Disability determinations for adults with mental disorders: Social Security Administration vs independent judgments

Objectives. Disability determinations made by the Disability Determination Service for Social Security Administration (SSA) disability claims due to mental impairment were compared with the independent judgments of a team of mental health workers. The decisions of the Service and the team's agreement with those decisions were predicted from a set of explanatory variables. Methods. One hundred fifty-eight adult applicants for or beneficiaries of SSA benefit programs participated. The team used SSA disability criteria to judge disability based on in-depth interviews. Results. Team members voted yes, no, or maybe regarding approval for disability. Of the cases approved by the team, 89% were actually allowed by the Disability Determination Service. However, the team could not reach a yes or no decision for almost half of the subjects, contributing to a total agreement with the Service on only 40% of the cases. Conclusions. Sufficient evidence exists to question the reliability of SSA disability determinations for mental disorders. Although the Disability Determination Service decision for mental impairments can be predicted above chance, a direct test of the reliability of such determinations should be conducted, with particular attention to the effect of the quality of the medical information.