In Psychiatric Times today, noted Vanderbilt clincal professor Samuel O. Okpaku MD, PhD notes that about 20% of adults who receive Social Security disability benefits have psychiatric disability. Psychiatric disability accounts for a significant proportion of private long-term disability claims and payments.Advances in technology that have had an impact on physical disabilities have not had a corresponding effect on psychiatric disability.

This article is based on the United States Social Security Administration (SSA) model of disability assessments for psychiatric impairment. Since its inception in 1935, there have been several amendments and rul-ings that have attempted to expand and refine the Disability Act. Despite these efforts, the reliability and validity of the disability determination process have been impaired by several factors:

• The inherent difficulty of objectifying psychiatric signs and symptoms
• The fluctuating nature of psychiatric disorders
• Problems with language and communication (central to the collection of data from patients), which may be compromised by the disease process

In addition, many individuals who apply for disability on the basis of physical illness also have comorbid mental disorders.

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Coming Home” is an investigative series about U.S. Army troops who have returned from Iraq. Salon national correspondent Mark Benjamin and Colorado-based journalist Michael de Yoanna have looked into inadequate medical care and preventable deaths among returned soldiers.

Salon writes today: “Late last month, the Army announced data showing the highest suicide rate among soldiers in three decades. At least 128 soldiers committed suicide in 2008. Another 15 deaths are still under investigation as potential suicides. And suicide is only one manifestation of the mental health ills coming home with U.S. troops. Four years after Salon first exposed problems with healthcare at Walter Reed Army Medical Center that ultimately became a national scandal, the situation, at least at some Army posts, has only deteriorated. For the “Coming Home” series, in which today’s two entries are the second installment, Salon put together a sample of 25 cases of suicide, prescription drug overdoses or murder involving Fort Carson soldiers since 2004. A close study of 10 of those cases exposed a pattern of avoidable deaths, meaning that a suicide or murder might well have been prevented had the Army better handled the predictable and well-known symptoms of combat stress. (Read the introduction to the “Coming Home” series here.) As Alderman’s death shows, part of the problem is an apparent tendency of Army doctors to substitute large doses of prescription medication for adequate mental healthcare.” Personal stories of preventable deaths here

“I am under a lot of pressure to not diagnose PTSD” says an Army psyciatrist.
A secret recording reveals the Army may be pushing its medical staff not to
diagnose post-traumatic stress disorder. The Army and Senate have ignored the
implications.
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