SSDI for depression and anxiety?

[Attending1985]

Does anyone understand SSDI for depression and anxiety? Taking someone out of the workforce and the structure, socialization and meaning that gives to people’s lives seems detrimental. Many people with treatment depression and anxiety also have personally disorders. Isn’t work an appropriate place to get the experiential learning to sort these things through with the help of the therapist? I can see short-term disability for IOP etc. but this makes absolutely no sense to me. I am seeing so many patients on this and trying to get this. When did mental health turn in a such a chronic model? Shouldn’t we be promoting recovery?

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[st2205]

Does anyone understand SSDI for depression and anxiety?

Logically or conceptually?

Taking someone out of the workforce and the structure, socialization and meaning that gives to people’s lives seems detrimental.

It seems that way because it is.

Many people with treatment depression and anxiety also have personally disorders. Isn’t work an appropriate place to get the experiential learning to sort these things through with the help of the therapist?

Yes.

Shouldn’t we be promoting recovery?

Yes, but we live in a society that strongly values, among its highest virtues, not “being mean” and having “sympathy” which translates into some kind of intervention that reduces anxiety and mental tension in the one delivering it but absolutely devastates the one receiving it.

 

[Attending1985]

Logically or conceptually?



It seems that way because it is.



Yes.



Yes, but we live in a society that strongly values, among its highest virtues, not “being mean” and having “sympathy” which translates into some kind of intervention that reduces anxiety and mental tension in the one delivering it but absolutely devastates the one receiving it.

This is a public health problem that no one seems to notice/tries to ignore. Why isn’t the field addressing this?

 

[st2205]

This is a public health problem that no one seems to notice/tries to ignore. Why isn’t the field addressing this?

This really goes far beyond a psychiatry problem. It’s medicine wide (and even broader than medicine). We’re just a bit more apt to recognize it (at least we should be more apt to recognize it — plenty of us who don’t, hence we’re having the problem).

 

[Attending1985]

This really goes far beyond a psychiatry problem. It’s medicine wide (and even broader than medicine). We’re just a bit more apt to recognize it (at least we should be more apt to recognize it — plenty of us who don’t, hence we’re having the problem).

Yes we are the experts in mental health so it is our job to intervene. I’m just so sick of anti-psychiatry arguments about disability for mental health sky rocketing. We started giving SSDI for a disorder you can feign of course the numbers are skyrocketing.

 

[st2205]

Yes we are the experts in mental health so it is our job to intervene. I’m just so sick of anti-psychiatry arguments about disability for mental health sky rocketing. We started giving SSDI for a disorder you can feign of course the numbers are skyrocketing.

Step into the VA from anything that’s got a service connection (GERD and OSA, seriously?)

 

[Bartelby]

I think one good side of the argument is posted here, and I am concerned with how widespread psychiatric disability is becoming myself. On the other hand, especially when you lump in personality disorders...

Many people with treatment depression and anxiety also have personally disorders. Isn’t work an appropriate place to get the experiential learning to sort these things through with the help of the therapist?

Work can be a great place to get experiential learning for those who can get and hold a job. Still, in order to get work you need to:
-Transport yourself to work
-Show up to work on time, consistently
-Be bearable enough to avoid getting fired
-Be able to meet minimal performance standards (drawing on attention, memory, executive functioning, etc.)
-Avoid acting out that will make getting a future job even harder, or land a criminal charge (threats, destruction of property, substance abuse at work, etc.)

The patient's wanting employment does not guarantee that an employer will hire them, and not every personality disordered patient is in an appropriate place to get a job at any given time. If they cannot get a job, then a slide into homelessness, food insecurity, etc etc. may not provide optimal social conditions for recovery. The problem is, once the help starts coming where do you from promoting recovery into fostering dependence? When is withholding money, and potentially food and shelter, a motivator and when is it a callous affirmation that indeed no one does care about them? I don't think there is a straightforward answer, but it is an issue that could use more open and thoughtful discussion (and research?).

 

[WisNeuro]

Step into the VA from anything that’s got a service connection (GERD and OSA, seriously?)

At my old VA job, my SVT/PVT failure rate, whether it be malingering/somaticization/whatever, was 45%. In the past 6 months in my new job, I've had 2 patients total who have had invalid data. When we build up an incentive system, people will take advantage of the incentives until it's hard to tell whether or not you are providing healthcare, or are merely administering welfare benefits.

