SSDI for mental health?
January 12, 2012 7:30 AM   Subscribe

Please tell me about your experiences with SSDI obtained for mental health reasons.

A few details about me:
-bipolar I, ptsd, panic disorder, agoraphobia, add.
-out of work for over a year due to instability
-several year history of instability & being hospitalized
-currently under the care of a therapist and pdoc
-i do have insurance via my husband, but just have been unable to work

Anything you can tell me about the whole process would be great, including tips on how to ensure success.
posted by anonymous to Health & Fitness (10 answers total) 5 users marked this as a favorite
Not quite SSDI (I am not in the US) but when I applied for ODSP for my husband there was a significant delay between submitting the paperwork and having it approved (9 months for us). I believe this also applies to SSDI. At around the eight month of waiting I called to see if I could do anything to help make his applicant quicker/successful/easier for the caseworker and a very helpful intake worker advised me that judging on the timelines they may consider some of the medical information out of date; obtaining confirmation that his mental health was still negatively affecting his life would most likely delay approval. He advised that since the application would most likely be reviewed soon that I should obtain as much co-orborating information as possible and fax it in to be added to the file so that caseworker would have the historical and contemporary information in one place to make a decision and move on to the next file. I filled out ALL the forms (or directed the Dr's to fill out the forms) in a way that the caseworker would find clear and compelling, I looked at the language of the legislation and used the same words to illustrate clear examples of the impact of his health on his daily activities. This took a long time and a lot of energy as well as my executive experience in dealing with bureaucracy as a civil servant. There is no way my husband could have done it himself successfully. Is there someone with a similar background that can help you with the forms?
posted by saucysault at 8:14 AM on January 12, 2012

I am a lawyer, but I am not your lawyer, and this is not legal advice.

Step one, look for legal service providers for low income people in your area; some of them will do SSI work, some will require that you apply and be rejected before they will help you out. If you can find someone to help you, get a lawyer; it will help a lot. If you don't qualify for low income legal services, look for social security lawyers in your area, again, many will ask you to apply and be rejected first. They are paid out of the payment of back disability payments you get if you qualify, with a cap on the percentage/amount they can make you pay them.

If none of the legal services providers in the area will help you, you have to apply on your own, at least initially. In that case, you'll want to spend some time with this site.

To simplify the process, SSA has to determine that you're eligible for disability (this process is the same for SSI and SSDI, I believe). This process has six steps:

Step One: Are you working? If you're doing "substantial gainful activity" you're not disabled.

Step Two: Is your impairment expected to last more than a year or result in death?

Step Three: SSA keeps what it calls a "List of Impairments." The adult list is found here. If you meet a listed impairment, you are disabled. Of course, SSA goes out of its way to find that people don't meet the impairment, but that's what your shooting for.

Step Four: SSA calculates what it calls your "residual functional capacity"(RFC) this means what work you can do; if you can do work you've done in the past, then you are not disabled.

Step Five: Based on your RFC, age, work experience, and education, SSA decides if you can transition to other work; if you can, you're not disabled.

That's the barebones of how they assess disability. Initially, you'll want to file an application, which can be done online or at an SSA office. You fill out several pieces of paperwork, including an authorization for your doctor to release medical information to SSA. The file is then sent to a local office(the names vary by state) which uses the five step process to determine if you are disabled.

The case manager at the local office will do some of the following things (probably all): call you in for an interview, call your doctor and get medical records, ask you to go to an independent evaluation with a new doctor that SSA hires to evaluate you. Having a good working relationship with your treating doctor and a doctor who is willing to put in a little extra effort can be a big help. Ideally, you want your doctor to opine that you meet a listed impairment. Give your doctor a copy of the listing of impairments and ask them if you meet any of the listed impairments that are relevant for your condition; if you do, the doctor can write a letter to SSA telling them that and include it with their medical records. If they don't think you meet a listed impairment, they can make an assessment of limitations they think you would face in the work place and include that.

All of this is given to your SSA case manager who will make a determination of disability. This will seem like it takes a long time. The odds are that you will be denied. There's an appeals process (that you almost certainly can find a legal aid organization/lawyer to help with).

