Download Impairment in the Legal Profession

Impairment
in the
Legal Profession
by
Steven A. Ornish, M.D.
Associate Clinical Professor (voluntary), UCSD School of Medicine, Department of Psychiatry
Diplomate American Board of Psychiatry and Neurology
Diplomate in the Subspecialty of Forensic Psychiatry
Types of Impairment
Mental illness:
Major depression/“burn out.”
Anxiety disorders (e.g., generalized anxiety disorder,
panic disorder, PTSD, OCD).
Bipolar (manic-depression) disorders
Psychotic disorders
Eating disorders
Compulsive gambling
Sleep disorders (e.g., obstructive sleep apnea)
Types of Impairment
Substance abuse:
Alcohol
Crystal methamphetamine
Cocaine
Marijuana
Nicotine
Prescription medications (e.g., opioids,
benzodiazepines, psychostimulants)
Dual diagnosis
Types of Impairment
Personality Disorders:
Antisocial personality disorders.
Narcissistic personality disorders (grandiose,
fantasies of unlimited success; feels “special”;
requires excessive admiration; entitled; lacks
empathy; exploitive; arrogant; envious)
Obsessive-compulsive personality disorders.
Borderline personality disorders.
Histrionic personality disorders.
Prevalence of Impairment
(depression)
Highest in lawyers of all professions. 3.5 x greater than
the general population.
On study surveyed 2570 lawyers and found 25%
suffered from depression. Another study reported that
32% of attorneys reported feeling depressed at least
once a week.
Women suffer from major depression at more than
twice the rate of men.
Symptoms of Major Depression
Depressed or irritable mood.
Changes in sleep.
Changes in interest in pleasurable activities.
Feelings of inappropriate guilt or worthlessness.
Loss of energy.
Changes in concentration.
Changes in appetite.
Psychomotor agitation or retardation.
Suicidal ideation.
Prevalence of Impairment
(substance abuse)
Substance abuse is twice as likely among attorneys as the
general population.
Alcohol abuse: 10-11% of the general population vs.
15-18% of lawyers.
Research shows that law students increase their usage of
drugs and alcohol while in law school.
Suicide by Attorneys
Suicide ranks among the leading cause of premature
death in lawyers, and male lawyers are twice as likely as
the general population to commit suicide.
A quality-of-life survey by the North Carolina Bar
Association in 1991 revealed that almost 26% of
respondents exhibited symptoms of clinical depression,
and almost 12% said they contemplated suicide at least
once a month.
Malpractice and Misconduct
Substance abuse and/or mental health issues are factors
in up to 30%-70% of attorneys who are disciplined by
the Bar.
The ABA reports “a majority of discipline problems
involve chemical dependency or stress.”
> 25% of attorneys surveyed in multiple reports
reported suffering from stress so severe it impaired
their practice.
Warning Signs
Excessive
absenteeism.
Procrastination, “file stagnation,” or
lowered or erratic productivity.
Missed deadlines.
Avoiding mail or the telephone.
Warning Signs (continued)
Mood
swings
Poor judgment
Fatigue/feeling depleted.
Psychosomatic symptoms (e.g, headaches,
back pain, GI symptoms).
Warning Signs (continued)
Legal
problems (e.g., DUIs, trust account
violations, sexual harassment allegations ).
Lack of balance in life.
Difficulty concentrating.
Complaints from clients.
Inattention to detail.
If you answered YES to any one of these
questions, there is a DEFINITE WARNING
that you have a problem with alcohol/drugs.
If you answered YES to any two of these
questions, the CHANCES ARE that you have a
problem with alcohol/drugs.
If you answered YES to three or more of these
questions, you DEFINITELY have a problem
with alcohol/drugs.
“CAGE” Questionnaire
Have
you ever felt that you should CUT down
on your drinking?
Have
people ANNOYED you by criticizing your
drinking?
Have
you ever felt bad or GUILTY about your
drinking?
Have
you ever had a drink first thing in the
morning to steady your nerves or get rid of a
hangover (EYE-OPENER)?
Lawyer Assistance Program
(LAP)
Completely voluntary
Thorough Assessment (60-90 day process)
Professional Support Groups
Financial Assistance for those who cannot
afford the services.
Lawyer Assistance Program
Population in program:
40% primary mental health.
30% chemical dependency
30% co-occurring disorders.
Lawyer Assistance Program
Two-thirds are
self-referred and strictly
voluntary.
40%
have disciplinary matters pending.
Referrals also
come from family members,
colleagues, judges, and the court staff.
Confidentiality
Participation in the LAP is strictly
confidential as provided by statue.
(ABA Rule 1.6 of the Rules of Professional Conduct)
The LAP has absolutely no
connection with the disciplinary
function of the bar.
Resources
(All Calls are Confidential)
LAP
1-877-LAP 4 HELP
[email protected]
www.calbar.ca.gov
www.otherbar.gov
Alcoholics Anonymous (AA)
(619) 265 8762 (main number for AA)
Private practitioners.
Inpatient/outpatient programs.
Alcoholics Anonymous
for Lawyers
“Doctor’s and Lawyers AA Group”
Wednesdays, 8:00 p.m.
Christ Lutheran Church Garage
1004 Chalcedony St./at the 4800 block of Cass St.
San Diego, California 92109