SSDI Evaluations

[PSYDNEUROGUY]

I was curious; I ran into a psychologist at the recent Rehabilitation Psychology conference in Orlando this past week and he told me some very interesting things.

He is evidently retired living and told me that he has a private practice with two locations and hires two people to do the testing. He stated that he grosses $600K annually mostly from SSDI evals. He said after overhead, he nets $130K annually.

Maybe I misunderstood him, but is this possible? Expect? What is typical for SSDI evals?

I know he said as an approved consultant through his state, he was seeing 6 people a day. He said his referral source was nice and steady. Any thoughts?

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[erg923]

I was curious; I ran into a psychologist at the recent Rehabilitation Psychology conference in Orlando this past week and he told me some very interesting things.

He is evidently retired living and told me that he has a private practice with two locations and hires two people to do the testing. He stated that he grosses $600K annually mostly from SSDI evals. He said after overhead, he nets $130K annually.

Maybe I misunderstood him, but is this possible? Expect? What is typical for SSDI evals?

I know he said as an approved consultant through his state, he was seeing 6 people a day. He said his referral source was nice and steady. Any thoughts?

My understanding is that an opportunistic physician/psychologist should be doing much better with that kind of work actually.

My thought is that this is a "one and done" boring, repetitive, and mind-numbing kind of work...if that's all he/she does. But certainly lucrative when done in high volume.
I also don't believe for one second that he/she is following/adhering to current SSDI/AMA guidelines in these evals. If you want to know why I think this, PM me.

The base-rate for malingering in this population is like 40%...

 

[PsyDr]

When you see a psychologist doing SSDI evaluations, start thinking quack.


The relevant law defines disability as the INABILITY to engage in ANY substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

ANY is a very very very high standard. It’s not any job you like. It’s not any job in your area. Its not even jobs that will pay for poverty wages.

INABILITY is very very very different than “its hard” or “I’m hit or miss” or anything other than “its not possible”. You’re unable to sprout wings. You’d probably have trouble getting six pack abs. Totally different s.

If you think of prett much all affective disorders, you’ll note that none of them would fit that definition, by merit of length or impairment. Intellectual disabilities are mostly unlikely to qualify for that definition either aside for the more severe. ASD likewise, along a continuum which only accounts for the more severe along the spectrum.

Next, you’ll notice that malingering in the compensation seeking setting is approximately 40%. Anyone say that in ssdi evals? No? That either means they’ve redefined the science or discarded it.

Now moving along: the pay, last I looked isn’t fantastic. It’s much much more if volume business. And since the 2008 crisis there are many people going for disability. Not that the level of disabilities suddenly skyrocketed in 2008; unless there’s some epidemic no one told me about.


Together that’s: people doing high volume of work, and not adhering to the science or law. Sound great?


Pragmatically: you have to think about the hassles associated with people who approximately 40% are malingering for the chance to win like $14k/yr. think that’s gonna be polite, hassle free, easy to talk to, good smelling people?

There are obviously people who really deserve it. But the hassle is not worth it, imo.

 

[WisNeuro]

The few people I know locally who do SSDI evals have....questionable training. And, it is evident in their reports when I review them.

 

[Therapist4Chnge]

The few people I know locally who do SSDI evals have....questionable training. And, it is evident in their reports when I review them.

Same. The volume needed to make it worthwhile is concerning.

 

[PsyDr]

Also: A $470K overhead for $140k net is beyond reckless.

Think of this: Your income source is largely comprised of one revenue stream. You have to make about $40k A MONTH just to stay afloat. There's staff, there's office rent, etc. None of those are going to be okay with you being late. What happens when there's gov't shutdown? What happens when you want to go on vacation, be sick, whatever. What happens if the payor source delays paying you for a month or two because they want an audit? You're making $140k. So do you have $80k IN CASH, ON HAND to keep yourself afloat for two months? What if stuff just slows down for four months and there's no backlog of cash expected.

