Mental and psychological disabilities are among the conditions that can qualify for benefits from the Social Security Administration (SSA). You may qualify with severe depression, bipolar disorder, an anxiety disorder, or another mental illness that prevents you from maintaining gainful employment.
Social Security disability benefits can cover everyday living expenses, medical bills, and other financial obligations. Benefits are paid monthly and can alleviate many of your financial worries, making it possible for you to get by without income from employment.
Benefits for Disabled Adults
The SSA pays disability benefits through two separate programs:
SSDI is available to disabled adult workers who have paid Social Security taxes, while SSI is a need-based program only available to applicants that meet strict limitations on income and asset holdings. If you have never worked due to your mental illness, you will not qualify for SSDI. If you have financial support from friends or family, you will not qualify for SSI.
Basic Eligibility for Benefits
The SSA must see that you meet basic eligibility requirements before further reviewing your application for benefits. This basic eligibility includes having:
- A formal diagnosis of a potentially disabling condition
- A diagnosed condition that will disable you for 12 months of longer
After the SSA confirms that you meet basic eligibility, they will then move on to review your medical condition in detail and verify that you meet all program requirements for SSDI and/or SSI.
Medical Qualifying with a Mental Illness
The SSA conducts a detailed review of your medical records to determine your eligibility for benefits. During this review, they try to match your records to a disability listing in the “Blue Book.” The Blue Book is the SSA’s medical guide that is used to evaluate every disability application.
Disability listings outline the severity level requirements and the specific medical evidence needed to support a claim for benefits. Mental illnesses appear in Section 12.00 and include:
- 12.06, Anxiety-related Disorders – you may qualify under this listing if you have a severe phobia, post-traumatic stress, a panic disorder, or another anxiety-related condition.
- 12.08, Personality Disorders – this is the listing under which you may qualify if you have severe, clinical depression.
- 12.04, Affective Disorders – if you have bipolar disorder, your application will be reviewed under this listing.
Extensive medical records are necessary to qualify, including:
- Information on your diagnosis, ideally from a psychiatrist or psychologist
- Brain scans or other evidence of physical abnormalities that document an organic cause for symptoms, if applicable
- Treatment records, documenting medications, therapy, and other management methods used and their effects
- Thoroughly documented episodes of increased symptoms or periods of decompensation
- Well documented affects of your symptoms on your everyday abilities or “activities of daily living” (ALDs)
Activities of daily living can include many tasks, from being able to dress yourself, to interacting with others. If you can prove that your mental illness makes it nearly impossible for you to function outside of your place of living, you will have a strong chance of being approved.
For most mental illnesses, you will need to prove that you have been taking medication for two years or more and have not seen any improvement in your condition.
It can be quite challenging to get approved for benefits with a mental illness, especially if you do not precisely meet a Blue Book listing. Be prepared for a tough fight to get approved. Work closely with your doctor when applying for benefits. He or she can help you understand Blue Book requirements and can ensure your medical records contain the types of details necessary for the SSA to accurately evaluate your claim for benefits.
For the best chance of getting approved, be sure to gather the following information:
- ALL medical records. This includes everything from hospitalizations to therapist sessions.
- Any professional’s opinion on the matter. This can include doctors, psychologists, psychiatrists, therapists, or anyone else who has helped you with your mental illness.
- A list of the medications you’ve been taking, whether or not they have improved your symptoms, and the negative side effects you experience from these medications.
Submitting an Application
If you’re applying only for SSDI, you can do so online, or you can apply at the SSA office nearest you. For SSI however, there is no online application available. This is because an interview is part of the standard application process, and must be completed in person, or under some circumstances, via phone.
Visit the SSA’s website to start your application online or call 1-800-772-1213 to schedule an appointment. There are more than 1300 locations across the US, so you are sure to find an office close to you.
After Approval
If you are approved for a mental illness, expect to have your case reviewed every year. Some applicants with conditions that will clearly not improve, such as paralysis, are reviewed every 7 years or so. But since mental illnesses can often be treated, you will expect yearly check-ins with the SSA. So long as your condition remains the same year-to-year, you will not later be denied disability benefits.
