One New England state is not like the others when it comes to the percentage of their populations receiving benefits through the Social Security Disability Insurance (SSDI) program for mental disorders in 2015.
Maine led the nation with 3.4 percent of its 18- to 65-year-olds receiving SSDI benefits because of a mental disorder diagnosis, such as for developmental and mood disorders or schizophrenia.
New Hampshire ranked second with 3.2 percent, Rhode Island was third at 3.0 percent and Vermont fourth at 2.9 percent. Massachusetts ranked eighth with 2.64 percent. Connecticut ranked 26th with 1.83 percent. That’s still slightly above the national average of 1.76 percent.
“Connecticut looks more like the rest of the country than the other New England states,” states the report by economist Jonathan Schwabish, senior fellow in the Income and Benefits Policy Center at the Urban Institute in Washington, D.C.
The report released in June analyzed data from the Social Security Administration, U.S. Census Bureau, and other sources.
Mental disorders represent the largest and one of the fastest growing reasons for receiving SSDI benefits. More than 12 million people receive these benefits, including 8.9 million workers with disabilities and 3.1 million family members. That represents a 59 percent increase since 2000.
Since 2001, New Hampshire, Vermont, Maine and Rhode Island have respectively ranked first (1.78), second (1.45), third (1.35) and fourth (1.20) in percentage point growth in SSDI recipiency rate for mental disorders.
By comparison, the recipiency rate for mental disorders grew 0.54 percentage points nationally during this period.
Schwabish said he wanted to explore how economics, demographics, policy, health and access to the health care system might influence SSDI participation.
The SSDI recipiency rate for all diseases in 2015 in five New England states was slightly higher than the national average of 5.06 percent, but Connecticut was the only state in the region with a rate below that at 4.19 percent.
Schwabish found states with higher rates of poverty and lower levels of educational achievement in their populations – such as some in the South and Appalachia – had higher rates of benefit receipt for common physical disabilities involving the musculoskeletal, nervous and circulatory systems.
There was also a correlation with aging as states with higher median ages like Maine, Vermont and West Virginia having higher recipiency rates than younger states like Alaska, California, Texas and Utah.
Maine ranks fifth in the nation for SSDI benefits for musculoskeletal diseases, fourth for diseases of the nervous system and 15th for circulatory diseases.
But the pattern changes with mental disorders. Schwabish’s deep data dive found positive correlations between the number of psychiatrists in a state and its SSDI participation.
There were also positive correlations for drug overdose deaths, treatment admissions for opiate use, oxycodone use, health insurance rates and people reporting “fair” or “poor” health.
He found no strong correlations between SSDI participation and unemployment or median household income in 2015. The unemployment rate that year in Maine, Massachusetts, New Hampshire and Vermont was below the national average of 5.3 percent but slightly higher in Connecticut and Rhode Island.
In contrast, a 2012 Social Security Administration report found a negative relationship between a state’s unemployment rate and the rate at which disability applications are allowed during the initial step of SSDI eligibility determination.
The report by Kalman Rupp, a senior economist with the Division of Policy Evaluation, Office of Research, Evaluation, and Statistics in the administration’s Office of Retirement and Disability Policy, found an increase in the unemployment rate was strongly associated with a decrease in the initial allowances for both adults and SSI children with a mental diagnosis.
That could be a reflection of the increased volume of applicants: As the unemployment rate increases, more people apply for disability benefits.
New Hampshire, Connecticut, Massachusetts and Vermont had household incomes higher than the national median of $56,516 in 2015. New Hampshire had the nation’s highest at $75,675.
Schwabish said the different portrait of Connecticut that emerges compared to the rest of New England was beyond the scope of his study.
“I’m not sure what’s going on in Connecticut,” Schwabish wrote via email. “I wonder whether it’s proximity to New York (City) and the commuter population in those areas is masking some other populations?”
But the question is worth exploring, he said. Schwabish said the next set of research he would like to do is to examine patterns by state and gender and age as well as patterns in different diagnoses groups.
“It would also be interesting to look at people with multiple impairments, but I think that’s a somewhat separate line of research,” he added.
Connecticut Psychological Association Director of Professional Affairs Traci Cipriano J.D, Ph.D., said the Urban Institute report raised the possibility that Connecticut’s history of providing quality public mental health services has allowed more people to participate in the workforce.
She also suggested that relatively high income levels in some parts of Connecticut may allow families to financially support a family member who would otherwise qualify for SSDI.
To qualify for SSDI benefits, a person must document having a “substantial” impairment preventing them from working that is expected to last at least 12 months or lead to death. Applicants also cannot work beyond certain income thresholds – about $1,170 per month in 2015 – for at least five months before applying.
Scott Mack, director of the Maine Disability Determination Service, was not surprised when told that Maine had the number one SSDI recipiency rate for mental disorders.
“We’ve seen over the years that a large percentage of the claims that come to our office have a mental component,” Mack said.
Thirty psychologists are currently active conducting disability evaluations in Maine and receive a standard fee of $150, Mack said.
Among them is Nick Rehagen, Ph.D., of Livermore Falls, a small city 30 miles north of Lewiston. Now semiretired at age 72, Rehagen conducts two evaluations per week.
Rehagen said the fee is supposed to be a two-hour consultative exam to review mental status and the person’s ability to handle money and render a diagnosis and prognosis.
“Now by the time I set up the file, review it, see the person and write up the evaluation, it’s about three, three and a half hours, but I know how to do these. I’m efficient. I actually like working with these claimants,” Rehagen said.
“They come in. I see them. I write a strong objective report. And then they go and I don’t see them again, and I don’t even hear the outcome. It’s just done.”