 

[Sanman]

I am curious to know what kind of volume is required for this. I have very limited exposure to this stuff (I sat in on a few evals as an extern; Rehab psych did this on occasion as part of their outpatient clinic to generate some revenue), so excuse my ignorance on the topic. However, from what I recall, the eval was standard assessment stuff and the report was all sent in to be reviewed by disability determination services. Mostly 90791 interview plus maybe a bit of testing. Now, I wouldn't suggest compromising your ethics and being the go to shill for it, but it seemed like decent side stream of income if in practice. What am I missing?

 

[WisNeuro]

I am curious to know what kind of volume is required for this. I have very limited exposure to this stuff (I sat in on a few evals as an extern; Rehab psych did this on occasion as part of their outpatient clinic to generate some revenue), so excuse my ignorance on the topic. However, from what I recall, the eval was standard assessment stuff and the report was all sent in to be reviewed by disability determination services. Mostly 90791 interview plus maybe a bit of testing. Now, I wouldn't suggest compromising your ethics and being the go to shill for it, but it seemed like decent side stream of income if in practice. What am I missing?

At least when I've seen it, people do these in large volume. Lot of the time it's reimbursed for the eval, not for the time. So, people pump these out as fast as they can, and the quality shows the rush and incompetence. I'm sure there are some fine people out there who do a good job, but these evals don't usually attract very good providers in many jurisdictions.

 

[Sanman]

At least when I've seen it, people do these in large volume. Lot of the time it's reimbursed for the eval, not for the time. So, people pump these out as fast as they can, and the quality shows the rush and incompetence. I'm sure there are some fine people out there who do a good job, but these evals don't usually attract very good providers in many jurisdictions.

That is understandable and fairly common which many types of contact/government work. The result of no increased pay for quality. Unfortunately, I see it often and there is a great business case if you are not the licensed clinician doing the eval.

 

[deleted343839]

I am curious to know what kind of volume is required for this. I have very limited exposure to this stuff (I sat in on a few evals as an extern; Rehab psych did this on occasion as part of their outpatient clinic to generate some revenue), so excuse my ignorance on the topic. However, from what I recall, the eval was standard assessment stuff and the report was all sent in to be reviewed by disability determination services. Mostly 90791 interview plus maybe a bit of testing. Now, I wouldn't suggest compromising your ethics and being the go to shill for it, but it seemed like decent side stream of income if in practice. What am I missing?

I got approached to do these evaluations for a third party company and the pay was bad for the effort required. Maybe the company is profitable but their product has got to be awful.

 

[Sanman]

I got approached to do these evaluations for a third party company and the pay was bad for the effort required. Maybe the company is profitable but their product has got to be awful.

I'm sure their product is awful and the pay was terrible because they are taking all the profit. I'm also sure no one pressuring quick turnover has a license to their name. More likely, an MBA than a clinical degree. I have seen several companies in various areas of the field operate like this. They make large profits. I can think of one of the largest private employers of psychologists owned by a private equity group that uses a similar model. Unfortunately, it is a big business.

 

[BuckeyeLove]

I know of a few individuals who will mark out 6 hours of their day, and within that time period, will see 20 people (...with the help of psych assistants). They write the reports as they see the individuals. They do this twice a week as part of their overall practice. Take from that what you will.

 

[Sanman]

I know of a few individuals who will mark out 6 hours of their day, and within that time period, will see 20 people (...with the help of psych assistants). They write the reports as they see the individuals. They do this twice a week as part of their overall practice. Take from that what you will.

I can't even imagine how that works. We used to do a 45-60 min interview of each person when I did it plus testing.

 

[WisNeuro]

I can't even imagine how that works. We used to do a 45-60 min interview of each person when I did it plus testing.

It's easy, you hold the rubber stamp up, lower arm to stamp, then place stamped report on "completed" stack, rinse and repeat.

