To be eligible for the additional assistance the client must:

• have an accepted mental health condition under the MRCA or DRCA which is contributing to their incapacity for work;
• be experiencing one or more of the flags at 9.13.3 [4] that indicate that they may be vulnerable in an employment setting;
• be in receipt of incapacity payments; and,
• be on a rehabilitation program with the eventual goal of returning to work.

Once approved, Streamlined Access to Incapacity Payments is valid for one year from the date the client commences employment.

Streamlined Access to Incapacity Payments is designed to support clients who are in the process of accepting an offer of employment and preparing to return to work. The policy can provide clients with  confidence they can attempt a return to employment with full rehabilitation support, and if they not successful, their incapacity payments can be reinstated.

It is expected that Rehabilitation Providers and clients will work together to ensure that there is a good match between the client’s needs, skills, expectations and experience and the job that they have been offered. This will provide the client with the best possible opportunity to be successful in returning to sustainable employment. While this  is a business as usual approach for any client who is participating in a vocational rehabilitation plan, it is recognised that mental health issues have the potential to create greater difficulties for clients, resulting in hesitancy regarding their return to employment. Issues that should be worked through before returning to work include (but are not limited to):

• from the client’s point of view:
  • attitude to their employer e.g. are there trust issues, how health literate the employer is;
  • ability to perform work tasks and develop skills to enable them to fulfil their work role including understanding what is required from the employer’s perspective;
  • understanding how receiving an income will impact on their financial situation
  • planning what steps need to be taken if they need to modify/leave work;
  • potential impact of any changes in the their condition(s) and health management;
    • health and safety risk for the client and/or their workmates,
    • ability to schedule and attend medical appointments around work commitments (where possible, to reduce the impact on the employer), and
    • difficulty managing the change in routine.
• pertaining to employers;
  • expectations of the client e.g. are they aware of how military culture can impact on the person’s interactions in a work place;
  • willingness to provide reasonable adjustments to the workplace for the client;
  • willingness to train and lead the client where new skills are needed, and
  • ability to explain when expectations are not being met.

It is expected that if any of these issues are concerning the client prior to commencing new employment,  the client and the Rehabilitation Provider will work together to develop management strategies. Undertaking this process may help to resolve whether a particular job is a suitable option, or whether it may be better for the client to be looking for an alternate role or employer.

In addition to potential difficulties, the range of benefits should also be discussed, including:

• a feeling of empowerment in developing new skills and knowledge;
• improved relationships and interactions;
• improving self-confidence;
• improving financial security, and
• understanding health management in a whole-of-life perspective, rather than an injury-focus.

Streamlined Access to Incapacity Payments should be considered for specific clients:

• who are undertaking a vocational rehabilitation program with the goal of securing employment; and
• may be particularly vulnerable to experiencing difficulties in managing and maintaining employment because of mental health conditions for which DVA has accepted liability under the MRCA or DRCA (refer to flags below); and
• would benefit from additional support as they test their ability to return to, and maintain employment.

Through this policy, clients who meet the criteria can access rehabilitation support through the continuation of their rehabilitation plan for up to 12 months once they have secured employment. This will enable them to access the support of a Rehabilitation Provider to manage any issues they are experiencing in the workplace and in the event that they need to cease or reduce their hours due to their accepted mental health condition, their incapacity payments will recommence.
 

Identifying eligible clients

There are many individual differences in the way that mental health conditions impact on a person’s life. For example, having a particular diagnosed condition may manifest in an episodic flare of mental health symptoms for some clients which impacts on their ability to manage in a workplace. In contrast, another client with the same condition, who has developed a range of strategies and skills to manage their symptoms effectively may not require a break from their employment.

Rather than this policy applying to all clients with mental health conditions, consideration must be given to if a client’s accepted mental health condition is contributing to their incapacity.  The flags outlined below are intended to guide Rehabilitation Providers to identify issues that may place a client at risk of managing and sustaining their return to work due to their mental health conditions:

• reduced cognitive function - concerns about the person’s ability to process information and effectively undertake tasks required for their work role
• interpersonal function - the client has an inability to work collaboratively as a member of a team, or to manage any conflict in a workplace, a lack of coping strategies, or limited supports that a person may have available to them;
• medication and drug use -  the client  is struggling to find the right combination of medication to stabilise their symptoms.  The client  may require maximum levels of medication to be able to function in a work role and may experience side effects that could impact on their work role
• affect/mood - reduced energy level, decreased motivation, increased pain levels, a lack of resilience, and concerns about work goal orientation and commitment;
• personal confidence - lack of confidence for the specific work role and for returning to work generally;
• personal defensiveness - sense of injustice, or concerns about condition stigma;
• health literacy - concerns about the client’s understanding of their personal health conditions, management of their symptoms and the course of the condition;
• lifestyle balance - sleep issues, social isolation and a lack of positive recreation activities or other commitments which may make it challenging for them to be able to maintain a healthy lifestyle, which includes work;
• clients’ co-morbidities - including non-accepted conditions, which may add to the complexity of managing their employment obligations; and
• client’s attitude to other’s behaviours -  ie of supervisors and co-workers, indicating concerns about their ability to maintain positive working relationships with others;
   

