Does mental illness qualify as a disability?

Q:

Does mental illness qualify as a disability?

A:

Disability benefits are offered by the federal government through two separate programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

Social Security Disability Insurance (SSDI) is provided to disabled workers who have a severe mental illness or a physical health condition that does not allow them to work for at least 12 continuous months. Claimants must also have worked and earned sufficient work credits to be considered insured for SSDI benefits.

Supplemental Security Income (SSI) is provided to aged, blind and/or disabled people who are unable to work for at least 12 continuous months, including those with a mental illness. Claimants do not have to have work credits to qualify for SSI benefits. They must, however, have limited income and resources.

How do I win disability benefits with a mental illness?

The Social Security Administration (SSA) has two methods to determine whether a claimant with a mental illness is disabled. First, the SSA will determine whether the claimant’s condition and related symptoms are listed in the SSA Listing of Impairments.

Also known as the Blue Book, this listing includes a number of conditions that the SSA considers automatically disabling. Listings for mental illnesses are listed under Listing 12.00, Mental Disorders, and include the following:

  • Schizophrenic, paranoid and other psychotic disorders
  • Affective disorders
  • Intellectual disability
  • Anxiety-related disorders
  • Somatoform disorders
  • Personality disorders
  • Substance abuse disorders
  • Autistic and other pervasive developmental disorders
  • Organic mental disorders

To meet a listing, claimants must be diagnosed with one of the conditions outlined above or have another mental illness that is as severe as a listed condition. Having a diagnosis, however, will not be sufficient to win benefits. Claimants must also meet the symptoms identified for their condition.

For example, claimants with depression (Listing 12.04 Affective Disorders) must not only have a diagnosis and be under the care of a doctor, they must also “meet the listing,” which means that they must have four of the symptoms listed for depression (i.e., lack of pleasure in activities, decreased energy, lack of appetite or overeating, insomnia, lack of physical movement and concentration, suicidal thoughts, feelings of worthlessness; or delusions, paranoia or hallucinations).

These symptoms must also affect the claimant’s ability to focus, interact socially, and complete activities of daily living. Additionally, the claimant must have extended and repeated periods of what the SSA refers to as “episodes of decompensation.”

What if my condition does not meet a listing?

Meeting a listing is the simplest and fastest way to win disability benefits. Claimants who do not meet a listing, however, can also win benefits under the second SSA disability determination method: a medical vocational allowance.

Under a medical vocational allowance, a claimant must provide medical evidence that they have a mental illness and the severity of the mental illness eliminates their ability to work or perform what the SSA terms “substantial gainful activity.” Specifically, the SSA will evaluate the claimant’s mental residual functional capacity to work.

Unfortunately, winning benefits through a medical vocational allowance can be tough. In fact, most claimants who have a mental illness and cannot prove that it meets a listing will have their case denied the first time they apply for SSDI or SSI benefits.

To improve your chances of winning benefits, you will need to make sure that your mental health doctor has documented your condition and clearly stated within your medical records the symptoms that make it difficult for you to work.

For example, do you have difficulty in remembering simple instructions, understanding work requirements, handling changes in your work routine, and getting along with your co-workers or your employers? Do you have difficulty in performing your daily activities such as paying bills, bathing or grocery shopping? Do you have episodes of decompensation, where your symptoms get worse for extended periods of time?

Other information that the SSA will review include:

  • The severity of your mental illness
  • The progression of your condition
  • The treatment steps for your condition, including medication, hospitalizations and therapy
  • The test results, medical notes and symptoms for your condition

Note: to improve your chances of winning SSDI or SSI benefits for a mental illness, it may be necessary for you to ask your psychiatrist, psychologist or treating mental health doctor to provide a mental residual functional capacity form that details your limitations to work.

Why is it so difficult to win disability benefits for mental illness?

While it’s possible to win disability benefits for mental illness, it can be much more difficult than winning disability for a physical disorder. Physical conditions can often be visually confirmed or validated through laboratory testing or clinical methods. Mental disabilities, however, are often subjective and not visible.

To improve your chances of winning disability for mental illness, it’s important to consistently visit a doctor and follow their prescribed treatment plan, take the prescribed medication, and verify that your doctor has clearly documented your diagnosis, your symptoms and your mental limitations that make it impossible for you to work.

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Whether you're facing a legal issue or just seeking information, Justipedia aims to be your most trusted resource for legal information on the Web. With the help of legal professionals across the country, we put the law in plain language to help answer your top legal questions.

Justipedia was founded by Internet veterans Cory Janssen and Mitchell Allen. Janssen founded Investopedia.com and grew it one of the largest investing sites on the Web. Allen is an author, speaker and the founder of LeadRival, the leading provider of pay-per-action advertising in consumer legal services.

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