 

[boogaaloo]

Sometimes when you're depressed, it can be quite hard to go to work. Same applies for panic disorder, severe PTSD, etc

 

[Attending1985]

I think one good side of the argument is posted here, and I am concerned with how widespread psychiatric disability is becoming myself. On the other hand, especially when you lump in personality disorders...



Work can be a great place to get experiential learning for those who can get and hold a job. Still, in order to get work you need to:
-Transport yourself to work
-Show up to work on time, consistently
-Be bearable enough to avoid getting fired
-Be able to meet minimal performance standards (drawing on attention, memory, executive functioning, etc.)
-Avoid acting out that will make getting a future job even harder, or land a criminal charge (threats, destruction of property, substance abuse at work, etc.)

The patient's wanting employment does not guarantee that an employer will hire them, and not every personality disordered patient is in an appropriate place to get a job at any given time. If they cannot get a job, then a slide into homelessness, food insecurity, etc etc. may not provide optimal social conditions for recovery. The problem is, once the help starts coming where do you from promoting recovery into fostering dependence? When is withholding money, and potentially food and shelter, a motivator and when is it a callous affirmation that indeed no one does care about them? I don't think there is a straightforward answer, but it is an issue that could use more open and thoughtful discussion (and research?).

I don’t view lack of transportation, being unreliable or antagonistic as medical problems. I think the problem we’ve created in society and in psychiatry is calling them medical problems and offering medical treatments.

 

[AcronymAllergy]

Sometimes when you're depressed, it can be quite hard to go to work. Same applies for panic disorder, severe PTSD, etc

Very true. However, by incentivizing what could easily become work avoidance, there's the potential for reinforcement of maladaptive behaviors and coping strategies. This then could significantly exacerbate the underlying mental health condition, particularly if it's depression, panic d/o, PTSD, or anxiety (including social phobia).

 

[Attending1985]

Sometimes when you're depressed, it can be quite hard to go to work. Same applies for panic disorder, severe PTSD, etc

Yes short term disability would be appropriate for treatment purposes but what does long term disability acheive?

 

[randomdoc1]

I agree with many of these posts. I recently had someone who worked full time up into her late 50's. She's been on FMLA for a few months, now seeking permanent disability. From what I can tell so far, I don't think she qualifies. The question specifically asks me on the paperwork if I think she is incapable of any kind of gainful employment for the rest of her life. There's many cases where I find longterm disability to be enabling and in the longterm not helpful for their psychiatric issues. Not to mention that it places some unnecessary societal burden. It's a lose lose. Yes, there are cases where it is warranted, but I see so many people walking in asking for it without having seen they've given full effort to see what other options they have which will serve everyone including themselves better in the long run.

 

[Attending1985]

I agree with many of these posts. I recently had someone who worked full time up into her late 50's. She's been on FMLA for a few months, now seeking permanent disability. From what I can tell so far, I don't think she qualifies. The question specifically asks me on the paperwork if I think she is incapable of any kind of gainful employment for the rest of her life. There's many cases where I find longterm disability to be enabling and in the longterm not helpful for their psychiatric issues. Not to mention that it places some unnecessary societal burden. It's a lose lose. Yes, there are cases where it is warranted, but I see so many people walking in asking for it without having seen they've given full effort to see what other options they have which will serve everyone including themselves better in the long run.

Yes seems like SSDI would be the anti-treatment for this woman

 

[wannabie]

Step into the VA from anything that’s got a service connection (GERD and OSA, seriously?)

I've seen service connection for adjustment disorder and neurosis. Only 10%, but still!

At my old VA job, my SVT/PVT failure rate, whether it be malingering/somaticization/whatever, was 45%. In the past 6 months in my new job, I've had 2 patients total who have had invalid data. When we build up an incentive system, people will take advantage of the incentives until it's hard to tell whether or not you are providing healthcare, or are merely administering welfare benefits.

I've felt that the VA is essentially a large welfare system for a while now. Much of the hospital are employed veterans, which is great because it helps veterans, but they're almost always under trained and poorly motivated.

 

[WisNeuro]

I've felt that the VA is essentially a large welfare system for a while now. Much of the hospital are employed veterans, which is great because it helps veterans, but they're almost always under trained and poorly motivated.