Where the Rehabilitation Provider and/or the client identify any of the above flags that are likely to make the client vulnerable in an employment setting, then they are expected to discuss this with the DVA Rehabilitation Coordinator, to determine suitability for streamlined access to incapacity payments.

Early identification of these flags and pro-active management of issues is more likely to result in the client better handling their situation and recovering sooner. Identifying these issues quickly can also enable whole-of-person rehabilitation support to be provided, which may help the client to overcome some of their concerns about managing their work role.

Informing Incapacity Payments

The Incapacity delegate must be informed when considering and approving Streamlined Access to Incapacity Payments, as they need to be aware of the implications. As part of this process Rehabilitation Coordinators will need to check that the person’s accepted mental health condition is contributing to their incapacity. Approval for Streamlined Access to Incapacity Payments is recorded in the rehabilitation claim in R&C ISH, and also creates a flag in the Incapacity claim screen for the incapacity payment delegate.

Monitoring

Streamlined Access to Incapacity Payments allows a veteran to utilise rehabilitation support for up to 12 months following their return to work. During this 12 month period, it is expected the Rehabilitation Provider  will maintain regular contact, which is agreed upon with the client to allow proactive identification and resolution of  emerging issues while ensuring the client has adequate space and time to focus on their new employment.  For example, one client may want weekly calls and another client may need only 3 monthly calls from the provider, but also be willing to the call the provider themselves if they need assistance.  

Additional rehabilitation activities can be approved during the 12 month monitoring timeframe to assist the client to maintain employment. It is still important to close any existing goals that have been met, and set new activities under an appropriate goal related to monitoring employment.  Activities appropriate for this monitoring period might include:

• working with the employer to help resolve any difficulties in the workplace, or with the client fulfilling their work role;
• working with treating health professionals to ensure the client accesses appropriate medical support to help them get better as soon as possible;
• counselling on resilience and understanding healthy relationships; and
• developing management strategies to overcome work and personal issues impacting the client.

Ceasing or reducing hours of work due to accepted conditions

If the client needs to cease their employment or reduce their hours because of their accepted conditions, they are not required to submit a new claim for incapacity payments. Once notified, the Rehabilitation Coordinator will liaise with the client’s incapacity claims manager to ensure that incapacity payments are reactivated.

Reinstatement of incapacity payments under this policy is not restricted to the client’s mental health condition(s) impacting their employment, however their accepted mental health condition must be a contributing factor.  As long as the Rehabilitation Coordinator is satisfied that the reason for the change affecting their employment is genuine and that their accepted mental health condition has contributed to the change, the impact on their employment can be due to any of their accepted conditions,  Clients who have not been previously accepted under Streamlined Access to Incapacity Payments will need to follow the normal procedures, which may include a new Incapacity Payments claim.

Streamlined Access to Incapacity Payments provides additional rehabilitation support for clients who are vulnerable to moving in and out of employment due to their accepted mental health conditions. It is also important that clients continue to access appropriate treatment and support from their treating health professionals, to ensure that any flare in symptoms can be managed as quickly as possible.

For this reason, DVA expects that a client who is accessing support through Streamlined Access to Incapacity Payments will visit their GP, psychiatrist, psychologist or other appropriate health provider when they begin to experience difficulties in managing their employment responsibilities. A medical certificate from any treating health professional, including their GP, will provide DVA with required assurance that the client’s mental health condition(s) is a main contributor to the client needing to reduce their hours of employment, or to cease their employment. This certificate must be provided to the client’s DVA Rehabilitation Coordinator.

Where the person remains in employment at a reduced number of hours, it is important that DVA has evidence of the client’s current rate of pay, as this will ensure that the correct rate of incapacity payments is paid, and will reduce the risk of overpayments. If the person has completely ceased employment, an employment separation certificate will be required before incapacity payments can be reinstated. If the client is having difficulty accessing these documents, the Rehabilitation Provider can assist and ensure that they are forwarded to the client’s DVA Rehabilitation Coordinator. The Rehabilitation Coordinator will then liaise with the client’s incapacity claims manager so that incapacity payments can recommence as quickly as possible.

