Behavioral Health Disability - Innovations in Prevention and Management

Preface

Acknowledgments

Contents

Contributors

Chapter 1: A Critique of the Behavioral Health Disability System

1.1 Overview of the Explosion of Behavioral Health Concerns

1.2 Problematic Factors That Complicate Behavioral Health Care

1.2.1 Comorbid Physical and Psychological Concerns

1.3 The Systemic Problems in the Treatment and Management of BH Concerns

1.3.1 The De Facto Behavioral Health Care System in the United States

1.3.2 The Contributory Factors of the Behavioral Health Treatment System and Insurers

1.3.3 Federal Agencies and the Incidence of Behavioral Health Disability

1.4 The Need for Improvement in Communications Among Professionals Involved in the BH Fields to Reduce BH Disability

References

Chapter 2: Prevalence of Behavioral Health Concerns and Systemic Issues in Disability Treatment and Management

2.1 Prevalence of Behavioral Health Concerns

2.2 BH Professionals Involved in the BH Disability Process and Problematic Issues

2.2.1 Problematic Inconsistencies in Professional BH Training

2.2.2 Clinical Psychologists

2.2.3 Physicians

2.2.4 Lack of Objective Assessment in the BH Evaluation Process

2.2.5 Problematic Selection of BH Treatment

2.2.6 Problematic Utilization of Inappropriate or Nonevidence-Based Treatment

2.3 Common Misperceptions That Occur with by All Professionals Involved in the BH Disability Process

2.3.1 Determination of Functional Impairment Versus Disability

2.3.2 A BH Diagnosis Is Automatically Equal to Impairment in Functioning

2.3.3 Behavioral Health Impairment in Functioning Is Permanent

2.3.4 Inappropriate Usage of Subjective Information Versus Objective Data for Behavioral Health Concerns

2.3.5 Over-Reliance on Subjective Information in the Diagnostic Process

2.3.6 Physical Disability Concerns Represent the Majority of the Disability Claims

2.3.7 Disability Concerns Can Only Be Physical or Behavioral in Nature, But Not Both

2.3.8 BH Issues Must Be Treated Differently from Physical Issues

2.3.9 Treating Professionals Are the Most Appropriate to Evaluate BH Impairment in Functioning Issues

2.3.10 BH Concerns Can Only Be Work- or Nonoccupationally Related

2.4 Causality and Behavioral Health Concerns

2.4.1 Professional Barriers to Objective BH Causality Determination

2.5 Causes of Iatrogenic Behavioral Health Disability

2.5.1 Personal Factors That May Contribute to Behavioral Health Disability

2.5.2 Treating Professional Causes of Iatrogenic Disability

2.5.3 Employer Contributory Factors to Iatrogenic Behavioral Health Disability

2.5.4 Attorney Contributory Factors to Iatrogenic Behavioral Health Disability

2.5.5 Insurer Contributory Factors to Behavioral Health Disability

2.6 Conclusion

References

Chapter 3: Effective Psychological Evaluation and Management of Behavioral Health Concerns