The VA actually provided better coordination and access to different rehab/supportive options for my patients who actually needed certain types of care than any other system I've worked in, it's just frustrating to be a provider in that system. You get compensated better outside of the system and I don't have to spend about half of my time doing what accounts to disability evals.

 

[Armadillos]

This is what happens when you live in a society with poor social safety nets, the medical profession becomes the gate keeper to the last remaining refuge.

IMHO we should completely get rid of disability (outside of privately bought insurance) and institute some sort of minimum universal income instead.

 

[WisNeuro]

This is what happens when you live in a society with poor social safety nets, the medical profession becomes the gate keeper to the last remaining refuge.

IMHO we should completely get rid of disability (outside of privately bought insurance) and institute some sort of minimum universal income instead.

With the ever increasing automation of unskilled labor, this will inevitably happen. It'll be a political fight for years, but it'll happen.

 

[thoffen]

Depression and anxiety can certainly be chronically disabling. The notion of disability income promoting dependence and reinforcing illness behavior applies to any disability. Many people with schizophrenia can work and be independent in self-care. Many people with chronic back pain are able to recover and function.

 

[aim-agm]

This is what happens when you live in a society with poor social safety nets, the medical profession becomes the gate keeper to the last remaining refuge.

IMHO we should completely get rid of disability (outside of privately bought insurance) and institute some sort of minimum universal income instead.

Disability is UBI, as are service connections, Food Stamps, prison, and many other ways society provides money or food+shelter to those it can't employ or integrate. There's a lot of benefit to society to have UBI but that would be difficult to pass or implement, so it crops up in various ways to accomplish the same objectives.

 

[birchswing]

It seems the ubiquity of stress and sadness causes a dilution in the perceived ability for clinical anxiety and depressive disorders to make a person rather nonfunctional. I wish I were better at searching this forum, but someone wrote a while back about an anxious person who was so refractory they were inpatient and being tried on almost everything under the sun with no improvement. And of course you can have depression as severe as catatonia.

We don't perceive a ubiquity of schizophrenic or intellectually disabled traits, so it's easier to conceptualize them as crippling.

 

[thoffen]

Personally, I would like to focus our entitlement interventions on direct provision of needs and services rather than income.

 

[erg923]

Sometimes when you're depressed, it can be quite hard to go to work. Same applies for panic disorder, severe PTSD, etc

Lots of things in life are hard. That's not disability and thats not we we are talking about here.

There's a difference between writing a patient off of work for several days for acute stressors/crisises, etc. and being literally unable to work.

 

[Attending1985]

Depression and anxiety can certainly be chronically disabling. The notion of disability income promoting dependence and reinforcing illness behavior applies to any disability. Many people with schizophrenia can work and be independent in self-care. Many people with chronic back pain are able to recover and function.

I disagree with this. It’s obvious to when someone is legitimately disabled. These people deserve benefits because of an inability to work not a decreased ability to work. We can’t even the playing field with disability. I think our patients need us to believe in them not buy into their distorted views of reality and themselves. This is strength giving. What a damning thing for an expert to say that you are permanently disabled.

 

[PsyDr]

I think one good side of the argument is posted here, and I am concerned with how widespread psychiatric disability is becoming myself. On the other hand, especially when you lump in personality disorders...



Work can be a great place to get experiential learning for those who can get and hold a job. Still, in order to get work you need to:
-Transport yourself to work
-Show up to work on time, consistently
-Be bearable enough to avoid getting fired
-Be able to meet minimal performance standards (drawing on attention, memory, executive functioning, etc.)
-Avoid acting out that will make getting a future job even harder, or land a criminal charge (threats, destruction of property, substance abuse at work, etc.)

The patient's wanting employment does not guarantee that an employer will hire them, and not every personality disordered patient is in an appropriate place to get a job at any given time. If they cannot get a job, then a slide into homelessness, food insecurity, etc etc. may not provide optimal social conditions for recovery. The problem is, once the help starts coming where do you from promoting recovery into fostering dependence? When is withholding money, and potentially food and shelter, a motivator and when is it a callous affirmation that indeed no one does care about them? I don't think there is a straightforward answer, but it is an issue that could use more open and thoughtful discussion (and research?).

None of that is compatible with SSDI.

 

[erg923]

There is always a problem of definitions here:

@PSYDR has frequently articulated the standards of/for disability set forth by various payers (SSA, commercial insurers, etc). Not sure how many are listening or really understanding this? The rest is simply academic and clinical discussions of whether you think your patient can/should work or not. This is subjective and silly and is largely moot in the grand scheme of things.

