Help! My friends mom is at her whit’s end. Her son is 34, bipolar and schizophrenic diagnosis. He has been in a psycisos episode for over a month now. She has been talking to me about how he has been denied SS or disability because he has not been hospitalized 3 times in a year. I have tried to help her, but am hitting a wall!
Does anyone know the laws in CA regarding this? Is there anything we can do? Mom is 72, dad is 75 and they are very worried about passing and leaving him without care.
No direct experience, but indirect knowledge from a paralegal I’ve known for years. There are two Federal programs SSI and SSDI which are administered by Social Security, and SDI which is a California specific program. I can’t speak to SDI, but my understanding is SSI and SSDI are rarely granted at first application. The general advice I’d heard is hiring a lawyer experienced in working with the Social Security Administration is your best path to receiving benefits. Granted, this information comes from a law office, but even with legal help I understand claims often take months or years, not days and weeks to be processed.
It is common for people to be denied social security benefits even when they are legitimate claims of disability because the decision on whether someone is able to work is so difficult to judge in cases of mental illness. There are lawyers who specialize in helping people apply for SSI/SSDI and they are only paid if the claim is won.
I recommend your friends mom read the book, “Planning for the Future providing a meaningful life for a child with a disability after your death” by L. Mark Russell et. al.
The book is a bit outdated, but it offers a detailed description of the Social Security benefit system along with some good advice for setting up a special needs trust. The book features examples of people with developmental disabilities as well as serious mental illness.
I found it very useful in trying to get a handle on this complex topic. It is a primary concern for most parents in this situation.
My son was approved for SSI in California on his second application attempt, without an attorney. I’m not familiar with a hospitalization requirement under SSI. His initial application was early in his illness. The county p-doc saw him once and did not deem him sufficiently disabled (what a farce); this likely was cause for denial. I don’t recall what his p-doc under private insurance at the time submitted.
Two years later I tried again. By then he had been hospitalized four times over the two years. He was no longer being provided services by the county, but had a new p-doc under private insurance. I contacted an attorney and he thought my son had a good case for approval. He thought we didn’t need his help yet and suggested we just reapply. So I asked my son’s p-doc to complete the dr’s questionnaire, confirming the diagnosis of scz. Reading that completed questionnaire just about broke my heart. But the attorney was right; the application was approved.
I suggest checking out the state’s SSDI/SSI website if you haven’t already done so: SSDI/SSI. The local NAMI chapter should have some resources. Also, your friend’s parents might want to just call around to local disability attorney’s offices and try to get an informational appointment. I’ve spoken to three attorneys and a paralegal at different offices with no charge this way. They won’t get a lot of time with them but may get good information to add to their understanding of disability benefits and services. Good luck.
You can appeal when social security is denied. There may be local organization providing free legal help with the social security application/appeal. In my area that organization is called Mental Health Advocates. Hospitalization is not necessary for SS, but having a treatment history helps, if he has not been receiving treatment for his illness, it is more difficult. Check also for a NAMI chapter in your area. They can offer a lot of helpful information on what is available in your area–and perhaps support groups that are helpful. Your friend’s mom should be sure to have herself or someone responsible named as a payee so the SS money does not go directly to her son, but is managed by someone who can make good decisions and see that living expenses are paid.
I would get in to a local Community Health Center. If he isn’t already of California’s version of Medicaid/care, they will have intake resources flooding to them so long as they go in. The local NAMI chapter will have volunteer staff and a resource list for her to contact.
Other parts about making his SSI and SS applicable for chronic disability means he needs a clinical assessment by an OTP (Occupational Physical Therapist) and reports of AOL’s (Activities Of Daily Living) that he can and cannot do. Upon visiting with a counselor and care provider from community services, they will need a further record of any difficulties (finding where he is, leaving the house, going shopping, ect) that he cannot do. Again, it sounds as though he cannot care for himself, she needs to appeal the decision with the information mentioned above.
Ideally, she would be able to get that assessment from Out Patient Services, especially if he is not medicated and refuses medication, it makes the possibility of his benefits award more likely as he is even less functional than his parents help would make him out to be.
At their age, he needs a care trust, which will not affect his ability to receive SSI or SS afterward. The controller (not the actual word but you get the picture) of his funds needs to be designated. If they don’t have family willing or able to do it, he will have one appointed to him by the state. Inheritance absolutely can cut off his SSI and SS, which he sounds like he definitely won’t have the ability to reapply or advocate for, if that happens.
If they cannot access AOT (Assisted Outpatient Treatment) and the help they need, as a last resort, he may need to be admitted via the ER the 3 times the SSI agency is recommending. It sucks but California has the worst intake system, bed availability, and outpatient community services of any state in the U.S. It’s one of the reasons they have such an acute problem with homelessness. In comparison, I’ve heard very good things about support services and care in Wisconsin. Their governor prioritized immediate care because of the high risk of death for the mentally ill in their cold climate. It’s a shame that CA basically allows those who can least advocate for themselves to die slowly in the dessert sun.
Add: His primary care physician can forward a verification of his diagnosis of schizophrenia as well as a referral for assessment and determination of services. This may be completed in a hospital setting but is not the same as an involuntary admittance for psychiatric treatment or services.
Usually, so long as a patient is safe to be by themselves, they live on a unit outside family help and over a period of days or weeks they assess what skills the person can do independently for themselves or what confuses/overwhelms them at any given time. The assessment needs to be made outside the home as it is his best shot at getting full time disability care and welfare checks put in place whether he is ultimately placed in their home or into an assisted living space/community housing option. As a warning, the last option can be pretty rough. It’s not contingent on anyone fulfilling their medication but will keep them in contact with a care team and social workers. Usually, at the point they force medication, it is because someone has delusions or behaviors that can/do endanger or upset other residents, like screaming, banging walls, destroying property, lighting things on fire or accidentally leaving things like a stove or heater on/covered with blankets ect. Worst case scenario, while they will not be put out onto the street, they will be sectioned to something more like a long term nursing facility which has VERY different expectations for care and life/long term goals than a community home or apartment. Although it sounds harsh, if someone refuses medication there is a remediation process to ensure they take their meds AND that it is legal. Separate doctors, legal counsel, and the assessments of uninvolved care takers (aside from their usual counselors/ect) are referred to to absolutely make sure this is both necessary and prudent to maintain a patients best interests when they cannot advocate for themselves. It’s long and stressful but worth it, if this level or care is needed.
Thanks for reaching out for your friend. I hope something from this board has helped you win and reach the appeals process and assessments that it sounds like your friends family needs.