There are no barriers to a client being able to participate in Streamlined Access to Incapacity Payments on more than one occasion, however, each incident cannot be extended beyond 12 months. For example, a client may commence employment two times and can access streamlined access to incapacity payments both times. But if the client remains in employment for 12 months and asks for an extension to the Streamlined Access to Incapacity Payments, then this cannot be granted and the client will need to re-claim for payments in the normal way.

Ceasing or reducing hours of work due to other reasons

If the client needs to cease their employment or reduce their hours, because of a reason that is not their accepted conditions, they cannot automatically have their incapacity payments reinstated.

Other reasons might include when the client;

• has a family emergency;
• has parental duties;
• doesn’t like the work;
• is moving out of commutable range;
• is wanting time off to travel;
• has their employment contract ceased due to employment performance issues; or
• has an unrelated health issue which is the cause of leaving employment or reducing hours.

In this case, if the client must choose if they wish to submit a new Incapacity Payments claim, which may or may not be accepted.

Non-compliance

The expectations of clients accessing additional support through this policy are available at section [4]9.13 [4] of the Rehabilitation Policy Library. The general rights and obligations of clients undertaking rehabilitation can be found at section 13 [5] of the Rehabilitation Policy Library.

Clients accessing additional support through this policy have been identified as requiring additional support due to the episodic nature of their mental health conditions.  In keeping with the intent of this policy, clients should be given every assistance in meeting their obligations before any action is taken to remove benefits. In all likelihood, non-compliance may be as a result of clients being involved in their new employment and not believing they require any assistance.

It is essential that if the plan is being closed due to non-compliance, that it is the Rehabilitation Coordinator that discusses this with the client, and informs them that the plan will be closed, and the consequences of this occurring. At no time must a Rehabilitation Provider progress a discussion regarding, or be asked to communicate closure of a plan due to non-compliance with rehabilitation obligations with a client. The policy regarding closure of a rehabilitation plan can be found at section 3.10 [6] of the Rehabilitation Policy Library.

Successful return to work at 12 months

At the end of the 12 month monitoring period, where the Rehabilitation Coordinator is satisfied that the client has returned to sustainable employment and all other goals are closed, the rehabilitation plan will be closed. 

In situations where the client needs ongoing assistance, due to their mental health conditions or other conditions, and an appropriate goal is still active, then the rehabilitation plan can continue. However, the Streamlined Access to Incapacity Payments flag should be removed at the 12 month mark.

Ceasing/reducing work after the 12 month approved period

There is a 12 month maximum period to Streamlined Access to Incapacity Payments, and after this period, rehabilitation (and access to incapacity payments) reverts to BAU.

Clients approved for the Streamlined Access to Incapacity Payments are expected to be:

• motivated and ready to attempt a return to employment;
• willing to continue to participate in whole-of-person rehabilitation activities approved under their extended rehabilitation plan that may assist in making their return to work more sustainable;
• happy to be contacted by their Rehabilitation Provider on a regular basis while their extended rehabilitation plan remains open;
• agreeable to their Rehabilitation Provider contacting their health providers, and/or their employer to:
  • seek information about issues where it is appropriate for them to do so,
  • to try to resolve difficulties with their employment role, or
  • to access documents from their employer to ensure that their incapacity payments can recommence as quickly as possible if they need to reduce their hours or cease employment;
• prepared to address issues that may arise during their employment, and be proactive in seeking out and using strategies that may help them to remain in employment for as long as they are able to;
• committed to contacting their Rehabilitation Provider as soon as they begin to experience difficulties in their work role, or relationships with employers or co-workers, or a change in their mental health symptoms;
• agreeable to visiting their GP, psychologist, psychiatrist or other appropriate medical specialist if they begin to experience an increase in the symptoms of their accepted mental health conditions;
• prepared to access appropriate treatment during the period that they are away from work, or working reduced hours; and
• willing to contact their Rehabilitation Provider when they are comfortable for their extended rehabilitation plan to be closed, as they feel that they are managing their employment effectively.

Participation in Streamlined Access to Incapacity Payments is voluntary and clients can decide that they would like to withdraw from their involvement at any time. However, clients who are participating will be expected to continue to be involved in activities on their rehabilitation plan that focus on building on their capacity to sustain long term employment.

As the client will be concurrently managing their employment obligations while adjusting to changes to routine and demand on their time that they may not be used to, it is important that the rehabilitation  activities are not too onerous and that participation these can be realistically achieved. A rehabilitation plan for a participating client would be expected to be less complex and include fewer activities relative to other clients.  Any achieved goals need to be closed, and an appropriate monitoring of employment goal needs to be created for any activities relating to this period.  Scheduled Rehabilitation Provider contact needs to be agreed upon, and can be more or less frequent, depending on the clients’ needs.

