Skip to main content
SpringerLink
Log in

Psychiatric Issues in Behavioral Health Disability

  • Chapter
  • First Online:
Behavioral Health Disability

Abstract

This chapter explores the essential differences between two important professional roles that a psychiatrist may routinely practice. The distinction is important because of the separate professional responsibilities associated with each. A psychiatrist may engage in the psychiatric disability or workers’ compensation process in either a forensic role or as a treating provider. Thus, it is imperative for a psychiatrist to be aware of these differences in order to avoid intrinsic ethical and potential legal issues when one attempts to perform both roles simultaneously. As a treating provider, the psychiatrist is in a position to improve an individual’s overall health function by many measures, increase quality of life for mentally ill individuals and families, and impact the multidimensional costs of mental illness. There is a growing body of evidence to support that shorter recovery and better clinical outcomes result from focusing psychiatric treatment on restoration and maintaining function. This is in contrast to traditional psychiatric thinking that recovery from mental illness requires an individual to be “away from” the demands of a stressor, such as his or her work situation. There are numerous evaluation and treatment approaches available to the treating psychiatrist who wishes to shift away from the traditional paradigm in order to serve as an advocate for his or her patient, as well as in promoting the individual’s full participation in work and in other life activities.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    Often in relation to mental health disability, entities distinguish between “subjective” data (what the patient or claimant reports) and “objective” data (clinician findings and obervations, as well as laboratory and imaging data.) This can connote minimizing the “subjective” data as “less real” than objective data. Therefore this author and others prefer the distinction of “self reported” data (for which the patient or claimant is the source) and “findings and observations (for which the mental health professional is the source).

References

  • Summits (2009) Available at www.60summits.org

  • Allison, T. G., Williams, D. E., Miller, T. D., et al. (1995). Medical and economic costs of psychologic distress in patients with coronary artery disease. Mayo Clinic Proceedings, 70, 734–742.

    Article  PubMed  CAS  Google Scholar 

  • American Academy of Psychiatry and the Law (2005). Ethics guidelines for the practice of forensic psychiatry. Available at www.aapl.org

  • American College of Occupational and Environmental Medicine (ACOEM). (2006). Preventing needless work disability by helping people stay employed. Journal of Occupational and Environmental Medicine, 48, 972–987.

    Article  Google Scholar 

  • American Physical Therapy Association (2009). Guidelines: occupational health physical therapy: work conditioning and work hardening programs. Available at www.apta.org

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4 th edition, text revision. Washington, D.C: American Psychiatric Association.

    Book  Google Scholar 

  • American Psychiatric Association. (2006). Practice guidelines for the treatment of psychiatric disorders, compendium 2006. Washington, D.C: American Psychiatric Association.

    Book  Google Scholar 

  • American Psychiatric Foundation, Partnership for Workplace Mental Health (2005). Assessing and treating psychiatric occupational disability: new behavioral health functional assessment tools facilitate return to work. Available at www.workplacementalhealth.org

  • Barofsky, I. (1978). Compliance, adherence, and the therapeutic alliance: steps in the development of self care. Social Science and Medicine, 12, 369–376.

    CAS  Google Scholar 

  • Barsky, A. J., Delamanter, B. A., & Orav, J. E. (1999). Panic disorder patients and their medical care. Psychosomatics, 40, 50–56.

    Article  PubMed  CAS  Google Scholar 

  • Bartley, M. (1994). Unemployment and ill health: understanding the relationship. Journal of Epidemiology and Community Health, 48, 333–337.

    Article  PubMed  CAS  Google Scholar 

  • Binder, L. M. (1993). Portland digit recognition test manual. Beaverton, OR: Laurence Binder.

    Google Scholar 

  • Blackwell, B. (1976). Treatment adherence. The American Journal of Psychiatry, 129, 513–531.

    Article  CAS  Google Scholar 

  • Chodoff, P. (2002). The medicalization of the human condition. Psychiatric Services, 53, 627–628.

    Article  PubMed  Google Scholar 

  • Conrad, P. (2007). The medicalization of society: on the transformation of human conditions into treatable disorders. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Druss, B. G., Rosenheck, R. A., & Sledge, W. H. (2000). Health and disability costs of depressive illness in a major US corporation. The American Journal of Psychiatry, 157, 1274–1278.

    Article  PubMed  CAS  Google Scholar 

  • Egede, L. E. (2004). Diabetes, major depression, and functional disability among US adults. Diabetes Care, 27, 421–428.

