Psychiatric Disability Assessment

A psychiatric disability assessment is an important part of your case for disability benefits. It includes the diagnosis of mental illness, a description on how it affects your daily routine and a score for how severe the limitations are.

The SSA uses this rating to determine whether you meet the criteria for one or more of their list of disabled.

Background

Patients with psychiatric conditions frequently request psychiatric patient assessment disability evaluations. These evaluations can be complex and challenging and require a thorough understanding of the laws and programs governing disability in the United States. Despite these challenges PCPs can conduct practical disability assessments by (1) the evaluation of the ability of their patients to function at home as well as in the workplace, (2) collaborating with consulting services and stakeholders, and (3) setting functional recovery and RTW as a primary goal of treatment. Psychologists can also aid in progress towards RTW by encouraging gradual functional improvement and by educating their patients on the bidirectional connection between symptoms and functioning.

During the disability examination the doctor will talk with the patient in order to gather a complete account of the symptoms and their duration and severity. The doctor is able to compare the symptoms to the patient's everyday activities, as described in the World Health Organization International Classification of Functioning, Disability and Health. This assessment is usually performed using a mental state examination (MSE) together with one or more structured questions, like the Medical Outcomes Survey and Functional Independence Measure.

Additionally, the doctor may conduct additional tests, such as the World Health Organization Disability Assessment Schedule. The assessment comprises items that pertain to six domains: understanding and communication; moving around and moving around as well as personal care and social interactions; living on your own or in a group. The assessment can be completed by the doctor or self-administered. Other assessment tools include the Symptom Severity Index and the Memory Scale Exam, which are given to patients who have short-term memory loss.

While psychiatric disability assessments are crucial to help patients recover, they are not taught in psychiatric courses. It is important that psychiatrists are aware of how to conduct these assessments and have the required skills to ensure a positive outcome. A greater awareness and education in this area will enable psychiatrists to better understand the role they can play in helping their patients get back to work. This is essential to reduce the amount of time a patient remains on disability, as well as for encouraging an RTW culture.

Methods

The process of determining disability is complex and involves a variety of factors that include the severity, diagnosis and duration of the disorder. The full psychiatric assessment disability accounts for a significant portion of Social Security disability awards and private long-term disability claims.

Although a psychiatrist's evaluation isn't the sole source of a disability decision the quality of the assessment report is vitally important. Physicians are often asked to act as consultative examiners or expert witnesses in disability determination cases. It is therefore crucial to understand how disability assessments function to to provide an effective service.

Evaluations of psychiatric impairments typically begin with a thorough history. This includes a complete mental status exam, and special investigations such as psychological testing (particularly for children) and physical exams. The evaluator must obtain additional information, such as interviews with family members, teachers and other professionals, like treatment providers.

When conducting the evaluation it is important to link impairments and limitations to the person's performance in their daily life and work. For example, the Psychiatric Review Technique form includes ratings of no, mild moderate, significant, and extreme restrictions in activities of daily living and work-related activities. It is also important to identify the psychopathology underlying (positive and negative findings) in terms of the likely aetiology of the disorder.

The ability of a person in a workplace-like setting to interact with others is also an important part of determining disability. This can be evaluated using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) which evaluates the capacity of a person to take care of themselves mobility, understanding, and reasoning.

A psychiatric assessment of disability should include any comorbid conditions, such as muscular and cognitive disorders as well as musculoskeletal conditions. These disorders are common among those with intellectual disabilities, and they can have a profound impact on their capacity to function and ability to work. It is important to also take into consideration the effects of medications on functional capacity, including the side-effects of antipsychotics and antidepressants which are typically prescribed to people with disabilities.

It is important to keep in mind that disability determination is both a legal and administrative procedure. The person evaluating the claim should not be able to make a final determination on disability and should be prepared for honest disagreement.

Results

In the United States psychiatric disability claims and payments account for the majority of disability benefits. This is why psychiatric disability assessments are becoming increasingly important. A thorough psychiatric examination requires a thorough interview as well as the use of standard measures and adequate documentation. These psychiatric assessments can be complicated because the symptoms and signs of psychiatric disorders can interfere with daily activities, from basic self-care to the ability to work.

In order to determine whether a person is disabled, the psychiatrist has to assess the extent to which the condition hinders with daily activity and demonstrates significant impairment in working functions. This must be documented on the psychiatric assessment report that is submitted to the Department of Disability Services. The Psychiatric Assessment Report must also include a diagnosis and a description of daily activities. The report should not recommend that the application be accepted or rejected. This is a function of the DDS team. The psychiatric report must include the name, title, professional credentials, address and telephone number of the doctor conducting the exam.

The adverse effects of psychiatric medication can have a negative effect on academic performance. They can cause drowsiness, fatigue, dry eyes, blurred vision, hand shaking, slow reaction time, and inability to tolerate noises, crowds or smells. Mental disorders that affect academic performance can affect students from a wide spectrum of backgrounds and make up significant proportions of the student population in postsecondary education.

In 1980 the Diagnostic and Statistical Manual of Mental Disorders, third edition, introduced the GAF score. It measures the functional impairment of an individual. The GAF score is still used, even though it's not in the most current edition of the manual. In its place the World Health Organization Disability Assessment Schedule has been adopted. The new assessment incorporates a number of cross-cutting symptom measures that aid in identifying functional impairments that cannot be detected by individual diagnosis alone. These measures can improve the efficiency of disability evaluation and provide more information for the DDS team.

Conclusions

Psychiatrists are often asked to conduct disability assessments in their role as treating doctors, consultative examiners and expert witnesses. They may be asked to assist in SSA disability determinations based on the inability to perform substantial gainful work.

A psychiatric disability evaluation requires a thorough history and a clinical examination to determine the severity of the patient's symptoms, and how they interfere with functioning in daily life. For instance, a patient with severe depression might report difficulty in concentrating, staying focused on their work and maintaining stamina, while a mental status exam might show an inefficient response time, slowed speech, diminished eye movement coordination, diminished control of the limbs, and a lack of or no facial expressions.

Due to side effects of medications, patients might have trouble accomplishing school or work tasks, such as drowsiness and fatigue, blurred vision, mouth and hand tremors, and a speech rhythm that is impaired. Some patients with psychiatric conditions, such as schizophrenia, bipolar disorder, or depressive disorders, might be unable to recognize and communicate social cues that signify the presence of others.

The doctor must examine the symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders with the actual limitations and issues of the patient. The GAF score is based upon a series of questions designed to assess a person's level of functioning, is an easy to use tool to do this. The GAF score is not present in the most recent version, the DSM-5. Instead, it has been replaced with the World Health Organization Disability Assessment Schedule 2(WHODAS 2.0).

It is important to remember that mental illness does not necessarily mean that a person has a disability according to SSA regulations. The SSA defines disability as the inability to engage in "substantial gainful activity." There are nine mental disorders that qualify for benefits.

Psychologists can learn from the most effective "barrier free" techniques for working with clients who have disabilities, including how to properly document functional impairments. They should also be familiar with the SSA guidelines for disability assessments. These guidelines are intended to increase the discussion and training on disability issues in psychology and to ensure that all psychological assessments and interventions are inclusive of disabilities and barrier-free.