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

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Abstract
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. 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. 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. 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.