Mental Illness and Social Security Disability Benefits

If you are applying for Social Security disability benefits (SSDI and/or SSI), the Social Security Administration (SSA) does not look favorably on claims for disability related to mental illness, where the claimant has not used psychotropic medication in an effort to control symptoms.

The February 2017, JAMA Intern Med. reported adults 18-85 years old use three classes of medications: (1) antidepressants; (2) anxiolytics, sedatives and hypnotics; and (3) antipsychotics. “16.7% of 242 million U.S. adults reported filling one or more prescriptions for psychiatric drugs; including 12.0% for antidepressants; 8.3% for anxiolytics, sedatives, and hypnotics, and 1.6% for antipsychotics.”

The top 10 psychiatric drugs used by U.S. adults are:

  1. Sertraline hydrochlolride (Zoloft)
  2. Citalopram hydrobromide (Celexa)
  3. Alprazolam (Xanax)
  4. Zolpidem tartrate (Ambien)
  5. Fluoxetine hydrochloride (Prozac)
  6. Trazodone hydrochloride (Desyrel)
  7. Clonazepam (Klonopin)
  8. Lorazepam (Ativan)
  9. Escitalopram oxalate (Lexapro)
  10. Duloxetine hydrochloride (Cymbalta)

Also, keep in mind, if the SSA finds evidence (your medical records) of illicit drug use in combination with the use of prescription medication, the SSA may not award disability benefits. The SSA considers the possibility that illicit drugs interfere with the effectiveness of prescription drugs and therefore, the claimant may be sabotaging their own health. However, the SSA is aware “self-medication” is prevalent related to mental illness.

Furthermore, if a claimant applies for SSDI or SSI due solely to mental illness, but the claimant stays home and raises children, the SSA may not award benefits. The SSA may conclude the claimant can work outside the home, if mentally capable of raising children. Additionally, if the claimant, without difficulty, can take care of a home, clean, cook, take children to and from school, go to children’s sporting events, and assist children with homework, the SSA may also deny the claim.

According to a survey by the National Institute of Mental Health (NIMH), there were 44.7 million adults, or one in six adults in the U.S. with mental illness. This statistic refers to any mental illness (AMI), not just severe mental illness (SMI), which is a smaller number. AMI covers mental, behavioral and/or emotional disorders, which may cause either no impairment, mild, moderate, or severe impairment. SMI also includes mental, behavioral, and/or emotional disorders which significantly limit one or more activities of daily living.

The same survey found that among the 44.7 million adults with AMI, 19.2 million (43.1%) received mental health treatment in the prior year. 48.8% of women received mental health treatment compared to 33.9% of men. The number of young adults (18-25) with AMI who received treatment was 35.1%, compared to adults 26-49, where 43.1% received treatment, and adults 50 and older of whom 46.8% received treatment. (NIH)

The survey found an estimated 10.4 million U.S. adults 18 years or older (4.2% of all U.S. adults) had SMI. Women outnumbered men 5.3% to 3.0%. Of those with SMI, the greatest incidence, 5.9%, were adults 18-25. The incidence of serious mental illness among 26-49 year olds was 5.3%, and in people 50 and older, 2.7%.

The survey defined “mental health treatment” as inpatient treatment/counseling, or outpatient treatment/counseling, or having used prescription medication for problems with emotions, nerves, or mental health. The survey found that 6.7 million (64.8%), of the 10.4 million adults with SMI, received mental health treatment in the prior year. 68.8% of women with SMI received treatment compared to 57.4% of men with SMI. 51.5% of adults 18-25 years with SMI, received treatment compared to 66.1% of adults 26-49 years, and 71.5% of adults 50 and older.

Ironically, the survey did not include people who, for the entire year, did not have a fixed address (e.g., homeless), were on active military duty, or lived in institutional group residences (e.g., correctional facilities, nursing homes, mental institutions, and long-term hospitals).

Additionally, 31.6% of the sample selected did not complete the interview. The survey acknowledged that more people with mental illness than without mental illness may end up in the non-response group.