Let's all be clear. VA service connection is NOT disability. And true (psychiatric) "disability" is rarely your decision anyway.

 

[SpinDktr]

Disability is a problematic definition. I do not think it is readily apparent that someone is disabled, especially when it comes to mental health issues. I find in my practice that depression can still be disabling, but it takes a very nuanced approach. And why can't a personality disorder be grounds for disability, for that matter? I had an attending ask that question in my residency, and it still sticks with me to this day.

 

[PsyDr]

Disability is a problematic definition. I do not think it is readily apparent that someone is disabled, especially when it comes to mental health issues. I find in my practice that depression can still be disabling, but it takes a very nuanced approach. And why can't a personality disorder be grounds for disability, for that matter? I had an attending ask that question in my residency, and it still sticks with me to this day.

Because the ama says so, and by definition one would not had enough credits for ssdi

 

[Attending1985]

Disability is a problematic definition. I do not think it is readily apparent that someone is disabled, especially when it comes to mental health issues. I find in my practice that depression can still be disabling, but it takes a very nuanced approach. And why can't a personality disorder be grounds for disability, for that matter? I had an attending ask that question in my residency, and it still sticks with me to this day.

This type of thinking makes me wonder if I can remain in psychiatry long term

 

[Armadillos]

Individual symptoms and impairment seem more relevant to me than any given diagnsosis. Plenty of my pts with schizophrenia are more employable than several of my borderline patients.

 

[erg923]

And why can't a personality disorder be grounds for disability, for that matter? I had an attending ask that question in my residency, and it still sticks with me to this day.

Because society is not/should not be financially responsible for bearing the burden of your lack of maturation.

 

[PsyDr]

Patients can get disability for personality disorder though often it's labeled as "bipolar" lol that said I have had patients get disability for personality disorder, primarily SSI but SSDI occasionally too. I was kinda shocked at first but yes personality disorders are qualifying conditions. Some people manage to have multiple jobs they get fired from and have enough work credit to qualify

SSDI is only for total inability to work in any job. If a personality disorde is a pervasive pattern of behavior, then acquiring sufficient work credits to qualify for ssdi is rei ipsa evidence that the condition is not totally disabiling.

 

[PsyDr]

This type of thinking makes me wonder if I can remain in psychiatry long term

The AMA specifically states that treating physicians should not opine about disability. That is the technically correct answer when confronted with this. Might help you out.

 

[Shikima]

If someone is psychiatrically disabled from depression and anxiety, that means it's all Axis II and we need to bring back the asylums for permanent hospitalization.

 

[WisNeuro]

Transorbital lobotomies for everyone!

 

[birchswing]

If someone is psychiatrically disabled from depression and anxiety, that means it's all Axis II and we need to bring back the asylums for permanent hospitalization.

Have you not come across refractory OCD? Catatonic depression? Some people have psychosurgery for some anxiety disorders, which is not something undertaken lightly unless you've had extreme impairment of functionality.

And how is permanent hospitalization a solution to Axis II disorders?

 

[675015]

Just so everyone is arguing about the same thing when talking about "disability":

"The 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." -Off of the Social Security Administration's website.

Substantial gainful activity is a job that $1,180 a month. (also from the SSA's website).

 

[Attending1985]

The AMA specifically states that treating physicians should not opine about disability. That is the technically correct answer when confronted with this. Might help you out.

thanks I have been asked this

 

[Ceke2002]

In Australia we have two levels of payments - sickness benefits, and disability. Sickness benefits is usually for a 12 month period and is means and assets tested; Disability means you are unable to work, or to only work at a very minimal level for a period of 2 years, and that your condition is stable and not acute. My Psychiatrist was willing to try and get me onto disability, despite my perhaps not quite meeting the exact criteria at the time, because it would've allowed me access to numerous job support and return to work programs that I would not have been able to access otherwise. I didn't care about how much money I got paid, I just wanted some help to get back into the work force after an extended period away. I was the one who eventually pulled the plug on applying for disability though because it turned out to be an exhausting nightmare and I wasn't well enough at the time to deal with the difficulties. It's a catch-22, they make it next to impossible to get disability for Psychiatric conditions, but chronic Psychiatric health issues often mean long periods away from the workforce making finding future employment difficult at best, so they have all these programs to help people out with that except you have to be on disability in order to access them and good luck getting your application approved. Chronic unemployment is a huge issue with mental health patients here, and costs the government a lot of money that could otherwise be used in better ways (such as funding better mental health treatment) - but instead of getting people with mental health problems onto disability and into a return to work program, which would get a lot of willing people back into the workforce, they make it as hard as possible on us to even put in an application. And in my experience, talking to other mental health patients over the years, the image of the scammer, with exaggerated or feigned symptoms, sitting on their backside and collecting a government handout is the exception and not the rule.