Feel free to MeFi mail me if you have other questions; I'm not experienced in SSDI cases, but I've done one SSI case (involving mental health issues) and I might be able to answer some questions.
posted by Bulgaroktonos at 8:18 AM on January 12, 2012 [7 favorites]

You seem to be nearly identical in situation to my husband. He applied on his own, and was rejected, and then used a lawyer and was awarded disability. The lawyer's fees came out of the award of back payments. It was really difficult for him to go through the process, and I helped as much as I could - having someone to help you out as you navigate the process would probably be a good thing. It also took a long time, which thankfully we were prepared for or else it would have been very frustrating.
posted by PussKillian at 8:27 AM on January 12, 2012

You sound similar to one of my family members. She applied and was accepted. No need for lawyers. A few years later (after she had gone back to work but continued to accept money from SSDI) she got a letter from them saying, "Hey, we're not going to pay you anymore." She strung that out as long as she could with appeals she could do on her own. At some point, more than a year after that initial letter, they finally cut her off. YMMV.
posted by BlahLaLa at 8:33 AM on January 12, 2012

I think there are people who might be more inclined to answer with their personal experiences if you provide a throw-away e-mail address. (Maybe through the mods?)

Disclaimer: I am a disabled person. I am not your disabled person, and this is not disability advice. You should seek such advice from a qualified disabled person.

1. Everyone gets rejected their first time. Everyone. You contest it and inevitably win the minute a judge sees your appeal. In my case, I won before there was ever any hearing. Because it was just so obvious from the documentation that I was disabled. But you will get rejected. You will.

2. Shorter is better, with regards to what you disclose. You need an evaluation/letter from your psychiatrist -- he or she will know how to write these -- and you need another eval/letter from your therapist. Work with your therapist to construct the narrative you want to put in the hands of the SSA. You tell the truth, but you focus on one or two main illnesses. Talk specifically about things you are unable to do as a result of your illnesses. "I cannot leave the house as a result of" -- and then the framing comes in -- "agoraphobia caused by my PTSD and aggravated by my depression." (If that's what it's caused by.)

3. You'll be called in for an interview with a person at a Social Security office. Be nice to your interviewer, and he or she will probably work with you to ensure your application comes out right. In my case, because of the interviewer, the SSA actually categorized me as disabled from several years before I stopped working, because of the fact that I had so many jobs in a row and wasn't considered "gainfully" employed at any point during those years. You could similarly find your disability backdated. So be completely honest with the interviewer, without oversharing, and you may find they can help you apply for as much as you qualify for.

4. Have documentation about each job you've held, and for how long. This will help for the afore-mentioned interview. Explain how your illnesses caused you to lose jobs/your career.

I had an employer with whom I was on good terms write a letter for me explaining how my illness had interfered with my work, cost me promotions, and ultimately cost me my job. That ended up being unnecessary, but it's always good to have the extra documentation on hand. So letters from family, friends, past employers -- these are good insurance for when your claim is initially denied.

5. You might have to meet with a psychiatrist through the SSA. If so, work with your therapist to discuss how you should interact with this psychiatrist.

6. Have a friend or family member who is good with paperwork help you with this. You may be in a healthy-ish place right now, but should you end up in the hospital with an SSA deadline coming up or so depressed that you can't get out of bed, you may need help.

7. Deciding whether to get a lawyer to help you is one of those things you do once you've already had the SSA interview and have a feeling about how well you're able to communicate about your disability. I didn't get a lawyer, but almost all of the other folks I know who got SSDI did hire an attorney. The lawyer will take a chunk of your initial lump sum payment, so keep that in mind.

8. You might request your prior hospitalization records soon-ish. You may not need them, but again, you want to arm yourself with as much documentation as you can get.

9. Discuss every part of this with your therapist and psychiatrist. Seriously. They will know what works and what doesn't work, and they'll be able to help you navigate this maze.

10. Try not to get discouraged. It's a long process and it's invasive and demeaning and it will probably take at least a year before you're approved. (A lawyer may help speed things up, if you choose to go that route.) But really, just hang in there.
posted by brina at 8:34 AM on January 12, 2012 [4 favorites]

As soon as she found out I was applying for disability, my psychiatrist accused me of lying about my symptoms. I had been getting worse over the course of a year. She asked me how the job hunt was going and I said "Well, I'm trying for disability." Her two immediate statements were "So it's a COINCIDENCE that you're getting worse and you're applying for disability" and "No matter what I give you, you won't come in here and say you're doing any better because it will hurt your chances at disability." She very angrily wrote me a new prescription to max out my antidepressant dose. I had to find a new doctor.

My attorney required me to apply once, and appeal once, before he began to help me. Now it's been.... 8 months? and I'm still waiting for a hearing date. It takes a long time.
posted by Socky McSockersons at 11:33 AM on January 12, 2012

I was on SSDI (as well as SSI) for several years, and since then have watched a few family members and friends also apply. My experience was much smoother than theirs, with fewer frustrations, no lawyers, and nowhere near as much time wasted.

