ABSTRACT
OBJECTIVES: Disability determinations made by the Disability Determination Service for Social Security Administration (SSA) disability claims due to mental impairment were compared with the independent judgments of a team of mental health workers. The decisions of the Service and the team's agreement with those decisions were predicted from a set of explanatory variables. METHODS: One hundred fifty-eight adult applicants for or beneficiaries of SSA benefit programs participated. The team used SSA disability criteria to judge disability based on in-depth interviews. RESULTS: Team members voted yes, no, or maybe regarding approval for disability. Of the cases approved by the team, 89% were actually allowed by the Disability Determination Service. However, the team could not reach a yes or no decision for almost half of the subjects, contributing to a total agreement with the Service on only 40% of the cases. CONCLUSIONS: Sufficient evidence exists to question the reliability of SSA disability determinations for mental disorders. Although the Disability Determination Service decision for mental impairments can be predicted above chance, a direct test of the reliability of such determinations should be conducted, with particular attention to the effect of the quality of the medical information.
Subject(s)
Disability Evaluation , Judgment , Mental Disorders/diagnosis , Patient Care Team/organization & administration , Social Security/organization & administration , Adolescent , Adult , Decision Making, Organizational , Female , Humans , Interview, Psychological , Male , Managed Care Programs , Mental Disorders/epidemiology , Middle Aged , Predictive Value of Tests , Rehabilitation, Vocational , Reproducibility of Results , United StatesSubject(s)
Disability Evaluation , Eligibility Determination/legislation & jurisprudence , Mental Disorders/rehabilitation , Social Security/legislation & jurisprudence , Social Welfare/legislation & jurisprudence , Cost Control/legislation & jurisprudence , Humans , Mental Disorders/psychology , United States , Work Capacity EvaluationABSTRACT
As psychiatrists become more active in the care of the chronic mentally ill, they are taking a greater role in relation to the entitlement programs of Social Security Disability Insurance and Supplemental Security Income. In a review of the application and appeals processes of the disability determination system, the author focuses on areas in which psychiatrists are likely to be involved, such as identifying patients qualified to receive benefits, providing reports on their own patients for disability determination, and examining other patients as a consultant. Psychiatrists should be knowledgeable about the Social Security entitlement programs, the author believes, and should increase their linkages with the Social Security Administration.
Subject(s)
Mental Disorders/rehabilitation , Psychiatry , Social Security/legislation & jurisprudence , Disability Evaluation , Expert Testimony , Humans , Psychiatry/organization & administration , Referral and Consultation , Schizophrenia/rehabilitation , United StatesABSTRACT
The Penn-VA psychotherapy project was designed to test the hypothesis that the addition of supportive expressive or cognitive behavioral psychotherapy might add a differential benefit to the usual drug counseling of opiate addicts. The results indeed showed that the patients who had treatment administered by the trained psychotherapists did better than those who had only the regular drug counseling. This author describes his experiences as one of the psychoanalytically oriented psychotherapists. Important aspects of this technique and common themes that emerge in the course of treatment are discussed. It is suggested that this treatment approach can be successfully applied to the treatment of the abuse of other substances including alcohol and outside the research setting.
