Informing Social Security's Process for Financial Capability Determination (2016) / Chapter Skim
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3 Effects of Appointment of Representative Payees on Beneficiaries
3 Effects of Appointment of Representative Payees on Beneficiaries
Pages 67-80
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From page 67... ...
terminology, a representative payee -- to perform that function. Representative payees who appropriately discharge their role can enable beneficiaries who lack financial capability to meet their basic needs and to sustain the quality of their lives.
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From page 68... ...
In sum, the committee recognizes that appointment of a representative payee can have significant positive effects on individual beneficiaries, with notable improvements in their abilities to live independently, and on communities, which can avoid the costs associated with providing institutional care -- whether in shelters, residential treatment facilities or correctional facilities -- to incapable beneficiaries. However, in addition to such positive effects, appointment of a representative payee also has potential negative consequences.
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From page 69... ...
Beneficiaries can be negatively affected by strain in their familial relationships resulting from conflict over the money management responsibilities of family members acting as representative payees. Indeed, having a family member who serves as their representative payee or on whom they are otherwise financially dependent has been found to be associated with a significantly increased risk of interpersonal conflict, aggression, and family violence perpetrated by individuals with severe mental illness (Elbogen et al., 2005b, 2008; Estroff et al., 1994, 1998)
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From page 70... ...
For example, a community mental health center may disburse benefits only when a treatment group is scheduled, thereby encouraging the beneficiary's attendance. State-wide surveys of mental health center representative payee programs in Illinois and Washington State found disbursement of benefits to be at least moderately linked to avoidance of substance abuse in most programs and tightly linked in a substantial minority of programs.
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From page 71... ...
Dixon and colleagues (1999) interviewed 54 clients with persistent mental illness who participated in an inner-city assertive treatment program and their case managers who served as representative payees regarding the benefits and problems associated with having a representative payee.
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From page 72... ...
As the authors note, lack of spending money may be highly problematic given the importance of social skills and social networks for individuals with severe mental disorders. Taken together, this literature suggests that while beneficiaries may perceive some benefits to having a representative payee, such as maintaining stable housing, those who have a clinician as representative payee may perceive this arrangement as coercive and may experience a loss of 3 Respondents were categorized as experiencing perceived financial leverage based on an affirmative response to questions regarding (1)
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From page 73... ...
MINIMIZING THE IMPACT ON AUTONOMY OF HAVING A REPRESENTATIVE PAYEE As noted above, appointing a representative payee raises legal issues related to individual civil liberties; it also raises philosophical issues of autonomy, societal responsibility, and justified paternalism. On the one hand, individuals who have reached adulthood are presumed to possess moral agency and legal rights that, in general, protect their decisions about personal health and well-being, how they spend their money, and how they manage their affairs.
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From page 74... ...
Accordingly, recent years have seen a call by disability rights activists to move away from the traditional model of surrogate decision making, in which individuals are authorized to make decisions for persons with intellectual and cognitive disabilities, to a model of supported decision making, which acknowledges that some elements of autonomy -- of holding values and preferences -- survive despite these disabilities and are deserving of support by others. Such a model has increasingly been encouraged or endorsed both in the United States and internationally.
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From page 75... ...
Representative payees endorsing and using a supported decisionmaking model may encourage the expression of preferences, beliefs, and values; foster collaboration in decision making; provide skills training to improve financial competence and performance; and ensure opportunities for beneficiaries to make independent decisions, whenever possible. When supported decision making is pursued appropriately, a person with a representative payee may have more actual control over his or her life than someone without such support.
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From page 76... ...
Representative payee programs can have significant positive effects on a beneficiary's ability to live independently; meet basic needs; avoid hospitalization, homelessness, victimization, or a rrest; remain engaged in substance abuse treatment; and increase quality of life. Such programs may also have positive economic implications for communities in which beneficiaries live, which can avoid the costs associated with providing institutional care to incapable beneficiaries.
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From page 77... ...
2006. Randomized trial of psychiatric care with representative payeeship for persons with serious mental illness.
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From page 78... ...
2003. Representative payeeship and mental illness: A review.
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From page 79... ...
1997. Impact of representative payees on substance use by homeless persons with serious mental illness.
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