TN 37 (09-12)

DI 11005.076 Interviewing People with a Mental Impairment(s)

Some initial or post-entitlement interviews may involve people who react emotionally to stressful situations or otherwise show signs of a mental impairment(s). This section provides guidelines for interviewing people who exhibit signs of a mental impairment(s).

IMPORTANT: If a person exhibits the signs described below, this does not necessarily mean he or she has a mental impairment(s). However, these guidelines may still be useful.

If the person you are interviewing threatens suicide, notify management staff, the appropriate community service, or law enforcement agency. Suggest help at the nearby crisis prevention center and provide the emergency telephone number. The 800-system Information and Referral (INFO) screen shows suicide prevention agencies. Use any other local office guidelines, as appropriate.

A. Common signs of a mental impairment

Some people may exhibit signs of:

  • disorientation

  • decreased level of alertness

  • reduced ability to pay attention or concentrate

  • disorganized thinking (for example, jumping from topic to topic)

  • unstable mood and behavior (for example, crying spells or poor impulse control)

  • delusions or hallucinations

  • fearfulness or mistrust

  • obsessions

  • compulsions

B. Interviewing considerations for people with a mental impairment(s)

NOTE: If you are conducting a post-entitlement interview, check the following system queries for the impairment code before proceeding with the instructions in this subsection:

  • Master Beneficiary Record (MBR);

  • Supplemental Security Record (SSR); or

  • Disability Determination Query System (DDSQ).

If a person appears to have one of the following mental impairments, use the following the guidelines.

1. Organic mental disorders (Impairment codes: 2940, 3140, 3150, 3152, 3153, 3195)

The main feature of organic mental disorders is a loss of brain function.

When you communicate with people who have an organic mental disorder, they are not likely to fully comprehend, remember, or respond appropriately to your instructions. You should:

  • reduce distractions in the interview environment as much as possible;

  • speak simply, slowly, clearly, and calmly; and

  • listen to the person in an accepting manner.

NOTE: You may need an appropriate third party to participate in your interactions with a person exhibiting this feature (for example, a family member, friend, representative payee, or someone suggested by the person you are interviewing).

2. Schizophrenic, paranoid and other psychotic disorders (Impairment code: 2950)

The main feature of psychotic disorders is a loss of contact with reality.

When you communicate with people who are schizophrenic, paranoid, or have some other type of psychotic disorder, they are likely to:

  • misunderstand;

  • misconstrue your words; or

  • perceive you as untrustworthy.

You should avoid making the person feel uneducated or disrespected.

NOTE: You may need an appropriate third party to participate in your interactions with a person exhibiting this feature (for example, a family member, friend, representative payee, or someone suggested by the person you are interviewing).

3. Affective disorders (Impairment code: 2960)

The main feature of affective disorders is an abnormal lessening or increase in mood, activity level, and engagement of pleasurable activities.

When you communicate with people who have an affective disorder, they may not pay attention due to:

  • distractibility;

  • preoccupation; or

  • fearfulness.

Their ability to comprehend, remember, and act appropriately may improve if you:

  • use clear and slow repetition;

  • reduce distractions in the interview environment as much as possible; and

  • respond in a calm and relaxed manner, even to odd or peculiar questions.

4. Intellectual disability (Impairment code: 3180)

The main features of an intellectual disability are a significantly sub-average general intellectual functioning and deficits in day-to-day functioning.

When you communicate with people who have significantly sub-average general intellectual functioning and deficits in day-to-day functioning, they may not be able to comprehend, remember, or respond appropriately to your instructions. You should:

  • reduce distractions in the interview environment as much as possible;

  • speak simply, slowly, clearly, and calmly; and

  • listen to the person in an accepting manner.

NOTE: You may need an appropriate third party to participate in your interactions with a person exhibiting this feature (for example, a family member, friend, representative payee, or someone suggested by the person you are interviewing).

5. Anxiety-related disorders (Impairment code: 3000)

The main feature of an anxiety-related disorder is a persistent or specific irrational fear.

When you communicate with people who have an anxiety-related disorder, they may not pay attention due to:

  • distractibility;

  • preoccupation; or

  • fearfulness.

Their ability to comprehend, remember, and act appropriately may improve if you:

  • use clear and slow repetition;

  • reduce distractions in the interview environment as much as possible;

  • avoid confrontations;

  • speak simply, slowly, clearly, and calmly; and

  • listen to the person in an accepting manner.

6. Somatoform disorders (Impairment code: 3060)

The main feature of somatoform disorders is the presence of physical symptoms that medical professionals cannot explain by any known medical condition(s).

When you communicate with people who have a somatoform disorder, they are likely to comprehend, remember, and respond appropriately to your instructions. However, people with this type of disorder are also likely to be hypersensitive to a real or perceived lack of belief in the credibility of their complaints. You should:

  • avoid expressing disbelief regarding reports of signs and symptoms or suggesting that a psychiatric component may be involved in the condition;

  • respond to questions in a calm and relaxed manner, even to odd or peculiar questions;

  • avoid making the person feel uneducated or otherwise prompt the person to respond in a defensive or angry manner.

7. Personality disorders (Impairment codes: 3010, 3120, 3138)

The main features of personality disorders are long-standing and inflexible personality traits that significantly impair social and occupational functioning.

When you communicate with people who have a personality disorder, they are not likely to act appropriately upon your instructions. They may intentionally ignore or distort what you have said to them. You should:

  • avoid confrontations;

  • respond to questions in a calm and relaxed manner, even to odd or peculiar questions;

  • avoid making the person feel uneducated or otherwise prompt the person to respond in a defensive or angry manner.

NOTE: You may need an appropriate third party to participate in your interactions with a person exhibiting this feature (for example, a family member, friend, representative payee, or someone suggested by the person you are interviewing).

8. Substance addiction disorders (Impairment codes: 3030 for alcohol or 3040 for drugs)

The main feature of a substance addiction disorder is ongoing abuse or dependence on alcohol or other substances that impair the central nervous system.

When you communicate with people with a substance addiction disorder, they are not likely to act appropriately upon your instructions. They may intentionally ignore or distort what you have said to them. You should avoid:

  • confrontations; and

  • making the person feel uneducated or otherwise prompt the person to respond in a defensive or angry manner.

NOTE: You may need an appropriate third party to participate in your interactions with a person exhibiting this feature (for example, a family member, friend, representative payee, or someone suggested by the person you are interviewing).

9. Autistic disorder and other pervasive developmental disorders (Impairment code: 2990)

The main feature of an autistic or other pervasive developmental disorder is a gross and sustained impairment in social interaction (for example, failing to respond to his or her name, poor to no eye contact, appears unaware of others’ feelings, or prefers solitary play).

When you communicate with people who have an autistic or other pervasive developmental disorder, they are not likely to comprehend, remember, or act appropriately upon your instructions. You should:

  • reduce distractions in the interviewing environment as much as possible;

  • speak simply, slowly, clearly, and calmly; and

  • listen to the person in an accepting manner.

NOTE: You may need an appropriate third party to participate in your interactions with a person exhibiting this feature (for example, a family member, friend, representative payee, or someone suggested by the person you are interviewing).

C. Related references


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411005076
DI 11005.076 - Interviewing People with a Mental Impairment(s) - 08/05/2013
Batch run: 08/05/2013
Rev:08/05/2013