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Published Mon, Feb 1 2016 10:05 AM ESTUpdated Mon, Feb 1 2016 10:05 AM EST
Successfully applying for Social Security disability benefits can seem like a daunting prospect.
Claims for Social Security Disability Insurance — which pays out $143 billion each year to more than 11 million Americans unable to work because of a serious illness or impairment — have been ticking upward. The Social Security Administration received nearly 2.7 million applications for the program in 2013, up from 1.9 million a decade earlier, according to its most recent annual report.
The rate of applicants who are ultimately approved, however, has remained slim — averaging just 36 percent for claims filed from 2004 to 2013, according to the report. About a quarter are awarded benefits on their initial claim, while another 2 percent are approved on appeal and 11 percent at hearings.
"The reality is, more often than not, you'll be denied," said Stephen Dunn, a staff attorney with the New York Legal Assistance Group, which provides free legal services to low-income New Yorkers.
In fact, waits for a hearing can stretch the process out for a year or longer, he said.
Congress has been looking at possible reforms for years that could streamline the process without sacrificing the rigor necessary to nix fraudulent claims, said former Congressman Earl Pomeroy, a co-chair of the Committee for a Responsible Federal Budget's SSDI Solutions Initiative. Congress pledged last fall to address the issue, after bailing out SSDI in its budget deal — using temporary measures to extend the program fund's solvency through 2022.
But that's unlikely to provide short-term relief.
"My guess is, while reforms are being studied and proposed, it's unlikely that in the very near future, Congress is going to enact anything sweeping by way of process reforms," said Pomeroy.
In the meantime, the SSDI process puts a lot of responsibility on the applicant to get the right materials to the right people at the right time. "[Applying] is almost like a job in itself," Dunn said. "That's ironic, because you're applying because you can't work."
Sometimes, applicants simply aren't eligible, said Nolo senior legal editor Bethany Laurence, an attorney who specializes in disability law, Social Security and Medicare. Namely, they don't meet SSDI requirements that their condition be "expected to last at least one year or result in death," preventing them from working.
But there are also missteps that could unjustly kick your application to the denial pile.
To improve your chances of a successful claim, make sure to gather as many of your medical records as possible in advance of filing your claim. "How long this process takes is opaque to the claimant," said Dunn. "It's possible [SSA] will make a decision while you're waiting for these records to be sent." You want them to have as full a picture of your condition as possible, right from the start.
Claims examiners want to see that you've received medical care for your condition regularly and recently, said Laurence, who is also the editor of DisabilitySecrets.com. Good medical records help establish both the seriousness of your condition and how it has impaired your abilities. "The doctor's opinions about your limitations can make or break a claim," she said.
(Per Social Security Administration data, 28 percent of final medical denials in 2013 were because the impairment was considered "not severe," and another 31 percent because the applicant was still considered able to do other kinds of work.)
It helps to have your doctor fill out a residual functional capacity form detailing your limitations and prognosis. Include that with your initial SSDI application, said Laurence.
If you do get denied, you have to act on requesting an appeal quickly, within two months.
Stephen Dunn
staff attorney, New York Legal Assistance Group
Follow up to make sure copies of those records make it into the right hands, said Dunn. After your application is submitted, you'll receive a packet in the mail with more forms. Resubmit your medical records with those, he said. That eliminates the risk of records being waylaid.
It's also important to carefully navigate income. To qualify for disability benefits, an applicant can't be engaging in "substantial gainful activity," which in 2016 the Social Security Administration considers to be earning more than $1,130 per month.
"A big mistake people make is continuing to work full-time up until the application date, or until they get a decision," Laurence said. "They say, I can't afford to not work." But doing so can undermine your claim that a disability prevents you from working.
Collecting unemployment benefits can also hurt your case, but not always, she said. (It's a catch-22. You're telling unemployment that you're willing and able to work but telling Social Security that you are unable to work.) Be prepared to explain how your circumstances have changed.
Don't make the mistake of failing to anticipate a denied claim, either.
"If you do get denied, you have to act on requesting an appeal quickly, within two months," Dunn explained.
While the appeal process can be lengthy, if your claim is ultimately approved, you can receive retroactive benefits based on that initial filing date. Start over and you're resetting that clock, too.
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