Mental illness is no joke, especially when it is severe. These types of conditions can be just as hard on both sufferers and loved ones as physical illnesses. In many cases, physical illness and mental illness are related.
There have been studies showing a link between mental and physical illness. Research has shown that people with conditions such as depression, schizophrenia, and bipolar disorder may have shortened lifespans not only due to “unnatural causes,” but to physical illnesses as well.
For people suffering from a severe mental illness, it can be impossible to work.
If you’re someone who has lost the ability to work due to a severe mental health condition, Social Security disability benefits can help you cope financially.
When beginning a disability claim application for mental illness, it’s important to know what information Social Security needs in order to determine that your condition is a disability.
We have another article about applying for disability benefits for mental illness that covers a more general scope. We encourage you to read that article first, if you haven’t already, and then return to this article. Here, we’ll be diving a bit deeper into how to prove that you have a mental illness.
There are essentially three steps to proving your mental illness is a disability to Social Security:
- Getting an official diagnosis and beginning treatment
- Checking that your mental illness matches Social Security’s Blue Book criteria
- Gathering medical documentation for your disability claim application
First, let’s talk about diagnosis and treatment.
Getting a Diagnosis and Treatment
Because Social Security requires a lot of medical documentation to establish that your medical condition is disability, you need to start a paper trail.
This means getting your condition officially diagnosed by a medical professional, if you have not already, and starting treatment. If you have done this already, you can skip down to the next section. But if you haven’t taken this step yet, it is crucial that you do so before applying for benefits.
If you do not get an official diagnosis from a medical professional and seek treatment, you cannot claim disability benefits.
There are basically three steps to getting a diagnosis for a mental health disorder.
Before you call a psychiatrist, see a physician to get a physical exam done.
It’s important to rule out physical problems that could be causing your symptoms. Physical imbalances and illnesses can be underlying causes of depression, anxiety, and other mental disorders.
Ask for lab tests that may give an indication of an underlying issue, such as a thyroid disorder.
Consult with you doctor about which tests would be most beneficial. Particularly if you have a family medical history with serious conditions, lab tests may reveal how your genes are impacting your health.
Finally, ask for a psychological evaluation.
In an evaluation, a doctor or mental health professional will talk to you and ask you questions about the symptoms, thinking, emotional, and behavioral patterns you’re experiencing.
Getting an accurate diagnosis is important both for treatment purposes and for your disability claim. You may start with one diagnosis only to find out that you are dealing with something different than your care team initially thought.
For example, some people who are diagnosed with major depression actually have bipolar disorder and are experiencing a depressive episode. Others who are initially misdiagnosed with schizophrenia also have bipolar disorder and were experiencing a manic episode with psychotic features.
These types of misdiagnoses often occur in hospitals, but they can also occur in clinics. It is very important to discuss all the symptoms you are currently experiencing as well as those you’ve experienced in the past. Make sure you tell the evaluating medical professional the following…
- Any specific triggers that worsen your mental health
- Whether your mental health problems come and go or are ongoing (chronic)
- When you first noticed changes in your mental health as well as what was happening in your life at that time
If you are diagnosed in an inpatient setting after a mental health crisis, make sure you get a full psychological evaluation once you are discharged.
Because psychiatrists working in hospitals are dealing with crisis situations and prioritize getting patients stabilized, their evaluation might not be as accurate. Upon your discharge from the hospital, you will want to work with a psychiatrist one-on-one in a clinic to get the most accurate diagnosis.
There are many, many types of mental health disorders, but some of the most common ones include:
- Anxiety disorders
- ADHD (Attention-deficit hyper-activity disorder)
- Autism spectrum disorder
- Mood disorders (including depression and bipolar disorder)
- Disruptive behavior disorders
- Eating disorders
- OCD (obsessive-compulsive disorder)
- Personality disorders
- PTSD (Post-traumatic stress disorders)
- Substance abuse disorders
Please note that Social Security does not consider substance abuse disorders disabling in themselves. We’ll say more in the next section about how substance abuse is evaluated.
