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Does Schizophrenia Qualify for SSI?

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Types and symptoms of schizophrenia

Schizophrenia is a serious mental disorder in which the affected individual has a mental breakdown and can't differentiate between reality and delusions. People who have schizophrenia who qualify may be approved for disability benefits through the Supplemental Security Income (SSI) program.

Schizophrenia is a serious mental disorder in which the affected individual has a mental breakdown and can’t differentiate between reality and delusions. People who have schizophrenia who qualify may be approved for disability benefits through the Supplemental Security Income (SSI) program.

Schizophrenia is a serious mental disorder in which the affected individual has a mental breakdown and can’t differentiate between reality and delusions. Schizophrenia can cause difficulties in social situations and interfere with an individual’s ability to function personally and professionally and care for their own needs. 

Although schizophrenia can’t be cured, advances in research have progressively offered safer treatments to those affected by this condition. 

Individuals diagnosed with schizophrenia are no more dangerous than the general population. One common misconception is that those who have schizophrenia usually live in hospitals or become homeless. But a majority of people with schizophrenia live alone, with their families, or in group homes unless they have limited resources which would cause them to be homeless or be admitted to hospitals.

Symptoms of schizophrenia typically emerge during early adulthood and should exist for at least six months to be diagnosed. But some signs such as a poor academic record, diminished motivation, and difficult relationships may exist earlier. 

People with this condition may have symptoms such as hallucinations (experiencing events that are not real), delusions (feelings of persecution or paranoia despite evidence to the contrary), and uncoordinated speech (suddenly jumping from one topic to another during a conversation). 

Symptoms also include psychosis (unable to recognize what is real and what is not) and unusual motor behavior (frequent movement for no reason). Many of the symptoms of schizophrenia are treatable, and this may also help reduce the possibility of a recurrence.

Some of the absent positive traits (negative symptoms) associated with schizophrenia include being emotionally unresponsive, unable to find happiness in any activity, and avoiding social interactions. In some cases, it may lead to confusing thoughts and difficulty with logical thinking.

Although the effects of schizophrenia vary from person to person, they are grouped into four main types:

  • Paranoid schizophrenia: In this, the individual may have extreme paranoia, exhibit odd behavior, and their emotional responses may not be equivalent to the situation that they come across. 
  • Catatonic schizophrenia: This causes a complete emotional, physical, and mental shutdown, almost like paralysis. Catatonic schizophrenia could lead to a medical emergency if the condition lasts for a considerable period. 
  • Undifferentiated schizophrenia: The person displays several vague symptoms and may not be able to express themselves adequately. 
  • Schizoaffective disorder: The person becomes delusional and also shows other symptoms of schizophrenia. 

Is schizophrenia included in SSI benefits?

The Social Security Administration (SSA) looks at specific criteria to decide whether someone qualifies for mental or physical disability. As per the SSA, you may be considered for medical benefits if your condition or disability is life-threatening. They review their records to check if your condition matches a disability listed in their “Blue Book,” which is the guide used by the SSA to evaluate all applications.

The schizophrenia spectrum and other psychotic disorders come under Listing 12.03 of the Social Security Disability Evaluation. If you qualify, you may be approved for disability benefits through the Supplemental Security Income (SSI) program.

Do you need to be under medical care to qualify for SSI benefits for schizophrenia?

It’s essential to be under psychiatric care since there’s no established test to diagnose schizophrenia. The American Psychiatric Association recommends being under the care of a qualified psychiatrist. The SSA is more likely to consider the medical opinion of a person who has examined you rather than the opinion of a medical source who has not personally evaluated your condition.

While making a diagnosis, a psychiatrist carries out a comprehensive medical examination to exclude other causes like substance misuse and other neurological and medical conditions that may lead to symptoms that are similar to schizophrenia. This helps treat your disease through an accurate medical plan and also improves your chances of getting approved for benefits.

How do you know if you qualify for SSI benefits for schizophrenia?

To be eligible for disability benefits, you should be able to establish that you:

  • Have delusions or hallucinations
  • Are disorganized or show a catatonic demeanor
  • Repeatedly endure confused thoughts
  • Are emotionally distant and stay away from social interactions

You will also have to give medical proof to support your claim that your symptoms don’t allow you to carry out everyday activities and be employed. If the SSA decides that your symptoms don’t make you eligible for full-time care, but are still grave enough to prevent you from being employed, you may still qualify for disability benefits.

You will need to submit the relevant proof to support your claim. This includes documentary evidence to support the following conditions.

  • You’ll have to submit your medical records that show you have had a psychotic condition for at least two years that has affected your ability to work.
  • You’ll also have to prove that you cannot carry out normal functions in the world without support. In other words, you need to live in a home and are unable to get a job, or you need to be given assisted living arrangements.

In case your medical evidence does not meet what is needed as per Listing 12.03, the SSA also checks your residual functional capacity (RFC). This involves determining if you can do simple tasks given your condition. To qualify as disabled, you should show that you’re unable to do any work that you’ve previously done.

Since schizophrenia is a mental disorder, the SSA will consider your ability to complete cognitive tasks. Since the mental skills of people with schizophrenia are vastly reduced, the RFC in such cases also evaluates the ability to focus on tasks for a prolonged period, the ability to work with others, and the ability to complete work within a given deadline.

If you have schizophrenia and cannot carry out basic mental activities such as focusing and understanding instructions, the SSA will deem you as unable to do any work. But if you’re able to do simple tasks that don’t need much skill or even some physical work that doesn’t call for much interaction with other people, the SSA may decide that you are not disabled.
 

Medically Reviewed on 5/23/2022

References

SOURCES:

American Psychiatric Association: “What is Schizophrenia?”

Cleveland Clinic: “What Are the 4 Types of Schizophrenia and How Do They Affect You?”

Disability Benefits Help: “Schizophrenia and Social Security Disability.”

National Alliance on Mental Illness: “Schizophrenia.”

Social Security: “Code Of Federal Regulations,” “Code Of Federal Regulations: Residual Functional Capacity.”

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