Episodes of Decompensation in Mental Illness: Social Security Disability

Having episodes of decompensation can help you get disability benefits if they are well documented.

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Understanding the meaning of the term "episodes of decompensation" is important if you are applying for SSDI or SSI disability benefits on the basis of a mental illness. Decompensation is a term that refers to the deterioration of the mental health of an individual who, up till that point, was maintaining his or her mental illness. Episodes of mental or psychiatric decompensation play a big role in evaluating Social Security disability claims and SSI disability claims. And it should, considering that decompensation leads to a lessened ability to engage in normal daily activities, and the ability to engage in normal daily activities relates strongly to the ability to engage in work activity. 

Definition of Episodes of Decompensation

Episodes of decompensation, according to the Social Security Administration (SSA), include:

  • a temporary worsening of symptoms
  • a loss of the ability to adapt to normal changes and stress, and
  • difficulty with normal activities of life, including concentrating, being persistent at tasks, pacing oneself, or maintaining social relationships.

In short, an episode of decompensation refers to a time when you experience an increase in symptoms and a loss of function.

Causes of Episodes of Decompensation 

There are a few different potential causes of episodes of decompensation. 

Your medical treatment is no longer working. This may call for an increase in medications to decrease symptoms and allow you to function on a more normal level.

A stressful situation may be affecting you. You may need environmental changes or more structure in your support system, such as hospitalization or placement in a halfway house. 

The cause is not especially important to your eligibility for benefits; what is important is that the episode is documented and provable. 

Documenting Episodes of Decompensation

It's important to have the proper documentation for all of these episodes of decompensation. This means you have to seek treatment during each period of decompensation, if possible. Just as seizure patients need to have their seizures documented, and asthma patient need to have their asthma attacks documented, you need to have a record of your episodes of decompensation. And your doctor's notes concerning your decompensation must be very detailed as to the character and duration of your decompensation episodes, and how your functioning is impaired during the episodes.

How Episodes of Decompensation Affect Disability

If you experience times when your symptoms are exacerbated, or you just seem to fall apart, this means that your mental illness is not being maintained. And Social Security knows that you can't function and work when your mental illness is not being maintained. For that reason, you may have an easier time getting disability benefits if you suffer from these episodes, as they are part of the criteria for some mental illnesses to qualify as disabilities.

The disability listings that allow episodes of decompensation as a factor in qualifying for disability benefits include:

For episodes of decompensation to help you qualify for disability for these conditions, generally you must have at least three episodes of decompensation per year (an average of one every four months), and each episode must last for a minimum of two weeks. However, this is just a guideline; if you have more frequent episodes of less duration or fewer episodes of longer duration, the SSA will evaluate you accordingly.

Updated by: , J.D.

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