There are a couple of things to keep in mind--and this is really just rephrasing some of those excellent answers above: First, focus on the real disabling condition. One of my relatives has a host of problems--thyroid, some sort of autoimmune thing affecting her energy level, a cyst in her brain--and when she applied for disability, she treated the paperwork and her interviews the way she would treat a conversation with a friend, listing her woes (and true, there were many). Every illness, every symptom, got a mention, making a tangled mess. But I think part of the reason she did this, was feeling like if she didn't show she was sick enough, no one would believe her (because in the real world, that was often true). And it was apparent, as she got more frustrated with the process, that she felt like the denials from SSA were condemnations of her.

However, on the List of Impairments page Bulgaroktonos mentions, check out the anxiety disorder symptoms. Since the SSA isn't a friend, or a person in your community, but rather an organization with checklists and rules, they want to know whether in your case these particular symptoms are resulting in these particular outcomes. That's it. Not to treat them like automatons or anything, but it's a process, and you don't want to distract them with too much of the wrong information, or worse, leave out the really defining symptoms of the central disabling illness because you're giving too much time to the other illnesses.

So, for me, this turned out to be pretty easy because I had one big major thing going on, panic disorder and agoraphobia wiping out my usefulness to the human race. There were things I could do--dress myself, cook food--but plenty I couldn't, like going out to actually buy the food. The other things going on--depression, mainly--stayed in the background (at least in terms of the paperwork).

And you will have interviews with psychologists or psychiatrists, and you may have to do some psychological or cognitive testing. Don't worry about appearing sick enough or not sick enough in these meetings. The first guy I saw for this kind of interview, I broke down in tears because I couldn't remember what the day's date was when he asked, I was so scared of getting it wrong, of him not believing me, all that. The last guy I saw didn't even make eye contact with me, just hastily scribbled stuff down after mechanically asking me questions. Both approved me, even though I was a wreck in one interview and pretty calm (well, as calm as I got back then) in the other. A friend had a disability interview where the doc actually thanked her for not hobbling in on a cane, like most of his disability cases did. In other words, there's really no pressure to make things seem worse in case they somehow miss that you're sick. You've been out of work, you've been to the hospital. That's valid.

And that kind of leads to the other thing to keep in mind, as you go through this, and talk to people about it: None of this is a judgment on you, none of this is someone deciding whether or not you're actually in pain, or are a worthy human being, or anything. This is an application to activate an insurance plan. That's it. I say that, because--and you have probably already encountered this--sometimes people who haven't been through it, raise an eyebrow when they hear you're applying for disability. It's like hitting a very small lottery that everyone begrudges. Keep your focus on the process: You have paid these insurance premiums, and now there is an oddly high amount of paperwork to do to collect on those premiums. No different, in the moral sphere, than trying to get insurance to pay for a wrecked car.

One last thing: When you get better, and return to work, please make sure SSA knows about this, and if you are making enough money that they should stop paying you, pretend that they have stopped paying you, and any further money they send you, don't spend it. This will prevent any overpayment nonsense from happening.
posted by mittens at 5:52 PM on January 12, 2012

Other people have given great answers, my experience is much the same. I am on SSDI right now for MH. It took almost three years from my first application, which Welfare required me to submit. I had to go all the way through a hearing, but the judge was very reasonable. Get help with the application from people who know how to fill it in, and go to a lawyer specializing in disability as soon as you are denied. If you have any anxiety issues, try to be at your worst whenever they interview you, but I never found that a problem. Be brutally honest to them about how bad it is. And don't look for work while you're waiting.

I think of it this way, the first application denial weeds out the scammers, the second denial those who really aren't that sick or desperate. If you jump through all of their hoops, you must have enough wrong with you to be on SSD. (I seem to have some issues here that bring out my nastier sense of humor.)
posted by monopas at 12:57 AM on January 13, 2012

Are you looking for temporary or permanent SSDI? In many states, there is a considerably higher burden of proof for permanent that will require the aid of a lawyer and a physician. For temporary, it may be as simple as printing out the form, taking it to a physician, and returning the form to your county assistance office. I work at a clinic or two in an urban area, and our docs sign a lot of temporary disability forms. MH issues are almost always listed as the primary diagnosis. Once you have the medical side of things worked out, you'll likely need legal or social services help figuring out your eligibility for cash assistance. Good luck to you-- there's a lot of red tape, but sometimes you'll find compassion where you least expect it.
posted by The White Hat at 9:36 PM on January 13, 2012

Erratum: in my state, maybe in yours, some Nurse Practitioners can sign your Employability Assessment form.
posted by The White Hat at 9:38 PM on January 13, 2012

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