    Article  PubMed  Google Scholar 

  • Eisenthal, S., Emery, R., & Lazare, A. (1979). Adherence and the negotiated approach to parenthood. Archives of General Psychiatry, 36, 393–398.

    Article  PubMed  CAS  Google Scholar 

  • Ekman, P. (1985). Telling lies: clues to deceit in the marketplace, politics, and marriage. New York: Norton.

    Google Scholar 

  • Fenton, W., Blyler, C., & Heinssen, R. (1997). Determination of medication compliance in schizophrenia: empirical and clinical findings. Schizophrenia Bulletin, 23, 637–6510.

    Article  PubMed  CAS  Google Scholar 

  • Fishbein, M., & Ajzen, J. (1975). Belief, attitude, intention, and behavior. Massachusetts: Reading.

    Google Scholar 

  • Frances, A. (2009). A warning sign on the road to DSM-V: beware of its unintended consequences. Psychiatric Times, 26(8), 1–9.

    Google Scholar 

  • Frederick, R., Sargaty, S., Johnston, J. D., et al. (1994). Validation of a detour response bias on a forced-choice test of nonverbal ability. Neuropsychology, 8, 118–125.

    Article  Google Scholar 

  • Garriga, M. (2007). Malingering in the clinical setting. Psychiatric Times, 24(3), 1–4.

    Google Scholar 

  • Gerdtham, U. G., & Johannesson, M. (2003). A note on the effect of unemployment on mortality. Journal of Health Economics, 22, 505–518.

    Article  PubMed  Google Scholar 

  • Goldfinger, S. M., Hopkin, J. T., & Surber, R. W. (1984). Treatment resisters or system resisters?: toward a better service system for acute care recidivists. New Directions for Mental Health Services, 21, 17–27.

    Article  PubMed  Google Scholar 

  • Greenberg, P. E., Kessler, R. C., Nells, T. L., et al. (1996). Depression in the workplace: an economic perspective. In J. P. Feighner & W. F. Boyer (Eds.), Selective serotonin re-uptake inhibitors: advances in basic research and clinical practice. New York: Wiley and Sons.

    Google Scholar 

  • Hales, R. E., Yudofsky, S. C., & Gabbard, G. O. (2008). The american psychiatric publishing textbook of psychiatry (5th ed.). Arlington, VA: American Psychiatric Publishing.

    Google Scholar 

  • Hall, J. A., & Dornan, M. C. (1988). What patients like about their medical care and how often they are asked: a meta analysis of the satisfaction literature. Social Science and Medicine, 27, 935–939.

    Article  PubMed  CAS  Google Scholar 

  • Harris, I., Multford, J., Solomon, M., et al. (2005). Association between compensation status and outcome after surgery. Journal of the American Medical Association, 293, 1644–1652.

    Article  PubMed  CAS  Google Scholar 

  • Haynes, R. B., Taylor, D. W., & Sackett, D. L. (1979). Compliance in health care. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Horwitz, R. I., & Horwitz, S. M. (1993). Adherence to treatment and health outcomes. Archives of Internal Medicine, 153, 1863–1868.

    Article  PubMed  CAS  Google Scholar 

  • Jin, R. L., Shah, C. P., & Svoboda, T. J. (1995). The impact of unemployment on health: a review of the evidence. Canadian Medical Association Journal, 153, 529–540.

    PubMed  CAS  Google Scholar 

  • Johnson, D. A. W. (1979). Further observations on the duration of depot neuroleptic maintenance therapy in schizophrenia. The British Journal of Psychiatry, 135, 524–530.

    Article  PubMed  CAS  Google Scholar 

  • Kahn, J. P. (2008). Diagnosis and referral of workplace depression. Journal of Occupational and Environmental Medicine, 50, 396–400.

    Article  PubMed  Google Scholar 

  • Kahn, J. P., & Aidinoff, S. (1999). Occupational psychiatry and the employee assistance program. In J. Oher (Ed.), The employee assistance handbook. New York: Wiley and Sons.

    Google Scholar 

  • Katon, W., Von, K. M., Lin, E., et al. (1990). Distressed high utilizers of medical care: DSM II diagnoses and treatment needs. General Hospital Psychiatry, 12, 355–362.

    Article  PubMed  CAS  Google Scholar 

  • Kessler, R. C., Berglund, P., Demler, O., et al. (2005). Lifetime prevalence and age-of-onset distributions of DSM IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Greenberg, P. E., Mickelson, K. D., et al. (2001). The effects of chronic medical conditions on work loss and work cutback. Journal of Occupational and Environmental Medicine, 43, 218–225.

