Stuart Anfang - Academia.edu (original) (raw)

Papers by Stuart Anfang

Oxford University Press eBooks, Jul 1, 2013

Journal of the American Academy of Psychiatry and the Law, Apr 1, 2011

Disability assessments of patients are among the most common nontherapeutic evaluations requested... more Disability assessments of patients are among the most common nontherapeutic evaluations requested of treating psychiatrists. Yet, there has been relatively little empirical analysis of how psychiatrists approach these evaluations in real clinical practice. Treating psychiatrists, those both with and without forensic expertise, struggle with the challenge of dual agency and overlapping therapeutic and forensic roles. Making the different roles clear to the patient can allow for more therapeutic exploration and alliance around further treatment goals, expectations, and interventions. Given the high prevalence of psychiatric disability and requested evaluations, psychiatric trainees would benefit from formal teaching, and it should be considered an important area for psychiatric continuing education.

Harvard Review of Psychiatry, Jul 1, 1996

Routledge eBooks, May 30, 2022

PubMed, 2006

The evolution of U.S. civil commitment law needs to be understood within the context of changes i... more The evolution of U.S. civil commitment law needs to be understood within the context of changes in psychiatry and medicine, as well as larger social policy and economic changes. American civil commitment law has reflected the swinging pendulum of social attitudes towards civil commitment, oscillating between more and less restriction for both procedural and substantive standards. These standards have evolved from a "need for treatment" approach to a "dangerousness" rationale, and now may be moving to a position in which these justifications are combined, particularly in the context of involuntary outpatient commitment. Civil commitment in the United States has been shaped by multiple factors, including sensitivity to civil rights, public perception of psychiatry, availability of resources, and larger economic pressures. We suggest that current American commitment practice is influenced more by economic factors and social perceptions of mental illness than by changing legal standards.

Psychiatric Services, 1997

Psychiatric Services, Mar 1, 2004

Psychiatric Clinics of North America, Sep 1, 2006

Fitness-for-duty examinations are a common type of psychiatric disability evaluation. These evalu... more Fitness-for-duty examinations are a common type of psychiatric disability evaluation. These evaluations are typically best performed by the independent (nontreating) psychiatrist with forensic training or expertise in these examinations. A comprehensive evaluation requires careful definition of the referral questions and consideration of the terms of the referral; review of relevant job-specific documentation and medical records; the collection of collateral information from relevant third-party informants; a thorough clinical psychiatric examination; and possibly additional testing. The examination report needs to be comprehensive, address the specific questions in clear language understandable to the non-mental health clinician, and use all available data to substantiate the logical conclusions in a fair, accurate, and objective manner.

Psychiatric news, Apr 6, 2001

Oxford University Press eBooks, Dec 1, 2017

Over the next few decades, there will likely be an increase in the frequency of will challenges r... more Over the next few decades, there will likely be an increase in the frequency of will challenges related to testamentary capacity and undue influence, given a U.S. elderly population with a disproportionate amount of wealth. Psychiatric clinicians are likely to be called upon to advise the courts about a person’s capacity to make a will or susceptibility to undue influence. This chapter reviews the important legal and psychiatric issues involved in determinations of testamentary capacity and undue influence. It also touches on the policy considerations of promoting liberty and autonomy which set a low threshold for testamentary capacity while allowing for the doctrine of undue influence as a mechanism to protect those who are vulnerable. The complex interplay between cognition, a potentially conflictual milieu, and the extent of the assets at stake is also discussed. This chapter also provides guidance with respect to some of the challenges faced by clinicians conducting a contemporaneous versus retrospective assessment. Finally, mechanisms to avoid estate litigation, such as power of attorney and estate planning, are also discussed.

This chapter explores the question of payment barriers and economic challenges for psychiatric se... more This chapter explores the question of payment barriers and economic challenges for psychiatric service delivery within the medical setting. We first summarize how payments for psychiatric services developed and are treated differently than other medical services. Integrated care and patient-centered medical homes are shifting American health care from a fee-for-service model to a complex model of global payment, risk sharing, and incentives for quality and coordinated care. Psychiatry and behavioral health will play an essential role in consultation, care management, and coordination with primary care partners. Integrated behavioral health care models can be safer, better, and ultimately less expensive. We provide suggestions on how to address the challenge of convincing the health care system to integrate the payment for psychiatric and other behavioral services.

Springer eBooks, 2013

Disability evaluations for public or private insurance claims are among the most frequently reque... more Disability evaluations for public or private insurance claims are among the most frequently requested psychiatric evaluations for non-treatment purposes. This chapter provides an overview and framework for independent medical examination (IME) providers, which are particularly relevant for evaluations in private long-term disability claims. These evaluations are typically best performed by an independent (non-treating) clinician with forensic training or expertise in these examinations. IME providers should be familiar with the referral context, expectations, and careful definition of the referral questions. Clinicians performing independent examinations should provide a comprehensive evaluation and detailed report; address the specific questions in clear language understandable to the non-mental health clinician; and use all available data to substantiate the logical conclusions in a fair, accurate, and objective manner.

<p>Over the next few decades, there will likely be an increase in the frequency of will cha... more <p>Over the next few decades, there will likely be an increase in the frequency of will challenges related to testamentary capacity and undue influence, given a U.S. elderly population with a disproportionate amount of wealth. Psychiatric clinicians are likely to be called upon to advise the courts about a person's capacity to make a will or susceptibility to undue influence. This chapter reviews the important legal and psychiatric issues involved in determinations of testamentary capacity and undue influence. It also touches on the policy considerations of promoting liberty and autonomy which set a low threshold for testamentary capacity while allowing for the doctrine of undue influence as a mechanism to protect those who are vulnerable. The complex interplay between cognition, a potentially conflictual milieu, and the extent of the assets at stake is also discussed. This chapter also provides guidance with respect to some of the challenges faced by clinicians conducting a contemporaneous versus retrospective assessment. Finally, mechanisms to avoid estate litigation, such as power of attorney and estate planning, are also discussed.</p>

The American Psychiatric Association Publishing Textbook of Forensic Psychiatry, 2017

Journal of the American Academy of Psychiatry and the Law, 2017

Edited by Ezra E. H. Griffith, Michael A. Norko, Alec Buchanan, Madelon V. Baranoski, Howard V. Z... more Edited by Ezra E. H. Griffith, Michael A. Norko, Alec Buchanan, Madelon V. Baranoski, Howard V. Zonana. Boca Raton, FL: CRC Press, 2017. 408 pp. $79.95 paperback. This is a thoughtful and ambitious effort, edited by leaders of the Law and Psychiatry program at Yale University School of Medicine. (