Navigating the Disability Process: Persons with Mental Disorders Applying for and Receiving Disability Benefits
Article first published online: 7 MAR 2003
Volume 81, Issue 1, pages 75–106, March 2003
How to Cite
Bilder, S. and Mechanic, D. (2003), Navigating the Disability Process: Persons with Mental Disorders Applying for and Receiving Disability Benefits. Milbank Quarterly, 81: 75–106. doi: 10.1111/1468-0009.00039
- Issue published online: 6 JUN 2003
- Article first published online: 7 MAR 2003
The Social Security Disability benefit programs (SSDI and SSI) constitute an essential safety net for individuals unable to work because of disability. Eligibility for SSDI is based on work history and is viewed as an entitlement for individuals who meet disability criteria. SSI eligibility, however, depends on means testing and, although it is administered as a Social Security program, is seen more as income support for persons with disabilities who have not worked and cannot work. Ideally, such programs seek to provide assistance to those who most need it without encouraging those who can work to leave the workforce or to stop looking for work. The search for balance among meeting need, encouraging work, and containing public expenditures is a source of underlying tension that typifies such safety net programs. Outcomes depend on both the administration of the eligibility process and the processes by which persons and their associates become aware of the disability program, decide to apply, negotiate the application process, and succeed or fail in their attempts.
Persons with mental disorders are less likely to be working and more likely to apply for and receive SSDI and/or SSI benefits than are those without such disorders. Data from the National Health Interview Survey on Disability (NHIS-D) were examined to identify the predictors of SSDI/SSI application and receipt among persons with self-reported mental disorders. Compared with nonapplicants, applicants had higher levels of disability, fewer financial and interpersonal resources, and better access to information about the disability programs. Among applicants, similar factors distinguished recipients from those who did not receive benefits. Navigating the disability process is associated with the extent of impairment, economic and social disadvantage, and linkage to the disability determination process.