Some thoughts on psychiatric impairment guides

Some thoughts on psychiatric impairment guides

March 2, 2016

I have written about problems with impairment guides several times 1,2.3. Recently I have compiled data on the answers to 5 case studies by 114 psychiatrists who have completed the GEPIC training program. Although we assert face validity in other words we think it measures psychiatric impairment, the critical issue is reliability, do different psychiatrist come up with the same numbers with the same claimant. We have a statistician looking at this. I will be presenting a paper on the findings of the study at the Congress in Hong Kong.

It has focused my thinking on the problems caused by repetitive failures by the authors of the AMA guides to give us a reliable method of determining psychiatric impairment. Although I am one of the co-authors of the GEPIC I have some concerns particularly with regard to measuring low levels of impairment with any precision and especially with regard to class III that ranges from 25 to 50%. On reviewing the PIRS and cannot even be said to have face validity.

For this end for other reasons I have written an impairment guide called the RAPID MSE (The Rating of Psychiatric Impairment Determined by the Mental State Examination). I wrote a paper in 2014 about the various methods used in Australia. On rereading this paper I was struck by the idiocy of the methods described in chapter 14 AMA 6 and the metastatic spread of the PIRS.

I think there are fundamental requirements for any method of psychiatric impairment assessment.

  1. It should measure impairment and not disability.
  2. It should be easily and rapidly administered using data arising from the clinical interview rather than a checklist. The line it should be able to produce a reliable percentage figure.
  3. It should be transparent and readily understood by courts and tribunals.


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