The voices of Urban Institute's researchers and staff
July 10, 2017

Why do more New Englanders receive Disability Insurance benefits for mental disorders?

July 11, 2017

A greater share of people in New England states receive Social Security Disability Insurance (DI) benefits for mental disorders than the share nationwide. We don’t definitively know why, but evidence suggests that demographics and economics play a large role, as does greater access to health insurance and health care.

More than 10.2 million people in the country received benefits from the DI program in 2015, including workers with disabilities, disabled widows and widowers, and disabled adult children. Of those, more than 3.5 million received benefits because of a mental disorder, such as developmental disorders, mood disorders, or schizophrenia.

We find that 1.8 percent of 18- to 65-year-olds received DI benefits because of mental disorders in 2015, but that recipiency rate was markedly higher in New England. In Maine, 3.4 percent of 18- to 65-year-olds received benefits because of mental disorders, followed by New Hampshire (3.2 percent), Rhode Island (3.0 percent), and Vermont (2.9 percent). Massachusetts (2.6 percent) ranked 8th in the country, and Connecticut (1.8 percent) ranked 26th, right around the national average.

What’s driving these higher recipiency rates? In a recent paper, I show that, on average, people in New England states tend to be richer, whiter, and more highly educated, and they tend to live in more rural areas. These basic characteristics about people, the region, and the economies of these areas tend to be highly correlated with overall DI receipt, but little research has investigated what is driving changes in specific disabilities.

Some evidence suggests that access to the health care system may help people not only identify their illnesses but also get in contact with the DI program and other services (and after a two-year waiting period, to health services through Medicare). People in New England have significantly higher health insurance rates than in other parts of the country, according to the Kaiser Family Foundation. Massachusetts and Rhode Island have the highest insurance rates, with Vermont only slightly behind.

Other variables that measure mental illness suggest a possible correlation with DI receipt. People in New England appear to have slightly higher rates of mental illness, are more likely to report having used Oxycodone, have higher rates of drug overdose deaths, and are admitted for treatment for opiate use more often than in other parts of the country. These findings do not necessarily suggest that higher treatment for illicit drugs causes participation in the DI program (or vice versa), but rather point to some correlation.

Finally, Bureau of Labor Statistics data suggest that people in New England are much more likely to have access to psychiatric care than elsewhere in the country, using a measure called the location quotient that shows where occupations are concentrated. Rhode Island, Connecticut, Vermont, and Maine had the highest location quotients for psychiatrists in 2016.

Perhaps an openness about mental health (and drug use) and access to health and mental health providers in New England states leads to more and better diagnoses of mental health issues. As policymakers wrestle with the opioid drug epidemic and the looming financial shortfall in the Social Security system, we need more research to better understand these patterns.

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