Advertisement

A Critique of the Behavioral Health Disability System

  • Pamela A. Warren
Chapter

Abstract

A snapshot of the behavioral health (BH) spectrum reveals numerous factors that dramatically impede favorable treatment and disability leave outcomes. The managed care system was originally developed as a means to have the primary care physician (PCP) manage an individual’s health concerns. However, an unintended result has been that PCPs have become the primary professionals who are treating BH concerns. Thus, the primary care system has become the de facto mental health system in this country. Moreover, the additional aspects of poor diagnostic processes, treatment follow-up, and referrals to BH professionals further compound the poor treatment outcome issue. Additionally, these same issues impact insurers, the State Workers’ Compensation (WC) and Federal Employees’ Compensation Act (FECA), the Social Security Administration (SSA), as well as the private disability insurers. All of these disability systems utilize lengthy and ineffective approval processes for requested services. In addition, these systems lack incentives to facilitate the individual’s return to work. Taken as a whole, the combined issues that occur collectively across all disability systems have resulted in a problematic, complex disability conundrum.

Keywords

Behavioral Health Disability Workers’ Compensation Federal Employees’ Compensation Act (FECA) Social Security Administration De Facto Behavioral Health Care System Behavioral Health Treatment System Insurance Disability Psychology 

References

  1. Agency for Healthcare Research and Quality. (2009). National Healthcare Quality Report, 2008 (pp. 09–0001). Rockville, MD: Agency for Healthcare Research and Quality (Publication No.Google Scholar
  2. American Medical Association. (2008). Guides to the evaluation of permanent impairment (6th ed.). Chicago: American Medical Association.Google Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual on mental disorders (5th ed.). Washington, DC: American Psychiatric Association. (DSM-5).CrossRefGoogle Scholar
  4. American Psychiatric Foundation, Partnership for Workplace Mental Health. (2005). Assessing and treating psychiatric occupational disability, executive report. Washington, DC: American Psychiatric Association.Google Scholar
  5. American Psychiatric Association. (2006). Practice guidelines for the treatment of psychiatric disorders: Compendium. Arlington, VA: American Psychiatric Association Press.Google Scholar
  6. Anssea, M., Dierick, M., Buntink, F., et al. (2004). High prevalence of mental disorders in primary care. Journal of Affective Disorders, 78(1), 49–55.CrossRefGoogle Scholar
  7. Bagenstos, S. R. (2000). Subordination, stigma, and “disability”. Virginia Law Review, 86, 397–534.CrossRefGoogle Scholar
  8. Bruns, D., & Disorbio, J. M. (2005). Chronic pain and biopsychosocial disorders. Practical Pain Management, 5(7), 2–9.Google Scholar
  9. Bruns, D., Mueller, K., & Warren, P. A. (2010). A review of evidence-based biopsychosocial laws governing the treatment of pain and injury. Psychological Injury and Law, 3, 169–181.CrossRefGoogle Scholar
  10. Buist-Bouwman, M. A., de Graaf, R., Vollebergh, W. A. M., & Ormel, J. (2005). Comorbidity of physical and mental disorders and the effect on work-loss days. Acta Psychiatrica Scandinavica, 111(6), 436–443.CrossRefGoogle Scholar
  11. Campbell, L. C., Clauw, D. J., & Keefe, F. J. (2003). Persistent pain and depression: A biopsychosocial perspective. Biological Psychiatry, 54, 399–409.CrossRefGoogle Scholar
  12. Centers for Disease Control and Prevention. (2015a). Behavioral risk factor surveillance system prevalence data. Atlanta, GA: CDC.Google Scholar
  13. Center for Disease Control and Prevention. (2015b). Health, United States-Mental Health. https://www.cdc.gov/nchs/hus/mentalhealth.htm#access Google Scholar
  14. Centers for Disease Control and Prevention; National Center for Injury Prevention and Control. (2006). Web-based injury statistics query and reporting system (WISQARS). Retrieved from http://www.cdc.gov/ncipc/wisqars/default.htm
  15. Chellappa, P., & Ramaraj, R. (2009). Depression, homocysteine concentration, and cardiovascular events. Journal of the American Medical Association, 301(15), 1542.CrossRefGoogle Scholar
  16. de Waal, M. W. M., Arnold, I. A., Spinhoven, P., et al. (2009). The role of comorbidity in the detection of psychiatric disorders with checklists for mental and physical symptoms in primary care. Social Psychiatry and Psychiatric Epidemiology, 44(1), 78–85.CrossRefGoogle Scholar
  17. Dersh, J., Gatchel, R. J., Polatin, P., & Mayer, T. (2002). Prevalence of psychiatric disorders in patients with chronic, work-related musculoskeletal pain disability. Journal of Occupational and Environmental Medicine, 44, 459–469.CrossRefGoogle Scholar
