January 26, 2017
I have compiled a list of common drugs so I can quickly refer to the list to find out what particular drugs are in various medical reports rather than ploughing through MIMS. Drugs are sometimes called by their generic name but also by their brand-name and it can become confusing. In the same report I read about fluoxetine, Prozac, Lovan et cetera. I hope you find it useful
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December 16, 2016
A paper published in 2014 concludes that the stresses associated with making a workers compensation claim make recovery less likely.
The authors conclude:
Many claimants experience high levels of stress from
engaging with injury compensation schemes, and this experience is positively
correlated with poor long-term recovery. Intervening early to boost resilience
among those at risk of stressful claims experiences and redesigning compensation
processes to reduce their stressfulness may improve recovery and save money.
Those of us who are a little more cynical may have come to different conclusions
such as the lack of incentive for many people to return to work and being paid
not to work is a powerful driver.
I wonder how many academics actually have much understanding of this complex system.
I may have mentioned before that in one year there was a major outbreak of mental health
in the Victorian police Force as the number of WorkCover claim halved. It was probably
because the superannuation schemes suddenly became much more generous and
more accessible and the number of superannuation claims made more than doubled during that year.
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December 9, 2016
The TAC has developed a useful website for ‘health care providers”.
This page provides useful information, such as updated fees, policies and industry events.
You can also choose your profession from the drop down list to access information
specific to you.
For example the link to IMEs brings up:
Independent Impairment Assessors – TAC – Transport Accident Commission
Independent Impairment Assessors (IIAs) are medical practitioners specially trained
to conduct impairment assessments.
These assessments are required for a person injured in a transport accident, who have
made a claim for impairment benefits,
as a result of sustaining a permanent impairment.
Impairment assessors, play a critical role in ensuring the TAC provides timely and equitable
lump sum benefits to a person
injured in a transport accident.
Becoming an Independent Impairment Assessor
All IIA’s must undergo specific training. Training is delivered by an accredited training provider
approved by the Minister for the TAC.
The course offers:
- Administrative information on the assessment of impairment
- Theory and practice of assessing impairment
For further information about the training course, visit AMA Victoria or email iat@amavic.com.au
Providing services to the TAC
Upon the successful completion of the impaiment assessment training course, you can request
to provide services by directly contacting us.
Fees
The TAC can pay the reasonable costs of impairment assesment service as detailed in the
below fee schedules:
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November 28, 2016
Mental stress has accounted for an average of 95% of mental disorder claims over the past 10 years.
SafeWork Australia produced a report about this in April 2013.
Their findings were:
Mental stress claims are the most expensive form of workers’ compensation
claims because of the often lengthy periods of absence from work typical of
these claims.
>> Mental stress claims are predominantly made by women.
>> Men and women are more likely to make a claim for mental stress as they
get older but after they reach 54 years the likelihood that they made a claim
decreases.
>> More Professionals made claims for mental stress than other any other
occupation with over a third of their claims made for Work pressure.
>> There were more mental stress claims made for Work pressure than any
other sub-category.
>> The hazards that result in mental stress claims vary with worker age.
Younger workers are more likely to make claims as a result of Exposure to
workplace or occupational violence, whereas Work pressure is the main
cause of mental stress claims for older workers, peaking for those aged
45–49 years.
>> General clerks, School teachers and Police Officers accounted for the
majority of claims for Work pressure.
>> Women were around three times more likely than men to make a workers’
compensation claim due to Work-related harassment &/or workplace
bullying. Approximately one-third of all claims in this mental stress subcategory
were made by workers in the occupational categories of Advanced
clerical & service workers and General clerks.
>> For the industries with the highest number/rate of mental stress claims, the
majority of claims were for Work pressure. This was particularly true in the
Education sector. Claims for Exposure to workplace or occupational violence
were notable in the Retail trade industry, while the Transport & storage and
Health & community services industries dominated claims for Exposure to a
traumatic event.
WorkSafe Australia produced a further report in 2015 – Work-Related Mental Disorders profile
Their findings were that 6% of all workers compensation claims were for mental disorders .
The typical compensation payment for such a claim was $23,600 totalling $480 million for the 7820 Australian claimants. The average period of time spent off work was 14.8 weeks. 39% of these claims were for harassment/bullying/exposure to violence. 90% of all mental disorder claims were attributed to stress.
