Social Security Notes
Geraty, C. Cooper,, III, Developments in Mental Health Law
The Social Security Disability Benefits Reform Act of 1984 made a number of important changes in disability law, including requiring the Social Security Administration (SSA) to promulgate new mental impairment criteria and a new standard of review for termination of disability benefits. P.L. 98-460, 98 Stat. 1794 (1984). For a summary of the Act, see "Social Security Notes" 4 Developments in Mental Health Law 13 (1984). Final mental impairment and standard of review regulations have now been published. These two sets of regulations will affect greatly the millions of Americans who apply for or are receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits by reason of mental impairment.
On August 28, 1985, final regulations providing updated mental disability criteria were published. Listings of Impairments--Mental Disorders, 50 Fed. Reg. 35,038 (1985) (to be codified at 20 C.F.R. [section] 404, subpt. P, App. 1, (hereinafter "Listings"). A copy of the criteria component of the new Listings follows this article. The new Listings are in large part the product of a SSA work group comprising representatives of national mental health professional organizations and SSA personnel. There are substantial changes contained in both the approach to and structure of the regulations.
The major change in approach involves the differing role assumed by clinical signs, symptoms, and laboratory findings (sometimes known as "Part A" criteria), compared to the role assumed by functional limitations criteria (sometimes known as "Part B" criteria). Data pertinent to the former group are used to establish the existence of a medically determinable mental impairment recognized by the Social Security Administration. However, in a departure from past practice, no effort is made to evaluate the severity of an impairment by use of clinical signs or other data from this group. Rather, severity is usually assessed through data documenting the existence of the four Part B functional limitations criteria: activities of daily living; social functioning; concentration, persistence, and pace; and deterioration or decompensation in work or work-like settings. Compared to the old regulations, these four functional criteria are improved, but still not always highly predictive indicators of severity of vocational impairment. For a further explanation of the roles of each of these two groups, see Listings 12.00 (C) 1-4.
A set of secondary changes in approach is also included in the new Listings. First, there is a recognition that the results of a single mental status examination may not adequately describe the clinical condition of persons with chronic mental impairments. Review of a wide range of longitudinal data is necessary to obtain a better picture of the person's abilities and limitations. Listings 12.00 (E).
Second, the ameliorative effect of structured settings on overt symptomatology is discussed. The ability of a person to function outside of such a structured setting must be determined before proper evaluation of that person's work capacity can occur. Listings 12.00 (F).
Finally, attention is given to the complex influence of medication on vocational capacity. While psychotropic medications may attenuate overt symptomatology, they may or may not affect the functional limitations imposed by the underlying mental disorder. Furthermore, any possible negative side effects of medication must be considered in the disability determination.
The structure of the new Listings is much improved, but rather more complex than the old regulations. The number of Listings categories is increased from four to eight, and they are organized in diagnostic groups: Organic Mental Disorders; Schizophrenic, Paranoid and Other Psychotic Disorders; Affective Disorders; Mental Retardation and Autism; Anxiety Related Disorders; Somatoform Disorders; Personality Disorders and Substance Addiction Disorders. …