Schizophrenia is a truly horrible disease. It's tragic to see once promising young people reduced to unstable, unproductive lives haunted by the madness of schizophrenia. Schizophrenia always starts before age 30 but continues for the rest of a person's life. There is no cure for schizophrenia. The treatments available generally make long term institutionalization unnecessary and can prevent frequent hospitalization but do little to restore normal functioning. In particular, the treatments available don't touch the negative symptoms of schizophrenia -- lethargy and inability to have appropriate emotional and social responses. The negative symptoms may not sound that bad but they are actually devastating. Everyone familiar with the disease prays for some treatment that would improve the lives of schizophrenics.
One approach to schizophrenia that seemed to have promise was early intervention -- identifying schizophrenics as soon as possible and offering them intensive treatment. This led to various Recovery After an Initial Schizophrenia Episode (RAISE) studies funded by the National Institutes of Mental Health (NIMH).
Some results from a RAISE study are available and they're not encouraging, at least insofar as Social Security might be concerned. Here's an excerpt from the abstract of a RAISE study:
Method: The Recovery After an Initial Schizophrenia Episode–Early Treatment Program (RAISE-ETP) study, a 34-site cluster-randomized trial, compared NAVIGATE, a coordinated specialty care program, to usual community care over 2 years. Receipt of SSA benefits and clinical outcomes were assessed at program entry and every 6 months for 2 years....
Results: Among 399 RAISE-ETP participants, 36 (9%) were receiving SSA disability benefits at baseline; of the remainder, 124 (34.1%) obtained benefits during the 2-year study period. The NAVIGATE intervention improved quality of life, symptoms, and employment but did not significantly reduce the likelihood of receiving SSA disability benefits. Obtaining benefits was predicted by more severe psychotic symptoms and greater dysfunction and was followed by increased total income but fewer days of employment, reduced motivation (e.g., sense of purpose, greater anhedonia), and fewer days of intoxication. [I'm not sure what sort of intoxication they're talking about. Substance abuse isn't a part of schizophrenia. Some schizophrenics have substance abuse problems like some schizophrenics have high blood pressure but as far as I know there's no connection.]
Conclusions: A 2-year coordinated specialty care intervention did not reduce receipt of SSA disability benefits. There were some advantages for those who obtained SSA disability benefits over the 2-year treatment period, but there were also some unintended adverse consequences. Providing income supports without impeding recovery remains an important policy challenge.
I think I would draw a somewhat different conclusion - at least based on the post above, having not read the full study. It seems like the key sentence in the post is this: "The NAVIGATE intervention improved quality of life, symptoms, and employment but did not significantly reduce the likelihood of receiving SSA disability benefits." So it improved outcomes for individuals - that's a good thing!
ReplyDeleteSimilarly, SSA's Mental Health Treatment Study (www.ssa.gov/disabilityresearch/mentalhealth.htm) found that comprehensive services for DI beneficiaries with schizophrenia and other affective disorders were successful in improving outcomes (improving health, lowering hospitalizations, and increasing employment), but not to a level that would replace disability benefits.
So my take-away from both of these studies is that more/better services really can help people with schizophrenia or similar conditions, and at the same time, that SSDI remains critical for these individuals. But services do not need to replace SSDI in order to have value for the individuals or at a society-wide level.
It's a good thing for people to get these services, absolutely. But members of Congress should not expect that they will pay for themselves or lead to more solvency in the DI trust fund.
ReplyDeleteWhat we're really talking about here is that the intervention, treatments, counseling, etc. can be used to reduce the percentages of those that require INSTITUTIONALIZATION. For many, if not most, recovery so as not to require SSI/SSDI is a pipedream. To expect recovery to a more employable level is just not currently realistic. The medications can reduce the voices they hear for periods of time, especially when around people that they trust and are comfortable with. However, going places with crowds can be difficult for them, even for short periods of time. Often, the anxiety alone of being around strangers and the fear of hearing more voices can cause panic attacks. My best friend has had schizophrenia since the age of 18. He can seem normal, even friendly to strangers at times. But, his "friendliness" to others is largely a coping strategy: if he's nice to them, then maybe they "won't call him 'names'," meaning he won't "hear" them call him names. He often "hears" neighbors, people on the radio and television, etc. call him names, etc. Plus, the medications have side-effects, the biggest of which is drowsiness. Anything that takes them out of their comfort zone is problematic. For many of these people, the mere thought that they might have continuing reviews is incredibly stressful. The plan to require such reviews is incredibly cruel, not to mention an unproductive expense.
ReplyDeleteOne thing that I think definitely still happens is many ALJ's take physical impairments more seriously than mental ones. One ALJ regularly asks claimants with psychological impairments if they are dangerous to society, or the ALJ, and if they need to be locked up. Very sad these types of attitudes are being dragged into the 21st century. As a practicioner and having someone close in my family who suffers I know how real these illnesses are. If this ALJ ever had a teenage child waking them up at 1:00 AM with a major psychiatric episode I'm sure there would be a change in practice. Very sad that with all the medical literature available these problems are still not always taken seriously unless personally experienced.
ReplyDeleteThe SSA determining that physical injuries are just mental issues only to disparage them to deny SSA should be addressed. Mentally ill can have physical and vice versa but it is the "mental illness" that gets looked upon as not credible, then the physical injuries or illnesses are not addressed either.All of this based on false evidence. It's a lose lose and it's sadly intentional to save costs for the SSA/Medicare. The govt bought into this particularly fake and malicious paradigm since back into the 60's,all TO save money, cut costs. as all insurers do. It's permeated into all self insured employers private and public. One psychologist working for a HMO started this back in the late 50's to insure psychologist's future in medicine and of course getting higher pay and the rest is history. Most people are looked at as if they are all mental no matter their physical problems that are so carefully hidden and no care.
ReplyDeleteThe problem is that too many ALJ's don't educate themselves on the medical part of cases and don't review files closely. And no one seems to be able to explain why so many incompetent and lazy ALJ's are not fired.
ReplyDeleteBTW, the reviews are called "means testing" where one wrong answer on the test could mean loss of benefits and a period of homelessness. There's nothing wrong with being homeless, it's just a worry and it is not a stable feeling.
ReplyDeleteOne way I think I tilted the system in my favor when I was applying for benefits was this: My doctor was on the phone with me for the entire duration of the 40 minute interview phone call with SSA. My doctor was present, so I think that may be one reason my claim was not denied. I think other people should do this so they will not be denied on their claim.
Another way I think I had an advantage was years before I applied for benefits, I participated in something called Voc Rehab, which is vocational rehabilitation. That program at the VA got me 6 jobs which I could not hold down, but I gave it my best shot. I think other people should try Voc Rehab. If the job(s) work out, you will not need SSA benefits.