3.1 The Importance of Appropriate Psychological Evaluation of Behavioral Health Concerns

3.2 Current BH Evaluation Model

3.2.1 Relationship Status

3.2.2 Employment Status

3.2.3 Presenting Problem(s)

3.2.4 Personal Habits

3.2.5 Social History

3.2.6 Educational History

3.2.7 Past and Current Psychological History

3.2.8 Medical History

3.2.9 Mental Status Evaluation

3.2.10 Diagnostic Impressions

3.2.11 Summation and Treatment Recommendations

3.3 Additional Assessment Components to Add to the BH Evaluation

3.3.1 Military History

3.3.2 Legal History

3.3.3 Disability History

3.3.4 Evaluation for Potential Medicalized Issues, Malingering, and Symptom Exaggeration

3.3.5 Collaborative Communication and BH Referrals

3.3.6 Corroborating Documentation and Data

3.3.7 Objective, Standardized Psychological Testing

3.3.8 Appropriate Documentation Regarding Potential Limitations in Objective Impairment in Functioning

3.3.9 Drawing on the Strength of Scientifically Based Treatments of BH Concerns

3.3.10 Appropriate Treatment Goals (Including RTW)

3.4 The Behavioral Health Return-to-Work Process

3.4.1 Workplace Accommodations for Behavioral Health Concerns

3.5 Conclusion

References

Chapter 4: Assessment of Psychosocial Contributions to Disability

4.1 Introduction

4.1.1 Biopsychosocial Aspects of Disability

4.1.2 Subjective Risk Factors for Disability

4.2 The Assessment of Psychological States Leading to Disability

4.3 Psychometric Assessment and Disability

4.4 An Introduction to Psychological Testing Concepts

4.4.1 What Is a Standardized Test?

4.4.2 Validity Assessment

4.4.3 Malingering, Exaggeration, and Denial

4.4.4 Psychosocial Predictors of Poor Treatment Outcome and Disability

4.4.5 When to Administer Psychological Tests

4.4.6 Test Selection

4.5 Conclusions

Appendix: Psychometric Assessment Tools

References

Chapter 5: Psychiatric Issues in Behavioral Health Disability

5.1 Epidemiology and Prevalence of Psychological and Behavioral Health Concerns in Psychiatry

5.1.1 Psychiatry as a Medical Specialty

5.1.2 Psychiatry and Behavioral Health Disability

5.2 The Usual Treatment Process and the Role of the Psychiatrist

5.2.1 The Traditional Treatment Approach and the Paradigm Shift

5.2.2 The Usual Treatment Process

5.2.3 Avoiding Dual Roles

5.2.4 The Treating Psychiatrist as “Advocate”

5.2.5 Defining “Disability”

5.2.6 Challenges for the Treating Psychiatrist

5.3 Determining Current Psychiatric Functioning

5.3.1 The General Psychiatric Evaluation

5.3.2 The Psychiatric General Functional Assessment

5.3.3 The Psychiatric Occupational Functional Assessment

5.4 The Psychiatric Referral and the Occupational Referral

5.4.1 The General Psychiatric Referral Process

5.4.2 The Occupational/Workplace Psychiatric Referral

5.4.3 The Occupational Psychiatric Referral in Practice

5.5 Medicalization

5.5.1 The Process of Medicalization and Psychiatric Context

5.5.2 Overmedicalization in the Mental Health Disability Process

5.6 Symptom Exaggeration and Malingering

5.6.1 Malingering and the Disability Process

5.6.2 Malingering and Psychiatric Disorders

5.6.3 Psychiatric Response to Suspected Malingering

5.7 Patient Compliance Issues

5.7.1 Compliance and the Psychiatric Patient

5.7.2 Identifying Noncompliance

5.7.3 Treatment Approaches to Improve Compliance and Prevent/Reduce Noncompliance

5.8 Appropriate Documentation of Impairments and Limitations in Functioning

5.9 Treatment Outcomes: Strategies for Addressing Return to Work

References

Chapter 6: The Occupational Medicine Perspective on Behavioral Health Concerns

6.1 Epidemiological and Prevalence of Psychosocial and Behavioral Health Concerns

6.2 Discussion of Usual Care Treatment Process: Strengths and Weakness Within Occupational Medicine

6.3 Determining Current Psychiatric Functioning: Strengths and Weakness Within Occupational Medicine

6.4 Referral and Coordination of Treatment Considerations: Strengths and Weaknesses in Current Processes

6.5 Medicalization

6.6 Symptom Exaggeration and Malingering

6.7 Patient Compliance Issues

6.8 Appropriate Documentation of Limitations in Objective Impairment/Functioning

6.9 Treatment Outcome: Strategies for Addressing the Individual’s Return to Work

References

Chapter 7: Physical Therapy Treatment and the Impact of Behavioral Health Concerns

7.1 Epidemiological and Prevalence of Psychological and Behavioral Health Concerns in PT

7.1.1 Discussion of Usual Care Treatment Process

7.2 Determining Current Psychiatric Functioningand/or Behavioral Health Concerns, such as Fearof Reinjury: Strengths and Weaknesses in the Current Process

7.3 Referral and Coordination of Treatment

7.4 Medicalization

7.5 Symptom Exaggeration and Malingering

7.6 Patient Compliance Issues: Limitations and Strategies for Improved Management

7.7 Appropriate Documentation of Limitations in Objective Impairment/Functioning

7.8 Treatment Outcomes

7.9 Summary

References

Chapter 8: Vocational Rehabilitation Considerations for Mental Health Impairments in the Workplace

