Can Initial Psychiatric Evaluations Determine Disability Levels?

Q: Can Initial Psychiatric Evaluations Determine Disability Levels?

Dear online user： Since you have already come to our hospital for a consultation, I suggest that we discuss these issues in person during your outpatient visit for clearer communication. <br>Dr. <br>Wu En-Liang

Can a disability assessment be conducted during the initial visit at your hospital?

Hello Dr.
Wu: Thank you for helping with the referral to the rehabilitation center during my brother's initial consultation.
He has successfully been admitted.
Wishing you great success and prosperity in the Year of the Tiger.

Since my brother was admitted to Shin Kong Hospital on October 19, the doctor only classified him as a severe case under the "Jingwei Method" at the end of November.
I inquired whether we could also change his disability rating to "severe," but since he was about to be transferred, the doctor advised us to go to Tucheng Chang Gung Hospital for re-evaluation.
However, due to it being a new hospital, they are unable to conduct disability assessments for all internal and external medicine cases, so that was put on hold.
My brother is classified as a severe case under the Jingwei Method and, after many years, still cannot develop work abilities that meet the regulatory standards for sheltered employment.
His classification includes: chronic mental illness with severe occupational and social functioning deterioration, requiring long-term psychiatric rehabilitation treatment to maintain the most basic self-care abilities in daily life, and needing supervision from others.
Chronic mental illness with moderate occupational and social functioning deterioration, after long-term psychiatric rehabilitation treatment, may develop some work abilities in sheltered employment, and can maintain self-care abilities in daily life with partial supervision from others.
Additionally, during his military service re-evaluation at age 20, he was noted by the Veterans General Hospital as having borderline intellectual functioning, with a score of 82.
Does this qualify as an intellectual disability? I once suspected he might have autism (being introverted, not speaking, and avoiding eye contact), but our parents never took him to see a doctor.
Is it possible to assess for multiple disabilities, including autism, together?
The following are the classifications for autism:
1.
Severe autism: severe impairment in social adaptation and moderate or mild impairment in language function.
2.
Moderate autism: moderate impairment in social adaptation and severe or moderate impairment in language function.
3.
Mild autism: mild impairment in social adaptation and profound impairment in language function.

After special education and corrective training, individuals usually develop the most basic self-care abilities for daily living but cannot develop work abilities and still rely on caregivers.

For moderate autism:
1.
Moderate impairment in social adaptation and mild impairment in language function.
2.
Mild impairment in social adaptation and severe or moderate impairment in language function.

After special education and corrective training, individuals can usually manage daily life in a sheltered environment or may be trained to develop simple work abilities.
(2) Regarding medication issues: My brother is currently taking medications including Rhythmol, Parkinson's, Litanda, Rifampicin, and Ulotar.
I am unsure which of these can be discontinued.
Please help us adjust the medication dosage.
For example, could he manage with just Litanda? In 2019, during his hospitalization at Songde, he was able to stop taking the other medications entirely in the last month, but after discharge, due to lack of supervision at home, he ended up taking someone else's medication again and has not returned for follow-up.
The family's stance is that since the medication list indicates side effects, we hope he can take as few medications as possible and only take necessary ones.
(3) Regarding nutritional and natural therapies: I would like to know your thoughts on these therapies, especially the translations by Su Shengjie and the two books linked here: https://www.books.com.tw/products/0010708180 and https://www.books.com.tw/products/0010650594.
Do you believe these therapies are effective?

A Zuo, 30~39 year old female. Ask Date: 2022/02/09

Dr. Wu Enliang reply Psychiatry

Dear online user: Since you have already come to our hospital for a consultation, I suggest that we discuss these issues in person during your outpatient visit for clearer communication.
Dr.
Wu En-Liang

Reply Date: 2022/02/09

More Info

Initial psychiatric evaluations can play a significant role in determining disability levels, but they are not the sole factor in making such determinations. These evaluations typically assess a patient's mental health status, functionality, and the impact of their psychiatric condition on daily living and work capabilities. The evaluation process often includes standardized assessments, clinical interviews, and observations that help clinicians gauge the severity of the patient's condition.

In the context of disability determination, various criteria are used to classify the level of impairment. For example, the Social Security Administration (SSA) in the United States has specific guidelines for evaluating mental disorders, which include assessing the individual’s ability to perform basic daily activities, social interactions, and work-related tasks. The evaluations can help establish whether an individual meets the criteria for severe mental illness, which may warrant a disability designation.

For your brother, who has been diagnosed with severe mental illness under the Mental Health Law, it is crucial to have a comprehensive evaluation that considers his history, current functioning, and any co-occurring conditions, such as potential autism spectrum disorder (ASD). The mention of borderline intellectual functioning (with an IQ of 82) raises the possibility of intellectual disability, which can complicate the assessment process. It is essential to have a multidisciplinary team involved in the evaluation, including psychiatrists, psychologists, and social workers, to ensure a holistic understanding of his needs.

Regarding the potential for multiple disabilities, if your brother exhibits traits consistent with autism, it would be beneficial to have him assessed for ASD alongside his psychiatric evaluations. This dual assessment can provide a clearer picture of his social and communicative abilities, which are critical for determining appropriate support and interventions.

As for medication management, it is vital to consult with a psychiatrist before making any changes to his medication regimen. The medications listed, such as antipsychotics and mood stabilizers, can have significant side effects, and any adjustments should be made cautiously and under professional supervision. The goal should be to find a balance between managing symptoms effectively and minimizing side effects. It is not advisable to reduce or eliminate medications without a thorough discussion with a healthcare provider, as this could lead to a worsening of symptoms or withdrawal effects.

In terms of nutritional and natural therapies, while some individuals report benefits from such approaches, it is essential to approach these methods with caution. Evidence supporting the efficacy of alternative treatments can vary widely, and they should not replace conventional medical treatment, especially in cases of severe mental illness. It is advisable to discuss any interest in alternative therapies with a healthcare provider to ensure they complement the existing treatment plan.

In summary, initial psychiatric evaluations are crucial in determining disability levels, but they should be part of a comprehensive assessment process. It is essential to involve qualified professionals in evaluating your brother's condition, considering all aspects of his mental health and functioning. Medication management should be approached carefully, and any interest in alternative therapies should be discussed with a healthcare provider to ensure safety and efficacy.

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