By Martha A. Churchill


Some individuals with mental illness are not aware of their own behaviors and symptoms. The person realizes he or she cannot work, but does not understand exactly why.  This makes it difficult for someone with a mental illness to obtain benefits.  

It's hard for you to prove you are disabled when you don't even realize what your behaviors are, and how you affect others.

Thatís why it is so important for friends, family, and former employers to write letters and reports about you. They notice the things you do or say that donít fit in at the employment scene.  Statements from the people who know you best are important to your Social Security claim.  Observations from your family can carry a lot of weight and make a big difference for the success of your claim.

Your doctor is a key person when you are trying to prove your disability to the Social Security Administration.  A doctorís report carries more weight if your doctor knows you well, and has been treating you for a long time.

A psychiatrist or psychologist is the best type of doctor to write a report about your disability. A family practitioner is okay, but a specialist is better.  Your psychologist, social worker, or psychiatrist should be helping you with your Social Security claim by writing a suitable letter explaining your symptoms and behaviors, in detail.

Anyone who is around you frequently, and knows you well, can write a report or come to your hearing and explain what problems you have interacting with other people. For example, maybe you isolate yourself for hours at a time when you feel stressed, but you donít realize you do this. Your friends or family might notice this. Information of this type is extremely helpful when you are trying to prove that you are disabled due to mental illness.

Some people think that if they have a diagnosis such as "depression" or "schizophrenia," the Social Security Administration will automatically grant benefits. That is not true. You canít get benefits just because you have a label like "schizophrenia." First, you have to prove that your illness is severe enough to stop you from working.

There is a "Catch 22" here. Because of your illness, you have trouble realizing what the problems are that you have in the workplace, and you donít know how to explain it. But if you are too good at writing reports and expressing yourself, the Social Security judge will think that you are capable of getting a job. So, you need other people to talk or write about your difficulties. It isnít pleasant to hear these things about yourself, but it has to be done if you want to receive Social Security benefits or SSI.

As a general rule, for people with psychiatric disabilities, having an attorney or other representative is a must.

There are four main areas of functioning that are considered by the Social Security judge in deciding whether your illness is severe enough to prevent you from working: (a) daily living, (b) social functioning, (c) concentration, and (d) decompensation. (see chart.)

If you have bipolar disorder, major depression, phobias, agoraphobia, Tourette Syndrome, obsessions, compulsions, or panic attacks, you must prove that you have problems in at least two of the four areas of functioning.

If you have somatoform disorder or a personality disorder, Social Security requires you to have serious problems in three of the four areas.



Daily living skills

Activities of daily living include cooking, cleaning, and laundry. It includes getting dressed, brushing your teeth, going to the grocery store, and paying your rent on time. If you need reminders to do those kinds of tasks, or just donít do them, you have "marked restriction of activities of daily living." That is important in proving that your mental illness prevents you from working.


Social functioning

Social functioning means knowing how to say the right thing, and when. Evictions, firings, fear of strangers, and social isolation are important signs that you canít work. Are you unable to start up a conversation? Do you make rude remarks-- or "clam up" and donít speak to others? Can you get along okay with family, neighbors, and the landlord? Can you get things done with a group of people? How do you act with people in authority? Those social skills are necessary to work, no matter what the job.


(c) Concentration, persistence, or pace

If you canít complete tasks in a timely manner, that shows you have a deficiency in your "pace." Lots of people start a project and donít finish it, especially with a hobby. But if you start important projects and never finish them, because your mind wanders, then you have a significant deficiency in concentration and you canít work.


(d) Episodes of deterioration or decompensation

Decompensation means that you withdraw from the situation when you feel stress, or perhaps you "blow up" all of a sudden when things arenít going right. Do you go into a tailspin sometimes, and lose your cool?  Does this happen even when you are trying to be on your best behavior?  Any exacerbation of your signs and symptoms is an "episode" that keeps you from working.  Having episodes like that, repeatedly, is a sure sign that you canít function at work.

For schizophrenia, the criteria is a little bit more complicated. Delusions, hallucinations, or illogical thinking could help prove you canít work. Emotional withdrawal could be a factor. If you have problems in two of the four areas, that could show disability. Or, you could show that you canít function outside a highly supportive living situation, and that itís been that way for at least two years.

Conclusion: To prove that you are disabled, the Social Security office needs to know all about your behavior as it relates to the four areas of functioning. Your doctor has to write a letter or report that explains whatever problems you are having in these areas. The doctor has to give specific examples, and go into detail. Show your doctor this chart about the Four Areas of Functioning. Make sure he or she has written a report that discusses your problems in a way that will be understood at the Social Security office.

For a look at the complete Social Security rules for mental illness, check the "Listing."  This listing has a wide variety of mental conditions covered, including personality disorders, mental retardation, and panic attacks.  For your convenience, I have added a few comments in brackets [like this] to help you navigate.  The first half of this listing is an essay on mental illness generally, and the second half is a list of mental illnesses with a description, by the number.  Click on  "Listing."    

Martha A. Churchillhas prepared summaries of some actual law cases which deal with "Activities of daily living."