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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