65% of all mental disorder claims were awarded to workers aged 40 or over.
For 1 million hours of work there were 0.5 mental disorder claims.
Occupations most at risk:
First responders-police, paramedics and firefighters comprising one in five of this group
welfare and community workers affirm one in 10 were compensated, prison officers, bus and rail drivers and teachers of whom one in five were compensated.
The more common conditions included reactions to stressors (41%), anxiety/stress disorders (28%) and post traumatic stress disorder (11%). Combined they accounted for, on average, about 4/5 mental disorder claims over the period.
The most up-to-date statistics are those provided by WorkSafe Western Australia in October 2016.
Their findings were that: Over four years, the number of stress-related claims increased by 25 per cent. In 2015/16, there were 547 stress-related claims lodged, representing
3.2 per cent of all workers’ compensation lost-time claims.
Although the number of stress-related claims increased, the frequency rate (claims per million hours worked) for stress-related claims is stable.
Females accounted for 59 per cent of stress-related claims compared with 41 per cent for males.
In terms of prevalence of stress claims, female workers tend to have a higher frequency rate.
The top three industries for stress-related claims were:
Health care and social assistance 25%
public administration and safety 24%
education and training 16%
The causes of stress and later claims included:
Work pressure 39%
Harassment and bullying 23%
exposure to a traumatic event 19%
exposure to workplace violence 14%
other causes 5%
There appears to be a significant drop in the number of stress-related claims in WA representing 3.2% of all workers compensation lost time claims, the WorkSafe Australia statistics were that 6% of all claims were stress-related. In Victoria in the late 1990s about 5.5% of all claims were stress-related. There appears to have been little real change in the incidence of stress-related disorders over the last 20 years.
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The College has issued a strong position statement condemning the use of subpoenas to access patient records without their consent and refers to significant issues damaging patent- psychiatrist trust and possibly a breakdown in therapy. it is worth reading.
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November 24, 2016
I have downloaded all the permanent impairment guidelines I can find in Publications, look in Guidelines Workers Compensation
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Examination and provision of report and certificate — psychiatric — complex assessment (eg. reviewing significant documented prior psychiatric history) $3554.35 or $3863.35 (minus fee for intrpreter. Think about what you get paid.
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I have just returned from five weeks in Africa. I went to the World Psychiatric Association meeting in Cape Town.
It so happened that on the way I went to the Kruger National Park, the Serengeti National Park, Zanzibar, Tanzania, Kenya and then drove the Garden Route from Port Elizabeth to Cape Town, all fabulous and astonishing. I managed to film some animal porn of two lions mating, typical, no foreplay and the act took 15 seconds!. I had the amazing experience in the Serengeti and in the Ngorongoro crater of seeing thousands of a zebra, buffalo, wildebeest, camels, elephants, hippopotami, lions, leopards, cheetahs, hyena and warthogs, amongst others.
But that is all by the bye. I attended a workshop at the WPA on Impairment Assessment in South Africa. The system is very different, there is no real workers compensation and transport accident schemes as such but a significant number of people make claims on their insurance policies particularly with total and permanent disability. A working group has been developing guidelines. There was a real sense of déjà vu particularly with regard to looking at the question of psychiatric opinion that was all over the shop.
All of you would be familiar with the usual requirements about contents of reports, opinions, reasons for opinions and so forth. Regrettably there is some talk about using AMA 6 and I strongly urged that this would be a mistake.
I will continue to be in contact with the working group to assist them in refining the document.
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September 29, 2016
We are familiar with various websites that rate those who do independent medical examinations. Some of these posts are incorrect and indeed defamatory.
Here is an example of comments from the workcovervictimsdiary Website.
Those IMEs who totally disregard honesty should be eliminated from the process. Consider having the state refer to an IME doctor rather than the insurer and the whole attitude towards fairness and honesty would likely improve
Get rid of the (few) nutters doing most of the IMEs. If an IME doctor loses a certain amount of cases then don’t allow them to undertake more IME examinations. The reason these IMEs don’t succeed is because they are either wrong incompetent, dishonest or all three
Dr Alan Jager has sent us a post about a successful application to shut down such a website. It makes interesting reading
Al Muderis v Duncan [2016] NSWSC 1363 saw the applicant, an orthopaedic surgeon, make an interlocutory application to to restrain the continued publication on the internet of material he alleges is defamatory of him. The defendant had not responded to correspondence and was not represented at the interlocutory hearing.
