Treating V preventing secondary psychological conditions: Why these require fundamentally different approaches
Lauren Kotevski, Clinical Psychologist & Team Leader
This is the sixth post in a nine blog series where Navigator Group will set out what we believe the current evidence tells us about psychosocial risk, recovery and workers' compensation, and where the open questions still are.
Workers' compensation discussions about psychological conditions tend to focus on treatment: what services are available, whether they are adequately funded and how to ensure workers can access them in a timely way. Treatment is necessary and the quality of the treatment matters. However, it addresses a different problem from prevention, and conflating the two has consequences for how models are designed and resources are allocated.
Treatment and prevention are not the same activity delivered at different points in time. They operate on different timelines, require different clinical infrastructure and produce different outcomes.
What treatment addresses
Treatment of secondary psychological conditions occurs after those conditions have developed. A worker may have been in the compensation system for several months, distress symptoms have become visible and documented, and a referral is made to a psychologist.
Treatment at this stage is both appropriate and necessary. Some workers will inevitably present at a point where prevention was not possible, and the quality of their clinical care matters. The limitations of treatment at this stage, however, are real.
By the time a worker presents with entrenched anxiety, a disrupted relationship with their treating team or a chronic pain condition compounded by psychological distress, the recovery trajectory is substantially more difficult. The worker may have accumulated months of negative experiences within the system. Their self-efficacy, meaning their belief in their capacity to recover and return to work, may be significantly eroded. The biological, psychological and social factors sustaining their condition have had time to become mutually reinforcing.
Treatment under these conditions is resource-intensive and produces more limited results than intervention at an earlier stage. The It Pays to Care guide notes that full psychosocial matched care, a model fundamentally oriented toward prevention, achieves claim duration reductions of 30 to 50 per cent. Treatment-only models have not demonstrated reductions of the same magnitude.
What prevention requires
Prevention of secondary psychological conditions requires intervention before those conditions develop. This means identifying psychosocial risk within weeks of injury onset, rather than months later. It means having the clinical capacity to assess the specific barriers present for the individual, and then delivering a proportionate response, intensive where the risk is elevated and minimal where it is not.
Prevention is not the absence of intervention. It is a more demanding form of intervention. It requires a screening and triage infrastructure embedded within the claims process from the outset. It requires practitioners skilled in early risk identification, and a clinical response calibrated to risk level rather than to visible symptom severity.
The distinction also has implications for population reach. A treatment model is reactive in that it supports the workers who present with identifiable problems. A prevention model is proactive in that it identifies workers at risk before the problems are visible and intervenes at the point when intervention is most likely to be effective.
For scheme environments, that is not a trivial operational shift. It requires different referral criteria, different triage processes and a different set of clinical capabilities at the front line.
What the NSW legislative reforms are signalling
Recent legislative reforms for the NSW scheme are relevant in this context, though implementation timelines have not yet been confirmed. Among the proposed changes are new eligibility requirements, entitlements and claims processes for primary psychological injuries during the assessment period; interim entitlements for conduct-based claims while liability is being determined; and a refined standard for what constitutes reasonable and necessary medical treatment
The shift to a 'reasonable and necessary' test for treatment, aligned with the approach applied in the NSW CTP scheme, will require providers to demonstrate that the treatment being delivered is clinically warranted and proportionate to the worker's clinical needs. The three questions this standard implies are: Is the treatment related to the injury? Is it reasonable? Is it necessary? These are questions that a well-specified psychosocial matched care model can answer with confidence.
For providers delivering evidence-aligned individually matched programs, the new standard is consistent with what good practice already requires. For providers delivering generic or poorly specified programs, it raises the bar.
The design and resource implications
The treatment-prevention distinction carries direct implications for program design and the financial case for investment. Prevention programs, when implemented with fidelity, cost less per worker over a claim and produce substantially better outcomes than reactive treatment for the same population. They require upfront investment in screening infrastructure, practitioner capability and integration with claims processes, and that investment precedes the return.
Making the case for that investment requires an honest account of what prevention delivers and what the alternative costs. It is a conversation that belongs in every commercial relationship between service providers and the insurers and schemes they work with.
Source Materials:
Workers' Voice Solutions Series (Monash University, October 2025)
It Pays to Care: Early Systematic Psychosocial Matched Care - A Best Practice Guide (Wyatt, Garton, Nicholas & Iles, May 2025).-