    Article  PubMed  CAS  Google Scholar 

  • Krause, N., Frank, J. W., Dasinger, L. K., et al. (2001). Determinants of disability and return to work after work-related injury and illness: challenges for future research. American Journal of Industrial Medicine, 40, 464–484.

    Article  PubMed  CAS  Google Scholar 

  • Kroenke, K., & Mangesldorff, A. D. (1989). Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. The American Journal of Medicine, 86, 262–266.

    Article  PubMed  CAS  Google Scholar 

  • Langlieb, A. M., & Kahn, J. P. (2005). How much does quality mental health care profit employers? Journal of Occupational and Environmental Medicine, 47, 1099–1199.

    Article  PubMed  Google Scholar 

  • Lecrubier, Y. (2001). The burden of depression and anxiety in general medicine. The Journal of Clinical Psychiatry, 62(Suppl 8), 4–9.

    PubMed  Google Scholar 

  • Lepine, J. P. (2002). The epidemiology of anxiety disorders: prevalence and societal costs. The Journal of Clinical Psychiatry, 63(Suppl 14), 4–8.

    PubMed  Google Scholar 

  • Lerner, B. H., Gulick, R. M., & Dubler, N. N. (1998). Rethinking nonadherence: historical perspectives on triple-drug therapy for HIV disease. Annals of Internal Medicine, 129, 573–578.

    PubMed  CAS  Google Scholar 

  • Lustman, P. J., Griffith, L. S., & Clouse, R. E. (1997). Depression in adults with diabetes. Seminars in Clinical Neuropsychiatry, 2, 15–23.

    PubMed  Google Scholar 

  • Moran, A. E., Freedman, R. I., & Sharfstein, S. S. (1984). The journey of sylvia frumpkin: a case study for policy makers. Hospital & Community Psychiatry, 35, 887–893.

    CAS  Google Scholar 

  • Morgan H (2006) A conflict of roles: expert witness or treating physician? SpineLine July/August 2006: 27–30

    Google Scholar 

  • National Institutes of Mental Health (2001). Depression can break your heart. Available at www.nimh.gov

  • Norell, S. E. (1981). Accuracy of patient interviews and estimates of clinical staff in determining medication compliance. Social Science and Medicine, 15, 57.

    Article  CAS  Google Scholar 

  • Palardy, N., Greenberg, L., Ott, J., et al. (1998). Adolescents health attitudes and adherence to treatment for insulin dependent diabetes mellitus. Journal of Developmental and Behavioral Pediatrics, 19, 31–37.

    Article  PubMed  CAS  Google Scholar 

  • Pampallona, S., Bolini, P., Tibaldi, G., et al. (2002). Patient adherence in the treatment of depression. British Journal of Psychiatry, 180, 104–109.

    Article  PubMed  CAS  Google Scholar 

  • Parker, J. (2009). Managing complex disability cases: a conversation about finding exceptions. Back to Work: Disability Management and Return to Work Strategies in Canada, 13(3), 6–7.

    Google Scholar 

  • Perkins, D. O. (2002). Predictors of noncompliance in patents with schizophrenia. The Journal of Clinical Psychiatry, 63, 118–1121.

    Article  Google Scholar 

  • Purcell, T. B. (2002). Factitious disorders and malingering. In J. A. Marx, H. S. Robert, & R. M. Walls (Eds.), Rosen’s emergency medicine: concepts and clinical practice (5th ed.). St. Louis: Mosby.

    Google Scholar 

  • Reed, P. (Ed.). (2005). The medical disability advisor (5th ed.). Reed Group, Ltd, Westminster: CO.

    Google Scholar 

  • Reid, W. H. (1993). Law and psychiatry: treating clinicians and expert testimony. Journal of Practical Psychiatry and Behavioral Health, 4, 1–3.

    Google Scholar 

  • Rogers, R., Harrell, E. G., & Liff, C. D. (1993). Feigning neuropsychological impairment: a critical review of methodological and clinical considerations. Clinical Psychology Review, 13, 255–274.

    Article  Google Scholar 

  • Rosen, J., Mulsant, B. H., Bruce, M. H., et al. (2004). Actors’ portrayals of depression to test interrater reliability in clinical trials. The American Journal of Psychiatry, 161, 1909–1911.

