Case Conferences (RTWCC) bring together the worker, referring medical practitioner, employer, WorkSafe agent, occupational rehabilitation provider, and other relevant parties. They can be used to discuss the worker's capacity, any barriers affecting recovery, set goals, and agree on timeframes for recovery at/return to work.

Typically, a RTW case conference will be requested by an agent or the occupational rehabilitation consultant however, a treating health practitioner can request a case conference by contacting the agent or the occupational rehabilitation consultant directly. RTWCCs will be remunerated as outlined in the occupational therapy services fee schedule.

Service delivery expectations

Services must:

• achieve the best clinical, functional and vocational outcomes for injured workers
• be provided in accordance with the Clinical Framework
• be provided in consultation and collaboration with other THPs, community and support services and vocational service providers involved in the management and treatment of an injured worker
• be provided under reasonable directions and instructions provided by WorkSafe

Facilities and equipment

Mental health occupational therapists must ensure facilities and equipment used to conduct examination and treatment are clean, safe and fit for purpose.

Quality management

The mental health occupational therapist must take part in quality improvement and performance management processes as required.

Required information for agents

Referral requirements

WorkSafe considers occupational therapy a referred service. Mental health occupational therapy must be referred by a medical practitioner before treatment commences.

Invoicing requirements

All services must be invoiced per WorkSafe's Occupational Therapy Services fee schedule and mental health occupational therapy Services Declaration.

For further information, refer to instructions for invoicing WorkSafe.

Concerns about unpaid or returned invoices should be directed to the agent case manager. Unresolved queries can be escalated by submitting an online complaint.

Agent processing times

The agent will advise the outcome of a request for payment within 10 working days, or they may request extra information before making a decision.

If extra information is requested, the agent will confirm the request outcome within 10 working days of receiving the extra information.