We know Social Security Disability Insurance (SSDI) is available to those who have some kind of physical disability that prevents them from working. However, it is unclear to many whether the Social Security Administration (SSA) offers benefits for those who suffer from mental health disabilities.
Social Security Disability Insurance does offer disability benefits for individuals who have a mental health disability that prevents them from working. If you have a mental health condition that limits your ability to perform routine daily tasks and prevents you from working, you may qualify for disability benefits. However, there are some special requirements that such applicants must meet.
Keep reading below as we take you through these requirements.
Can Mental Health be a Disability?
The state of one’s mental health has significant implications for their physical and social well-being. Many disability attorneys report a rise in the number of claims they’re handling on behalf of clients whose mental health has prevented them from working.
Insurance companies frequently reject claims for mental health disabilities because they are more difficult to prove than physical impairments.
Disability payments for mental health disorders are notoriously difficult to obtain, but a dedicated advocate or a knowledgeable SSDI attorney may be able to help. In order to protect their rights and insurance coverage and get the help they need to get better, people who face disabilities due to mental health disorders need competent representation.
What Constitutes a Mental Disability?
The Social Security Administration refers to the Blue Book while deciding whether or not to approve an applicant for disability benefits. The Blue Book’s Section 12 addresses mental illnesses by explaining the criteria for receiving benefits based on the presence or absence of certain mental health conditions.
The Blue Book covers nine distinct types of mental illness. Among these are:
- Affective disorders
- Anxiety Disorders
- Autism and related disorders
- Intellectual disabilities
- Organic Mental Disorders
- Personality disorders
- Schizophrenia, paranoia, and psychotic disorders
- Somatoform disorders
- Substance addiction
Evaluation of a disorder is done using its own unique set of criteria, which are exclusive to that particular type of disorder.
In order to be eligible for SSDI benefits with this condition, you need to be able to establish that you satisfy the criteria, that the combined effect of all of your debilitating ailments is equal to the specified requirements, or that it somehow completely prohibits you from participating in any gainful activity.
You have to be able to demonstrate that you are getting treatment for whatever form of mental health disability you are struggling with and that you are following the prescribed course of action in order to be eligible for benefits.
You should keep up with your treatment even as you apply for Social Security disability benefits. If you believe that your mental health condition will prevent you from being able to maintain full-time employment due to your illness, then you should consider consulting with a disability lawyer or an advocate for people with disabilities.
Reasons Why Your Mental Health Disability Got Denied
Following are some reasons why you may have been denied mental health disability benefits.
You Do Not See a Primary Care Physician on a Regular Basis
Getting “regular treatment” from a doctor is a condition of every insurance plan and disability program, including SSDI. This means that you need to schedule consistent appointments with your primary care physician.
The frequency of appointments is determined by the nature of your mental illness and the course of treatment you are undergoing.
The most important thing for you to do is demonstrate that you want to feel better and that both you and your physician are working towards achieving that goal. Or at least that you have done everything in your power to improve your health and have exhausted all other avenues.
When people talk about getting “regular treatment” from their doctor, they typically mean they are visiting their doctor every other week or once a month. Medication is frequently the most effective form of treatment for mental illness. Therefore, your doctor may recommend that you take it.
In most cases, the medication that is recommended to treat mental illness needs to be closely evaluated and adjusted based on how well the patient responds to the treatment. It’s possible that you’ll have to stop taking a certain drug and begin taking another if it turns out the first one isn’t helping. The essence of this is that you require constant checkups during treatment.
You are putting yourself in jeopardy if you do not visit your primary care physician on a consistent basis, preferably at least once every month. If you have a history of unpredictable and unscheduled visits to the doctor, then you, too, are in a precarious position. The SSA will have valid reasons to reject your claim for benefits.
A Psychiatrist is Not Treating You or Seeing You
Psychiatrists are medical doctors who specialize in diagnosing and treating mental health conditions. If you are claiming to be disabled due to mental illness but have not seen a psychiatrist, this will raise a red flag for the SSA.
Even if you don’t think you require regular visits from a psychiatrist, including one in your treatment plan is a good idea. It is quite possible that your application will be rejected if you have not visited a psychiatrist yet and have no current plans to do so.
Since you aren’t seeing a doctor, the SSA will most likely doubt the severity of your condition.
If your mental health doesn’t get better, the SSA may deny you benefits on the grounds that you haven’t seen a psychiatrist.
The only exception to this rule is if your primary care physician can provide evidence that they are treating your mental disorder to an exceptionally high standard. However, this is incredibly rare.
You are not Pursuing the Recommended Therapy
When it comes to dealing with mental health problems, a holistic approach often works best. Most of the time, this is done with a mix of therapy and medication that is tailored to each person’s needs. Participation in therapy is an important factor that can influence the outcome of your application for mental health disability benefits.
