Marken Law Group, PS, has helped hundreds with mental health disorders in Washington, Idaho, Oregon and California obtain benefits through the Social Security Administration (SSA). Below we explain what the SSA is looking for with a mental health claim in order for you to obtain benefits.
Both programs pay monthly benefits for people with disabilities. Individuals can qualify for both programs and receive monthly income from SSDI and SSI. However, people who have never worked due to the impact of their mental health condition may not be eligible for SSDI. Those who receive income from other sources can affect their SSI income.
To qualify for benefits from any of these programs, claimants for mental health conditions must prove the impact of their condition on their daily living activities and the lack of improvement despite receiving treatment. But before that, let us brush up on the basic requirements for disability benefits and what mental health disabilities that SSA covers.
✓ Official diagnosis of the claimant’s mental health condition
✓ Severe impact of the mental health condition that prevents you from working
✓ The mental health condition expected to last at least one year or result in death
✓ Inability to perform past work or adjust to new work due to the claimant’s mental health condition
Disability Benefits for People with Mental Health Conditions
Disability benefits are available through two programs of SSA: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). SSDI: For workers who’ve paid into the system- You’ve earned these benefits through your work history
- Based on your Social Security tax contributions
- Monthly payments available when mental health prevents work
- No work requirements needed
- Available even if you’ve never worked
- Benefits based on financial need
Both programs pay monthly benefits for people with disabilities. Individuals can qualify for both programs and receive monthly income from SSDI and SSI. However, people who have never worked due to the impact of their mental health condition may not be eligible for SSDI. Those who receive income from other sources can affect their SSI income.
To qualify for benefits from any of these programs, claimants for mental health conditions must prove the impact of their condition on their daily living activities and the lack of improvement despite receiving treatment. But before that, let us brush up on the basic requirements for disability benefits and what mental health disabilities that SSA covers.
Basic Requirements for Disability Benefits
Before reviewing your application for benefits, the SSA representative must confirm that the individual meets the following basic requirements:✓ Official diagnosis of the claimant’s mental health condition
✓ Severe impact of the mental health condition that prevents you from working
✓ The mental health condition expected to last at least one year or result in death
✓ Inability to perform past work or adjust to new work due to the claimant’s mental health condition
Common Mental Health Disorders Covered by Social Security
During the review of your claim, SSA will try to match the evidence in your medical records to a disability listing in the “Blue Book” under “12.00 Mental Disorders.” From there, your condition must fulfill 2 or 3 criteria. The common mental health disorders covered by SSA are the following:- Neurocognitive disorders: Disorders that affect mental function due to a medical disease rather than a psychiatric illness.
- Schizophrenia spectrum and other psychotic disorders: Group of related mental disorders that affect reality perceptions and thought processes, sharing symptoms, such as hallucinations, delusions, and disorganized speech.
- Depressive, bipolar, and related disorders: Mood disorders where there is a disconnect between actual life circumstances and the person’s state of mind or feelings.
- Intellectual disorders: Neurodevelopmental disorders with intellectual difficulties as well as difficulties in conceptual, social, and practical areas of living.
- Anxiety and obsessive-compulsive disorders: Disorders that cause anxiety and interfere with everyday life.
- Somatic symptom and related disorders: Mental health conditions characterized by an excessive and intense focus on their symptoms that cause significant distress and can interfere with their daily functioning.
- Personality and impulse-control disorders: Group of behavioral conditions that involve the inability to control impulses and behaviors.
- Autism spectrum disorder: A spectrum of brain development conditions that impacts how a person perceives and socializes with others, causing problems in social interactions and communications.
- Neurodevelopmental disorders: Types of disorders that affect brain functions and neurological development, causing difficulties in social, cognitive, and emotional functioning.
- Eating disorders: A group of mental health conditions characterized by severe disturbances in eating behaviors that affect physical or mental health.
- Trauma- and stressor-related disorders: A group of emotional and behavioral problems developed from exposure to a traumatic or stressful event.
