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What Mental Health Disorders Qualify for Disability

Discover what mental health disorders qualify for disability, from diagnosis to benefits eligibility.

steven zauderer
Steven Zauderer
May 13, 2024
8 min read
min read

Mental Disorders and Disability

A key aspect of understanding what mental health disorders qualify for disability is being familiar with the criteria set by the Social Security Administration (SSA) in the United States, as well as the provisions for disability benefits in Canada. Both countries acknowledge mental disorders as disabilities, offering benefits to individuals whose mental health conditions prevent them from maintaining gainful employment.

Social Security Administration Criteria

In the United States, the Social Security Administration (SSA) provides disability benefits through two separate programs: the Social Security Disability Insurance (SSDI) for disabled adult workers who have paid Social Security taxes, and the Supplemental Security Income (SSI), a need-based program for applicants who meet strict limitations on income and asset holdings.

The list of mental disorders that qualify for disability under the SSA is extensive, including neurocognitive disorders, schizophrenia spectrum and other psychotic disorders, depressive, bipolar and related disorders, intellectual disorder, anxiety and obsessive-compulsive disorders, somatic symptom and related disorders, personality and impulse control disorders, autism spectrum disorder, neurodevelopmental disorders, eating disorders, and trauma- and stressor-related disorders.

The basic eligibility requirements set by the SSA include having limited income and resources, as well as having a medically determinable mental impairment that prevents you from working.

Disability Benefits in Canada

Like in the United States, mental illness in Canada is considered a disability. Individuals suffering from mental health disorders, such as severe depression, bipolar disorder, anxiety disorders, and other mental illnesses, can qualify for benefits similar to those with physical ailments or health conditions that affect their ability to work, such as fibromyalgia, ALS, epilepsy, or cancer.

In both countries, the recognition of mental disorders as disabilities that can significantly impact one's ability to work is a significant step forward in addressing the often overlooked implications of mental health disorders. While the specific criteria and benefits may vary, the intent is to provide support to those whose mental health conditions prevent them from maintaining gainful employment.

Mental Health Disorders Eligible for Disability

Understanding what mental health disorders qualify for disability can be crucial for individuals seeking support. According to the Social Security Administration, several disorders are recognized for disability evaluation. Here, we break down these conditions.

Neurocognitive Disorders

Neurocognitive disorders are considered qualifying mental health disorders for disability evaluation under category 12.02. These disorders involve cognitive decline from a previous level of performance in one or more cognitive domains. They may include conditions such as Alzheimer's disease, Traumatic Brain Injury (TBI), and other dementias.

Disorder Category
Neurocognitive Disorders 12.02

Schizophrenia and Psychotic Disorders

Schizophrenia spectrum and other psychotic disorders are considered as qualifying mental health disorders for disability assessment under category 12.03. These disorders are characterized by delusions, hallucinations, disorganized speech, and abnormal psychomotor behavior.

Disorder Category
Schizophrenia and Other Psychotic Disorders 12.03

Depressive and Bipolar Disorders

Depressive, bipolar, and related disorders are among the mental health disorders evaluated for disability under category 12.04. These are characterized by an irritable or depressed mood and a loss of interest or pleasure in almost all activities.

Disorder Category
Depressive and Bipolar Disorders 12.04

Intellectual Disorders

Intellectual disorders are considered qualifying mental health disorders for disability evaluation under category 12.05. These disorders are characterized by significantly below-average general intellectual functioning accompanied by significant deficits in current adaptive functioning.

DisorderCategoryIntellectual Disorders12.05

Autism Spectrum Disorder

Autism spectrum disorder is one of the mental health conditions that qualify for disability determination under category 12.10. This disorder is characterized by qualitative deficits in social interaction, verbal and nonverbal communication skills, and restricted, repetitive patterns of behavior, interests, or activities.

Disorder Category
Intellectual Disorders 12.05

It's important to note that the presence of a disorder alone does not automatically qualify an individual for disability benefits. The severity of the condition, its impact on the individual's ability to function, and the treatment regimen are also taken into account during the evaluation process. Therefore, it's crucial to provide comprehensive medical evidence when applying for disability benefits.

Disability Evaluation Process

The process of evaluating a disability, particularly in the context of mental health disorders, involves several key steps. This process is overseen by the Social Security Administration (SSA) and involves establishing an impairment, submitting evidence, and potentially participating in a consultative examination.

Establishing Impairment

The first step in the disability evaluation process is establishing an impairment. The SSA requires specific medical evidence to establish that a claimant has an impairment. This evidence must be "objective medical evidence" from an "acceptable medical source" to show a medically determinable impairment [4]. This means that the evidence should be based on standardized clinical and laboratory diagnostic techniques and not just on the claimant's statements about their symptoms.

Once the existence of an impairment is established, the SSA considers all evidence from medical and nonmedical sources to assess the extent to which the impairment affects the claimant's ability to function in a work setting or, for children, compared to their peers without impairments.

Evidence Submission

Claimants have an ongoing responsibility to inform the SSA or submit all evidence related to their disability. This evidence needs to be complete and detailed enough for the SSA to determine the claimant's eligibility for disability benefits. The evidence might come from medical sources such as doctors or therapists, but can also come from nonmedical sources.

Nonmedical sources that can provide information on the severity of the claimant's impairment include educational personnel, social welfare agency personnel, family members, caregivers, friends, neighbors, employers, and clergy. This wide range of sources ensures a comprehensive assessment of the claimant's condition.

Consultative Examination

If the evidence provided by the claimant's own medical sources is insufficient to determine disability, the SSA may arrange for a consultative examination (CE) to gather additional medical information. This examination aids in the evaluation of the claimant's disability and provides the SSA with a clearer understanding of the claimant's condition.

The CE can be conducted by the claimant's own medical source or by an independent source. The examination does not involve treatment but focuses solely on gathering detailed medical information to aid in the disability determination process [4].

The disability evaluation process is a key step towards understanding what mental health disorders qualify for disability. It's a thorough and comprehensive process that ensures only those with genuine impairments that limit their ability to function receive the benefits they need.

Disability Benefits and Eligibility

Understanding the eligibility requirements for disability benefits is crucial for individuals with mental health disorders. These requirements vary based on the specific program and country. In the United States, the Social Security Administration (SSA) pays disability benefits through two separate programs: Social Security Disability Insurance (SSDI) for disabled adult workers who have paid Social Security taxes, and Supplemental Security Income (SSI), a need-based program for applicants meeting strict limitations on income and asset holdings.

Eligibility Requirements

Basic eligibility requirements set by the SSA include having limited income and resources, as well as having a medically determinable mental impairment that prevents you from working [1]. To qualify for disability benefits with a mental illness, applicants need to demonstrate difficulty in activities of daily living and continued medication with no improvement for two years or more. It's important to note that applicants should expect yearly reviews of their cases by the SSA to ensure the condition remains the same year-to-year in order to continue receiving disability benefits.

Disability Tax Credit

The Disability Tax Credit (DTC) is a program that aims to offset some costs related to the impairment by reducing the amount of income tax an individual may have to pay. The eligibility for DTC is based on the effects of an impairment rather than a specific diagnosis or medical condition.

To qualify for the DTC, individuals must have a severe and prolonged impairment that significantly restricts their ability to perform mental functions necessary for everyday life. The impairment must affect adaptive functioning and memory all or substantially all of the time, rendering the individual unable to live independently [5].

Understanding the eligibility requirements for these benefits can greatly assist individuals with mental health disorders in navigating the process and securing the necessary support.

Ongoing Disability Reviews

Maintaining disability benefits, particularly for those with mental health disorders, involves regular reviews to ensure continued eligibility. Both the Social Security Administration (SSA) and the individual claimant have responsibilities in this process.

SSA and Disability Benefits

The SSA conducts regular reviews of disability cases to ensure that individuals still meet the criteria for receiving disability benefits. If an individual's condition improves to the point where they're no longer considered disabled, they may lose their eligibility for benefits.

Claimants have an ongoing responsibility to inform the SSA or submit all evidence related to their disability [4]. The evidence must be complete and detailed enough for the SSA to determine their eligibility. This includes documentation from both medical and nonmedical sources.

Once the existence of an impairment is established, the SSA considers all evidence to assess the extent of how the impairment affects the claimant's ability to function in a work setting, or for children, compared to their peers without impairments.

Nonmedical sources that can provide information on the claimant's impairment's severity include educational personnel, social welfare agency personnel, family members, caregivers, friends, neighbors, employers, and clergy.

Annual Case Reviews

For individuals with mental health disorders who are receiving disability benefits, they should expect yearly reviews of their cases by the SSA. These reviews are intended to assess whether the individual's condition remains the same year-to-year.

The goal of these reviews is to ensure that only those who continue to meet the criteria for disability receive benefits. It is therefore crucial that individuals keep their medical records up to date and continue to provide the SSA with all necessary documentation.

In conclusion, ongoing disability reviews are a key part of the process when it comes to receiving benefits for mental health disorders. By understanding what to expect from these reviews, individuals can be better prepared and increase their chances of maintaining their benefits.

Disability Tax Credit (DTC) in Canada

Within the Canadian tax system, there exists an initiative known as the Disability Tax Credit (DTC) to support those with impairments. Unlike other disability benefits, DTC is not limited to specific diagnoses or medical conditions, but rather focuses on the impact of the impairment on an individual's everyday life.

DTC Eligibility Criteria

The Disability Tax Credit (DTC) eligibility is based on the effects of an impairment rather than a specific diagnosis or medical condition. The aim is to offset some costs related to the impairment by reducing the amount of income tax an individual may have to pay [5].

To qualify for the DTC, individuals must have a severe and prolonged impairment that significantly restricts their ability to perform mental functions necessary for everyday life. The impairment must affect adaptive functioning and memory all or substantially all of the time, rendering the individual unable to live independently [5].

The DTC eligibility criteria checklist outlines that individuals must meet all three criteria to qualify for the tax credit. If uncertain about eligibility, individuals can still apply, and the decision will be based on information provided by their medical practitioner.

Impact on Financial Burden

The primary purpose of the DTC is to alleviate some of the financial burden associated with living with an impairment. With the reduction in income tax, individuals with impairments can have more financial flexibility to manage their conditions and maintain their quality of life.

For example, a patient with Type 1 diabetes who has severe and prolonged impairment affecting adaptive functioning and memory, making them unable to live independently, would be eligible for the Disability Tax Credit (DTC). This provision can significantly ease the financial stress associated with managing their condition.

Ultimately, the DTC serves as an essential support system for individuals living with impairments, providing financial relief and acknowledging the additional challenges they face in their everyday lives. By understanding the eligibility criteria and the application process, individuals can take full advantage of the benefits offered by the Disability Tax Credit system.

References

[1]: https://www.mhamd.org/information-and-help/paying-for-care/applying-for-disability-benefits-with-a-mental-illness/

[2]: https://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm

[3]: https://www.firstsession.com/resources/mental-illness-disability-benefits-canada

[4]: https://www.ssa.gov/disability/professionals/bluebook/evidentiary.htm

[5]: https://www.canada.ca/en/revenue-agency/services/tax/individuals/segments/tax-credits-deductions-persons-disabilities/disability-tax-credit/eligible-dtc/mental-functions.html

steven zauderer

CEO of CrossRiverTherapy - a national ABA therapy company based in the USA.

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