Agency Needs to Hear from You Now
November 1, 2010-- The Social Security Administration (SSA) has proposed changes to the way decisions are made for awarding disability benefits based on a mental impairment. These changes will threaten the ability of people with serious mental illnesses to obtain benefits.
SSA will not revise these proposed changes unless it hears a large outcry from consumers, providers and experts on mental health and disability. The deadline for comments is November 17th.
The changes appear in a regulation that would amend the “Medical Listings” —the standards that SSA uses to determine eligibility for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits. While the proposed new Listings include some very good features, these are undermined by a provision that could limit the number of people with mental illnesses who can qualify to only one or two percent of the nation’s population. This is far below even the most conservative estimate of the number whose mental health disability makes them unable to work (the criterion for eligibility for federal disability benefits) and who therefore need this monthly income.
To qualify under the proposed Listings, individuals must have more than one “marked” impairment in functioning or one “extreme” functional limitation. (A list of functions is provided in the Listings. It includes such things as the ability to get along with co-workers and others, the ability to maintain concentration, persistence and pace, and the ability to understand, remember and apply information). These standards are similar to current rules and pose no problem. The trouble lies in the process disability examiners would use in deciding how an individual meets them.
What’s Bad About the Proposed Listings
The specific problem with the proposed Listings, for both children and adults, is a reference to standardized test results and the scores a person must have on those tests in order to meet the new standard. The definitions of the minimum scores are arbitrary and exclusionary.
First, there are no suitable tests that validly measure ability to work, nor is there any research showing a link between the tests of mental functioning that do exist and the ability to work that needs to be measured for the SSA process. Nonetheless, SSA would encourage its disability examiners to use “standardized tests.”
If a test is used, under the proposed rule an individual’s score must be two standard deviations below the mean for the level of functioning to be considered “marked,” and it must be three standard deviations below the mean for the level of functioning to be considered “extreme.” So in addition to encouraging the use of tests that cannot measure what needs to be measured, SSA has created a stringent— and flawed— standard in terms of the score required to qualify. This change would drastically reduce the number of children and adults with serious mental disorders who qualify for disability benefits.
What’s Good in the Proposed Rule
Aspects of the new rule that are positive include the following:
- A shift away from reliance on a specific diagnosis, creating instead a functional focus. This would bring the Listings in line with scientific thinking that diagnosis is less a determining factor in a person’s ability to work than level of functioning.
- The proposed Listings still include a description of the signs and symptoms of the various categories of mental illness, as guidance to disability examiners. These descriptions are appropriate and helpful.
- There are some modifications to the functioning that is measured and these would align well with a later step in the disability determination process, which measures “Residual Functional Capacity” (RFC).
- The proposed Listings suggest (while not requiring) that disability examiners use a five-point scale in assessing whether someone’s impairment results in a “marked” or “extreme” limitation in function. Until now, examiners have had no way to anchor this. The change would be helpful in making assessments more uniform.
- The proposed Listings recognize that reaction to the stress of work is relevant and that this may differ from one person to another. They also include a focus on how someone’s functioning varies over time, a longitudinal approach that is helpful.
However, these positive aspects are outweighed by the detrimental impact of the proposed testing.
SSA needs to hear about the problem now from advocates, consumers and experts.
What You Can Do
Please ask SSA to revise its proposed mental impairment Listings —and please circulate this alert widely. The deadline for comments is November 17.
You should make the following points in your messge to SSA:
- The proposed use of standardized tests to measure the functioning of people with serious mental illnesses is a flawed approach, with no scientific basis.
- SSA should drop all reference to standardized tests in the mental illness sections of the proposed Mental Impairment Listings, especially the requirements for people to score so low on such tests in order to qualify for benefits.
- Under the proposed rule, every year thousands of people who cannot work would be unable to qualify for federal disability benefits.
When you submit your comments, refer to Docket No. SSA-2007-0101 so your comments are connected to this particular regulation.
To send your message , use one of these methods:
- Internet—go to http://www.regulations.gov and search for docket number SSA-2007-0101 and follow directions.
- Fax to 410/966-2830
- Mail to Office of Regulations, Social Security Administration, 137 Altmeyer Bldg., 6401 Security Boulevard, Baltimore, MD 21235-6401.
To read SSA’s proposed changes, download http://edocket.access.gpo.gov/2010/pdf/2010-20247.pdf.