Disability and Mental Health

Mental health as a whole is one of the most stigmatized areas of medicine and as such comes with its own unique challenges when talking about mental health and disability. Unlike the deficits seen with a stroke or broken leg which are obvious, people with serious mental health conditions may on the surface seem to others as “normal.” However, just because symptoms associated with mental health disorders are not always seen, does not mean that they don’t exist, or seriously interfere with a person’s life.

In fact, sometimes mental health conditions can become so severe that a person’s ability to function is substantially decreased. This may lead to difficulties taking care of activities of daily living, keeping up with demands at work, social isolation, substance use, hospitalization, or even suicide attempt.

Like physical health conditions, mental health conditions also take time to heal. In the same way a person with open heart surgery after a heart attack is instructed to keep stress low, eat healthy, take their medication, get adequate sleep, follow up with their doctor, and not rush back to work… the same principles apply to someone who is struggling with a mental health condition.

How to be proactive

Since “don’t get sick,” “don’t get hurt,” and “don’t get diagnosed with a mental health condition” is not a viable plan there are ways you can be proactive and take charge of your health. Diet, exercise, and regular health check-ups are some of the best ways to prevent both physical and mental health conditions. Your primary care physician can also screen you for symptoms of depression or anxiety with a short questionnaire and refer you for services if indicated. However, sometimes despite our best efforts, the combination of our genetic make-up, environment, and unexpected life events can leave us in a very difficult position.

Many people decide to purchase disability insurance in the event they become disabled. Not all disability insurance plans are created equally, so doing careful research and talking to several experts before making a decision is crucial. Ask questions that are relevant to your situation, personal history, and family history. An important example being, does disability insurance cover mental health related disabilities or just physical disabilities? When it comes to being proactive, it is better to have disability insurance and not need it, then become disabled unexpectedly and not have it. But you also want to be crystal clear with regard to the exact coverage you’re getting. You don’t want to find out in a crisis that your disability insurance doesn’t cover what you thought it did.

What can I do if I need help?

A serious mental illness like schizophrenia, bipolar disorder, major depressive disorder, panic disorder, post-traumatic stress disorder, etc. should be treated as seriously as physical conditions like diabetes, heart disease, cancer, or stroke because all of the above conditions negatively impact a person’s health, cause an immense amount of stress to the individual and their families, and are deserving of alleviation of suffering.

If you are struggling, it may be time to see a professional.

If you don’t know where to start, your primary care doctor is a good place to begin. They are often knowledgeable and should be able to point you in the right direction to facilitate referral and connection to mental health services if indicated.

What happens if I can’t work?

Sometimes mental health diagnoses can become so severe that people are unable to work.

Two programs run by the United States Social Security Administration help many people who have a physical or mental health condition(s).

One such program is Supplemental Security and Income also known as SSI. This is different from Social Security Disability Insurance or SSDI which will be discussed below. SSI is meant for individuals who are disabled and low income. Qualification is determined by current income and assets. Slightly over eight million people in the United Stated received SSI as of September 2018.

The other program is Social Security Disability Insurance or SSDI. This program provides monthly financial assistance to individuals who qualify for either a physical or mental disability. According to an article written by NAMI, a mental health advocacy organization, approximately nine million people received SSDI as of 2013. And 35.2% of SSDI recipients met disability criteria for a mental health condition. Data from the Social Security Administration as of December 2013 revealed the number of individuals afflicted with a mental health condition and were receiving SSDI was over 3.5 million. Diagnoses included mood disorders, autism spectrum disorder, developmental disorders, intellectual disability, and schizophrenia/other psychotic disorders.

The determination of qualification for a disability is not done by a person’s regular primary care physician or psychiatrist. The Social Security Administration has certain criteria that must be met to qualify, and they employ physicians that specialize in disability evaluations to help them make a determination on whether or not a person qualifies for disability.

Myths about disability

Many patients I speak to often say things like, “I don’t want to be on disability because I’ll never get off.” Or “I’m not weak.” Or, “I don’t need help.” Unfortunately the concept of disability is often met with negative connotations, however, temporary disability can help a person take the time they need to heal with the goal of getting back to their previous level of functioning. The overwhelming majority of patients I’ve seen do not want to be on disability long-term. Instead, they want to live happy and productive lives including having social relationships, employment, and a sense of contribution to society.

Disability is not about weakness or shame, it’s meant for the very real situations discussed in this article. It is a means to help those struggling get back on their feet, and is a source of support for those who cannot. There will be a point in everyone’s life where help is needed in some capacity. My hope is that as a society we support those who are courageously asking for help instead of passing judgement and perpetuating stigma.

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