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. Unlike physical conditions, doctors can't use an MRI or X-ray to objectively measure how severe a mental impairment is.

Because symptoms of mental illness aren't as easily evaluated as physical symptoms, claims examiners and disability judges are sometimes more skeptical of disability applications based on mental conditions. Fortunately, you can take steps to ease their concerns. We'll discuss what you can do to improve your chances of winning below.

Can a Mental Health Illness Be Considered a Disability for Social Security?

Social Security awards disability benefits to people who have one or more severe impairments that keep them from earning at or above the level of substantial gainful activity for at least twelve months. So if you've received medical treatment for a mental health illness that's kept you from working full-time for at least a year—or you don't expect that your mental health will improve enough to return to work for a year—you could qualify for SSDI or SSI benefits.

Qualifying for Disability Under the Mental Impairment Listings

When a disability application for mental illness comes to a claims examiner's desk, one of the first things the examiner will do is refer to Social Security's official listing of impairments—often referred to as the "Blue Book" as a nod to the historical color of the manual.

The Blue Book lists medical conditions that the SSA considers especially severe. Each condition has a set of requirements that have to be in your medical records in order for the SSA to say that you "meet" (or "equal") the listing. If you meet a listing, the agency can award you disability benefits automatically without having to decide that you can't do any work.

Mental health disorders have their own section (12.00) in the Blue Book. Specific diagnoses that have their own listing include:

• neurocognitive disorders
• schizophrenia spectrum and other psychotic disorders
• depression
• bipolar disorder
• anxiety
• obsessive-compulsive disorders
• somatic symptom disorders
• personality disorders
• autism spectrum disorders (such as Asperger's syndrome)
• neurodevelopmental disorders
• eating disorders (such as anorexia or bulimia), and
• trauma- or stressor-related disorders like PTSD.

Regardless of the diagnosis, every listing requires documentation that the claimant's (applicant's) mental health symptoms cause significant functional limitations. So even if you've been diagnosed with a severe mental illness, the SSA can't award you disability if your symptoms don't make it very difficult for you to finish routine tasks or get along with others.

Qualifying for Disability With Reduced Mental Functional Capacity

Not many disability claimants with mental disorders will meet the strict criteria for automatic disability benefits under the listings. But you can still be eligible for disability if your mental residual functional capacity (RFC) keeps you from working full-time.

Your RFC is a set of restrictions on the types of tasks you can do in a work environment. Social Security looks at a variety of evidence to determine what you can do and should avoid doing at work. Some of the most common sources of evidence include clinical notes from mental health professionals, third-party statements, and activities of daily living questionnaires.

Social Security reviews your ability to interact with others, complete chores, remember appointments, and focus on finishing what you started when assessing your RFC. For example, if you have trouble maintaining even superficial relationships with your friends and neighbors, your RFC will likely contain restrictions on your contact with the general public.

If your mental health symptoms are severe enough, your RFC might contain certain restrictions—such as spending too much time off-task—that keep you from working at any job.

The Right Medical Records Increase Your Chances of Getting Approved for a Mental Illness

Your medical records are the foundation of your mental health disability claim. Social Security wants to see certain specific evidence before the agency can determine that you're disabled, whether by meeting a listed impairment or having a mental RFC that rules out all work. Here's what your records should contain if you want to prove a disability based on a mental condition.

Get a Diagnosis From a Mental Health Professional

Your records should contain an indication of your diagnosis, such as major depressive disorder, anxiety, bipolar disorder, or borderline personality disorder. Your diagnosis should come from a psychiatrist or a psychologist (a doctor with an M.D. or Ph.D. degree). Social Security doesn't consider counselors or therapists to be "acceptable medical sources" for diagnosing a mental illness—although any records you have from them are important to show any progress you're making in treating your mental health.

Make Sure Your Doctor's Treatment Notes Are Comprehensive

Your records should include all your treatment notes from visits to your mental health providers. These notes should indicate how you've been doing since your last visit, what specific problems you're experiencing in your daily life, any episodes of worsening symptoms, and areas of progress. Ideally, you should be seeing a mental health professional at least every month or two.