 

[BuckeyeLove]

I can't even imagine how that works. We used to do a 45-60 min interview of each person when I did it plus testing.

The psych assistants did most of the work. Then psychologist comes in for 5 minutes and asks about work stuff. If I remember correctly, they rationalized it by making a weird false equivalency to psychiatry and their billable quarter hours (i.e., my time is just as valuable as their time). I had the same reaction as you when I first saw it, because I was also doing them at that time, and yeah, I felt rushed at 45-60 minutes just for the interview.

 

[PsyDr]

I. What am I missing?

1) Social Security has repeatedly refused to allow validity testing. There a congressional inquiry into this matter. IIRC, they do not pay for testing or if they do, they pay extremely poorly. So the pressure is to do an interview and move on.

2) None of that matters because the definition of disability is an incredibly high barrier. It is damn near impossible for most psychological disorders to cause a total inability for someone to do any substantial gainful employment in any environment in all of the USA for 12 months. Especially when you consider that the ADA requires an employer to determine if they can provide accommodations. That means that the psychologist must opine that there are zero employers anywhere in the USA that can provide suitable accommodations for a job that pays the federal minimum wage or more.

 

[MCParent]

$130K net income for someone who is working that much is pretty crap income honestly. So... you get to be unethical and dishonest, give people bad diagnoses.... and still make garbage income per hour? And the revenue steam is volatile as mentioned? And the clients suck? Is this like last ditch for people who are badly trained? There are ways to make WAY more money if you're willing to practice unethically.
[edit: why did I sign my post? Derp.]

 

[WisNeuro]

$130K net income for someone who is working that much is pretty crap income honestly. So... you get to be unethical and dishonest, give people bad diagnoses.... and still make garbage income per hour? And the revenue steam is volatile as mentioned? And the clients suck? Is this like last ditch for people who are badly trained? There are ways to make WAY more money if you're willing to practice unethically.
Mike

Cough *Amen Clinics* cough

 

[Sanman]

$130K net income for someone who is working that much is pretty crap income honestly. So... you get to be unethical and dishonest, give people bad diagnoses.... and still make garbage income per hour? And the revenue steam is volatile as mentioned? And the clients suck? Is this like last ditch for people who are badly trained? There are ways to make WAY more money if you're willing to practice unethically.
Mike

It depends on where that $130k net comes from. The way I understood the OP, the guys was making $130k for owning the practice and others were doing all the work and paid out of the overhead. I might be wrong, but that is a better income than earning $130k for doing the work yourself full-time.

 

[GradStudent2020]

I am curious to know what kind of volume is required for this. I have very limited exposure to this stuff (I sat in on a few evals as an extern; Rehab psych did this on occasion as part of their outpatient clinic to generate some revenue), so excuse my ignorance on the topic. However, from what I recall, the eval was standard assessment stuff and the report was all sent in to be reviewed by disability determination services. Mostly 90791 interview plus maybe a bit of testing. Now, I wouldn't suggest compromising your ethics and being the go to shill for it, but it seemed like decent side stream of income if in practice. What am I missing?

I’ve worked with some LP’s that do these. It’s a very small portion of their income, and I have heard they pay ****. Their services are pretty diviersified for all the practical reasons shared here. In their case, they still provided a fairly comprehensive evaluation. Those clients are given the same size time slot as other evaluations. I don’t think doing these frequently necessarily means you tend to determine eligibility frequently. From what I recall, they typically did not see impairment at a level to qualify.

 

[MAClinician]

2) None of that matters because the definition of disability is an incredibly high barrier. It is damn near impossible for most psychological disorders to cause a total inability for someone to do any substantial gainful employment in any environment in all of the USA for 12 months. Especially when you consider that the ADA requires an employer to determine if they can provide accommodations. That means that the psychologist must opine that there are zero employers anywhere in the USA that can provide suitable accommodations for a job that pays the federal minimum wage or more.