Understanding the SSDI and SSI Application Process for Mental Illness
When the claimant has passed the basic requirements for disability benefits and their mental health condition is covered by the SSA, the application process begins. Next, the SSA must determine the extent of the claimant’s disability to see if they need benefits or not. SSA does this by asking the following questions:- How much can the claimant be able to work?
- Does the condition impact their daily living?
- Is there a lack of improvement despite receiving treatment?
Five-Step Sequential Evaluation
SSA uses the Five-Step Sequential Evaluation process for adults to determine disability by their limitations from being able work:- Substantial Gainful Activity: Confirm if the claimant is working above SSA’s income limits.
- Severity of Impairments: Discover if the claimant’s impairments significantly limit their ability to perform basic work activities.
- Listing of Impairments: Determine if the claimant’s impairments meet or are equal to the severity of a condition listed in SSA’s listing of impairments
- Past Relevant Work: Assess if the claimant can perform any of their past relevant work.
- Other Work: Determine if the claimant can adjust to other types of work based on their age, education, work experience and residual functional capacity.
Functional Abilities Assessment
SSA also measures the extent of the claimant’s mental health disability by determining their functional capacity:- Activities of daily living (example: cooking, cleaning, self-grooming)
- Social functioning
- Concentration, pace, or persistence
- Episodes of decompensation (times when symptoms becomes worse and affects function for daily living)
Treatments Done
Lastly, SSA will need to determine if the claimant’s disability has been improved by treatment to determine the severity of their condition. The three fold analysis for for this evaluation consists of the following:- Treatment via counseling
- Treatment medication
- Whether drugs and/or alcohol play a role.
Counseling
Are you obtaining and have you obtained semi-consistent counseling? More importantly is your provider making good notes on your sessions?In evaluating disability, the Social Security Administration has to have medical records concerning an impairment/diagnosis over twelve months in duration. If you are not obtaining counseling/therapy for your mental health you are at a severe disadvantage to obtaining disability benefits through Social Security. If you are receiving therapy/counseling, is your provider taking notes and are those notes available? Many times mental health providers do not take adequate notes and this will hurt your disability claim.
Medication
Are you taking mental health medication? If not, why not?If the Social Security Administration calls a mental health expert to testify, or during review of your records at Division of Disability Determinations, they MIGHT make the assumption if you are not on mental health medication that either your problems are not as severe as alleged or your symptoms could be alleviated if you took the medication.
Substance Abuse Disorder
Are drugs and/or alcohol a factor?While alcohol is legal, and marijuana in some states (not federal), these along with illicit drugs can play a large factor in you being denied benefits if applying alleging mental health disabilities. The Social Security Administration is tasked to investigate, through your medical records, whether DAA play a material role in your disability. If you are alleging mental health disabilities but it is noted in your medical record you drink frequently, have abused prescription drugs in the past, or are currently using any illicit drugs or marijuana, the decision will likely come down that drugs and alcohol, if stopped, would improve your mental health.
How We Help You Prove Your Mental Health Disability
Based on the SSA application process for mental health conditions, they measure the extent of disability through the claimant’s capacity to work, functional abilities, and past treatments. To receive the actual benefits you deserve, we need to build a strong case in your favor, founded by evidence and health expertise.Medical Evidence and Documentation
Your medical records should cover a minimum of 12 months before your claim and include information from medical professionals involved in your treatment. Your medical evidence must include the following: 1. Professional Diagnosis Documentation- Reports from psychiatrists/psychologists
- Brain scans or other medical tests (when applicable)
- Every hospital visit
- All therapy sessions
- Medication history showing:
- 2+ years of consistent treatment
- Limited improvement despite compliance
- Side effects that impact your ability to work
- Document assistance needed for daily activities
- Record activity limitations
- Keep a daily journal. Even a log of what you did that day or what symptoms you’ve experienced is enough. Write in specific terms, such as:
Instead of writing… | Use numbers instead |
|---|---|
“I can’t sleep much” | “I have insomnia for 3 nights since Wednesday” |
“I need lots of rest” | “I require 3 hours of rest this afternoon” |
“It really hurts” | “Pain levels reach 7/10 when standing over 15 minutes” |