If a client withdraws from Streamlined Access to Incapacity Payments, the Rehabilitation Provider is expected to provide a rehabilitation closure report for the Rehabilitation Coordinator explaining that the client has chosen to withdraw, however, successful return to work (if still appropriate) can still be used as the reason for closure.

DVA’s expectations of Rehabilitation Providers who are working with clients accessing streamlined access to incapacity payments include:

• providing clear advice about why the client would benefit from Streamlined Access to Incapacity Payments;
• identifying and communicating the particular risk factors that apply for the individual client and how the client and the provider will work together to address these risks;
• gaining agreement from the client to maintain regular contact with the Rehabilitation Provider, together with a plan for how this contact will be maintained;
• gaining agreement from the client that they will alert their Rehabilitation Provider as soon as they begin to experience difficulties in managing employment because of their accepted conditions;
• closing achieved goals and establishing new SMART goals (with GAS) on the extended rehabilitation plan ,;
• ensuring that a whole-of-person approach is always utilised, so that barriers to rehabilitation and employment can be pro-actively addressed;
• continuing completion of the LSI;
• continuing using all standard DVA documents during the extended rehabilitation plan;
• maintaining contact with the DVA Rehabilitation Coordinator at agreed time periods and providing meaningful updates on the client’s rehabilitation plan;
• ensuring that the DVA Rehabilitation Coordinator is informed as quickly as possible if the client begins to experience difficulties in employment that may lead to incapacity payments needing to be recommenced;
• keeping in touch with the client’s treating health professionals and employer as appropriate, particularly when the client is experiencing difficulties in employment;
• using their judgement about whether, with the client’s permission, they may need to contact the client’s employer to access evidence of their current rate of pay if they have needed to reduce their hours of work, or a separation certificate if the client has needed to cease employment, if the client is too unwell to be able to do so; and
• a commitment to informing the DVA Rehabilitation Coordinator as soon as possible when the client is effectively managing their employment role, and has requested that their rehabilitation plan be closed.

As outlined in section 3.8.5 [7], progress reports are a key reporting tool which reports progress and planned actions against goals. However, during the employment monitoring phase, if no other goals are still active, Rehabilitation Coordinators and Rehabilitation Providers can agree to reduce the frequency or cease these reports. Providers are still required to communicate any issues or developments as they happen.

It is essential that a client receiving support through Streamlined Access to Incapacity Payments is not deemed with an ability to earn while their extended rehabilitation plan remains open. To do so would create barriers to the person’s incapacity payments being reinstated as quickly and as easily as possible. Clients participating in this policy will be identified on the claim in the rehabilitation and incapacity payments screens on R&C ISH. 

It is important that the client’s Rehabilitation Coordinator and the client’s incapacity delegate communicate regularly and that the incapacity delegate is immediately notified when a client needs to reduce, pause or cease their employment due to an increase in the symptoms, or impact of their accepted mental health condition(s). This will prevent any unnecessary delays in incapacity payments being recommenced.

Rehabilitation Coordinators are expected to ensure that value for money is being achieved during the extended rehabilitation program and that the Rehabilitation Provider is actively engaged and providing meaningful support to the client. If a Rehabilitation Coordinator has any concerns about the Rehabilitation Provider’s recommendation that a specific client be provided with an extended rehabilitation plan, then it is strongly suggested that they discuss the case with a DVA Rehabilitation Adviser, to help determine a way forward.

Rehabilitation Coordinators are expected to ensure that a whole-of-person rehabilitation approach is maintained during the extended rehabilitation program. If a client needs to reduce their hours or work, access sick leave or cease employment, their rehabilitation plan may move to focusing on medical management and/or psychosocial rehabilitation activities once their acute symptoms have diminished. This helps to ensure that the client will continue to work towards overcoming barriers to their recovery, which includes barriers to them remaining in employment.

This means for example, that it would be reasonable for an exercise program, healthy cooking course, dietician support or similar activities to be included on the extended rehabilitation plan, if a client’s physical health and weight gain is impacting on their ability to sustain employment.  Another example is that time limited anger management, stress management, mindfulness, meditation or yoga courses may be included on a rehabilitation plan to assist clients to develop strategies to manage stress in their workplace. Likewise, time limited drama courses, public speaking or other similar courses could be included on the rehabilitation plan if the client is having difficulty in communicating in a work place. A flexible approach will be required, with each case to be considered on its merits, being mindful that non-accepted conditions are also likely to impact on the client’s ability to sustain employment.  As the client starts to recover, and their symptoms reduce, then vocational rehabilitation activities can recommence.