INCOME MAINTENANCE, DEPENDENCE AND SERVICE SYSTEM USE

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Recent research indicates that approximately 50% of all chronically mentally ill persons receive Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI), while up to 90% of those in community treatment programs are recipients. Clinicians, patients, policy makers, and family members are all aware of the mixed blessing of income maintenance for the chronically mentally ill. While receipt may enable more independent living outside institutional settings, it may also consciously and unconsciously, decrease participation in the labor force and encourage continuation of disability--the entitling condition. There is a lack of systematic and longitudinal research about the roles, both positive and negative, that income maintenance based on disability, e.g., SSI and SSDI, plays in the lives of the chronically mentally ill. This research project is intended to investigate some of these roles, in particular to describe the natural history of decisions to apply, the short term effects of applicaiton and receipt on the recipient, and the influence of various forms of dependence on decisions to apply and on use of services. A prospective design is proposed, in order to map the sequence of events that lead to participation, to assess the respective contributions of various factors, and their effects over time on the recipients. Retrospective analysis is not adequate to determine the interactions among client, service and treatment system, disabling condition, social and psychological factors, all of which contribute to income maintenance use. These factors include: family relations with and attitudes toward the patient, family resources and attitudes toward disability income; staff realations with the patient and attitudes toward use of income maintenance; level of treatment and service system participation; degree and type of dependence; level of impairment, employment status, and duration of disability. We propose to follow persons discharged from three psychiatric inpatient treatment settings for two years, comparing those who apply for and receive SSI and SSDI and those who do not, and those who use services and participate in treatment and those who do not.