In addition to the cognitive distortions inherent in Mental Accounting, people with psychiatric illnesses face cognitive, psychological and social challenges that make it difficult to align their expenditures with their interests. Recipients of Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) may be assigned representative payees to manage their funds. Because of inconsistencies in the assignment of payees, high proportions of beneficiaries with psychiatric disabilities have difficulty managing their funds but have not been assigned a payee. In clients disabled by psychiatric illness, voluntary assistance may be sufficient to improve funds management. In others, not assigning a payee may represent a missed opportunity because data suggests that payee assignment is associated with improved treatment compliance and, when properly implemented, other clinical benefits too. The purpose of this Stage 1 study is to describe feasibility and preliminary efficacy of an intervention to provide money management assistance and to facilitate payee assignment when it is indicated. People who are in psychiatric treatment, receiving SSI and/or SSDI and at risk for needing a payee will be randomly assigned to Benefits Management or the control condition, a review of their income and expenses. Benefits Management involves the following components: (a) evaluation- reviewing the beneficiary's income, expenses and money management habits;(b) education and rapport building- helping clients identify their money management goals and providing advice to help clients manage their money better;and (c) skill-building - teaching clients how to plan a budget for the month. If funds mismanagement persists and is harmful, the Benefits Management counselor will talk to clients and their clinicians about alternatives to having the client manage their own money such as assignment of a representative payee. The counselor will facilitate payee assignment if the clinician indicates that a payee is needed. Benefits Management is designed to be an assessment, brief treatment and triage. In practice, the person providing Benefits Management to a large number of clients will be the person designated by the CMHC or other agency to liaison with the local Social Security Administration staff, available payees, and merchants who process financial transactions with clients. With input from expert consultants and iterative writing and revisions, a manual will be developed describing Benefits Management. One hundred twenty participants will be randomized to Benefits Management or the control condition, five sessions extracted from an Illness Management and Recovery program. The primary outcome will be observer-rated quality of life. The feasibility and client acceptability of Benefits Management will be characterized by the number of times meeting with the counselor, client-rated satisfaction with the intervention, initiation of payee application, aversive effects including perceived coercion and qualitative analyses of client perspectives.

Public Health Relevance

People who misspend disability payments often do not have money to meet basic needs and may be harmed when benefit checks are spent on things other than basic needs. Benefits Management has the potential to help beneficiaries spend their money well and thus, improve their quality of life.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Mental Health Services in MH Specialty Settings (SRSP)
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Juliano-Bult, Denise M
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Yale University
Schools of Medicine
New Haven
United States
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Serowik, Kristin L; Rowe, Michael; Black, Anne C et al. (2014) Financial motivation to work among people with psychiatric disorders. J Ment Health 23:186-90
Rosen, Marc I; Ablondi, Karen; Black, Anne C et al. (2014) Pathways to assignment of payees. Community Ment Health J 50:270-4
Rosen, Marc I (2012) Overview of special sub-section on money management articles: cross-disciplinary perspectives on money management by addicts. Am J Drug Alcohol Abuse 38:2-7
Fries, Heather P; Rosen, Marc I (2011) The efficacy of assertive community treatment to treat substance use. J Am Psychiatr Nurses Assoc 17:45-50