Curious if you know what the requirements are for children to be eligible? I’ve always been under the impression that it is to assist parents who may not be able to work because of the child’s disability (intellectual, developmental, complex medical etc). I’ve had a few clients over the years with multiple psych admissions so I can see how that would also impact the family. But I have a difficult time understanding how a child with ADHD only can qualify for SSDI (or even ADHD comorbid with another MH diagnosis). Would be interested in your thoughts on this, as I have no desire to look up the eligibility requirements myself and try to make sense of them.

 

[PsyDr]

Curious if you know what the requirements are for children to be eligible? I’ve always been under the impression that it is to assist parents who may not be able to work because of the child’s disability (intellectual, developmental, complex medical etc). I’ve had a few clients over the years with multiple psych admissions so I can see how that would also impact the family. But I have a difficult time understanding how a child with ADHD only can qualify for SSDI (or even ADHD comorbid with another MH diagnosis). Would be interested in your thoughts on this, as I have no desire to look up the eligibility requirements myself and try to make sense of them.

Ssdi is not ssi.

Children don’t qualify for ssdi. Ssdi is for people with like 10 quarters of income. The USA no longer allows child labor, so that’s not possible.

SSI is income for poor people with a serious ailment. And I mean poor. Like really poor. Iirc: it’s like $2000.00 in total assets. Not monthly. Not annual. Total.

So that’s a very hard barrier to get to. But if you’re that poor you can move into the next stage of applying for ssi.

SSI does not have a great definition for serious ailment. But it’s doenst really have to because you have to be super poor.

Say you’re a McDonald’s worker. You have a kid. Kid has an intellectual disability. You’re eligible for like $800/month because that sucks. And your kid gets Medicaid.

Where you see problems is that if you’re super poor, that’s a lot of money to you. So there are people that try to say that all of their many children have an easily fakabke diagnosis. They coach them. Or reinforce how real an imaginary friend is and say they’re hallucinating. At the extreme ends people will actually abuse their children to get this stuff.

You’ll see this a lot in neuropsych where an old person with dementia goes into a nursing home. They outlive their money. So the social workers help them spend down their assets until they have like $2000 to their name. Then they apply for Medicaid. So their nursing home care is paid for a combination of Medicare and Medicaid.

 

[MAClinician]

I work exclusively with Medicaid children , so thank you for answering my question. Makes sense then if the “requirements” are not well defined, that it is easier for kids to qualify for SSI than adults for SSDI.

 

[WisNeuro]

You’ll see this a lot in neuropsych where an old person with dementia goes into a nursing home. They outlive their money. So the social workers help them spend down their assets until they have like $2000 to their name. Then they apply for Medicaid. So their nursing home care is paid for a combination of Medicare and Medicaid.

Exactly, had an old guy who owned a lot of construction equipment and not much else. Couldn't qualify until all of that was sold off and he spent it down. He refused because he thought he was going to reopen his business someday. And this is where guardianship comes in...

 

[Sanman]

You’ll see this a lot in neuropsych where an old person with dementia goes into a nursing home. They outlive their money. So the social workers help them spend down their assets until they have like $2000 to their name. Then they apply for Medicaid. So their nursing home care is paid for a combination of Medicare and Medicaid.

That's more Medicaid spend down than SSDI though. Slightly different rules and slightly different pots of money. From what I was reading is that most of the recent SSDI spike is former construction and manufacturing people that are now on "disability" as they can't get a job and many found a way to get into the system.

 

[PsyDr]

That's more Medicaid spend down than SSDI though. Slightly different rules and slightly different pots of money. From what I was reading is that most of the recent SSDI spike is former construction and manufacturing people that are now on "disability" as they can't get a job and many found a way to get into the system.

Fair enough. I am not knowledgeable enough about Medicaid spend down. I probably shouldn’t have offered opinions about that.