 

[Mad Jack]

This is what happens when you live in a society with poor social safety nets, the medical profession becomes the gate keeper to the last remaining refuge.

IMHO we should completely get rid of disability (outside of privately bought insurance) and institute some sort of minimum universal income instead.

The trouble with that is where does the 330 billion dollars per month come from (assuming a basic income of $1,000 per month per person by the time it passes)? The current entirety of the US budget is 3.8T, UBI would cost more than that and would likely be untaxed, reducing revenue- basically it's a model that makes zero sense.

 

[tr]

The trouble with that is where does the 330 billion dollars per month come from (assuming a basic income of $1,000 per month per person by the time it passes)? The current entirety of the US budget is 3.8T, UBI would cost more than that and would likely be untaxed, reducing revenue- basically it's a model that makes zero sense.

It would be expensive no doubt. However 50% of the federal budget goes to Social Security as is, so that would go away entirely. If you halve your projected UBI to $500/mo we could provide that tomorrow by replacing SS wholecloth.

A UBI wouldn't (and shouldn't) be enough for most people to live on. At present 45% of the US pays no income tax because their incomes are too low. A UBI pittance wouldn't make the other 55% of us stop working for a living, so income tax revenue is unlikely to be affected. Sales tax revenues would likely rise.

UBI would put a safety floor under the poorest and, importantly, would obviate both the perverse incentives to claim disability (and hence have to avoid doing any productive work for fear of losing it), and the bureaucratic apparatus that exists to fight these claims. How many UBIs could we provide for the cost of the lawyers who hash out these disability claims and the specialists who must assess them?

 

[PsyDr]

you would think so but that's not how it works in practice. I suspect most personality d/o patients getting SSDI have a more bogus dx listed on the forms. but i have had a few pts who I have submitted my documentation for review where the only dx was a personality disorder (borderline or mixed) and they received SSDI. The bar is low.

also see: The 10-Year Course of Social Security Disability Income Reported by Patients with Borderline Personality Disorder and Axis II Comparison Subjects

Yeah, I can see the discord between how these things are being practiced and what is actually being asked. The only reason I am commenting on this stuff is that there seems to be a lacunae of knowledge regarding:

1) What the SSA means by disability.
2) What the AMA says about offering an opinion about disabliity
3) What the VA means by disability
4) What the federal government requires for one to determine disability
5) What the AMA says about psychiatric disability.
6) What the literature says about the impact of disability compensation on psychiatric symptom severity, longevity, etc.
7) The difference between disability and diagnosis.
8) The WHO literature about disability.

The easiest way to deal with a patient demanding one fill out a short disability form is to do it. There are many professional reasons why one should not.

 

[Attending1985]

If we’re giving disability for BPD why not ASPD or substance abuse. Let’s not forget what personally disorders are. They are unwanted/Undesirable behaviors that tend to cluster together that psychiatry has labeled as disorders. Medications Targeting the brain are not very effective. I’m not as interested in the definition of disability but what disability does to these people. In my experience it promotes chronicity, removes natural consequences of behavior that could drive change and promotes helplessness. I like working with people with personality disorders but once they get on disability it seems to be an endgame. They need help and some sort of social support but not permanent disability. I know this could be applied to other areas of medicine but I’m a psychiatrist so I’m interested in these problems.

 

[SpinDktr]

I think this is a thoughtful question all around, and perhaps the DSM-V "Spectrum" can apply to this in some respects. For instance, you probably have some autistic patients who are very "high functioning" and need little in the way of medications, accommodations, or supports. There are others who are very "low functioning".

I agree that your average neurotic "mild depression" who is just fed up with his/her supervisor and quit his/her job really would benefit from disability, but as a thoughtful doctor who has been doing this for over 5 years, I would seriously question that patient on why she feels like disability would help him/her.

