By Dr. Janet Meehan, Consultant Psychiatrist

Depression is a mental health condition that most people have heard of and one in four people have suffered from.

Depression often features in personal injury cases, sometimes as a stand-alone condition, sometimes as a condition co-existing with other diagnoses, requiring careful input from specialists in psychology and psychiatry.

In trauma cases, there is commonly a triad of post-traumatic stress disorder, depression, and substance misuse or dependence.

All three elements need to be recognised and treated for the client to make an optimum recovery.

Hidden Depression

Why is depression sometimes missed and how can medical and legal professionals get better at recognising it?

It is important to ask the right questions.

Many people with depression surprisingly don’t complain of low mood. They may instead complain of irritability, anger, or an inability to feel joy, excitement, or pleasure. In men, complaints of anger are more common and can cause conflict at work and in close relationships.

Mood changes are usually associated with “biological symptoms”, such as changes in sleep, appetite, and libido.

Many clients report cognitive dysfunction, which is prevalent in depression and can include poor concentration, poor memory, and difficulty remembering words or names. Some clients are even worried that they have dementia.

To deepen your understanding of the psychological impact beyond physical injuries, our blog on “Understanding Trauma Beyond the Physical” offers valuable insights into how trauma manifests and affects recovery.

Ask Directly

In a depressed person, always ask about suicidal thoughts.

Don’t be afraid to do this.

Most clients will be relieved to talk about these, and you will not increase their risk of suicide by talking to them about it. Ask if they have made any plans to end their life or if they have had any “near misses” or near-fatal attempts.

Ask them what is keeping them going even though they may feel quite hopeless.

Treatment Insights

Some people with depression have had similar episodes in the past, depression tends to be a recurrent illness. It is however readily treatable with antidepressant medication and psychological therapy. The more severe the depression, the more likely it is that the individual will require an antidepressant agent.

As a psychiatrist, I often find that people who are seriously ill are referred for CBT at the wrong time and are not able to make use of this, especially if their brain function is impaired.

These people often make the best use of therapy tools after 3 to 6 months on an antidepressant. The same applies to EMDR for trauma symptoms. Very depressed clients will do less well with EMDR unless their depression is treated. These are all common themes in my medico-legal reports.

Client Wellness

As a legal professional, you have a unique role to play in recognizing mental disorder in your clients.

In many cases, you will be the first person who has asked them about their mental health.

Yes, we can all talk more freely now about these subjects, which is positive, but many clients will not have sought medical help and will be embarrassed about doing so, unless they get the right reassurance.

Thank you, because you make a difference!

To better navigate the medico-legal landscape and support your clients effectively, “Making Clinical Negligence Clear by Nigel Poole Q.C.” is an essential read that clarifies key aspects of clinical negligence claims.

About the Author

Dr. Meehan is a Consultant Psychiatrist with extensive knowledge in psychiatric impairment and disability.

She is particularly focused on evaluating and addressing depression and suicide risk. She has extensive experience in various psychiatric conditions and can examine at her Liverpool clinic or via video.

To request her CV or for any medico-legal matters she can be reached at janetmeehan@inneg.co.uk