Mental Illness and Social Security Disability Benefits

Living with mental illness can make gainful employment impossible. The Social Security Administration (SSA) provides disability benefits to people with certain mental illnesses through two federal programs. Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) help support qualifying individuals with mental illnesses that significantly impair their ability to work.

To qualify, a person’s mental illness must be severe enough to prevent them from performing substantial gainful activity (SGA) for at least 12 months or result in death. The SSA has strict guidelines for evaluating mental illnesses. Not all individuals with a mental illness will qualify for disability benefits. A special needs planning attorney can discuss with you the available options for obtaining benefits.

SSA’s Criteria for Mental Illness Disability

The SSA evaluates mental illness using a five-step process to determine if an individual meets the criteria for disability.

1. Substantial Gainful Activity (SGA)

The SSA first evaluates whether the individual works and earns more than a certain annual adjusted income. If they earn more than the SGA amount, the SSA determines the individual doesn’t have a disabling mental illness.

2. Severity of Impairment

If the individual is not engaging in SGA, the SSA evaluates the severity of their mental illness. To meet the criteria for disability, the person must have a mental illness severe enough to significantly impair their ability to perform basic work activities.

3. Listing of Impairments

The SSA maintains a list of medical conditions and impairments that may qualify an individual for disability benefits. This includes certain mental health disorders. In some cases, mental illness is so severe it may qualify the individual automatically.

4. Past Relevant Work

If an individual’s mental illness doesn’t meet the criteria in the Listing of Impairments, the SSA assesses whether the person can perform any of their past relevant work. If they can still perform past work, they won’t qualify for disability benefits.

5. Other Work

If the individual can’t perform their past work, the SSA evaluates whether there are other jobs the person can perform in the national economy despite their mental illness. If they can perform this work, they will not qualify as disabled.

All individuals with mental illness who receive Social Security disability benefits must meet the criteria established by the SSA for their disability.

How Difficult Is It to Qualify?

Qualifying for SSDI or SSI based on a mental illness can be challenging but not impossible. One of the biggest hurdles to overcome is diagnosis and treatment. Symptoms can be hard to quantify, making it difficult to provide sufficient medical evidence to support a claim for disability according to the SSA’s strict guidelines.

Another hurdle is the five-step process described above, which can be complex and time-consuming. The process involves reviewing medical evidence, work history, and other factors determining a person’s benefits eligibility.

Even if the individual meets the SSA’s mental illness criteria, the process can take several months or years. In addition, many claims receive a denial on their first application.

Despite the challenges, it’s possible to qualify for SSDI and SSI based on a mental illness. You may benefit from seeking out the help of an qualified special needs planner. Attorneys experienced in this area can gather and present relevant medical evidence, navigate the appeals process, and advocate for your rights.

What Are Some Specific Mental Illnesses That May Qualify?

There is a range of mental illnesses the SSA considers, including:

• Schizophrenia and other psychotic disorders
• Bipolar disorder and depression
• Anxiety disorders, including generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder (OCD)
• Personality disorders, such as borderline personality disorder
• Intellectual disability and developmental disorders, such as autism spectrum disorder
• Trauma and stressor-related disorders such as post-traumatic stress disorder (PTSD)

As mentioned above, a person’s mental illness must meet the criteria established by the SSA for disability to qualify for benefits.

Qualifying for disability benefits and the evaluation process can be complex. It’s highly recommended to consult with an experienced attorney to discuss options and potential for success.

What About Minor Children?

The SSA has an SSI program that covers children up to the age of 18. To qualify, minor children must meet the same qualifiers for 12 months of mental illness that causes “marked or severe functional limitations.” The family of the child must be very low-income with limited resources. When the child turns 18, the SSA will determine if they continue to qualify for benefits as an adult.

Claim Denials and Appeals

Most first-time claims receive a denial, and most claimants will file an appeal. A properly filed appeal prompts a hearing before an administrative judge. Many claimants receiving first-time denials for benefits obtain benefits upon appeal.

However, successful claim appeals require navigation through complex hearings and appeals processes that require the legal expertise of an attorney. It often takes about 22 months from applying for benefits until an appeal hearing.

Social Security disability benefits for mental illness can help to cover financial obligations, including everyday living expenses, medical bills, and more. A special needs planning attorney will know what medical evidence requirements can support a claim for disability under the SSA’s strict guidelines. To ensure success, meet with a qualified attorney near you to discuss your case before applying for SSDI or SSI.