Clinical Guide to Mental Disability Evaluations

Nearly 25% of working-age adults have a diagnosable psychiatric disorder in any given year.¹ Of those, approximately 30% report some form of work disability.² With these statistics, it is not surprising that disability evaluations are the most common mental health evaluations conducted for nontreatment purposes. As a result, psychiatrists are increasingly being asked to assess disability and other work-capacity evaluations. Because of the limited postgraduate and continuing education training on this topic, providers may find themselves unprepared for the complexity and scope of problems that can arise from doing this type of work. Liza Gold and Donna Vanderpool sought to address this gap in training by publishing practical information for providers who perform disability assessments. In their text, A Clinical Guide to Mental Disability Evaluations, they accomplish their goal.

A companion volume to Evaluating Mental Health Disability in the Workplace,³ A Clinical Guide to Mental Disability Evaluations covers a full range of topics rated to disability assessments. Part I covers general topics relevant to disability evaluations. Chapter authors experienced in mental health and the law outline a model for conducting disability assessments and provide important subject matter background on the topics of disability law, ethics, dual role and boundary concerns, workplace accommodations, return-to-work evaluations, and the role of psychological testing.

Part II, in contrast, focuses on specific types of disability assessments, including social security disability income (SSDI), workers' compensation, private insurance, the Americans with Disabilities Act, workplace violence, and fitness-for-duty evaluations. The essential differences in the types of evaluations are presented in a clear manner.

The text is organized in a way that will appeal to clinicians who have limited experience with disability evaluations, as well as to seasoned forensic evaluators. Practitioners new to disability assessments are guided in a step-by-step approach to the assessments, from understanding the referral questions, to an outline of key components for an evaluation, to the nuts and bolts of specific questions to ask evaluees. Included throughout the text are concise tables and outlines for easy reference to main concepts. The chapter authors illustrate through case examples the common challenges encountered in performing disability assessments. In addition, each chapter concludes with a summary of concepts in the form of key points that emphasize the main themes. Pearls for experienced forensic psychiatrists include recent legal cases and updated references.

Unique to the text is material intended specifically for treating clinicians and contrasted for nontreating evaluators. By way of illustration, Chapter 6, “Malingering and Mental Health Disability Evaluations,” is an artful discussion of the challenges that a treating provider may face in completing disability evaluations. Included is a discussion of the competing interests that a provider may encounter in maintaining a treatment relationship when faced with evaluating for malingered illness. Chapter 7, which focuses on SSDI claims, similarly provides guidance on how an independent examiner can supplement or challenge information from the evaluee's regular treatment provider.

Although the editors include information on workplace accommodation and return-to-work planning, they made clear that services such as vocational rehabilitation and employee assistance programs are beyond the scope of the text. If there is anything missing in this comprehensive guide it is in this area, as disability evaluators may be asked to coordinate or evaluate recommendations regarding such services. Basic guidance on how these additional services relate in the context of disability assessments would be helpful.

In summary, Gold and Vanderpool aptly accomplish their goal of providing a much-needed guide to disability evaluations. There is little to criticize. This comprehensive guide provides a balanced text with content relevant to the general practitioner and experienced forensic evaluators, as well. It is sure to serve as a how-to guide for those new to disability evaluations, yet it provides sufficient detail and case law to serve as a reference for those looking to answer specific disability-related questions.

• © 2013 American Academy of Psychiatry and the Law