Evaluating Mental Health Disability in the Workplace

According to the National Institute of Mental Health, psychiatric disorders are the leading cause of disability in the United States and Canada for persons aged 15 to 44 years. As a result, psychiatrists increasingly are being approached to perform disability and other employment-related evaluations. Liza Gold and Daniel Shuman's comprehensive guide to the evaluation of psychiatric disability is an extremely timely addition to the literature. Together, they have produced a superb reference that will be sure to satisfy those readers who are seeking a how-to guide to performing employment-related assessments as well as those in search of an up-to-date resource to answer challenging legal or ethics-related questions.

The early chapters, which supply the ethics and legal background underlying employment evaluations, are instructive to psychiatrists who are primarily clinicians and may not be aware of the important distinctions between a treating psychiatrist and a forensic evaluator. The essential ethics and legal issues such as disclosure to third parties, informed consent, confidentiality, obligations owed to the evaluee in disability evaluations, and common sources of bias are presented in a very clear format. Experienced forensic psychiatrists will appreciate the review of recent relevant case law involving these topics.

Mental health professionals generally receive little training concerning the central role of work in their patients' lives. One of the chapters, “Why We Work: Psychological Meaning and Effects,” provides a structure for considering the impact of work on the individual. Topics that are rarely addressed, such as the effects of work on mental illness, the benefits of work, job satisfaction, the downside of work, assessment of goodness of fit between job assignment and employee, and occupational stress receive thoughtful attention. The emotional effects of job loss and unemployment are thoroughly examined. The authors use this information as a backdrop for their discussion of understanding and determining functional impairment. They describe a work capacity model that can be used to understand the evolution of a disability from the claimant's perspective, as a balancing effort involving work demand, work supply, and functional capacity. There are informative reviews of performing functional capacity assessments and determining an evaluee's level of impairment, as well as a summary of the available evidence-based assessments of functional impairment.

Those with little experience in performing disability examinations will appreciate Gold and Shuman's step-by-step approach, which generally follows the “AAPL Practice Guidelines for the Forensic Evaluation of Psychiatric Disability.”¹ In this systematic approach, the evaluator clarifies the nature of the referral with its source, reviews records and collateral information, and gathers information from multiple independent sources. The book also contains guidance for performing disability evaluations on behalf of claimants. The authors review the importance of obtaining examples of work-related impairment, seeking collaboration of the claimant's description of impairments, understanding the claimant's job requirements, and exploring alternative reasons for claims of impairment. There is a thorough discussion of the psychological meaning of work and work impairment. Integration of data is emphasized in this text, which describes the use of rating scales, to assess the effects of medical illness and medication, and the appropriate use of psychological testing. The authors emphasize the importance of presenting opinions that address the referral question and are supported by the data.

The authors have offered an impressive, novel model for assessment of psychiatric disability. For those seeking information about specific types of employment evaluations, there are chapters focusing on SSI, SSDI, Workers’ Compensation, Private Disability Claims, ADA, and fitness-for-duty evaluations. A sample disability report is included that incorporates the practice guidelines recommended throughout the book. Additional samples would have been welcome.

In summary, Gold and Shuman should be congratulated for this superb addition to the literature. They have provided a strong foundation for their model for performing workplace disability evaluations in a well-organized text. In my opinion, Evaluating Mental Health Disability in the Workplace will soon be considered the gold standard for this topic by forensic mental health trainees and practitioners.

• American Academy of Psychiatry and the Law