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Notice board Press release WPA Scientific meetings report Psycho-Geriatric Special Interest Group World Psychiatric Journal Membership Renewals.	Treating psychiatrists do not make decisions concerning patients' entitlement to disability benefits. It has become necessary to remind members of SASOP's position on the management of disability applications. This is being increasingly ignored by psychiatrists who motivate for boarding on psychiatric grounds for their patients. Unfortunately, some psychologists and occupational therapists have followed suit, even taken a lead, in recommending psychiatric illness as grounds for medical boarding. Non psychiatric doctors commonly state that the body systems encountered in their specialties are functional, but that the patients have emotional and psychological reactions which prevent them from being able to resume work. In 2003 the HPCSA officially endorsed the SASOP position statement on disability as contained in the guidelines issued jointly by SASOP and the LOA. The treating psychiatrist still has the all-important role of documenting clinical details of the psychiatric illness, the treatments that have been given and the patient's response leading up to the current state. Thus, the treating psychiatrist documents the extent and background history of the patient's impairment. But, in South Africa, as in other countries, final decisions on entitlement to disability benefits are not made by the treating psychiatrist, but by medical assessors of health departments, pension funds or insurance companies. Nevertheless, some psychiatrists, in full consultation with claimants, adopt an overtly adversarial role in motivating for and supporting disability claims. In too many cases this is based on the extent to which patients have reported dissatisfaction with various aspects of their work environment. Usually little effort has been made to obtain appropriate collateral information from other perspectives. Apart from other confounding factors, the treating doctor typically is not familiar with rules of the patients' employment or of their pension schemes. Thus, although she might feel that a patient would be advised to separate from a place of employment, options regarding the mechanism of such separation involve legal or industrial relations expertise rather than clinical judgement. The possibility that a patient's impairment would not in itself permanently prevent them from finding alternative work, should they be motivated to do so, may have profound and complex implications. When the treating psychiatrist recommends boarding and this is questioned by the pension fund, patients often cannot understand why anyone would question their trusted doctor's judgement. Some psychiatrists, too, become resentful and increasingly militantly adversarial in arguing for acceptance of their opinion. SASOP urges psychiatrists to make it clear to patients that they do not make decisions concerning disability benefits and to be very cautious about appearing to recommend a specific disability entitlement. An increasingly popular strategy employed by treating psychiatrists in these circumstances is to recommend a long period of time off work with the stated expectation that if recovery does not take place the patient will then have to be boarded. Now, we know that large numbers of disability applicants are, for a variety of reasons, completely amotivated for any return to work, and often they have a strong sense of entitlement to boarding. Repeatedly we see this type of recommendation being perceived only as a temporary stumbling block and, not surprisingly, the claimed impairment only becomes further entrenched. Why do psychiatrists feel the need to write such things? Even pessimistic prognoses should be documented with caution. The patients have complete access to the reports, even those who have not supervised the content. Most of the patients are depressed with, almost by definition, the typical distorted cognitions including, pessimism. I find it difficult to conceptualise a treatment approach to depression which, particularly early on in treatment, states in writing that it is a hopeless case with no possibility of a return to reasonable function. But then what we are talking about is really outside the parameters of optimal patient psychiatric care, and has more to do with how to help patients to get their boarding pass. As far as we know, no South African psychiatrist has yet been retrospectively sued by a patient for having, apparently inappropriately, encouraged her to press for disability benefits. Not yet!