 

[LadyHalcyon]

I see this quite frequently. It's sad because often times the child internalizes their "disability", which prevents them from upward mobility. I currently have a 27-year-old patient who has an extremely cluster B mother who is VERY pushy when it comes to getting what she wants. She refers to my patient as her "autistic son", even though I am 100% positive he does not have autism. He was recently arrested and spent 4 weeks in jail. The mom was coming to our office every day demanding I write letters to 5 different judges "to get him out of jail." She wanted that check so badly. When I first informed the patient he didn't have Autism he looked defeated, but indicated he suspected as much. I have yet to see SSI make anyone's adult life better. I'm sure there are cases, but from a behavioral activation perspective SSI is horrible. My patients who have chosen to stop receiving benefits to work full-time and/or have chosen to work part time and only receive partial benefits have seen drastic improvements in their overall psychological health.

Ssdi is not ssi.

Children don’t qualify for ssdi. Ssdi is for people with like 10 quarters of income. The USA no longer allows child labor, so that’s not possible.

SSI is income for poor people with a serious ailment. And I mean poor. Like really poor. Iirc: it’s like $2000.00 in total assets. Not monthly. Not annual. Total.

So that’s a very hard barrier to get to. But if you’re that poor you can move into the next stage of applying for ssi.

SSI does not have a great definition for serious ailment. But it’s doenst really have to because you have to be super poor.

Say you’re a McDonald’s worker. You have a kid. Kid has an intellectual disability. You’re eligible for like $800/month because that sucks. And your kid gets Medicaid.

Where you see problems is that if you’re super poor, that’s a lot of money to you. So there are people that try to say that all of their many children have an easily fakabke diagnosis. They coach them. Or reinforce how real an imaginary friend is and say they’re hallucinating. At the extreme ends people will actually abuse their children to get this stuff.

You’ll see this a lot in neuropsych where an old person with dementia goes into a nursing home. They outlive their money. So the social workers help them spend down their assets until they have like $2000 to their name. Then they apply for Medicaid. So their nursing home care is paid for a combination of Medicare and Medicaid.

 

[Sanman]

I see this quite frequently. It's sad because often times the child internalizes their "disability", which prevents them from upward mobility. I currently have a 27-year-old patient who has an extremely cluster B mother who is VERY pushy when it comes to getting what she wants. She refers to my patient as her "autistic son", even though I am 100% positive he does not have autism. He was recently arrested and spent 4 weeks in jail. The mom was coming to our office every day demanding I write letters to 5 different judges "to get him out of jail." She wanted that check so badly. When I first informed the patient he didn't have Autism he looked defeated, but indicated he suspected as much. I have yet to see SSI make anyone's adult life better. I'm sure there are cases, but from a behavioral activation perspective SSI is horrible. My patients who have chosen to stop receiving benefits to work full-time and/or have chosen to work part time and only receive partial benefits have seen drastic improvements in their overall psychological health.

That's blaming SSI for people abusing the system. SSI is simply a safety net for those that get sick and have not worked enough to qualify for social security disability income.

 

[LadyHalcyon]

How am I blaming SSI? What specifically in my post are you referring to? The point I was trying to make is similarly to @PSYDR response. More specifically, when he said:

"Where you see problems is that if you’re super poor, that’s a lot of money to you. So there are people that try to say that all of their many children have an easily fakabke diagnosis. They coach them. Or reinforce how real an imaginary friend is and say they’re hallucinating. At the extreme ends people will actually abuse their children to get this stuff. "

I have seen this happen several times. My other point was questioning whether people" abusing" the system are actually seeing improvements in their overall mental and physical health. Many times people may need SSI due to the severity of their illness. I see this a lot with ptsd diagnoses. After treatment, people often can resume work, either full or part time. Work gives them structure, a sense of purpose, and increases their self-esteem. Not to mention the behavioral activation piece. I'm just confused as to how your takeaway from my post was "you are blaming SSI."

