Chapter 6: Psychiatric/Mental Health Disability and Neurocognitive Disorders

INTRODUCTION

The term psychiatric/mental health (PMH) disability describes a wide range of mental and emotional conditions. Psychiatric/mental health disorders are common in the US. However, not all these disorders result in or qualify as a mental disability, as defined by the Americans with Disabilities Act (ADA) of 1990 and the ADA Amendments Act (ADAAA) of 2008 (P.L. 110-325). This definition is as follows:

The term psychiatric/mental disability describes only part of the ADA’s broader term of mental impairment (National Rehabilitation Information Center, 2014). Mental disability or mental impairment as addressed by the ADA also includes:

• Learning disability

• Developmental disability

• Intellectual disability

• Neurocognitive disability

• Disability resulting from brain injury

Psychiatric/mental disability—discussed in this chapter—refers to a PMH illness that significantly interferes with a person’s ability to engage in major life activities such as learning, working, and communicating.

There is less written about psychiatric disability than about other disabilities or PMH disorders (Rudnick, 2014). However, policy guidance from the Equal Employment Opportunity Commission (EEOC, 2002) addresses many questions about psychiatric disability in the context of the ADA. Although the EEOC’s main focus is on employment issues as they relate to disability (including psychiatric disability), its guidance is helpful for understanding psychiatric/mental disability.

According to the EEOC, the ADA’s definition of mental impairment includes any mental or psychological disorders such as emotional or mental illness. These include the following examples:

• Major depression

• Bipolar disorder

• Anxiety disorders (including panic disorder, obsessive compulsive disorder, and post-traumatic stress disorder)

• Schizophrenia

• Personality disorders

The EEOC (2002) guidance also lists major life activities relevant to psychiatric disability. These are as follows:

• Thinking

• Concentrating

• Interacting with others

• Caring for oneself

• Speaking

• Performing manual tasks

• Working

The American Psychiatric Association’s (APA) 2015 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the key reference on PMH disorders for mental health professionals for the purposes of diagnosis and insurance reimbursement. However, not all disorders included in DSM-5 are considered disabilities or impairments. According to the ADA, for an impairment to be considered a disability, its effect on a person’s major life activities must be significant. When a PMH disorder is severe enough to prevent a person from performing such activities—or significantly restricts the condition, manner, or duration under which the person can perform compared to the average person in the general population (EEOC, 2002)—it is considered a disability. Determining whether a limitation is a “substantial limitation” depends on its severity and on the length of time it restricts major life activities.

There are ...