It is strongly advised that you seek treatment for mental illness.
There are serious risks to leaving mental illness untreated. Once you are diagnosed, work with your psychiatrist to put together a treatment plan. This may mean a combination of medication and therapy as well as lifestyle interventions to help alleviate symptoms.
The four most commonly prescribed classes of prescription psychotropic medications include:
- Anti-anxiety medications
- Antipsychotic medications
- Mood-stabilizing medications
Some medications may result in side effects that can be debilitating. If this is the case for you, you and your psychiatrist will have to weigh the risks and benefits of medications.
To continue building your medical case, it is important to seek therapy even if you’re taking medication.
There are many different types of therapies, and some modalities are better than others for treating certain mental illnesses. Discuss what therapy type(s) would be most helpful for alleviating your symptoms with your psychiatrist.
When you create your treatment plan, make sure you ask your psychiatrist for a prognosis of your condition, i.e. your likelihood and timeline of recovery.
The reason for this is Social Security’s definition of disability. We’ve done a longer article on how Social Security evaluates your claim against their definition of disability, but the three essential criteria for their definition are:
- You have a verifiable medical condition.
- Your condition is severe enough to prevent you from substantially working.
- Your condition is expected to last more than a year or to terminate in death.
The prognosis needs to be submitted as proof that your condition is long-term or leaves you at a high risk for death.
That said, let’s move on to the next section discussing the Social Security Blue Book criteria for mental disorders.
Checking the Blue Book Criteria for Mental Disorders
The formal title of the Blue Book is Disability Evaluation Under Social Security. It lists impairments that the Social Security Administration (SSA) considers severe enough to prevent an individual from substantially working. The Blue Book lists the medical criteria for determining whether someone can receive disability benefits.
For the listing of adult mental disorders, there are 11 categories:
- Neurocognitive disorders (12.02)
- Schizophrenia spectrum and other psychotic disorders (12.03)
- Depressive, bipolar, and related disorders (12.04)
- Intellectual disorder (12.05)
- Anxiety and obsessive-compulsive disorders (12.06)
- Somatic symptom and related disorders (12.07)
- Personality and impulse-control disorders (12.08)
- Autism spectrum disorder (12.10)
- Neurodevelopmental disorders (12.11)
- Eating disorders (12.13)
- Trauma- and stressor-related disorders (12.15)
There are two or three paragraphs—depending on which listing applies to your case—designated A, B, or C, and each paragraph outlines a specific criterion that must be satisfied in order to qualify for disability benefits.
In most cases, your mental disorder must satisfy either the requirements of both paragraphs A and B or the requirements of A and C.
You may want to enlist your psychiatrist or physician’s help in understanding the criteria for your mental disorder(s). The Blue Book was written with medical and legal professionals in mind and uses language that can be difficult for untrained individuals to understand.
As we touched on earlier, there are special considerations for substance abuse disorders.
Substance abuse disorders, though extremely debilitating in many cases, are not considered disabilities by Social Security in and of themselves.
Essentially, you must have a comorbid diagnosis in which you have some other medical condition in addition to substance abuse disorder.
Under the Code of Federal Regulations Sections 404.1535 and 416.935, Social Security is required to determine whether an existing drug addiction or alcoholism is a contributing factor to your current symptoms.
The big question for them is whether you would still be disabled if you stopped using drugs and/or alcohol.
If they find that after recovering from substance abuse your remaining limitations would not be disabling, they will consider the substance abuse a contributing factor that is “material to” (i.e. influences) their determination of disability.
However, if you would be disabled even after recovering from substance abuse disorder, Social Security would find that the substance abuse was not a contributing factor material to their determination of disability.
Because severe mental illness can be comorbid with substance abuse disorder, it is extremely important to seek treatment for drug addiction and/or alcoholism in addition to whatever other mental disorder(s) you may be struggling with.
By treating substance abuse disorder before or alongside treatment for other illnesses your psychiatrist can get a better idea of the severity and prognosis of your other mental disorders.