 

[Sanman]

I have yet to see SSI make anyone's adult life better. I'm sure there are cases, but from a behavioral activation perspective SSI is horrible. My patients who have chosen to stop receiving benefits to work full-time and/or have chosen to work part time and only receive partial benefits have seen drastic improvements in their overall psychological health.

I was referring to this ^

While dependence is fostered for some people, having the program is a last resort for people who need it is important. I don't completely disagree with your point and maybe I misread your intentions. However, I feel it is a mixed bag. I have seen SSI help adults with early onset MS, etc, that are unable to qualify for other benefits. However, it does hurt those that use it as a crutch rather than attempting to function at their optimal level.

 

[LadyHalcyon]

Yes. That is why I said I personally have not seen it, but added that I'm sure there are cases where it has been helpful. I do have a client who had a brain aneurysm and SSI has been helpful for him in regard to securing housing etc. That being said, he recently started working with vocational rehab and feels better about himself now that he is working, even if only 10 hours a week. I don't think he would be able to work full time, given his physical impairments. While I am glad programs like SSI are available, I think it is essential people find a sense of purpose in their life. That can be achieved through volunteer work, part-time employment, etc. But they need SOMETHING. The people I have seen on SSI (mostly receiving SSI for psychological disorders) often internalize their disability status, which can negatively impact therapeutic progress.

I don't fault my patients for seeking disability, even when I suspect they are able to work. They are extremely poor and often have extensive trauma histories. They are doing what they can to survive, and, in some ways, I respect their resiliency. It sometimes reminds me of the CBT/ACT work I do with chronic pain patients; helping them change their underlying concepts of what their pain represents and means in regard to their dailu functioning and quality of life. Yes they have pain, yes it is real, and yes they may still be able to achieve a better quality of life if they are willing to increase their cognitive flexibility about how pain informs their overall identity.

I was referring to this ^

While dependence is fostered for some people, having the program is a last resort for people who need it is important. I don't completely disagree with your point and maybe I misread your intentions. However, I feel it is a mixed bag. I have seen SSI help adults with early onset MS, etc, that are unable to qualify for other benefits. However, it does hurt those that use it as a crutch rather than attempting to function at their optimal level.

 

[Sanman]

Yes. That is why I said I personally have not seen it, but added that I'm sure there are cases where it has been helpful. I do have a client who had a brain aneurysm and SSI has been helpful for him in regard to securing housing etc. That being said, he recently started working with vocational rehab and feels better about himself now that he is working, even if only 10 hours a week. I don't think he would be able to work full time, given his physical impairments. While I am glad programs like SSI are available, I think it is essential people find a sense of purpose in their life. That can be achieved through volunteer work, part-time employment, etc. But they need SOMETHING. The people I have seen on SSI (mostly receiving SSI for psychological disorders) often internalize their disability status, which can negatively impact therapeutic progress.

I don't fault my patients for seeking disability, even when I suspect they are able to work. They are extremely poor and often have extensive trauma histories. They are doing what they can to survive, and, in some ways, I respect their resiliency. It sometimes reminds me of the CBT/ACT work I do with chronic pain patients; helping them change their underlying concepts of what their pain represents and means in regard to their dailu functioning and quality of life. Yes they have pain, yes it is real, and yes they may still be able to achieve a better quality of life if they are willing to increase their cognitive flexibility about how pain informs their overall identity.

True, but children or working age adults were not the major intended group for the program anyway. The largest benefit as @PSYDR alluded to are elderly. SSI kicks in for those that do not qualify for enough social security/pension income or are unable to meet their medical bills. Medicaid and food stamps also kick in at this level. The biggest group helped by this is women who are homemakers or did not work enough to get social security and pension to meet their needs. I think SSI for the elderly (65+) and blind (another big group) is useful. The "disabled" group is the one your speak of and is the minority of people that get SSI, but the one that is most abused due to the wide coverage.