Think of counseling as a helpful resource on your path to better mental health, especially if your medical team has suggested it. Working with a clinical psychologist can lead to improved health and well-being. And what’s better is that it can help your mental health disability claim immensely.
Life is difficult, and we get that making it to therapy appointments isn’t always possible. You may be finding it difficult to attend therapy sessions regularly for a variety of reasons, including but not limited to financial constraints.
We recognize that private psychological treatment can be financially out of reach for some people. In such cases, getting on a waiting list for outpatient services at a nearby hospital or mental health clinic is an option to consider.
Taking part in the prescribed mental health treatment shows that you’re serious about improving your mental health. The SSA will take that into account when deciding whether or not to approve your claim.
Outpatient programs at hospitals and clinics are typically covered by Medicare, so there is no need for you to worry about how you’re going to pay for them.
The Quality Of Medical And Psychological Care You Receive Is Subpar
The SSA can continue to reject your disability claim if you’re receiving inadequate treatment, even if you’re actively seeking it out.
If your healthcare professionals are not adhering to the most effective practices for the treatment of your mental condition, then there is a high chance that Social Security will deny your claim. Receiving care that is below standard is largely out of your hands.
Social Security has its own team of doctors and nurses reviewing your care. These unseen medical experts have extensive training in the current best techniques for dealing with mental illness. They are quite good at showing you where your doctor or therapist is falling short.
If your doctor prescribes medication but fails to closely track your progress and make changes to the prescription drugs, this would be a case of a low level of care. Your mental health cannot improve without close observation.
This could result in your SSDI claim being rejected, despite the fact that you are currently taking the prescription that was prescribed to you.
Your Healthcare Providers Are Not Keeping Records
If the Social Security Administration can’t find evidence of a condition in the patient’s medical records, it does not exist.
Your treatment can be of the highest possible standard and follow the most effective procedures, but if the healthcare providers haven’t recorded it completely in the medical documentation, then in the eyes of the Social Security Administration, you weren’t provided with adequate treatment.
The truth about your current treatment is irrelevant. Your medical records are the only ones that really count. The SSA will ultimately make a determination based on the documents submitted with the claim. You might be receiving the finest medical attention available.
However, the SSA will have no record of such treatment if it is not properly recorded and documented. The likelihood of having your claim denied due to technicalities increases in the absence of “accurate” medical data.
Tips to Get Approved for Mental Health Disability
Following are some tips that can maximize your chances of getting a mental health disability approved.
Seek Out As Much Medical Attention As You Can
Getting the best medical care available for your mental illness is the single most important thing you can do when applying for disability. Don’t put off seeing a doctor any longer. Denial is more likely if you apply but are not currently receiving medical treatment.
This is particularly relevant if you are applying while experiencing mental health issues as opposed to physical ones, for which you can provide evidence of your disability through scans and tests such as magnetic resonance imaging (MRI) and x-rays.
Because the SSA will have to rely on your medical records and the notes that your doctor has written, it is essential that you continue keeping frequent appointments with your healthcare professionals.
Tell your doctor how you’ve been doing since your last appointment, if your symptoms have become worse, and if you’re having any trouble with anything in particular as a result of your mental health problem.
Determine Your “Mental Residual Functional Capacity” (MRFC)
On this form, it will specify the kinds of jobs that you can perform as well as those that you cannot. It won’t take more than an hour of their time and will be extremely beneficial to your case. If you need a copy of the MRFC form, you can contact your regional SSA office.
Stick to Your Treatment Plan
It can be difficult for the Social Security Administration to examine your case if you fail to take your prescriptions as directed. Inform Social Security if you are not able to take your prescription because of financial difficulties.
Look for the Right Providers
If you’re applying for disability benefits on the basis of a mental health disability, the SSA will want to see notes from your therapist or psychiatrist.
Therefore, without the help of a professional psychiatrist, therapist, or counselor, success is quite unlikely. Be prepared to describe any gaps in care you may have had due to things like cost, relocation, or other life events.
Maintain a Log
The subjective nature of mental illnesses makes it difficult to diagnose them accurately. This means that you will have to rely heavily on memories from your own life to prove your point.
Maintaining a record of your symptoms can help you stay on top of things and provide tangible evidence of the toll that your condition is taking on your life.
With everything you need to complete your SSDI application in one place, you can begin without worrying about leaving anything out. Because symptoms of mental health conditions might vary from day to day, keeping a record can be very helpful.
Conclusion
You can get disability benefits based on a mental health illness if you can prove your disability to the SSA. While proving a mental health disability to the SSA can be really difficult, it is not impossible if you make sure to follow the correct protocols.