The application arose against the background of a complaint by a patient to the Health Care Complaints Commission, which was dismissed. A medical negligence claim was also made and dismissed.
Later the patient pleaded guilty to offences of intimidation and using a carriage service to harass, menace or offend. He was convicted and sentenced to four months imprisonment suspended on conditions. An apprehended violence order was made prohibiting the patient from assaulting, molesting, harassing or threatening the doctor, engaging in any other conduct that intimidates him, or stalking him. The AVO made specific reference to operation of a website.
The court made orders as requested by the medical practitioner, including an order directed to the website host registration entity. The website now appears to have been taken down.
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September 20, 2016
The Victorian Ombudsman has released a report regarding an “Investigation into the management of complex workers compensation claims and WorkSafe oversight”
This report is very critical of practices of WorkCover agent’s particularly with regard to doctor shopping and is unsparing in its criticism of certain IMEs in particular with regard to their bias and poor quality reports. The report is a damning with regard to actions taken by work safe about IME reports that are inadequate. Based on the reports the following recommendations relevant to psychiatrist were made. A copy of the full report is available in publications and a summary is also available.
Recommendation 14
Implement changes to the current IME system to:
- prevent agents from selectively using ‘preferred IMEs’ or
- provide injured workers a choice of the IME with the appropriate speciality, by whom they are examined.
Recommendation 15
Amend its IME complaint handling policy to provide scope for examination of complaints where a worker does not provide consent for the complaint to be provided to the IME, which may include the referral of the matters raised to the IME quality assurance division for intelligence gathering purposes.
Recommendation 16
Amend the IME quality assurance process to:
- ensure IMEs subject to a high number of complaints are peer reviewed
- document the process by which WorkSafe will review an individual claim file where significant deficiencies are identified in relation to an IME’s report, to ensure a worker’s entitlements have not been unreasonably rejected or terminated based on the
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August 25, 2016
I have written a draft submission to the Medical Board of Australia expressing significant concerns about revalidation. The one area I have not included is probably the most important: What is the problem? Where is the evidence this complicated process is required? Is it just more Nanny state bullshit because the profession cannot be trusted?
These are the recommendations of thew Medical Board Expert Advisory Group. They are also present in the revised CPD program of the RANZCP
The recommendations include:
- maintaining and enhancing the performance of all doctors practising in Australia through efficient, effective, contemporary, evidence-based continuing professional development (CPD) relevant to their scope of practice (‘ strengthened CPD’), and
- proactively identify doctors at-risk of poor performance and those who are already performing poorly, assessing their performance and when appropriate supporting the remediation of their practice.
- The Expert Advisory Group (EAG) proposes that medical practitioners in Australia should participate in three core types of CPD, with activities prioritised to strengthen individual performance. A summary is provided of the core types of CPD.
- Undertaking educational activities:
- lectures
- conferences
- Reading
- research
- supervision
- workshops
- grand rounds
- online learning
Reviewing performance:
-
- peer review of performance
- peer-review of medical records
- peer discussions of cases, critical incidents, safety and quality events
- multisource feedback from peers, medical colleagues, co-workers, patients, other health practitioners.
- Measuring outcomes
- clinical audit
- review of medical records
- mortality and morbidity reviews
- clinical indicators
- comparison of individual data with local, institutional, regional datasets
- review of individual and comparative data from de-identified large datasets e.g. Medicare, PBS
The problem is that this is a generic list that does not fit some groups. The people who do medicolegal work measuring outcomes is meaningless. All of the third component has no relevance. Reviewing performances is also problematical particularly multisource feedback from peers, medical colleagues, co-workers, patient, other health practitioners. How on earth do we do that.
Similarly peer-reviewed medical records. We have no medical records we have reports. The reports are assessed by the various statutory schemes and by lawyers and ultimately attested in court. There is no recognition of that. Peer review is something that we do anyway but again there are no medical records so how can there be peer review of medical records other than peer review of reports. Most of us read many reports from our colleagues and sometimes give feedback with regard to these. We also have peer discussion of cases but we don’t have to deal with critical incidents.
I urge you to make your views known if you agree with this analysis.