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

• food and clothes shopping
• bathing and personal hygiene
• preparing meals
• paying bills
• cleaning your house
• visiting and talking with other people
• managing money, and
• caring for family members or pets.

You can't entirely control what appears in your treatment notes, 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.

Claims examiners and administrative law judges rely heavily on treatment notes in evaluating your claim, so it's important that they contain 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.

Keep a List of All Medications You've Been Prescribed

Your medical records should include a list of your past and current medications, such as selective serotonin reuptake inhibitors (SSRIs) for depression or mood stabilizers for bipolar disorder. If you experience any side effects from these medications, make sure they're mentioned in your treatment notes.

Submit the Results of Any Mental Status Examinations

If you've undergone any mental health or cognitive testing—even if the examinations aren't particularly recent—make sure that Social Security has the test results, especially if you've been evaluated for an intellectual disorder (low IQ) or memory impairments. Older examinations can be useful as a touchstone to monitor your mental health progress if you're asked to attend a consultative mental evaluation.

Ask Your Doctor to Write an Opinion

Social Security values the opinions of mental health providers who you've seen regularly for your mental illness, but the agency gives more consideration if the opinion is from a psychiatrist or psychologist than from a licensed social worker or counselor. If you (or your lawyer) can get your treating psychologist or psychiatrist to write a medical source statement describing your specific mental limitations, a claims examiner or disability judge may be swayed in your favor.

Why Does Social Security Deny Mental Illness Disability Claims?

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

Limited recordkeeping by a doctor or therapist can hurt a disability claim. Many mental health treatment specialists keep relatively short notes. Some doctors will just send in a synopsis of their notes to Social Security because the notes from office visits provide little detail and wouldn't be helpful to a case. Other doctors take short cuts by copying and pasting notes from previous visits, which won't show any progress or decline in your mental health.

No Record of Treatment for Mental Illness

For many reasons, not all disability claimants have a record of mental health treatment for the conditions they listed on their application. Some claimants are prescribed antidepressants by their family doctor, but haven't been seen by a psychiatrist. Others struggle to overcome the stigma associated with seeking counseling or therapy. And it's very common for mental health treatment to be prohibitively expensive, especially for people who are uninsured.

Not Taking Prescribed Medications

In some instances, applicants' medical records show that they've been prescribed medication for a mental health condition, but they haven't been taking the medication. Social Security can deny an application based on failure to follow prescribed treatment, because the agency needs to see whether your symptoms of mental illness respond to medication enough for you to return to work.

Being unable to afford medications can be an acceptable reason why you didn't comply with recommended treatment, however, so let Social Security know if you can't find free or low-cost prescription medications.

Lack of Long-Term Symptoms

Social Security doesn't award short-term disability benefits. You'll need to show that your mental health symptoms have lasted (or are expected to last) for at least one year.

Unfortunately, some claims examiners don't recognize the cyclical nature of many mental illnesses and may assume you're "cured" if you aren't currently experiencing symptoms. But those symptoms may have just temporarily improved and could come back in the near future. Make sure you document any "good" and "bad" periods in your mental health so the agency can understand how your symptoms progress over the course of a year.

Suspicions of Malingering

Because the criteria for evaluating most mental disorders is so subjective, some disability examiners may mistake common mental illness hurdles (like forgetting appointments or misusing medications) as malingering. Malingering is the medical term for a patient who is exaggerating or faking symptoms for a benefit.

Disability examiners at the initial or reconsideration level—who don't always have the entire medical picture yet—might not give claimants the benefit of the doubt and could deny a suspicious application, requiring you to appeal. For more information on what to avoid, see our article on exaggerating or malingering to get disability benefits.

Getting Help With Your Social Security Disability Claim for Mental Illness

If you receive a denial letter from Social Security, consider hiring an experienced disability lawyer. Your attorney can help collect your medical records, handle correspondence with Social Security, submit a pre-hearing brief on your behalf, and—perhaps most importantly—represent you in a hearing in front of an administrative law judge. Claimants who go to an appeal hearing represented by a lawyer have a better approval rate than those who represent themselves.

_{Updated September 20, 2023}