However, Severe depression with psychotic features, serious suicide attempts with resultant anoxic brain injury/gunshot wounds to the head and so forth: well, a medication and therapy can only help a damaged brain so much.

Another way to look at it is resiliency. I sometimes find resilience in people I least expect it, but I guarantee every person will eventually have their resiliency tested at some point. No, disability should not be looked at as the first option for depression, but for some people who really have lost all hope, I think it would be unethical to simply avoid it based on the fact that you may not want to do "extra paperwork".

 

[Doctor Eliza]

So I find this discussion interesting because I work part-time evaluating claims for social security disability. (Mostly psychologists evaluate mental health claims, but there are a few psychiatrists too.) The biggest take home message I have for clinicians is this: Don't want your patient to get disability? Send your notes! Want your patient to get disability? Send your notes! Your notes provide a paper trail which allows us to see what a patient typically looks like. When you don't send records, patients are often sent to a one-time interview. As you can imagine, it is much harder to know if the person is just playing it up for the interview or if they have chronically limiting conditions.

Just my 2 cents.

Dr. E

 

[Salpingo]

So I find this discussion interesting because I work part-time evaluating claims for social security disability. (Mostly psychologists evaluate mental health claims, but there are a few psychiatrists too.) The biggest take home message I have for clinicians is this: Don't want your patient to get disability? Send your notes! Want your patient to get disability? Send your notes! Your notes provide a paper trail which allows us to see what a patient typically looks like. When you don't send records, patients are often sent to a one-time interview. As you can imagine, it is much harder to know if the person is just playing it up for the interview or if they have chronically limiting conditions.

Just my 2 cents.

Dr. E

Fair point, but it’s tricky to be responsible both for treatment and these semi-forensic assessments, especially when the patient ends up seeing all of your notes in detail. While a healthier adult may be able to tolerate and even benefit from a frank discussion, these are the more fragile patients by definition, and an evaluation that goes the wrong way can essentially end a treatment relationship.

Ultimately, we need to change our entitlement system so that it encourages a transition back to wellness. I’d be much more eager to send a patient for SSD if it mandated x hours of volunteer or part time work, or bookmarked a certain amount of money for rehabilitative programs. Instead, it actively disincentivizes paid work, and hands checks to people who are claiming to be at least partially cognitively disabled.

 

[Salpingo]

SSDI is only for total inability to work in any job. If a personality disorde is a pervasive pattern of behavior, then acquiring sufficient work credits to qualify for ssdi is rei ipsa evidence that the condition is not totally disabiling.

A personality disorder entails impairment in work or social function, not necessarily impairment in haranguing your doctor into signing a paper, or impairment in calling a number for a lawyer on a bus ad.

While I’ve mostly seen cases of cluster B getting SSD, I’d be curious what would happen for someone requesting it for dependent PD. Dr. E?

 

[Attending1985]

Fair point, but it’s tricky to be responsible both for treatment and these semi-forensic assessments, especially when the patient ends up seeing all of your notes in detail. While a healthier adult may be able to tolerate and even benefit from a frank discussion, these are the more fragile patients by definition, and an evaluation that goes the wrong way can essentially end a treatment relationship.

Ultimately, we need to change our entitlement system so that it encourages a transition back to wellness. I’d be much more eager to send a patient for SSD if it mandated x hours of volunteer or part time work, or bookmarked a certain amount of money for rehabilitative programs. Instead, it actively disincentivizes paid work, and hands checks to people who are claiming to be at least partially cognitively disabled.

What do people think the best avenue for promoting this change is as psychiatrists? I have zero faith in the APA.

 

[st2205]

What do people think the best avenue for promoting this change is as psychiatrists? I have zero faith in the APA.

We can start by not facilitating patterns of avoidance. I know, I know — that would collapse the field over night.

 

[Salpingo]

What do people think the best avenue for promoting this change is as psychiatrists? I have zero faith in the APA.

Honestly, it’s probably a nonstarter right now. The Democrats are trying to reclaim populism and won’t touch entitlements in the near future, and the Republicans either won’t make the initial investment required or take a position on bolstering a government service.

Ironically, most of the people I meet on long term disability spend their time listening to Sean Hannity. My guess is if you can convince him or Fox and Friends to take up the cause, there would be a chance for change, but entitlement reform doesn’t bring in the same ratings as “Hillary sold uranium to the Russians” and “FBI is corrupt!”