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Taking Issue   |    
Let's End Disability As We Know It
Daniel J. Luchins, M.D.
Psychiatric Services 2003; doi: 10.1176/appi.ps.54.7.931
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For persons with serious and persistent mental illness, the current Supplemental Security Income (SSI) program, like the previous Aid to Families With Dependent Children (AFDC) system, has the paradoxical effect of maintaining persons in a state of impoverishment while promoting dependency and demoralization. The monthly SSI check is not sufficient to support adequate housing in any U.S. city. Thus persons with mental illness are left to play a game of musical chairs, vying with other disability groups and the poor for limited subsidized housing. Frequently, they end up homeless. Because SSI does not promote rehabilitation and actually discourages employment, the great majority of recipients remain unemployed. Is it a surprise that persons with mental illness who are impoverished, unemployed, and either homeless or inadequately housed also develop substance use problems and become involved with the criminal justice system? The fruit of our current disability system is an underclass that is unemployed and that has staggering rates of homelessness, drug abuse, and criminality.

Increasing the SSI benefit or ensuring that persons with mental illness receive a more equitable share of public housing funds are possible strategies for addressing these problems. However, there is an alternative. Learning the lesson from welfare reform, we should advocate for employment. Such an appeal can resonate with a larger segment of the political spectrum while remaining clinically sound. Other disability groups have promoted this approach. In the case of persons with mental retardation, employment is the norm. Mentally retarded clients in community settings work five days a week in jobs at workshops, at supported employment sites, or in the competitive market. They receive paychecks and spend and save these monies. Obviously, income from these jobs may not be the only source of support for these individuals. When this income is insufficient, it is supplemented. And if the jobs are not economically viable, they are subsidized. But these individuals are allowed to do what almost everyone else in our society does: go to work. They are allowed to both feel and be useful. Why can't we ensure the same dignity for persons with mental illness?

A determination that one is too disabled to work in the competitive job market should guarantee the opportunity to work with support or to be rehabilitated to enable competitive employment. The Surgeon General has made it clear that we have efficacious treatments for serious mental illness; now we have to ensure that the treatments that work are made available to people who work.

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