When it comes to disability, people often forget that mental health conditions (like PTSD, depression, or schizophrenia) may also qualify you for benefits. This is because when a chronic brain disorder hampers one’s capacity to function, it’s also practically impossible to work. Especially when just getting through the day feels difficult.
It’s important to note that individuals possessing severe mental disorders may be eligible for Social Security Disability Insurance (SSDI). Low-income individuals may also qualify for Supplemental Security Income (SSI) programs. However, one must meet the specific criteria outlined by the Social Security Administration (SSA) in order to receive benefits.
Schizophrenia — a mental disorder characterized by hallucinations and delusions making it difficult to recognize reality — is one SSDI/SSI covered condition. Schizophrenics may have a hard time caring for themselves and struggle socially. Accompanying an official diagnosis of schizophrenia, it’s possible to qualify for disability benefits. But what does that take? Read on.
What Are the Characteristics of Schizophrenia?
According to the National Institutes of Mental Health (NIMH), Schizophrenia is a mental disorder characterized by disruptions in thought processes. This includes perceptions, emotional responsiveness, and social interactions.
The way schizophrenia presents varies from person to person, but common symptoms include experiencing hallucinations and delusions. It may also show up as motor and cognitive impairment, social isolation and abnormal ways of thinking and acting. Schizophrenia usually develops in young adulthood — commonly late teens/early twenties for men and late twenties/early thirties for women. It can be treated with medication and therapy, but it can still be hugely disruptive to an affected individual’s life.
A qualified psychiatrist can effectively diagnose the condition, and a positive diagnosis will be necessary if seeking disability benefits. But that’s just the first step.
Related: Does Schizoaffective Disorder Qualify for SSD Benefits?
How Do You Qualify for Disability Benefits for Schizophrenia?
The NIMH estimates that schizophrenia is one of the top 15 causes of disability worldwide. But just because you’re diagnosed with it doesn’t mean you automatically qualify for disability.
Like with other disability claims, you’ll have to show that your condition has prevented you from working for 12 months. In addition to that, you’ll have to prove you meet the SSA’s definition of schizophrenia.
When filing for disability benefits, an individual with schizophrenia must meet the “listed impairment” found in the SSA’s “Blue Book.” This “listing of impairments” considers certain conditions especially serious. Schizophrenia falls into this category.
If an individual “equals” the SSA criteria for schizophrenia, they will automatically qualify for disability benefits. This is all outlined in the SSA’s Blue Book section 12.03.
What You Have to Show to Prove Medical Disability for Schizophrenia
Even if you’ve been diagnosed, keep in mind that qualifying for medical disability isn’t easy. To make things clearer, here is what you’ll have to prove at minimum:
1. Medical Documentation of Acute Symptoms
To begin with, your medical records will need to show that you suffer from at least one of these:
- Hallucinations or delusions
- Illogical or incoherent thoughts or speech patterns
- Catatonic (meaning rigid muscles or unresponsive physicality) or seriously disorganized behavior
To determine if you meet this first step, the SSA will examine medical records, medications, and notes from therapy sessions. Those who satisfy the SSA’s tests will then also need to show additional info in one of the next two categories.
2. Limited Mental Functioning
A diagnosis of schizophrenia is not enough. The SSA will want to see how this disorder affects your mental functioning and abilities. Disability applicants must also show an extreme limitation of one or marked limitation of two of the following:
- Learning, understanding, remembering, using, or applying information
- Interacting, cooperating, conversing, handling conflicts, or otherwise sustaining social relationships with others
- Concentrating or focusing on a task, or maintaining a routine, reasonable pace, or schedule
- Adapting (like regulating emotions or negotiating changes) or managing oneself (like handling everyday chores and self-care)
Keep in mind it can be tricky trying to prove these limitations since the terms “extreme” and “marked” are subjective. As a result, applicants should absolutely make sure they have medical and possibly legal representatives in place. It’s important to have experts who can back up claims about your condition.
3. Your Schizophrenia is Serious and Persistent
In lieu of presenting evidence to satisfy the “limited mental functioning” criteria, applicants could opt to show they’re consistently symptomatic. In other words, their schizophrenia is “serious and persistent.”
To satisfy this test, you must have a medically documented history showing your schizophrenia has been present for two years. Additionally, there must be evidence of both:
- Consistent medical treatment, psychosocial support, therapy, or a highly structured setting that diminishes your symptoms.
- Minimal ability to adjust to changes in your environment or responsibilities that are not already present in your life.
Most applicants who qualify will show evidence of “limited mental functioning” as well if they fall in this category. However, it may be easier for some severe applicants to concretely satisfy the SSA’s criteria within this category. That’s because it’s clear if an applicant requires a lot of help to remain functional. The SSA will look for social workers, support groups, family members, and/or group homes as evidence of need for assistance.
Qualifying for Disability Without Meeting the “Listed Impairment” for Schizophrenia
If your medical records don’t automatically qualify you for disability benefits, there is another option you can try. That avenue requires showing that your symptoms prevent you from keeping consistent full-time employment.
This is also not easy to prove, but it is possible. The SSA will want to know all the ways your symptoms affect your activities of daily living (ADLs). The premise being that if you have a symptom that’s unmanageable at home, it’s also probably unmanageable at work too.
For example, let’s say you are skipping taking showers at home because you keep hearing voices in the bathroom. The SSA could then probably project that you also might hear voices in different communal restrooms at work. So, this ADL limitation might affect your ability to keep a job.
It’s a little more complicated than that, but basically the SSA will examine all your compromised ADLs. Then they’ll assess any activities you can feasibly do. This is your residual functional capacity (RFC). The SSA will weigh the limitations your schizophrenia symptoms place on your RFC versus potential jobs. If limits on your RFC are high, the SSA may decide there are no jobs you can potentially hold. In that case, they’ll award you benefits after all.
Continuing Disability Reviews with Schizophrenia
Even if you are successful in your disability claim for schizophrenia, you should expect regular Continuing Disability Reviews (CDRs). This is because the disorder responds well to antipsychotic drugs and the onset is typically during early adulthood. As a result, many affected individuals may eventually be able to return to work at some point after treatment.
It’s also important to note that if you’re prescribed medications and you don’t take them, then you could lose your disability benefits. But if your condition improves with medication, the SSA might also remove you from disabled status. This seems like a catch-22, but really, it’s not. It’s meant to prevent abuse of the system. However, you want to make sure you’re not pushed to return to the work force before you’re ready.
All of this to say that managing disability with schizophrenia can be a process. So, it is important to have a solid medical team and a skilled Social Security disability lawyer in your corner.
You want to make sure you get not only the help you need, but also the benefits.
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Kimberly Dawn Neumann is a multi-published NYC-based magazine and book writer whose work has appeared in a wide variety of publications ranging from Forbes to Cosmopolitan. She graduated summa cum laude from the University of Maryland, College of Journalism. For more, visit: www.KDNeumann.com, Instagram @dancerscribe, and Twitter/X @KimberlyNeumann.