California Medical Evaluation Field Manual
In 1991, Dr. Lorrin M. Koran prepared the Medical Evaluation Field Manual at the request of the California legislature.
Quoting from the Introduction:
“This Field Manual shows California mental health program administrators and staff how to screen their patients for active, important physical diseases. The Manual explains how, where, and when to screen, how to initiate and staff a screening program, and how to maximize its cost-effectiveness. The Manual also includes a list of clinical findings that characterize patients whose mental symptoms are quite likely to be caused by an unrecognized physical disease.
“For several reasons, mental health professionals working within a mental health system have a professional and a legal obligation to recognize the presence of physical disease in their patients. First, physical diseases may cause a patient’s mental disorder. Second, physical disease may worsen a mental disorder, either by affecting brain function or by giving rise to a psychopathologic reaction. Third, mentally ill patients are often unable or unwilling to seek medical care and may harbor a great deal of undiscovered physical disease. Finally, a patient’s visit to a mental health program creates an opportunity to screen for physical disease in a symptomatic population. The yield of disease from such screening is usually higher than the yield in an asymptomatic population.”
The conclusions drawn in this manual are not theoretical; they were arrived at by extensive experimental evidence, and include such findings as:
“1. Nearly two out of five patients (39%) had an active, important physical disease.
“2. The mental health system had failed to detect these diseases in nearly half (47.5%) of the affected patients.
“3. Of all the patients examined, one in six had a physical disease that was related to his or her mental disorder, either causing or exacerbating that disorder.
“4. The mental health system had failed to detect one in six physical diseases that were causing a patient’s mental disorder.
“5. The mental health system had failed to detect more than half of the physical diseases that were exacerbating a patient’s mental disorder.”
The step-by-step procedures in this manual detected more physical diseases than the mental health programs had detected among 476 patients sampled, did so at a lower cost per diagnosed case, and can be performed by mental health personnel after very limited training.
Why Is This Important?
CCHR has always recommended a full, searching medical examination by a non-psychiatric health care professional, with appropriate clinical tests, to determine if there are undetected and untreated medical conditions that could be causing or contributing to mental distress.
The Missouri Department of Mental Health, with the recent passage of Senate Bill 716, is now instructed to develop guidelines for the screening and assessment of persons that address the interaction between physical and mental health to ensure that all potential causes of changes in behavior or mental status caused by or associated with a medical condition are assessed. This legislation goes into effect August 28, 2014.
One expects that this implies that those medical conditions found would then be medically treated, rather than simply passing out harmful and addictive psychotropic drugs, as is the more usual practice. We need to reinforce this expectation with our contacts, calls and letters to the Missouri DMH.
If you have professional expertise for helping to develop such guidelines, please volunteer your efforts to the Missouri Department of Mental Health.
If you would like to read the California Medical Evaluation Field Manual, you may download it from the CCHR St. Louis website.