Mental Illness and Social Security Disability

You can collect Social Security disability benefits for both physical and mental medical conditions, but it can be harder to collect disability for a mental illness than for a physical illness. Why? Part of the answer lies in the nature of mental illness itself. Symptoms of mental illness are not easily evaluated, and the severity of a condition can be hard to measure objectively.

While disability judges are sometimes more suspicious of claims based on mental illness, there are a number of steps you can take to ease their concerns. We'll discuss what you can do to improve your chances of winning below.

How Social Security Views Disability Claims Based on Mental Illness

Disability claims examiners who work for the Social Security Administration (SSA) aren't licensed psychiatrists and don't always understand the full scope of the limitations imposed by certain mental illnesses.

For instance, some disability examiners don't recognize the cyclical nature of mental illnesses, such as bipolar disorder (manic depression), and may assume you're cured if you aren't obviously displaying symptoms. But in reality, those symptoms may have just dissipated for the moment and could return in the near future.

In addition, some disability examiners may be biased against disability claims for mental illness. There are those who believe that some disability applicants who claim mental illness are lazy or "malingering" (faking their illness for benefits). This is unsettling since there are so many individuals who suffer from mental illness worldwide, but it is partially due to the fact that the criteria for evaluating most mental disorders are subjective.

Mental Impairment Listings

When evaluating an applicant's condition, a disability examiner will first refer to Social Security's official listing of impairments, often referred to as the "blue book."

The disability listings in the blue book contain medical conditions that Social Security recognizes as inherently disabling; in other words, Social Security accepts that anyone suffering from a listed condition is unable to do full-time work (or at least earn an amount equivalent to substantial gainful activity).

The disability examiner will review an applicant's medical records to see if an applicant's symptoms meet the criteria of any specific mental condition listed in the blue book. Mental listings in the blue book of impairments include:

• schizophrenia
• intellectual disorder
• autistic spectrum disorders
• anxiety
• depression
• bipolar disorder, and
• substance abuse disorders.

(For a full list of our articles on cognitive, emotional, and mental disorders, see our section on getting disability for mental illness.)

Disability examiners decide whether an applicant meets the requirements of a mental listing by reading your statements on the application, the clinical notes of mental health professionals, third-party questionnaires (friends are contacted and asked about the applicant's condition and normal daily routine), and an ADL (activities of daily living) questionnaire.

Mental RFCs

If your condition isn't as severe as what the blue book listing for your condition requires, but you've been diagnosed with a chronic mental condition that's preventing you from working, you could still be eligible for disability.

If your mental RFC (residual functional capacity) shows you have intellectual, social, or functional limitations that affect your productivity or your ability to sustain full-time work, you may be eligible for a what's called a "medical-vocational allowance," depending on your mental limitations, age, education level, and job skills.

For more information on how the SSA decides whether you should get a medical-vocational allowance, see our article on the mental RFC.

Improving Your Chances of Getting Approved for a Mental or Emotional Illness

For mental illnesses that may improve with treatment, such as anxiety, depression, and schizophrenia, the most important things that you can do to improve your chances of getting approved are to:

• see a mental health professional regularly (a psychiatrist or psychologist, if possible)
• let your doctor know how your condition affects you on a daily basis, and
• take the medicine that the doctor prescribes to you.

Learn more about how your doctor can help you qualify for benefits.

Medical Records: What Social Security Wants to See for a Mental Condition

In evaluating your claim, Social Security will review your medical records to determine whether they're consistent with your claims of disability. Here's what these records should contain if you want to prove a disability based on a mental condition.

Diagnosis. Your records should contain an indication of your diagnosis, such as major depressive disorder (or MDD, the medical term for depression), anxiety, bipolar disorder, borderline personality disorder, or something else.

Treatment notes. Your records should include all the treatment notes (sometimes called "progress notes") from your visits to your mental health provider. These notes should indicate how you've been doing since your last visit, particular problems you're experiencing in your daily life, episodes of worsening symptoms (which Social Security calls "episodes of decompensation"), and areas of progress. Ideally, you should be seeing a mental health professional at least every month or two.

Your notes should outline the particular activities of daily living (ADLs) you struggle with. These might include problems with:

• food and clothes shopping
• bathing and personal hygiene
• preparing meals
• paying bills
• managing money, and
• caring for family members or pets.