 

[futureapppsy2]

I see this quite frequently. It's sad because often times the child internalizes their "disability", which prevents them from upward mobility. I currently have a 27-year-old patient who has an extremely cluster B mother who is VERY pushy when it comes to getting what she wants. She refers to my patient as her "autistic son", even though I am 100% positive he does not have autism. He was recently arrested and spent 4 weeks in jail. The mom was coming to our office every day demanding I write letters to 5 different judges "to get him out of jail." She wanted that check so badly. When I first informed the patient he didn't have Autism he looked defeated, but indicated he suspected as much. I have yet to see SSI make anyone's adult life better. I'm sure there are cases, but from a behavioral activation perspective SSI is horrible. My patients who have chosen to stop receiving benefits to work full-time and/or have chosen to work part time and only receive partial benefits have seen drastic improvements in their overall psychological health.

The amount of ableism in not understanding how hard it is to get a job when you’re severely disabled is fascinating.

 

[LadyHalcyon]

The amount of ableism in not understanding how hard it is to get a job when you’re severely disabled is fascinating.

These specific patients I'm talking about are able to work, from a physical standpoint. If anything their SES is preventing them from obtaining employment. They cannot afford cars, often have suspended driver's licenses, and an extensive legal history. As I previously stated, I am sure SSI has helped many people and I am glad the program is available. I don't appreciate your comment; it felt like a passive aggressive jab. Are the other comments saying people abuse the SSI system also discriminatory? Or do they get a pass for some reason?

 

[WisNeuro]

The amount of ableism in not understanding how hard it is to get a job when you’re severely disabled is fascinating.

I think there is a definite base rate bias in some contexts. For example, in neuropsych, especially for those of us with VA experience, we see an outsized amount of people trying to game the system. Even outside of the system, I still get people whose lawyers try to get backdoor disability evals, where there is no real injury (e.g., mTBI, Lyme's, etc). Many of us do not see the actual disability patients. So, it's trying to reconcile what we see mostly from the system, to how the system is supposed to operate with those who need and benefit from those services.

 

[LadyHalcyon]

I think there is a definite base rate bias in some contexts. For example, in neuropsych, especially for those of us with VA experience, we see an outsized amount of people trying to game the system. Even outside of the system, I still get people whose lawyers try to get backdoor disability evals, where there is no real injury (e.g., mTBI, Lyme's, etc). Many of us do not see the actual disability patients. So, it's trying to reconcile what we see mostly from the system, to how the system is supposed to operate with those who need and benefit from those services.

I seriously have patients who have been trying to obtain disability for years. They are adamant they can't work, yet they are fully capable of "hustling" when necessary. I had a patient the other day ask me if I knew anyone who wanted to buy her food stamps! I don't fault the hustle, as they need money. I am sometimes amazed at all the effort they expend trying to obtain disability. I have noticed more and more of these patients are not qualifying for disability and are going through appeal after appeal. From what I understand, it was much easier to receive benefits for a PTSD diagnosis 15 years ago than it is today.

 

[WisNeuro]

I seriously have patients who have been trying to obtain disability for years. They are adamant they can't work, yet they are fully capable of "hustling" when necessary. I had a patient the other day ask me if I knew anyone who wanted to buy her food stamps! I don't fault the hustle, as they need money. I am sometimes amazed at all the effort they expend trying to obtain disability. I have noticed more and more of these patients are not qualifying for disability and are going through appeal after appeal. From what I understand, it was much easier to receive benefits for a PTSD diagnosis 15 years ago than it is today.

I definitely agree that there are abuses of the system. But, it's a baby and bathwater scenario. There is a definite need for certain populations for disability benefits, and a small percentage of people gaming the system who have an outsized footprint on the process. Some of the egregious cases are ferreted out, but in the end, tighter investigative reins may cost more than acknowledging a certain level of abuse of the system.