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August 16, 2016
The Victorian ombudsman has taken it upon herself to have an enquiry into the use of Independent medical examiners by WorkCover agents. We have had significant concerns about potential outcomes. In particular one of our members has been targeted by the ombudsman with the possibility of a recommendation that he no longer see WorkCover claimants. In an interesting denial of natural justice he has had no opportunity so far to respond to allegations made by a disgruntled claimant. In general however the focus of the investigation is on the agents rather than on Independent medical examiners. Nevertheless the Victorian Branch of the faculty of forensic psychiatry thought it would be useful to make a submission to the Ombudsman explaining our obligations including the College code of ethics, guidelines for medicolegal examinations, the WorkCover handbook for medicolegal assessment and legal requirements of expert witnesses. You can see a copy of the submission here
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June 3, 2016
The Victoria Police mental health review-summary report was released on 31 May 2016. This review referred to the negative views of mental health issues in the Victoria Police and made 39 recommendations including a prevalence study to gain accurate data on the organisational mental health and suicide risk profile with the possibility of other jurisdictions also becoming involved; developing an organisationwide comprehensive mental health literacy program involving mandatory participation by all employees and leaders; augment the existing police psychology unit and identify progress in reducing mental health stigma and develop a program to focus on expected behaviours and manage inappropriate behaviours. (full report)
These appear sensible recommendations. One of the advantages of long-term involvement in this field is that I am aware of previous similar reviews that made sensible recommendations including the development of the police psychology unit.
However the inescapable fact remains that Police work is inherently unpleasant. Police are required to repetitively deal with unpleasant people, unpleasant situations and are sometimes in fear for their life. There is no other job where there is a realistic prospect that a person may not return home from work because they have been killed.
Policing takes place in an organisation that is hierarchically based, performance focused and where people with mental health issues are not able to undertake full operational duties and frequently there is no adequate work available for them and there is always a stigma about mental health issues.
I remember speaking to a federal Minister for Health some years ago about the stigma of mental illness. He rubbished that notion and I said to him “How would you feel if your colleagues saw you coming out of a psychiatrist’s office?” He had the grace to admit that he would be embarrassed.
All of us who see police officers have heard of place breaking down having seen one to many fatalities or other such similar distressing experiences. This is particularly a problem for those who work in the sexual offences unit and those who do road patrol work. Most of the recommendations deal with the aftermath of the development of mental health issues. Particular emphasis is placed on the Sexual Offences and Child Abuse Investigation Teams with recommendations that they be allocated police psychology unit support to provide mental health screening, They should have opt out provisions either on a temporary or permanent basis and a supervision model.
it is very well to talk about changing the culture, implementing leadership programs, education sessions and so forth but, in practice, how does that work when people are exposed to repetitive trauma?
Maybe we need to think of the United States Air Force flight surgeon model. The flight surgeon has the power to stop someone flying. We also need to think about what do we do to provide for people with mental illness to return to the workforce. We know that going back to work as soon as possible is best for people with work injuries but not if they are going back into the same work situation that caused the injury.
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April 28, 2016
I have written previously about the problems forensic psychiatrists have had with vexatious notifications to the Medical Board. Two of our colleagues had had four notifications each, three of them had been shown to have no merit but it appeared that four notifications required action and so the two psychiatrist had a practice visit from two other psychiatrist over a period of a day. I thought this was questionable with regard to ethical practice in particular the psychiatrist roared through all the medical records not just those to do with the notifications and apparently sat in on one or two interviews.
Complaints were made to the Medical Board of Victoria by our representatives and as you will see there has been dialogue with the AMA. Some information about this was provided in the April newsletter of the Medical Board of Australia. (See below)
Improving the notification process
Continuing our work on a fair and timely process
Senior leaders from the Board, AHPRA and the AMA met in February 2016 to look at ways in which doctors’ experience can be improved when a notification is made about them. This was the second workshop with the AMA about this. The first workshop was held 12 months ago.
There was positive feedback about changes we have made in the last 12 months to improve the experience of doctors involved in the regulatory process. Improvements include:
- significantly reduced time frames for assessing matters. This means that low risk notifications can be resolved and high risk notifications can be investigated more quickly
- development of a decision matrix with the health complaints entities (HCEs) we work with in each state and territory to better steer complaints and notifications to the most appropriate pathway
- improved communication with practitioners. We have reviewed and revised the templates we use as the starting point for our correspondence with doctors and we are now providing more information to practitioners, particularly when we expect our inquiries to take longer than first thought, and
- senior staff and Board members are reviewing notifications at specific times, to make sure regulatory work is on track.