8.1 Introduction

8.1.1 Prevalence of Psychological and Behavioral Health Concerns in Vocational Rehabilitation

8.1.2 The Mental Health Conundrum: Impairment Versus Disability

8.2 Vocational Rehabilitation: The Treatment Process

8.2.1 Assessment and Appraisal

8.2.2 Career (Vocational) Counseling

8.2.3 Vocational Rehabilitation Plan of Service

8.3 Other Considerations in Vocational Rehabilitation

8.3.1 Malingering and Compliance with Services

8.3.2 Job Descriptions

8.3.3 How Are Essential Functions Determined?

8.4 The Dictionary of Occupational Titles

8.4.1 Temperaments

8.4.2 Procedure for Rating Temperaments

8.5 The O*NET

8.6 The Vocational Rehabilitation Tool Box

8.6.1 Case Management

8.6.2 Situational Assessment/Work Adjustment

8.6.3 Adjustment Counseling

8.6.4 Transferable Skills Analysis

8.6.5 Return to Work Services

8.6.6 Transitional Work Programs

8.7 Summary

References

Chapter 9: Case Management and Behavioral Health Disability

9.1 Epidemiological and Prevalence of Psychological and Behavioral Health Concerns

9.2 Co-morbid Behavioral Health and Physical Concerns

9.3 Defining Disability in the Behavioral Health Context

9.3.1 Types of Disability Benefits

9.3.2 Issues that Arise with Disability Benefits and Objective Evidence of Impairment

9.3.3 Family Medical Leave Act

9.4 Case Management Roles and Requirements in the Context of Treatment

9.4.1 General Problems Arising Within the Behavioral Health Claims Process

9.4.2 The Impact of Poor Documentation on Disability Claims

9.4.3 Objective Psychological Testing

9.4.4 Subjective Information

9.4.5 Assessment of the Behavioral Health Disability Claim

9.4.6 Assessment of the Treatment Being Provided

9.4.7 Psychosocial Concerns Versus True Psychological Disorders

9.4.8 Utilizing the Expectation of Consistency in Objective Impairment and Functioning

9.4.9 Patient Compliance Issues Within the Behavioral Health Disability

9.4.10 Symptom Exaggeration and Malingering

9.4.11 Collaboration Among Treating Professionals

9.4.12 Medicalization of Psychosocial Issues

9.5 The Return to Work Case Management Process in the Context of Behavioral Health

9.5.1 Workplace Accommodations and Return to Work Planning

9.5.2 Appropriate Roles for the Case Manager

9.6 Strategies to Address Weaknesses Occurring in the Behavioral Health Disability Case Management Process

9.7 Conclusion

References

Chapter 10: Behavioral Health and Disability Insurance: A Perspective

10.1 Important Definitions and Behavioral Health Disability Claims

10.1.1 A Simple Concept?

10.2 Overview of Social Security Administration Disability

10.2.1 Big Problem? Little Problem?

10.2.2 Workers’ Compensation (WC) and Behavioral Health Disability

10.2.3 A Private Insurer’s Overview of Behavioral Health Disability Trends

10.2.4 A Closer Look at Major Depressive Disorder

10.2.5 Disability Insurance and Disability Management: The Odd Couple

10.3 Common Problems that Occur with Behavioral Health Concerns

10.3.1 Bureaugenic Disability

10.3.2 Claims Adjudication

10.3.3 Disability Deception?

10.4 Strategies for Superior Management of Behavioral Health Disability Claims

10.4.1 Work Capacities and Job Demands

10.4.2 Controlling Risk

10.4.3 BH Risk Management Strategy 1

10.4.4 BH Risk Management 2: Transitions In and Out

10.4.5 Return-to-Work Planning

10.4.6 Incentives and Disincentives

10.4.7 Rehabilitation Benefits

10.4.8 Appropriate Determination of Impairment in Functioning

10.5 Protecting Productivity: A New BH Business Model

10.5.1 Employer Education

10.5.2 A Corporate Health and Productivity Strategy

10.6 Summary

References

Chapter 11: The Legal System and Behavioral Health

11.1 Causes of Action and Their Prevalence

11.1.1 Workers’ Compensation

11.1.2 Americans with Disabilities Act

11.1.3 Civil Rights Enforcement Under 42 U.S.C. 1983 and Under State Civil Rights Laws

11.1.4 Psychological Torts

11.1.4.1 Intentional Infliction of Emotional Distress

11.1.4.2 Hostile Working Environment (Sexual Harassment)

11.1.4.3 Posttraumatic Stress Disorder and Other Psychological Claims Rising from Traumatic Events

11.1.5 Disability and Health Insurance Claims

11.1.6 General Considerations Concerning Reporting of the Prevalence of Behavioral Health Claims

11.1.6.1 Stigma

11.1.6.2 Concentration on Physical Ailments

11.1.6.3 Failure to Diagnose Behavioral Health Concerns

11.2 What Works, and What Does Not Work, in Legal Representation of Persons with Behavioral Health Concerns

11.2.1 Plaintiff’s Lawyers

11.2.1.1 The Private Plaintiff’s Attorney

11.2.1.2 The Public Plaintiff’s Attorney

11.2.2 The Defense Attorney

11.2.2.1 Defense Attorneys Who Are Compensated According to Contract

11.2.2.2 Salaried Defense Attorneys

11.2.3 Treating Professionals

11.2.4 What Works, and Does Not Work, in the Legal System?

11.3 Determining Current Behavioral Functioning in the Legal System

11.3.1 The Legal Standard of Proof Concerning Scientific Evidence

11.4 Case Coordination and Coordination of Care

11.5 Medicalization of Claims

11.6 Professional Enabling

11.7 Symptom Magnification and Malingering

11.7.1 The Importance of Language

11.7.2 Symptom Magnification

11.7.3 Malingering

11.7.4 Other Reward Seeking Behavior

11.7.5 Control of Symptom Magnification and Malingering by the Plaintiff’s Advocates

11.7.6 Control of Symptom Magnification and Malingering by Defense Advocates

11.8 Facilitating Return to Work and Stay at Work Behaviors

11.9 Appropriate Documentation of Objective Impairment and Limitations of Functioning

11.9.1 Distinguishing Between Objective and Subjective Evidence

11.9.2 Impact of Objective and Subjective Evidence

11.10 Dispute Resolution Outcomes

11.11 Some Possibilities for an Improved Systemic Approach

11.11.1 Changes Lawyers Can Make

11.11.2 Disengagement of the Profit Motive from the Litigation Process

11.11.3 Beyond Professional Enabling

11.12 Conclusion

References

Index