MIRECC / CoE

New England MIRECC Brief Research Reports: Money Management

MONEY MANAGEMENT

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• Disability Payments and Substance Abuse in Patients with Severe Mental Illness
• Many Psychiatric Inpatients Need Money Management
• Money Management Benefits Dually Diagnosed Veterans

Disability Payments and Substance Abuse in Patients with Severe Mental Illness

VISN 1 MIRECC researchers have shown no increase in substance abuse when homeless patients 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 SMI patient as deemed appropriate.

The new study used repeated evaluations over a 12-month period to tract nearly 7000 homeless SMI patients 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 SMI patients’ money. Assigning a payee neither increased nor decreased substance use. Taken together, these results suggest that SMI patients 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.

UMHS Keywords: Seriously Mentally Ill; Substance Use Disorders; Rehabilitation & Recovery

Many Psychiatric Inpatients Need Money Management

VISN 1 MIRECC researchers detected a large unmet need for money management services among psychiatric inpatients at VA hospitals in Bedford, Northhampton, West Haven, and West Lost Angeles. Over one in ten (11%) patients surveyed were rated by clinicians to have major problems with handling funds they received from VA or social security pensions. Notably, most (78%) of those needing money management had a substance abuse diagnosis, and greater severity of substance abuse was related to more urgent need for money management. This study echoes concerns that public support payments to those with substance abuse problems are often used to purchase alcohol and drugs. This use of pension money for drug and alcohol can lead to re-hospitalization because psychiatric symptoms worsened and basic needs for food and shelter go unmet. The researchers suggest that assigning representative payees and money managers can improve patients' quality of life, reduce substance abuse, and prevent re-hospitalization. One approach uses patients' own public assistance payments to create incentives for staying away from drugs and alcohol. Pilot programs are underway in West Haven and Northampton. The research team includes Marc Rosen, Robert Rosenheck, Andrew Shaner, Thad Eckman, Gail Gamache, and Christopher Krebs.

UMHS Keywords: Seriously Mentally Ill; Substance Use Disorders; Rehabilitation & Recovery

Money Management Benefits Dually Diagnosed Veterans

VISN 1 MIRECC researchers have found beneficial effects of a new money management intervention to reduce substance use in veterans with mental illness and substance abuse (dual diagnosis). It has long been known that receiving money can trigger relapse to substance abuse. People prone to addiction show higher use of drugs and alcohol when checks are received at the beginning of the month. Spending money on drugs is a particularly poor decision for mentally ill substance abusers who rely on entitlement checks that provide little above that which is needed to cover basic living expenses. To counteract this pattern, the researchers developed a new intervention, Advisor-Teller Money Management (ATM) in which a money manager stores patients’ check-books, trains patients to manage their own funds, and links spending activities to treatment goals.

They tested the impact of ATM in a study comparing this treatment to a financial education workbook group with over 80 veterans who had a history of difficulty managing funds. Veterans receiving ATM had better substance abuse outcomes on some but not all measures and were more engaged in treatment. As an adjunct to usual treatment, ATM showed promise for facilitating the recovery process by helping dually diagnosed veterans gain control over their finances and their substance use. The MIRECC team was led by Marc Rosen and included Kathleen Carroll, Elina Stefanovics, and Robert Rosenheck.

UMHS Keywords: Seriously Mentally Ill; Substance Use Disorders; Rehabilitation & Recovery

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