The workshop also explored what we are doing to support good regulatory decision-making including:
- establishing a Risk-based Regulation Unit in AHPRA, to analyse our data to help identify risk of harm. As this work progresses, we will be publishing the results of our analysis to help inform and educate practitioners
- setting up a National Restrictions Library. This is a collection of conditions and other restrictions that decision-makers can use to ensure that any restrictions they impose on practitioners’ registration to manage risks to patients, are consistent, enforceable and able to be monitored, and
- asking notifiers what they are looking for from the regulatory process and providing more information up front about what it can achieve. This helps to better align notifier expectations with possible outcomes. As well, AHPRA is usually providing practitioners with all the information provided by the notifier, but specifying within this the issues that the Board is investigating.
The Board and AHPRA agreed to explore how we can most usefully ask practitioners for feedback about their experience of the regulatory process when a notification has been made about them, so we can improve our processes.
There was also good discussion about how the experience of the National Scheme1 can better support the profession to deal with practitioners whose performance is not satisfactory.
The Board and AHPRA appreciate the AMA’s commitment to continuing to work constructively with us to improve the process for practitioners, in a fair way, with clear information.
The AMA has also published information about the workshop at A refined way to complain.
For more information about notifications, AHPRA has published guides for practitioners on the notifications process (performance assessments).
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April 26, 2016
I came across some advice to claimants about how to increase their psychiatric impairment rating. It had to happen. I thought you might be interested. Of course is much easier in New South Wales where people can access ePIRS and test out different scenarios to see what produces the best score.
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April 23, 2016
I found an Ontario Law Report clarifying use of AMA 5 Chapter 14 there. As you know I disparage the AMA Guides from the 3rd to the 6th edition. In this case, the plaintiff claimed ‘Catastrophic Injury’ on the basis that she had an Adjustment Disorder with Depressed Mood, Specific Phobia, and Pain Disorder with both Psychological Factors and a General Medical Condition. The health practitioners who assessed Ms. Pastore concluded that she had a class 4 (marked) impairment in the activities of daily living category- Marked impairment ‘significantly impeding useful functioning’. Leaving aside that this is a measure of disability, nevertheless one score of 4 or above is sufficient to reach this threshold. Maybe the AMA Guides are not useless after all.
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April 22, 2016
I have previously posted about bullying in March 2015. Since then the impression I have gained is that claims of bullying are on the rise. Bullying seems as prevalent now as RSI was in the 1990s. My concern is that many claims of bullying are completely overstated, here are some recent examples:
My boss yelled at me when I accidentally closed the door on his hand.
I told my manager that my seat was uncomfortable and she did nothing about it.
A male co-worker put up a calendar on the noticeboard. It had pictures of girls in swimsuits. I felt angry and humiliated and tore it down. He swore at me. I left work. Management had not been supportive.
My boss made critical remarks about my work performance in my work appraisal. I felt angry and humiliated.
I told my boss that I had to leave early for a hairdressing appointment because it was my sister’s wedding on Saturday but she wouldn’t let me go early. I was really upset!
In each of these situations the person had ceased work and had made a WorkCover claim. One wonders what planet they came from.
On the other hand all of us have heard stories of what appears to be very clear verbal and sometimes physical abuse, discrimination, phone calls at night, trashing a person’s locker and so forth. These are genuine instances of terrible behaviour that all of us could identify with. The shame about the trivial complaints is that they diminish the impact of the serious complaints.
I have provided a link to an article quoting an anti-bullying website and to a recent decision at Fair Work in which a claim of bullying was rejected..
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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.
- It should measure impairment and not disability.
- 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.
- It should be transparent and readily understood by courts and tribunals.
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February 18, 2016
I have written about this before but it has been highlighted by the program for the faculty conference in Perth in Perth in September 2016. The theme is
Goals, purposes and strategies for prisoner and staff mental wellbeing in custody.
In October 2015 I wrote to the head of the faculty:
More and more me and my colleagues are feeling marginalised by the juggernaut of criminal psychiatry. There is only one paper in Canberra at the November 2015 meeting of the Foprensic Faculty relevant to the work I and others do in the civil field “Expert evidence in mental harm claims’ ( I am aware of the plenary session on family law but few of us do that work now). I know you require people to offer papers but you need to be more pro-active. The same goes for the vexed question of suitable training for psychiatrists doing civil work but the views we have seem to be swamped.