  18. Dewa, C., & Lin, E. (2000). Chronic physical illness, psychiatric disorder and disability in the workplace. Social Science & Medicine, 51, 41–50.CrossRefGoogle Scholar
  19. DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160, 2101–2107.CrossRefGoogle Scholar
  20. Disability Management Employer Coalition (DMEC). (2009). Tools of the trade: A compilation of programs and processes for the absence, disability, health and productivity professional. San Diego, CA: Disability Management Employer Coalition.Google Scholar
  21. DVA Information Technology Center; Health Services Training Report; VBA Education Service; VBA Office of Performance Analysis & Integrity; 1 VHA OABI and VSSC (10E2A); 2 DoD. Produced by the National Center for Veterans Analysis and Statistics. http://www.va.gov/vetdata/pocketcard/index.asp
  22. Evans, D. L., Charney, D. S., Lewis, L., et al. (2005). Mood disorders in the medically ill: Scientific review and recommendations. Biological Psychiatry, 58, 175–189.CrossRefGoogle Scholar
  23. Federal Employees’ Compensation Act (FECA), Department of Labor, Federal Employees' CompensationAct (1916), Sept. 7, 1916, ch. 458, 39 Stat. 742, 39 Stat. 742, ch. 458.Google Scholar
  24. Fava, M., Rush, A. J., Alpert, J. E., et al. (2006). What clinical and symptom features and comorbid disorders characterize outpatients with anxious major depressive disorder: A replication and extension. Canadian Journal of Psychiatry, 51(13), 823–835.CrossRefGoogle Scholar
  25. Gask, L. (2005). Overt and covert barriers to the integration of primary and specialist mental health care. Social Science & Medicine, 61(8), 1785–1794.CrossRefGoogle Scholar
  26. Gatchel, R. J. (2004). Comorbidity of chronic mental and physical health conditions: The biopsychosocial perspective. American Psychologist, 59, 792–805.CrossRefGoogle Scholar
  27. Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133(4), 581–624.CrossRefGoogle Scholar
  28. Gros, D. F., Antony, M. M., McCabe, R. E., & Swinson, R. P. (2009). Frequency and severity of the symptoms of irritable bowel syndrome across the anxiety disorders and depression. Journal of Anxiety Disorders, 23(2), 290–296.CrossRefGoogle Scholar
  29. Hutter, N., Scheidt-Nave, C., & Baumeister, H. (2009). Health care utilisation and quality of life in individuals with diabetes and comorbid mental disorders. General Hospital Psychiatry, 31(1), 33–35.CrossRefGoogle Scholar
  30. Kessler, R. C., Akiskal, H. S., Ames, M., et al. (2006). Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. American Journal of Psychiatry, 163(9), 1561–1568.CrossRefGoogle Scholar
  31. Kessler, R. C., Demler, O., Frank, R. G., et al. (2005). Prevalence and treatment of mental disorders, 1990 to 2003. The New England Journal of Medicine, 352(24), 2515–2523.CrossRefGoogle Scholar
  32. Kessler, R. C., Ormel, J., Dernier, O., & Stang, P. E. (2003). Co-morbid mental disorders account for the role impairment of commonly occurring chronic physical disorders: Results from the National Comorbidity Survey. Journal of Occupational and Environmental Medicine, 45, 1257–1266.CrossRefGoogle Scholar
  33. Koike, A. K., Unutzer, J., & Wells, K. B. (2002). Improving the care for depression in patients with comorbid medical illness. American Journal of Psychiatry, 159(10), 1738–1745.CrossRefGoogle Scholar
  34. Kroenke, K. (2003). Patients presenting with somatic complaints: Epidemiology, psychiatric comorbidity and management. International Journal of Methods in Psychiatric Research, 12, 34–43.CrossRefGoogle Scholar
  35. Kroenke, K. (2006). Review of biopsychosocial medicine: An integrated approach to understanding illness. Journal of Psychosomatic Research, 60(4), 433.CrossRefGoogle Scholar
  36. Kroenke, K., Spitzer, R. L., Williams, J. B., et al. (1994). Physical symptoms in primary care: Predictors of psychiatric disorders and functional impairment. Archives of Family Medicine, 3, 774–779.CrossRefGoogle Scholar
  37. McGlynn, E. A., Asch, S. M., Adams, J., et al. (2003). The quality of health care delivered to adults in the United States. The New England Journal of Medicine, 348, 2635–2645.CrossRefGoogle Scholar
  38. Merikangas, K. R., Ames, M., Cui, L., et al. (2007). The impact of comorbidity of mental and physical conditions on role disability in the US adult household population. Archives of General Psychiatry, 64, 1180–1188.CrossRefGoogle Scholar
  39. National Business Group on Health. (2007). An employer’s guide to behavioral health services (p. 100). Washington, DC: National Business Group on Health.Google Scholar
  40. National Committee for Quality Assurance. (2009). Healthcare effectiveness data and information set (HEDIS). Washington, DC: National Committee for Quality Assurance.Google Scholar