 

[LadyHalcyon]

I definitely agree that there are abuses of the system. But, it's a baby and bathwater scenario. There is a definite need for certain populations for disability benefits, and a small percentage of people gaming the system who have an outsized footprint on the process. Some of the egregious cases are ferreted out, but in the end, tighter investigative reins may cost more than acknowledging a certain level of abuse of the system.

I agree with this. I also work primarily with forensic populations and acknowledge that likely biases my view.

 

[123EW]

It is difficult to tease apart malingering from a manipulative standpoint and malingering that is a function of an underlying psychological disorder. It is easy to believe that if one is physically and cognitively capable of working, then they should be able to find a job and not rely on SSD benefits. However, think of it from an employer perspective: Would you hire someone who interviewed poorly? Would you keep someone employed who was disruptive (either blatantly or overtly) to the function of your business? I know I wouldn't. << So where do these people go?

I believe that we discount the power of mental illness in everyday functioning too much. I view major depression the same as amputating the leg of a marathon runner. Could they run again? Sure, with adequate rehab and proper supports such as a wheelchair or a prosthetic limb. Folks with depression (or fill in any psychological disorder) cannot just go out and do because they are physically capable. There are true barriers in place.

 

[LadyHalcyon]

I completely agree with everything you said. Psychological illnesses cause very real impairments and I don't think any psychologist would disagree with that statement. Unfortunately, what tends to happen (from what I have personally seen) is they do not return to the workforce and instead their identity becomes fused with their disability, which worsens the depression and decreases self-efficacy. They do not have activities in their lives that provide them with a sense of competence and mastery. Activities can be things other than employment, but I strongly believe people need to have a sense of purpose. I suppose it is all about finding a balance. If someone is suffering from severe trauma-related symptoms I would definitely support SSI while they undergo psychological treatment. Once their symptoms subside, I believe they should try to obtain employment or participate in volunteer work/structured activities, if possible. I don't mean this from a judgemental perspective, I just worry that it can cause more harm to not be "productive" for years and years and years.

It is difficult to tease apart malingering from a manipulative standpoint and malingering that is a function of an underlying psychological disorder. It is easy to believe that if one is physically and cognitively capable of working, then they should be able to find a job and not rely on SSD benefits. However, think of it from an employer perspective: Would you hire someone who interviewed poorly? Would you keep someone employed who was disruptive (either blatantly or overtly) to the function of your business? I know I wouldn't. << So where do these people go?

I believe that we discount the power of mental illness in everyday functioning too much. I view major depression the same as amputating the leg of a marathon runner. Could they run again? Sure, with adequate rehab and proper supports such as a wheelchair or a prosthetic limb. Folks with depression (or fill in any psychological disorder) cannot just go out and do because they are physically capable. There are true barriers in place.

 

[123EW]

I don't take your view as judgmental at all.

The only point I would bring up is that we know mental health services can be (in)valuable, but such services are not readily available to those most in need. I realize this can vary, but most folks that I encounter who do not have financial means for weekly therapy often see a provider once per month at the most. This is not adequate to properly treat and help an individual regain functioning. Those that have the financial means for evidenced-based treatment generally are not applying for SSD benefits (that is a completely subjective statement, btw)

There is no quick or easy answer (well, there is -- follow the UK model of mental illness treatment!), and unfortunately, SSD benefits are probably the best answer given the framework within which we have to work.

 

[ToneTone]

Yikes...$600k before overhead...I always thought those numbers were made up. My path hasn't turned out to be neuro even with almost 3 years of training in it, but I can't imagine churning out (what I assume are) bad/unethical assessments to net only $130k. What's wrong with people...I personally don't think it's worth potentially screwing up someone's life (non SSDI assessments) or the liability to take on assessments done on a whim with little care or training.
Edit* just complaining. I've seen some questionnaires to be filled out by clinicians for SSDI and had friends train at department of rehab doing some assessments.