Arizona Forensic Psychiatry
Roland Segal, M.D., DFAPA

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Psychiatric Impairment and Disability Determination

A psychiatric disability determination process may be divided into two components, clinical and non-clinical.  The purpose of the non-clinical portion is to determine what a person’s specific job demands are and then compare them to whatever the person is able or unable to do. 

The DSM is the standard reference for psychiatry in the United States.  There are over 300 different psychiatric illnesses that are listed in the DSM.  Not all people who have mental disorders have psychiatric restrictions or limitations. 

How common is mental illness in our community?

According to The Epidemiologic Catchment Area Survey (ECA) an estimated 28.1% or 51.3 million people in the United States have a mental disorder in any given one year period.  The most prevalent are anxiety disorders at 12.6%, followed equally at 9.5% by substance abuse disorders and affective disorders such as depression and bipolar.

Which conditions cause activity limitations most often?

The five conditions that cause the most limitations are heart disease, back problems, arthritis, asthma and diabetes.  Together these account for about 26.5 million cases.  The sixth leading cause for disability is the mental disorders that account for 2 million cases.  In the seventh place are learning disabilities and mental retardation accounting for another 1.6 million cases.  According to the National Institute on Disability and Rehabilitation Research, 3.7% of the United States population is on disability due to a mental disorder. 

What are the most disabling psychiatric illnesses?

According to the National Institute on Disability and Rehabilitation Research, the most impairing disorders listed in a decreasing order are Schizophrenia, Major depression, Bipolar disorder, Obsessive-compulsive disorder and Panic disorder.

What should be a part of a comprehensive psychiatric assessment?

A comprehensive psychiatric assessment clearly outlines the individual’s psychiatric review of symptoms, past psychiatric history, past medical history, social history, family history, and a mental status examination.  This assessment is formulated by a multi-axial analysis and finally concluded with specific restrictions and limitations.

A complete assessment will give a clear biological, psychological and social insight into your client. In disability evaluations, an assessment of functioning plays a very important role.  This is because it is one of only few places in psychiatry where an actual number is assigned to a patient based on both the severity of psychiatric symptoms and functioning limitations.

Once a psychiatric assessment is completed and functioning, or lack of ability to function, is determined, it is time to determine what the possible psychiatric restrictions and limitations may be.  Some people are so psychiatrically impaired that they simply cannot hold any job.  For example, as many as 70% of people who suffer from Schizophrenia, and as many as 25% of people with Major Depression, are permanently disabled.   On the other hand some may be able to hold a job and may need some accommodations.  These accommodations may include flexible hours, longer or more flexible breaks, part-time work schedules, quiet work environment, longer times for assignment, time off work for medical appointments and therapy and positive reinforcement.

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