The response I received was:
There are two issues, one regarding civil forensic content at the annual conference, and the second on training.
I had intended to table the email for discussion at the committee meeting.
I have forwarded it to Sophie Davison, convenor of the 2016 FFP conference for consideration. From the conference perspective, it would be best if a suitable keynote could be suggested. I suspect this may be too late for 2016 though nothing formal planned for 2017 yet.
It appears that the 2016 conference was set in stone some 11 months before it is to take place. There is nothing in the program about civil forensic matters!
The head of the faculty wrote further about the issue of training:
The training is a more delicate issue which I did raise at the recent college MAC meeting. While I think a formal training program in civil could lead to accredited faculty membership status, this does not fit with current college processes and may take a lot of work from a dedicated faculty committee to implement.
The Victorian Branch of the Faculty had a one-day conference two or three years ago. The conference was deliberately designed to cater for civil forensic psychiatry, criminal forensic psychiatry and those dealing with Family Court matters. We invited speakers and suggested topics. The conference was very successful, it can be done.
If this Faculty is to succeed there has to be an awareness of the legitimacy of the work done by civil forensic psychiatrists. this is not reflected in either the theme or the program for the conference in Perth where civil forensic psychiatry does not feature.
Today I received an email informing Faculty members of sessions in our area of interest at the College Congress in May 2016.
Several sessions may be of interest to members of the Faculty of Forensic Psychiatry, with highlights including:
Sunday 8 May Pre- Congress Workshop
· Civil Forensic Psychiatry Workshop
· Medico Legal Opinion Construction
Monday 9 May
· The Symphonie Fantastique: 3 Victims stories in respect to a person affected by Pseudological Fantastica
· Using Online Data in the Assessment of Psychiatric Disability
Tuesday 10 May
· Invited speaker Dr Scott Harden: Homicidal threats, ideation and behaviour in Adolescents – A clinicians view
· The injured motorist and the Psychiatrist
· A Survey of Mental Health Exclusion Clauses in Life Insurance Policies
· An assessment of the Reliability and Validity of the Guide to the Evaluation of Psychiatric Impairment for Clinicians (GEPIC)
The last session will be presented by myself! This is a step in the right direction but I believe we have a long way to go. For years we have been battling to be seen as a legitimate subspecialty. It has been very disappointing that the juggernaut of criminal forensic psychiatry appears to have ignored that.
I have had similar concerns recently about the Victorian Medical Panels where there has been an active program of recruitment of new young psychiatrists although, paradoxically, the work has been drying up. What has also been drying up is training for these new members. The high reputation of the Medical Panel in Victoria has come from outsiders recognition of the expertise of members of the Medical Panel. This is no longer the case, recently I did a training session for those people experienced in the use of the GEPIC, one young psychiatrist admitted that he had never used it. I asked him why he was there. He said he was a member of the Medical Panel and had been instructed to attend! I wrote to the convenor expressing concerns about his lack of expertise.
The response from the convenor was:
I can assure you that all of the psychiatrists added to the list ( which was only a small number to fulfil certain requirements ) are appropriately experienced and qualified. There is a wide range of issues that we need expertise in and impairment assessment is only one component
The view continues to permeate that the work we do requires no extra expertise and can be done by any experienced psychiatrist. Periodically various schemes bring an influx of psychiatrists to do this work but most psychiatrist find, to their dismay, that the work is difficult, often emotionally taxing, time-consuming and sometimes requires court appearances. There is a high dropout rate. The various schemes then revert to using the familiar faces, the problem is that there are not enough familiar faces, we need more of them.
I have argued and will continue to argue that there needs to be some system of training. The argument from faculty members has sometimes been that training in criminal forensic psychiatry has a component to deal with civil assessment and that that should be enough. This is nonsense.
So it goes
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January 21, 2016
There have been a number of amendments to the Victorian Wrongs Act 1958 (Wrongs Act Amendment Act) that took effect on 2 December 2015. The major issue for us is with regard to psychiatric assessment. The threshold wording has been changed from “impairment of more than 10%” to “10% or more”. This applies to any climate to have been assessed before that date where the matter has not yet been finalised. Victorian forensic psychiatrists will be asked to submit a new certificate incorporating the changed wording. There are 5 changes in all of which the above is the only one relevant to us.
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