With those preliminary steps in mind, we can move on to gathering medical documentation.
Gathering the Right Medical Documentation
One of the most important pieces of medical evidence to support your disability claim is a physician’s (or in this case psychiatrist’s) report.
The following items should be included in your doctor’s report:
- Your diagnosis/diagnoses
- Symptoms you experience with description of severity
- Treatments and their effectiveness
- Side effects of medications you are taking
- Your restrictions and limitations
- Prognosis of full or partial recovery (with an estimated timeline given treatment options) or no recovery
Keep in mind as well that your therapist can add valuable insight to your psychiatrist’s report on your case.
If you were not asked to do so at the initial appointment with the therapist you regularly see, ask to fill out a Release of Information (ROI) for your psychiatrist. Ensure that you ask your psychiatrist to give you the ROI form to fill out for your therapist.
This way, your care team can communicate with each other about your case. If you do not fill out an ROI form for each of your care team members, they will not be able to share information with each other due to HIPAA compliance regulations.
Other information required for your application includes the following:
- The names, address, and contact information of those on your treatment team - An SSA representative may need to reach out to your psychiatrist in order to verify medical information you’ve provided with your disability claim. You may also want to include physicians, nurse practitioners, and therapists who have seen you.
- Results of psychological evaluations and other diagnostic tests - Ask your doctor whether you need to be reevaluated if it has been a long time since your last evaluation.
- Detailed descriptions of treatments and rehabilitation - This would include treatments other than medication, such as intravenous therapy, brain stimulation therapy, acupuncture, and other such interventions.
- A list of your medications including names, dosages, and the purpose of each medication - Be specific about what symptoms your medication(s) are meant to alleviate, not just the particular mental illness for which they were prescribed.
- The names and contact information of all the medical facilities where you’ve been treated - This would include both inpatient and outpatient facilities, as well as any rehabilitation centers or clinics at which you received treatment.
- A note of recommendation for disability benefits from your psychiatrist or physician - Getting a recommendation for disability benefits from a medical professional really helps your case. Social Security takes these recommendations seriously in their evaluation of disability claims.
One final tip to help build the medical evidence for your case is to keep a journal. Many disability benefits lawyers recommend this practice to show Social Security the day-to-day difficulties of your medical condition.
Buy a notebook specifically for the purpose of documenting your experience with mental illness. Mark each entry with the date and time.
Note the following:
- What activities your symptoms prevent you from doing. Give details as to why you cannot participate in a specific activity because of your symptoms. This includes thinking, emotional, and behavioral patterns that make it difficult for you to function.
- How much pain you are in today. Where in your body is the pain? What does it feel like? If you decide to call the doctor because of pain, make a note of that as well when you are able.
- Side effects from medications that affect your day-to-day life. Take note of side effects, how they make you feel, and how they affect your daily activities, especially if you’re having difficulty functioning with them.
- Any incidences related to your disability recently. This includes mood episodes, panic attacks, and other such events. Note the date and triggers of the incident. If the result of an incident is that you had to cancel plans, go to the emergency room, or were admitted to an inpatient or outpatient program, be sure to write this down.
Include as many details as you can in your journal entries, as you are able. If you have multiple medical conditions, take note of how they interact with one another and impact you. You may also wish to document the impact of your mental illness on your loved ones.
Get Disability Benefits Assistance
So much time and effort go into the disability claim process, which can be arduous and overwhelming for those battling mental illness. Without proper help, it is all too easy to make a mistake on your application.
Unfortunately, 60% of applications receive a decision of denial due to simple mistakes, whether errors in information or omissions of evidence.
For that reason, it is high advisable to get disability benefits assistance from a legal professional.
At BenefitsClaim.com, we offer a free online disability case evaluation to help you determine whether you qualify for benefits. You can take the online disability case evaluation at no cost to you here.
From there, if you still need help, you can connect with a disability benefits lawyer from our team. An experienced disability attorney can build the most compelling case to increase the likelihood of approval from Social Security.