Articles from prior issues of The Advocate

November/December 2000

Managing the Mental Patient
by Lynn Murray-DeBlois, Maine DDS

A seminar presented by Silma Quinones, Ph.D., was a very interesting presentation. She examined the mental health patient and activities of daily living, information used quite often when evaluating a claim. However, she discussed subtleties and items that one might not investigate further without access to this information. She shared that families are sometimes embarrassed about their loved one’s mental problems and will coach and hide information. They may also have guilt, shame, denial, and be ignorant with terminology used about the condition. Understanding this will help the interviewer to gain the information necessary to help evaluate the claim. She shares that interviewers should be courteous, use simple questions, don’t pressure the person and don’t be judgmental. Questions, such as, “Does he/she take care of their personal hygiene?” may be too generic a question. Further questioning may reveal that although he/she does take care of their personal hygiene, they may do it too often, not often enough or go through rituals. “Can he/she dress him/herself?” also can be mistaken for someone who does not have problems in this area. Schizophrenics will dress themselves and if the clothes have holes in them it is okay. They are dressed and that is what the question asked.

Eating patterns can also be interesting with the right questions. People with certain conditions may fear poisoning; eat in odd places; eat odd things or be ritualistic about eating. When questioning about sleep habits, perhaps they sleep too much or too little. Perhaps they sleep in a closet. They may sleep with extremely odd things in their bed, as food, clothing, etc. Who cleans the room and what do they find?

Household chores can also give interesting information. If they break things while attempting to clean the house, this may show problems with concentration. A person with bipolar disorder may clean the cupboards but upon examination may never finish the job, leaving the contents around the kitchen. Ability to perform household chores can be a great indicator for the ability to perform simple repetitive tasks. Hobbies or recreational activities can tell you a lot about the claimant. A schizophrenic will go to the movies, but may spend hours watching the same movie. A manic person may go dancing but may want to dance all night. One may play the radio loud, but in actuality may be drowning out the noises in his/her head. These are areas that most all ADLs zero in on for lay information about the claimant.

What Dr. Quinones is telling us is that we may not be getting full use of this information without asking in-depth questions instead of superficial questions. She shares that the family of a truly ill person can provide your best information.