Already a Patient? Call 212-476-0905

Table of Contents

Does Mental Illness Qualify as a Disability? Here’s What to Know

Keeping your mental health in shape can be tough and often requires an investment of time and money, whether it’s virtual or in-person therapy, implementing extra self-care, medication, or home care services. But did you know that if you struggle with a mental illness (like 1 in 5 Americans), you may qualify for disability benefits? 

If your mental health disorder and its symptoms meet certain qualifications, you might qualify as disabled according to the Social Security Administration (SSA). Read on to find out whether you qualify for a weekly cash benefit.

Key Takeaways

  • If you suffer from a mental health condition that affects your quality of daily living, have medical evidence of your symptoms and their impact on your ability to function in major life activities, and/or your disorder has persisted for at least two years, you may qualify for disability benefits.
  • A list of the qualifying criteria for each mental disorder can be found in the Social Security Administration (SSA)’s online “Blue Book.”
  • In New York, your weekly cash disability benefit will be equivalent to your average weekly wage for the past eight weeks with a maximum of $170 per week.

Apply for CDPAP or HHA today

Mental Illness and Disability Benefits

The Social Security Administration (SSA) generally defines a disability as any condition preventing a person from engaging in “any substantial gainful activity” and which is either (a) expected to result in death or (b) expected to last for a continuous period of twelve months or more (or already has).

The SSA’s “Blue Book” outlines how disabilities are evaluated and which may qualify you for disability benefits, and Section 12 zeroes in on mental conditions. The Blue Book’s listing of potential qualifying conditions is broken down into the following categories:

  • Neurocognitive disorders
  • Schizophrenia spectrum and other psychotic disorders
  • Depressive, bipolar, and related disorders
  • Intellectual disorders
  • Anxiety and obsessive-compulsive disorders
  • Somatic symptom and related disorders
  • Personality disorders and impulse-control disorders
  • Autism spectrum disorder
  • Neurodevelopmental disorders
  • Eating disorders
  • Trauma and stressor-related disorders

Determining If You Qualify for Disability Benefits

If you are living with one of the disorders mentioned in the Blue Book, you may qualify for disability benefits, but you do not qualify automatically. 

In order to qualify for disability, you must provide evidence that you meet certain medical requirements pertaining to your specific disorder (i.e., for generalized anxiety disorder, you must have medical documentation that you’ve experienced three or more of the following symptoms):

  • Restlessness
  • Easily fatigued
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance

In addition to meeting these medical criteria, you must also meet criteria that determine how your disability affects or limits your mental functioning. You must be “extremely limited” in one or experience “marked limitation” of two of the following categories: 

  • The ability to understand, remember, or apply information
  • The ability to interact with others
  • The ability to concentrate, persist, or maintain pace
  • The ability to adapt or manage oneself

If you meet the medical criteria but not the functional criteria for your disorder, you may still qualify for disability benefits. In this case, you must have medically documented evidence that your disorder is “serious and persistent,” meaning that it has lasted for at least two years, required consistent structured medical attention/therapy, and you have achieved only “marginal adjustment” (i.e., adapting to changes in your environment or increased demands would lead to the exacerbation of your symptoms/the deterioration of your daily functioning abilities).

Criteria for Mental Illness as a Disability

Below are the medical criteria that you must meet in order to qualify for disability benefits as it pertains to each type of disorder listed in the SSA’s Blue Book. (In addition, you must meet the aforementioned functional criteria OR have evidence that your disorder qualifies as “serious and persistent.”)

Neurocognitive Disorders

  • Significant cognitive decline from a prior functioning level in one or more of the following areas:
    • Complex attention
    • Executive function
    • Learning and memory
    • Language
    • Perceptual-motor
    • Social-cognition

Schizophrenia Spectrum and Other Psychotic Disorders

  • One or more of the following:
    • Delusions or hallucinations
    • Disorganized thinking (speech)
    • Grossly disorganized behavior or catatonia

Depressive, Bipolar, and Related Disorders

  • Depressive disorder, characterized by five of more of the following:
    • Depressed mood
    • Diminished interest in almost all activities
    • Appetite disturbance with a change in weight
    • Sleep disturbance
    • Observable psychomotor agitation or retardation
    • Decreased energy
    • Feelings of guilt or worthlessness
    • Difficulty concentrating or thinking
    • Thoughts of death or suicide
  • Bipolar disorder, characterized by three or more of the following:
    • Pressured speech
    • Flight of ideas
    • Inflated self-esteem
    • Decreased need for sleep
    • Distractibility
    • Involvement in activities that have a high probability of painful consequences that are not recognized
    • Increase in goal-directed activity or psychomotor agitation

Intellectual Disabilities

  • This category has unique requirements and does not require the meeting of functional criteria or “serious and persistent” criteria to qualify
  • Satisfied by:
    • Cognitive inability to function at a level required to participate in standardized testing; AND
    • Dependence upon others for personal needs (i.e., using the bathroom, eating, dressing, or bathing); AND
    • Evidence that the disorder began prior to age 22.
  • OR satisfied by:
    • Significantly subaverage general intellectual functioning evidenced by:
      • An IQ score of 70 or below on a standardized IQ test; OR
      • An IQ score of 71-75 accompanied by a verbal or performance IQ score (or comparable part score) of 70 or below on a standardized IQ test; AND
    • Significant deficits in adaptive functioning currently manifested by extreme limitation of one, or marked limitation of two, of the following areas:
      • Understanding, remembering, or applying information;
      • Interacting with others;
      • Concentrating, persisting, or maintaining pace;
      • Adapting or managing oneself; AND
    • Evidence that the disorder began prior to age 22.

