When Does Mental Illness Mean Disability?

Many clients over the years have contacted our office looking for help as a result of mental health issues. If the condition is severe, the person may qualify for Social Security Disability or Supplemental Security Income benefits. If the condition occurred as a result of a physical or mental trauma at work, he/she may qualify for Workers’ Compensation or Accidental Disability benefits if employed by a municipality or the state government.

For the millions of Americans that suffer from some form of mental illness finding help is not always easy. Many individuals and families are unfamiliar with these types of issues and are confused, ashamed or unable to secure information, education and treatment. The National Alliance on Mental Illness (NAMI), which has chapters in every state across the country, can be a valuable community resource. The mission of NAMI is to educate, advocate and support individuals with mental illness and their families.

Securing treatment is the first step on the road to recovery. Mental Illness is like any other form of illness; it needs to be evaluated, diagnosed and treated by a professional who specializes in this area. As with any other condition, the treatment can vary depending on the individual’s particular situation. It can be in the form of counseling, medication, biofeedback, electro convulsive therapy or hospitalization, to name a few. Documentation of symptoms and resulting limitations is also crucial if a claim for any type of disability benefits is being made.

With mental illness the resulting limitations can vary widely from one person to another. While some people are able to adequately function in their daily work and personal lives, others may be significantly impaired by the same condition. The level to which a person’s functioning is impaired will usually dictate whether he/she will qualify for benefits.

Social Security’s framework for assessing disability is a useful tool to understanding these issues. Take the condition of Depression as an example. Under what is called the “A” criteria, the symptoms that are associated with Depression are listed. These include: loss of interest in activities, appetite disturbance with change in weight, psychomotor agitation (fidgeting, pacing, hand-wringing) sleep disturbance, decreased energy, feelings of guilt or worthlessness, difficulty concentrating or thinking, thoughts of suicide or hallucinations, delusions or paranoid thinking. If the individual exhibits at least four of these symptoms, the diagnosis of Depression can be substantiated.

Once a person has produced evidence of a medically determinable impairment, an assessment of how severely the person’s functioning is impaired as a result of the condition is conducted. This is done by reviewing what are called the “B” and “C” criteria. [1]

In the “B” criteria an individual must show two areas of marked interference. This can be in the domains of activities of daily living, maintaining social functioning or concentration, persistence or pace. In the event that the “B” criteria are not met, the “C” criteria will be reviewed.

In general, the “C” criteria look at whether an individual’s situation is fragile and could be exacerbated by increased demands associated with work, such as adhering to a schedule, the stress of performing within a certain timeframe, or being outside of highly structured environment. If the evidence shows that increased demands will likely cause the person’s condition to significantly deteriorate, this can be sufficient to meet the definition.

Our office has assisted hundreds of clients over the years in accessing the treatment and benefits they are entitled to as a result of their mental illness. In one recent case, the client, a young woman, had suffered a head injury and resulting depression. Although she was experiencing significant difficulties in her cognitive functioning, i.e.., thinking, concentrating, memory, and planning, the evidence in the medical record was insufficient to substantiate her limitations.

With the assistance of her doctor we were able to obtain a neuropsychological evaluation which highlighted the areas in which she was experiencing problems. This testing, along with the medical records and reports from her psychiatrist and counselor, was pivotal in winning her case.

If a client is disabled by mental illness, having a stable income and access to medical treatment is the foundation of their recovery. If you or anyone you know is suffering from a disabling mental illness, please have them contact our office at (800) 584-1116 and start the road to recovery.

[1] Disability Evaluation Under Social Security – Adult Listings – Mental Disorders. http://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm