More than 58 million people experience mental illness in the U.S., according to statistics from the National Institute of Mental Health. Some severe conditions appear on the Social Security Administration (SSA) disability illness list and may qualify for benefits. Many individuals may have anxiety or depression that doesn’t interfere with their everyday functioning or ability to work. Others cannot work or properly care for themselves, becoming increasingly more incapacitated due to a mental health disability. How do you get assessed if you think you have a mental disability?
Recognizing the Need: Identifying When a Mental Health Disability Assessment is Appropriate
At what point do you start to identify whether an assessment for a mental health disability is the right next step, and what are the benefits? If you have several signs and symptoms of a mental illness, you should consult a mental health professional first.
- Changes in appetite and sleep
- Sudden, prolonged, and severe mood changes
- Withdrawal from social activities and loss of interest in normally enjoyable activities
- Difficulty with concentration, memory, decision-making, and speech that are out of the ordinary and not due to a medical condition
- Loss of functioning ability
- Heightened or increased sensitivity to sounds, sights, smells, touch
- Lack of desire or initiative to take part in activities
- Disconnection from others, experiencing unreality
- Thinking illogically
- Extreme nervousness, fear, or heightened suspicion of others
- Unusual, odd, uncharacteristic, or peculiar behavior
- Sudden, unexplained changes in work, home, or school — including plummeting performance, relationship difficulties, increased absences
Is Your Disorder on the SSA Disability Illness List?
The next step in identifying when a mental health assessment may be appropriate is determining if your disorder is on the list of SSA disability illnesses. If you plan to apply for benefits, your condition must be on the list for any claim to be considered.
Mental disorders on the SSA disability illness list comprise 11 categories. These include the following disorders:
- Autism spectrum
- Anxiety and obsessive-compulsive
- Eating disorders
- Intellectual
- Neurocognitive
- Neurodevelopmental
- Personality and impulse control
- Schizophrenia spectrum and other psychotic disorders
- Somatic symptoms and related
- Trauma- and stressor-related disorders
The Assessment Process: What to Expect During a Mental Disability Evaluation
Anyone who has applied for mental health disability benefits through the SSA may be required to have a mental health exam or consultative exam (CE). Even if your disability appears on the SSA disability illness list, this does not automatically mean you qualify for benefits. A CE is more likely required if no recent (past 90 days) medical records exist. The SSA will pay for the CE, and they will make the appointment. You may be sent to your doctor or someone else for the exam.
What Kind of Tests Occur with a Mental Health Disability Exam?
This depends on the individual’s mental health issues. A licensed psychiatrist or psychologist usually conducts the CE. There are four primary types of CE for mental health that the SSA uses when evaluating claims on the SSA disability illness list:
- Psychiatric exam — Any past treatments, diagnoses, and hospitalizations in the individual’s mental health history are evaluated during this exam.
- Psychological exam — This test assesses memory, concentration, and cognitive abilities.
- Memory scale exam — During the memory scale test, the doctor evaluates your memory and information recall ability.
- Mental status exam — This exam assesses current mental state, including behavior, mood, and thought processing.
What Else Is Involved in the CE?
The CE may take anywhere between one and four hours to complete. It depends on how complex the person’s mental health disability is and the type of exam the SSA requires for the mental health disability assessment.
The findings of the CE are provided in a narrative form. This includes physical examination and mental health history.
The conclusions reached by the doctor providing the CE must be:
- Per the exam’s objective clinical findings
- The individual’s observed and reported symptoms
- Laboratory studies
- Treatment response
- Other information available, including the individual’s history
Afterward, the doctor conducting the CE has 10 days to submit their report to the agency that initially decides disability applications for the SSA. Then, the SSA’s claims examiner reviews everything in the mental health disability assessment and other parts of the individual’s record to determine if they are disabled and cannot work.
At this point, the claims examiner can decide the case or order more evaluation and testing.
Professional Involvement: The Role of Mental Health Experts in the Assessment
Mental health experts are essential in assessing claims for conditions on the SSA disability illness list. A licensed psychiatrist or psychologist conducts the assessment and provides their opinion. In addition, mental health experts are crucial to receiving the most comprehensive evaluation so that your claim for benefits can be more likely to succeed.
The criteria to meet the threshold for benefit qualification are high. Missing the supporting documentation can hinder your case. Diagnosed with a mild or not incapacitating mental health disorder may preclude you from receiving benefits for conditions otherwise on the SSA disability illness list. Mental health experts know what the SSA requires and are instrumental in providing the necessary documentation, records, reports, and opinions.
- While you can request that your doctor handle the mental health disability assessment, it may not be granted.
- Any inconsistencies in your record cannot be resolved when your treating doctor handles the psychological exam. That’s because the SSA may view your doctor as the potential source.
- However, you can request an independent psychiatrist or psychologist to assess your mental health.
Documentation and Medical Records: Gathering Relevant Information for the Mental Health Disability Assessment
To process a mental health disability claim for conditions on the SSA disability illness list, the SSA requires medical evidence of your disability and its severity. They must gather comprehensive evidence to support your claim that you cannot work before deciding your eligibility.
- Part of the process involves the SSA reviewer or claims examiner requesting your records from the doctors, treatment providers, and hospitals.
- You must sign a release agreeing to this.
- To help ensure there are no delays in releasing your medical and treatment records, it is best to contact your treatment doctors to tell them the SSA request is on the way.
Why Is This Important?
Medical records are cut and dried. While they provide a detailed report of a mental health disability condition, they lack context. On the other hand, the doctors currently treating you can offer an expert opinion about your condition that will potentially be more persuasive than mere medical records for your psychiatric disability assessment.
What If You Haven’t Had Treatment or Don’t Have Medical Records?
You may not have received treatment yet or haven’t recently seen a doctor, psychologist, or psychiatrist about what you suspect is a mental health condition. Your medical records may not show anything about your disability that you believe may qualify on the SSA disability illness list. In this case, the SSA can require you to have a CE as part of your mental health disability assessment.
Seeking Support: Navigating the Path to Diagnosis and Accessing Necessary Resources
While you’re waiting for a determination of your application for SSA disability benefits, remember that the process typically takes between 3-5 months before a decision is reached. If documentation is missing or incomplete, it can mean a much more extended waiting period. If your application is denied and you decide to appeal, the process can take years.
What to Do in the Meantime
While you wait for the decision, be proactive in seeking assistance for your mental illness. Remember that anxiety, depression, bipolar disorder, and other mental health conditions are highly treatable. Once you have a confirmed diagnosis, take advantage of all available support from mental health professionals, prescribed medications and treatments, and support groups. The mental health disability assessment can help you access what you need in immediate and ongoing treatment. But you don’t have to wait to get the professional help you need now.
Ask your loved ones and family members to be supportive at this time. Recognize that this is a stressful period for all concerned, and everyone wants the best for you. Try to remain flexible and optimistic and maintain good self-care.
Our mental health professionals at Restore Mental Health are always available to help you get back to feeling fully capable. We will work with you to help you develop workable and effective strategies for everyday living and be your partner in crafting a wholesome, productive, happy, and fulfilling life. Contact our team to get started.