    Article  PubMed  Google Scholar 

  • Rossi, A. S. (2001). Caring and doing for others: social responsibility in the domains of family, work, and community. Chicago: University of Chicago Press.

    Google Scholar 

  • Sajatovic, M., Davies, M., & Hrouda, D. R. (2004). Enhancement of treatment adherence among patients with bipolar disorder. Psychiatric Services, 55, 264–269.

    Article  PubMed  Google Scholar 

  • Samuel, R. Z., & Mittenberg, W. (2005). Determination of malingering in disability determinations. Primary Psychiatry, 12(12), 60–68.

    Google Scholar 

  • Schatzberg, A. F., Scully, J. H., Kupfer, D. J., & Regier, D. A. (2009). Setting the record straight: a response to Dr Frances’ commentary on DSM-V. Psychiatric Times, 26(8), 1. 9–10.

    Google Scholar 

  • Simon, G. E. (2003). Social and economic burdens of mood disorders. Biological Psychiatry, 54, 208–215.

    Article  PubMed  Google Scholar 

  • Simon, G. E., Revicki, D., Heiligenstein, J., et al. (2000). Recovery from depression, work productivity, and health care costs among primary care patients. General Hospital Psychiatry, 22, 153–162.

    Article  PubMed  CAS  Google Scholar 

  • Sleeth, J. (2009). Mental health, disability, and stress: what Selye and Mate can tell the human resources professional. Back to Work: Disability Management and Return to Work Strategies in Canada, 13(3), 8–9.

    Google Scholar 

  • Soumerai, S., McLaughlin, T. J., Ross-Degnan, D., et al. (1994). Effects of limiting medicaid drug reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. The New England Journal of Medicine, 331, 650–655.

    Article  PubMed  CAS  Google Scholar 

  • Starsburger, L. H., Gutheil, T. G., & Brodsky, A. (1997). On wearing two hats: role conflict in serving as both therapist and expert witness. The American Journal of Psychiatry, 154, 448–456.

    Google Scholar 

  • Trueblood, W., & Schmidt, M. (1993). Malingering and other validity considerations in the neuropsychological evaluation of mild head injury. Journal of Clinical and Experimental Neuropsychology, 15, 578–590.

    Article  PubMed  CAS  Google Scholar 

  • Trzepacz, P. T., & Baker, R. W. (1993). The psychiatric mental status exam. Oxford, UK: Oxford University Press.

    Google Scholar 

  • Twaddle, A. C. (1979). Sickness behavior and the sick role. Cambridge, MA: Schenkman Publishing.

    Google Scholar 

  • Unutzer, J., Patrick, D. L., Simon, G., et al. (1997). Depressive symptoms and the cost of health services in HMO patients aged 65 years and older: a four year prospective study. The Journal of the American Medical Association, 277, 1618–1623.

    Article  CAS  Google Scholar 

  • Weiden, P., & Olfson, M. (1995). Cost of relapse in schizophrenia. Schizophrenia Bulletin, 21, 419–428.

    Article  PubMed  CAS  Google Scholar 

  • Weiden, P., & Rao, N. (2005). Teaching medication compliance to psychiatric residents: placing an orphan topic into a training curriculum. Academic Psychiatry, 29, 203–210.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Each of us has the privilege of leaning on the shoulders of others. In formulating this chapter, I have drawn deeply from the well of extensive research by many scholars and practitioners, to whom I am in great debt. Special thanks to Jennifer Christian, M.D., President and CMO of Webility Corporation, and Founder of 60 Summits Project and Jeffrey P. Kahn, M.D., CEO, WorkPsych Associates, Inc. for providing a wealth of foundational research; and to Jeffrey Segal, M.D., J.D., F.A.C.S., CEO of Medical Justice, for invaluable assistance in defining and articulating the forensic psychiatric role.

Author information

Authors and Affiliations

  1. Disability Research and Consulting, LLC, Atlanta, GA, USA

    Bettina B. Kilburn

Authors
  1. Bettina B. Kilburn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bettina B. Kilburn .

Editor information

Editors and Affiliations

  1. Carle Physician Group, Urbana, 61801-2302, Illinois, USA

    Pamela A. Warren

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Kilburn, B.B. (2010). Psychiatric Issues in Behavioral Health Disability. In: Warren, P. (eds) Behavioral Health Disability. Springer, New York, NY. https://doi.org/10.1007/978-0-387-09814-2_5

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-09814-2_5

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-09813-5

  • Online ISBN: 978-0-387-09814-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation