Disability Payments and Substance Abuse in Patients with Severe Mental Illness

VISN 1 MIRECC researchers have shown no increase in substance abuse when homeless, veterans with severe mental illness (SMI) are provided with Social Security Administration (SSA) disability payments. Also, providing checks to a responsible third party did not reduce substance use in patients who are already receiving highly intensive Assertive Community Treatment (ACT). Researchers and policy makers have raised questions about the misuse of SSA disability payments in SMI patients who also have a history of substance abuse. In particular, several researchers have documented an increase in substance abuse and related problems around the beginning of the month, when welfare and disability checks are received. This pattern suggests that substance abusing disability recipients binge on drugs and alcohol when they receive their checks and then require hospitalization and/or stays in homeless shelters as a result. Proposed solutions to this problem have included assignment of a representative payee, a responsible individual without mental illness or substance abuse who receives the disability payment and provides funds to the patient with SMI as deemed appropriate. The new study used repeated evaluations over a 12 month period to tract nearly 7000 homeless patients with SMI in who entered ACT treatment which is designed to provide intensive, community based care.  The present study is unique because of its large sample size and its evaluation of SMI patients over a relatively long time. During that time, around one-fifth received SSA disability payments for the first time. Compared with those not receiving payments, this group had higher severity of mental illness and substance abuse. Following receipt of payments this group was more likely to be housed but showed no increase in substance abuse. Hence, benefits appear to have been used appropriately. The researchers also evaluated the impact of assigning a representative payee to manage the person with SMI’s money. Assigning a payee neither increased nor decreased substance use. Taken together, these results suggest that patients with SMI generally do not misuse disability payments on drugs and that assigning a representative payee is not necessary if patients are participating in an intensive ACT treatment program. MIRECC researchers Marc Rosen and Robert Rosenheck led the research team that included Yale researchers Thomas McMahon and Haiqun Lin.