Psychiatric Disability Flashcards
Rate of Malingering in Disability Evals
20-30%
Significant Point About Disability Defs
Vary - need to know def being used
AMA Impairment
“significant deviation, loss, or loss of use of any body structure of function”
AMA Disability
Activity limitations and/or participation restrictions
Impairment Rating
% est loss of activity and limitations of ADLs
Maximum Medical Improvement
Status were person to get “as good as he gets” from available tx, and date from which further recovery/deterioration no longer anticipated
AMA Guides 4 Essential Questions of both Provider and Rater
- What is the clinical problem/dx?
- What difficulty does the pt report (sx, functional loss)?
- What are the exam findings?
- What are the results of clinical studies?
Physical D/o w/ Mental D/o
Mental d/o included in physical impairment rating, so MH chapter not used
AMA Guides 3 Types of D/o Allowed
Mood, Anxiety, and Psychotic D/os (so pain-related, somatization, PDs, dissociative, substance-related, etc not allowed)
AMA Guides Psych Limitation
50% of whole person
SSDI vs SSI
SSDI - pays benefits to workers who have become disabled
SSI - social welfare proram to provide income support for people who have become disabled regardless whether they have ever worked
SSI Eligibility
Means-tested: dependent on meeting needs test against income, not work hx or contribution to fund / provides minimum income for indigent disabled
SS Disability Gen Def + 3 Reqs
“Inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment
- can’t do work they did before
- can’t adjust to other work bc of condition
- expected to result or death or last > 12 months
SS Medically Determinable Impairment (Gen def (2) and add’l req)
- results from anatomical, physiological, or psychological abn
- can be shown by medically acceptable clinical and laboratory diagnostic techniques
- Must be established by medical evidence other than self-report
SSA 11 Qualifying Categories of Mental D/o
- NCDs
- Schiz-spectrum/psychotic
- Depressive, BP, and related d/o
- ID
- Anxiety and OCDs
- Somatic sx and related d/o
- Personality and impulse-ctrl d/o
- ASD
- Neurodevelopmental d/o
- ED
- Trauma- and stressor-related d/os
SSA Add’l Qualifying D/o Category for Children
Developmental d/o in infants and toddlers
SS SUDs
- Don’t qualify, but independent d/os caused by substance use do
SSA Paragraphs
Combo of “paragraphs” established for each dx to meet their guidelines
SS Paragraph A
- Objective medical evidence to establish d/o (might be med recs, testing, collateral)
SS Paragraph B
Functional criteria, w/ rating scale, to evaluate how d/o limits functioning
SS Paragraph B 4 Areas of Mental Functioning
- Understand, remember, or apply information
- Interact w/ others
- Concentrate, persist, or maintain pace
- Adapt or manage oneself
SS Paragraph C
- D/o must be “serious & persist”
SS Paragraph C Duration and 2 Subcriterion
Must have medically documented period > 2 years
C1: Individual relies (ongoing) on medical tx, MH therapy, psychosocial supports, or highly structured setting
C2: Despite diminished sx/signs, have achieved on marginal adjustmentS
SS Residual Function Capacity
- If doesn’t meet all listing criteria, can consider all impairment-related physical/mental limitations, such as sfx to medications
Private Disability Purpose & Consideration
Provide benefits purchased by insured in addition to Workers’ Comp or SSA
- Need to know their def of disability and extent of context affected (same job, any occupation, etc)
Rehabilitation Act 1973 Historical Significance
First act in world to prevent employer discrimination against disabled
Rehab Act 1973 Jurisdiction
Only certain elements of fed, Postal Service, and Fed contractors/subcontractors
Rehab Act 1973 “Handicapped Individual Def” (3)
- Has physical/mental impairment which substantially limits 1+ major life activities OR
- Has a record of such impairment
OR - Is regarded as having such impairment by employer
School Board of Nassau County FL v. Arline (SCOTUS 1987) (FOTC, Issue)
Arline fired from teaching job after TB relapse
Issue: Is contagious ds “physical impairment” thereby qualifying her for protection under Rehab Act 1973?
School Board of Nassau County FL v. Arline (SCOTUS 1987) H & R
H: Yes, protected. Remanded to determine actual threat.
R: School argued was to protect others rather than inability, SCOTUS wrote society’s myths/fears about disability/ds are as handicapping as the actual physical limitations
School Board of Nassau County FL v. Arline (SCOTUS 1987) Historical Sig
Laid foundations for protections of HIV+
ADA Gen
Enacted 1990 to prohibit discrimination against persons w/ disabilities in all aspects of employment (hiring, training, comp, benefits, etc)
ADA Employer Req (& 2 caveats)
Reasonable accommodation to perform essential job functions
- Unless would cause undue hardship or if employee is a direct threat
ADA “Disability” (3)
Same as Rehab Act
1. Physical/mental impairment that substantially limits 1+ major life activities of such individual
2. “Record of impairment”
3. “Regarded as” having impairment
“Regarded as” having impairment
Doesn’t actually have to have, just show that they were regarded as to have one and discriminated against as such
ADA (EEOC) Physical or Mental Impairment Def
1) An physiological d/o or condition, cosmetic disfigurement, or anatomical loss affecting 1+ body systems, such as …
2) Any mental or psychotical d/o, such as ID, organic brain syndrome, emotional or mentail illness, and specific learning disabilities (Specifically mentions all the big ones)
ADA Excluded Dx (6)
- Transvestism/transgender/GID
- Pedophilia/exhibition/voyeurism/other sexual behavior d/os
- Compulsive gambling
- Kleptomania
- Pyromania
- Current psychoactive susbtance abuse d/os related to illegal drug use
ADA Other Code Listings Not Included (2)
Phase of life problems or parent-child problems
ADA Drugs (2)
- Not protected. Denies coverage of any employee/applicant currently (recently enough that reasonable belief ongoing problem) engaging in illegal use of drugs
- Protected only if in tx/completed program + not currently using
ADA ETOH
ETOH dependence protected by ADA
ADA Drugs/ETOH Additional Exclusion
If condition poses direct threat of harm to others or (arguably) selves
ADA PDs
Do count. Personality traits don’t
ADA Corrected Disabilities
Do qualify
ADA Amendments Act of 2008
Says that impairments must be examined in unmitigated state w/ only exception of ordinary eyeglasses or contact lenses
ADA “Substantially Limits” Considerations (5)
- Construed broadly in favor of expansive coverage
- Limits MLA compared to gen pop
- Don’t consider mitigating effects
- Episodic/remission count, if limits when active
- < 6mo can count
ADA Major Life Activities Gen Def
- Basic activities that the average person in gen pop can perform with limited or no difficulty2
2 Gen Categories of ADA MLAs
- General activities
- Major bodily functions
ADA Reasonable Accommodation Def
A modification or adjustment of the “way things are customarily done”
PA DOC v. Yeskey (SCOTUS 1999) Summ + Main Point
- Excluded from prison boot camp option instead of sentence bc PMH HTN. Sued under ADA T II.
- H: Prisoners covered entities, ADA applies to inmates in state prisons and can sue if excluded from programs due to disability (except dirt threat)