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Answering Material Questions in Injuries with a Mental Health Component - Dr Mark Burgin

18/02/19. Dr. Mark Burgin BM BCh (oxon) MRCGP explains how a generalist medical expert provides answers to the court’s material questions in a mental health assessment.

Most mental health assessments only answer one question, whether there is a diagnosis that complies with ICD-10 or DSM-V.

The courts will often require significantly greater information than a diagnosis to allow them to make the determinations that are required.

This problem is particularly acute where the claimant is thought to be simulating a mental health problem as a recent case Pinkus demonstrates. (1)

The generalist expert addresses the three basic questions which the court needs answers to; pre-existing problems, causation from the injury and other causes.


Pre-existing problems

Review of the claimant’s GP medical records are limited use to specialists because GP records are written in brief and require generalist expert interpretation.

The biopsychosocial model BPSM can determine likely premorbid personality from the descriptions that the claimant makes of events in their life before and after the injury.

Allowing the claimant to describe their first job or first relationship in their own words comes a wealth of information about their attitudes, difficulties and mental health at the time.

Even where a claimant is trying to suggest that they never had problems before the near impossibility of fabricating a perfect life will reveal the reality.

Causation from the injury

Each event in a person’s life has an emotional weight and significance so that the picture that a person choses to paint, however inconsistent will give the answer.

The generalist expert looks at the picture from many angles to see how the details fit together and like strings in a machine to see the emotional connections.

The BPSM looks for patterns within the emotional symptoms, the thoughts from the claimant and the behaviours without needing to challenge the claimant directly.

The expert uses a technique to test the model - a small change is made to see whether the ‘strings’ move together – whether the injury caused the symptoms.


Other causes

This is the most challenging part of the generalist expert’s assessment as although aware of the emotional weight that signifies another cause the expert must guess at what it might be.

Often the other causes can be discovered by review of the evidence, for instance occupational records might give a hint as to what difficulty the claimant has.

Without a clue the expert must explore the relationships until the claimant’s response gives away the location of an area that is causing the problem.

Once the other causes are found the emotional connections associated with them can be determined and the complete pattern described.


Conclusions

No system is completely fool-proof but the BPSM has some advantages over systems because it uses natural conversations rather psycho-speak as its evidence.

This system only works if the generalist expert is able to develop rapport with the claimant so that being kind is much more effective than being tough.

The claimant rather than the expert builds the model of their emotional world by being supported whilst talking about their life and feelings and thoughts.

This model can be tested in the same way as a system of weights and pullies by applying gentle pressure on one area to see how that part moves and whether any area is false.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

  1. Pinkus [2018] EWHC 1671 (QB)

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