Anxiety and Obsessive-Compulsive Disorders

  • Anxiety disorder, categorized by three or more of the following:
    • Restlessness
    • Easily fatigued
    • DIfficulty concentrating
    • Irritability
    • Muscle tension
    • Sleep disturbance
  • Panic disorder or agoraphobia, characterized by one or both of the following:
    • Panic attacks followed by persistent concern or worry about additional panic attacks and their consequences.
    • Disproportionate fear or anxiety about at least two different situations (i.e., using public transportation, being in a crowd or line, leaving your home, open spaces).
  • Obsessive-compulsive disorder, characterized by one or both of the following:
    • Involuntary, time-consuming occupation with intrusive, unwanted thoughts.
    • Repetitive behaviors aimed at reducing anxiety.

Somatic and Symptom-Related Disorders

  • Medical documentation of one or more of the following:
    • Symptoms of altered voluntary motor or sensory function that are not better explained by another medical or mental disorder;
    • One or more somatic symptoms that are distressing with excessive thoughts, feelings, or behaviors related to the symptoms;
    • Preoccupation with having or acquiring a serious illness without significant symptoms present.
  • Must meet functional criteria as well.

Personality and Impulse-Control Disorders

  • Medical documentation of a pervasive pattern of one or more of the following:
    • Distrust and suspiciousness of others
    • Detachment from social relationships
    • Disregard for and violation of the rights of others
    • Instability of interpersonal relationships
    • Excessive emotionality and attention-seeking
    • Feelings of inadequacy
    • Excessive need to be taken care of
    • Preoccupation with perfectionism and orderliness
    • Recurrent, impulsive, aggressive  behavioral outbursts
  • Must meet functional criteria as well.

Autism Spectrum Disorder

  • Medical documentation of both of the following:
    • Qualitative deficits in verbal communication, nonverbal communication, and social interaction;
    • Significantly restricted, repetitive patterns of behavior, interests, or activities.
  • Must meet functional criteria as well.

Neurodevelopmental Disorders

  • Medical documentation of one or both of the following:
    • Frequent distractibility, difficulty sustaining attention, and difficulty organizing tasks;
    • Hyperactive and impulsive behavior (i.e., difficulty remaining seated, talking excessively, difficulty waiting, appearing restless, behaving as if being “driven by a motor”);
  • OR medical documentation of significant difficulties learning and using academic skills;
  • OR medical documentation of recurrent motor movement or vocalization;
  • Must meet functional criteria as well.

Eating Disorders

  • Medical documentation of a persistent alteration of eating or eating-related behavior that results in a change in consumption or absorption of food and that significantly impairs physical or psychological health.
  • Must meet functional criteria as well.

Trauma and Stressor-Related Disorders

  • Medical documentation of all of the following:
    • Exposure to actual or threatened death, serious injury, or violence;
    • Subsequent involuntary re-experiencing of the traumatic event (i.e., intrusive memories, dreams, or flashbacks);
    • Avoidance of external reminders of the event;
    • Disturbance in mood and behavior;
    • Increases in arousal and reactivity (i.e., exaggerated startle response, sleep disturbance).

How Much Does Mental Health Disability Pay?

In New York, Social Security disability benefits are cash benefits equal to 50 percent of the employees average weekly wage for the past eight weeks, with a maximum of $170 per week. 

If counting the last week in which the disability began affecting the individual’s ability to work brings down the benefit rate, that week will not be included when determining the average. 

There is a seven day waiting period, meaning you’ll be paid starting on your eighth day of disability. You may receive disability benefits for up to 26 weeks during any consecutive 52-week period (if you have received less than 26 weeks of disability pay, are still disabled, and have not received a Notice of Rejection, you should submit further medical evidence to request additional benefits). 

You may not receive disability benefits at the same time as Paid Family Leave, and the total combined time that you receive Paid Family Leave and disability benefits within a consecutive 52-week period is also 26 weeks. Disability benefits provided by your employer or insurance carrier are also subject to Social Security and Medicare taxes.

Written by
Updated on
Read time
5 min
Share with a friend

What Others Are Reading…

5Min. Read
Medicaid is a public insurance program in New York that was created in 1965 to provide health coverage to…
1Min. Read
When it comes to finding a quality gastroenterologist, New York City is home to some of the…
3Min. Read
If you’re looking for a top-notch OBGYN in the New York City area and need one who…
5Min. Read
As a New Yorker, you know just how difficult it can be to find quality healthcare that…
5Min. Read
Are you looking for a top-rated NYC dermatologist who accepts Medicaid? We’ve compiled a list of five…
5Min. Read
If you live in New York City and are looking for an optometrist who accepts Medicaid, you’ve…
5Min. Read
Need a neurologist in New York City? Our guide lists seven top-rated NYC Medicaid neurologists so you…
5Min. Read
Finding a highly-rated dentist in NYC who accepts Medicaid can be tricky but not impossible. In this…
5Min. Read
Up to 26% of American adults are living with some type of disability, yet many are unaware…
5Min. Read
The Common Benefit Identification Card (CBIC) or “Medicaid card” is a crucial tool for those covered by…