  41. National Institute of Mental Health. (2008). The numbers count: Mental disorders in America. Washington, DC: National Institute of Mental Health.Google Scholar
  42. Norquist, G. S., & Regier, D. A. (1996). The epidemiology of psychiatric disorders and the de facto mental health care system. Annual Review of Medicine, 47, 473–479.CrossRefGoogle Scholar
  43. Ormel, J., Petukhova, M., Chatterji, S., et al. (2008). Disability and treatment of specific mental and physical disorders across the world. British Journal of Psychiatry, 192, 368–375.CrossRefGoogle Scholar
  44. Railroad Retirement Board (RRB). https://www.rrb.gov/mep/ee/forms_ret_surv_dis.asp, retrieved May 10, 2017.
  45. Roy-Byrne, P. P., Davidson, K., Kessler, R. C., et al. (2008). Anxiety disorders and comorbid medical illness. General Hospital Psychiatry, 30(3), 208–225.CrossRefGoogle Scholar
  46. Scott, K. M., Bruffaerts, R., Tsang, A., et al. (2007). Depression–anxiety relationships with chronic physical conditions: Results from the world mental health surveys. Journal of Affective Disorders, 103, 113–120.CrossRefGoogle Scholar
  47. Scott, K. M., Von Korff, M., Alonso, J., et al. (2009). Mental–physical co-morbidity and its relationship with disability: Results from the world mental health surveys. Psychological Medicine, 39(1), 33–43.CrossRefGoogle Scholar
  48. Seelig, M. D., & Katon, W. (2008). Gaps in depression care: Why primary care physicians should hone their depression screening, diagnosis, and management skills. Journal of Occupational and Environmental Medicine, 50(4), 451–458.CrossRefGoogle Scholar
  49. Simon, G. E., Grothaus, L., Durham, M. L., Von Korff, M., & Rabiniak, C. (1996). Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization. American Journal of Psychiatry, 153(3), 331–338.CrossRefGoogle Scholar
  50. Social Security Administration. (2015). Annual statistical report on the social security disability insurance program, 2015. Baltimore, MD: Social Security Administration.Google Scholar
  51. Substance Abuse and Mental Health Services Administration. (2015). Behavioral health barometer: United States, 2015. HHS Publication No. SMA–16–Baro–2015. Substance Abuse and Mental Health Services Administration: Rockville, MD.Google Scholar
  52. Suls, J., & Bunde, J. (2005). Anger, anxiety, and depression as risk factors for cardiovascular disease: The problems and implications of overlapping affective dispositions. Psychological Bulletin, 131, 260–300.CrossRefGoogle Scholar
  53. Talmage, J. B. (2007). Failure to communicate: How terminology and forms confuse the work ability/disability evaluation process. Journal of Insurance Medicine, 39, 192–198.PubMedGoogle Scholar
  54. Talmage, J. B., & Melhorn, J. M. (Eds.). (2005). A physician’s guide to return to work. Chicago, IL: American Medical Association Press.Google Scholar
  55. United States Department of Veteran Affairs., http://benefits.va.gov/compensation/. Retrieved May 1, 2017.
  56. Wade, D. (2006). Why physical medicine, physical disability and physical rehabilitation? We should abandon Cartesian dualism. Clinical Rehabilitation, 20, 185–190.CrossRefGoogle Scholar
  57. Warren, P. A. (2005). The management of workplace mental health issues and appropriate disability prevention strategies. San Diego, CA: Work Loss Data Institute.Google Scholar
  58. Warren, P. A. (2009). Behavioral health as a causation issue in workers’ compensation and disability claims. IAIABC Journal, 46(2), 17–56.Google Scholar
  59. Warren, P. A. (2013a). Those who hesitate are lost: The case for setting behavioral health treatment and disability standards, part I. Psychological Injury and Law, 6(3), 183–195.CrossRefGoogle Scholar
  60. Warren, P. A. (2013b). Those who hesitate are lost: The case for setting behavioral health treatment and disability standards, part II. Psychological Injury and Law, 6(3), 196–207.CrossRefGoogle Scholar
  61. Warren, P. A., & Hubbard, J. D. (2008). Psychosocial issues related to behavioral health disability claims. Dearborn National Life Insurance Company.Google Scholar
  62. WHO. (2004). The world health report 2004: Changing history. Geneva, Switzerland: The World Health Organization.Google Scholar
  63. Zibman, C. (2014, October). Expenditures for Mental Health among Adults, Ages 18–64, 2009–2011: Estimates for the U.S. Civilian Noninstitutionalized Population. Statistical brief #454. Agency for Healthcare Research and QualityRockville, MD. http://meps.ahrq.gov/mepsweb/data_files/publications/st454/stat454.shtml

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Pamela A. Warren
    • 1
  1. 1.Carle Physician Group and University of Illinois Medical SchoolDepartment of PsychiatryMonticelloUSA

Personalised recommendations