Claims for SSDI and SSI related to mental illness alone (i.e.e, no physical illness/limitations exist), are very difficult to win, especially if you are under 50 years old. To begin with, the SSA does not want to put “young” (under age 50) people, on benefits. Furthermore, the SSA does not want to put “young” people with mental illness on disability benefits. If the applicant is under 50, has mental illness, and a history of substance abuse, obtaining benefits may be difficult. If the applicant with mental illness is using, an award may be out of the question. Usually, it is not as difficult for people over 50, who have supporting medical records to obtain disability benefits. But, if a person 50 or older with a claim solely for mental illness, has a current addiction issue, obtaining benefits may be impossible.

To increase your chances of obtaining SSDI or SSI when you have a claim for benefits due to mental illness, you should be in regular treatment. Ideally, you should be on medication and in therapy for at least six to twelve months before you decide to apply for SSDI/SSI. After you apply for benefits, your psychiatrist, psychologist, and/or therapist needs to send treatment notes to the SSA when requested. Keep in mind many medical providers’ notes list medications prescribed, and state the patient is “normal,” and “in no acute distress.” Notes with broad/general statements will not help you obtain disability benefits.

Mental illness is not something the SSA can see on an x-ray. The words (statements) of your medical provider are the only medical evidence you have to offer the SSA. The SSA will base more than 90% of its decision on your medical records. The medical records need to state your specific diagnosis, its degree of severity, and how it affects your activities of daily living, especially with respect to work related activities. Most important to your claim, and in fact, essential, is a statement by your medical provider of your limitations caused by your mental illness.

Applying for Social Security disability benefits is not a quick or easy way to obtain money. If you are applying for SSDI and/or SSI related solely to mental illness, do NOT expect to be awarded benefits at the Initial or Reconsideration levels of the application process, unless you have spent a significant amount of time as an inpatient on a psych ward in the prior 12 months, and you do not have a history of substance use. If denied at the Reconsideration level, you may request a hearing with an Administrative Law Judge (ALJ). You could wait another two years for your hearing to be scheduled. At the hearing you will testify under oath in front of an ALJ. When you testify, if you are not found credible, you may not receive benefits.

To increase your chance of obtaining Social Security disability benefits, you may obtain an attorney. I speak with people everyday who are unable to get through a day, or week without symptoms of mental illness getting in the way of real life. Some of these people cannot get out of bed or dress on a daily basis. Others do not have the energy to take care of personal hygiene. Some do not eat on a regular basis. Others cannot stop eating and have morbid obesity. Some have tried to kill themselves. Others threaten to kill family, or unrelated people. Some have been inpatients for mental illness. Others live on the streets. Some have a history of substance abuse and still use. Others have been clean for years.

To find an attorney you can go on the Internet and search “Social Security disability attorney” then add the name of your city. If you want to find a Social Security disability attorney who also has a medical background, which may be advantageous to your claim, search, “nurse-attorney and Social Security disability.” It may also be to your advantage to find an attorney whose practice focuses solely on Social Security disability benefits.

Read about attorneys online. See if there is something on an attorney’s website that “speaks” to you. When you choose an attorney, find out how long the attorney has been handling SSDI/SSI claims. Keep in mind you could be working with the attorney for several years. After speaking to the attorney ask yourself, “Is this attorney someone I will feel comfortable calling? Does the attorney seem to know what s/he is talking about? Did the attorney give me enough time to ask all my questions? Did the attorney take the time to answer all my questions?

An attorney handling a Social Security disability claim may not collect a fee from you until the claim and Fee Agreement are approved by an ALJ. Generally, you must be awarded past due, also known as retroactive benefits in order for an attorney fee to be paid.

An attorney should ensure your claim is timely processed, and the SSA receives and reviews all relevant medical evidence. On the day of your hearing, the judge will expect your file to contain all available medical records related to your claim. The judge will want to hear concise arguments in support of your claim. An attorney whose practice focuses on Social Security disability benefits, and who has been representing claimants for many years in front of SSA ALJ’s is your best bet.