How to determine the right behavioral-health specialty for your independent mental health assessments
It’s a startling statistic: twenty-five percent of adults in the United States have been diagnosed with mental illness.1 With 1 in 4 Americans suffering with a behavioral health condition, individuals, families and communities are all affected.
While some people can manage their condition through counseling, behavior modification and medication, others have more difficulty. They may have a hard time engaging in relationships, performing basic daily self-care, working or participating in their typical daily routine.
When this happens to a person in a business environment—to one of your employees—their work performance suffers. The employee may be absent frequently or ineffective even when they are present. This doesn’t just hurt the individual employee—it ultimately it impacts the entire team and company.
Depression, for example, is now the leading cause of disability worldwide, with over 300 million people experiencing the condition.2 And the cost to businesses is tremendous: a study published in the Journal of Clinical Psychiatry in 2015 found major depressive disorder in adults3 alone cost workplaces over $210 billion due to absences and decreased performance.
Now, more than ever before, it is essential for organizations to help employees who have behavioral health conditions to address them, with both clinical efficacy and financial efficiency.
The first step is knowing who to contact for an independent opinion to guide you on the employee’s needs and ability to work. In other words, what type of expert or medical specialty can provide this insight, a psychologist or a psychiatrist?
Psychologists and Psychiatrists:
Both psychologists and psychiatrists are doctors who treat mental illness and both are qualified to diagnose and treat mental health disorders. They can both provide independent opinions to aid an insurance carrier or third-party administrator in claims management, or assess an employee’s fitness for duty to assist an employer (or EAP) in rendering workplace decisions.. But, while the two disciplines have their similarities, they also have significant differences in their areas of expertise.
Which specialty do you need?
Use a psychologist:
- Whenever psychological testing is needed
- to quantify severity and specificity of possible functional deficits
- if malingering, inconsistent effort, or the validity of self-reports is a concern
- When medication deficits are present, but the severity of the functional impact needs to be clearly assessed and quantified
Use a psychiatrist:
- When there are multiple comorbid physical conditions impacting on the behavioral health diagnosis
- When there is a question about whether a medication is impairing function (with psychology being the preferred specialty to determine precisely how, i.e. scope and severity, the medication is impairing functioning)
What is a psychologist?
A psychologist is a Doctor of Philosophy (PhD) or Doctor of Psychology (PsyD), rather than a medical doctor. These two degrees can overlap in many ways, with the difference being their emphasis on research and academic tracks (PhD) versus applied clinical practice tracks (PsyD).
Psychologists are specifically trained to provide quantifiable, objective psychological testing, and treatment through psychotherapy (or talk therapy). Psychologists may have subspecialties including neuropsychology, which focuses on understanding the relation between both structural and functional aspects of the brain and overt behavior. A neuropsychologist may be helpful when an employee’s cognitive and emotional functioning is in question as a result of a head injury – which may result from external impact as in concussion or blunt force trauma; or may result from internal impact as in a stroke or tumor.
If you need to determine your employee’s behavioral health function and it can’t be done effectively through a clinical interview alone, you’ll need to do a behavioral assessment, which is best done by a psychologist.
The psychologist’s advantage:
Psychologists excel at psychological and personality assessments because they can use quantified psychological test instruments to objectively measure emotional, cognitive, and behavioral variables. For a comprehensive assessment of an individual’s behavioral-health functioning, psychological testing is clinical best practice as it offers quantifiable, standardized, and objective data of that person’s functioning compared to similar groups. This allows empirical-based inferences to be made about the person’s functioning at present, as well as trajectory of their behavior or condition over time when placed within the context of known psychosocial factors.
A clinical interview alone cannot match the standardized, objective, and empirical basis achieved through psychological testing. For this reason, in situations requiring expert behavioral health evaluations that pose a higher risk of legal scrutiny, using a psychologist who conducts psychological testing is consistent with best practice and maximizes defensibility. Conversely, psychiatrists are rarely trained to administer, score, and interpret standardized psychological tests.
Psychological testing may be required for several reasons. If an employee’s cognitive deficits need to be quantified, psychological testing would be needed to determine not only if there is an area of functional deficit, but also how severe the deficit is in comparison to the person’s other abilities, as well as in comparison to other people of the same age.
If a person is being functionally impaired by a medication, while it would take a psychiatrist to determine if the medication is the cause of impairment; it would take a psychologist (likely a neuropsychologist) to perform psychological (or neuropsychological) testing to determine how and to what degree the individual is functionally limited (to quantify the impairments).
If you were concerned about malingering or symptom exaggeration, psychological testing can determine the level of the individual’s effort and the validity of self-reports. Furthermore, if the diagnosis needs to be clarified or verified, psychological testing is essential, and psychology would be the appropriate specialty in this case as well.
Although both psychiatrists and psychologists can perform Fit for Duty (FFD) evaluations, because of their extensive experience in psychological testing, we prefer to have psychologists conduct this type of assessment, as well as assessments for Threat of Violence (TOV) and Fit for Duty-Violence Screening (FFD-VS).
In addition to FFD evaluations, Pre-Employment Psychological Screening (PEPS) evaluations are also predominantly conducted by doctoral psychologists, given their expertise in behavioral functional assessment and use of psychological testing.
What is a psychiatrist?
A psychiatrist is a physician (or medical doctor), who went to medical school, and has an MD or DO degree. Psychiatrists specialize in treating mental illness with psychotropic medications (medicines that affect mind, emotions or behavior). In contrast, most psychologists cannot prescribe medicines.
Because psychiatrists are medical doctors, they are trained to consider how mental illness interacts with physical conditions that may be present. While a few psychiatrists are trained to conduct psychological testing, most are not. Psychiatrists’ training emphasizes biology and chemistry as the underpinnings to understand human behavior, while psychologists’ training emphasizes the use of psychological testing and assessment of emotion, cognition, and psychosocial factors as the underpinnings to understand human behavior.
The psychiatrist’s advantage:
If your employee has both a psychological and a physical condition (comorbidity), a psychiatrist would be the best choice. Say for example a manager has both cancer and depression or a sales person has both chronic pain and severe anxiety—this would be best addressed by a psychiatrist who could assess the medical issues.
The psychiatrist would also be the better choice if an employee has multiple medical conditions that might create an interaction. For example, a psychiatrist would be the better qualified to evaluate an employee diagnosed with depression, but who also has anemia and hypothyroidism, since both hypothyroidism and anemia have symptoms that mimic depression.
Additionally, when there is a question about whether a medication is causing functional impairments, or if taking a given medication would impact work performance or safety, a psychiatrist is the more appropriate choice, given their specialized training in medication.
Selecting your expert
Psychologists and psychiatrists can provide the expert opinions you need for workplace evaluations, and in some areas, there is some crossover in what they can provide. However, in other situations, one profession has the tools to make a better determination. By understanding your needs and the specialties of both professions, you can determine the type of expert whose experience is more appropriate for your case.
- Center for Disease Control and Prevention. (2011). Morbidity and Mortality Weekly Report. Retrieved from www.cdc.gov/mmwr/preview/mmwrhtml/su6003a1.htm
- World Health Organization. (2018). Depression Fact Sheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs369/en/
- Greenberg, P.E., Fournier, A.A., Sisitsky, T., Pike, C.T., & Kessler, R. C. (2015). The Economic burden of adults with major depressive disorder in the United States (2005 and 2010). Journal of Clinical Psychiatry, 76(2): 155-162.
- Association of American Medical Colleges (2018). Addressing the Escalating Psychiatrist Shortage. Retrieved from news.aamc.org/patient-care/article/addressing-escalating-psychiatrist-shortage/