How can you control what appears in your treatment notes? You can't entirely. But one thing is guaranteed: if you don't say it to your doctor, it won't appear in your notes. That's why it's essential that you remember to tell your mental health professional all of the various ways that your condition affects you on a daily basis. Make a list before your treatment sessions if necessary.

Disability claims examiners and judges rely heavily on treatment notes in evaluating your claim, so it's important that they lend insight into why you can't work. For example, if you claim at your disability hearing that you sometimes don't get out of bed all day due to depression, the judge will expect this fact to be mentioned in your progress notes.

Medications list. Your medical records should include a list of your past and current medications. If you experience any side effects from these medications, make sure they're mentioned in your treatment notes.

Objective testing. There are very few tests to evaluate the severity of an individual's mental condition. Only mental conditions such as intellectual disorder (low IQ), memory impairments, or other neurocognitive disorders can be tested objectively (using IQ and memory impairment testing). If you suffer from a condition that can be diagnosed using objective testing, make sure Social Security has a copy of those records, even if the tests aren't particularly recent.

Medical opinions. In general, the SSA gives more weight to opinions from a psychiatrist or psychologist than those from a licensed social worker or counselor. Your lawyer (if you've hired one) should contact your treating doctor or psychologist to try to get an opinion in the form of a mental RFC form (discussed above) or a letter outlining your limitations.

Learn more about the evidence Social Security needs for psychological or psychiatric conditions.

Why Mental Impairment Claims Get Denied for Disability

Mental conditions present special obstacles in getting approved for Social Security disability. Here are several issues that can cause a disability claim for mental illness to be denied.

Poor Treatment Notes

Many mental health treatment specialists keep relatively short notes. Some doctors will write and send in a synopsis of their notes to Social Security (either to the disability claims examiner or the disability judge) because the notes from office visits provide scant detail and would not be helpful to a case.

No Record of Mental Treatment

Sometimes disability applicants have no record of mental health treatment for the condition listed on the disability application. This tends to happen with cases involving depression. Applicants are sometimes prescribed antidepressants by their family doctor, but they've never been seen by a psychiatrist. This means that the applicants will have no substantial mental treatment records to present for their claims.

Not Taking Prescribed Medications

In some instances, an applicant's medical records will show that the patient has been prescribed medication for a psychiatric or psychological condition, but has not taken the medication. This is a huge problem for mental disability cases because Social Security focuses on what an applicant is able to do despite the limitations of their condition. The SSA can't accurately measure an applicant's limitations if the patient isn't taking the medications as prescribed.

Why is medication compliance an issue for some applicants? Sometimes, it's due to the cost of medication. Unfortunately, Social Security isn't usually concerned with whether or not an applicant can afford their medication, but, simply, whether or not they take their medication. But if you can't afford the medications, do inform Social Security if this is the reason that you don't take your medication. By law, this should be an acceptable nonmedical excuse for failing to take medication. If the agency can find a source of free medication for you, however, this will no longer be an excuse.

For more information, see our article on failing to follow your prescribed treatment.

Lack of Long-Term Symptoms

Some Social Security disability and SSI disability claims are denied on the basis of "duration," meaning that a disability examiner or disability judge doesn't believe that the applicant's condition hasn't lasted for a year or isn't expected to last for a year. This is problematic for claims that have a tendency to improve and get worse with regularity, whether the claim is based on a mental condition, like bipolar disorder, or a physical condition, such as lupus.

Social Security's regulations do provide for situations where applicants can't show current, severe psychiatric limitations due to the fact that they've been undergoing intense therapy or they've been living in a highly structured or protected situation. But you must show Social Security that you have little ability to adapt to demands that aren't already part of your daily life or to changes in your environment (such as a new job would require). And it usually takes going to an appeal hearing with a disability lawyer to convince Social Security that this is your situation.

If you receive a denial letter and feel your case is strong enough to win an appeal, consider contacting a disability lawyer. Applicants who go to an appeal hearing represented by a lawyer have a better approval rate than applicants who represent themselves.

Learn more about getting disability for mental health problems in our mental health section.

_{Updated December 21, 2021}