The CPP and mental disabilities
CMAJ 1997;156:1118
See response from: S.E.D. Shortt
I congratulate Nicole Baer on her article "Disability payments continue to climb: 'Tell us what you see, not what you think,' CPP tells MDs" (CMAJ 1997;156:61-4 [full text / en bref]). Canada Pension Plan (CPP) disability benefits are a very complex issue. I appreciate the final comment attributed to CPP administrators, "just tell us what you see -- don't tell us what you think."
However, I am alarmed by the accompanying article, "Too much money wasted on frivolous applications for CPP disability benefits" (CMAJ 1997;156:65-6 [full text / en bref]), by Dr. Samuel Shortt. He focused too much on physical disability and appeared to ignore mental illness and resulting handicaps. Further, one of his comments -- "there are also applicants who have no medical disability but rather social handicaps such as substance abuse" -- displays an ignorance that could be dangerous to his patients. Physicians' lack of appreciation for problems related to substance abuse and dependence leads to a lot of patient abuse. Not every patient suffering from substance dependence requires CPP disability benefits, but there are patients with a primary diagnosis of substance dependence who have other concurrent problems such as chronic pain or anxiety disorders that prevent them from obtaining gainful employment. There are some substance-dependent patients who suffer recurrent relapses because of inability to handle day-to-day life and work stressors. I encourage Shortt to approach his patients in a more open manner and to appreciate the biopsychosocial and spiritual aspects of the illness. Focusing too much on biophysiology leads to shortsightedness.
Raju Hajela, MD, MPH
Addictionist
Kingston, Ont.
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