Payeeship, financial leverage, and the client-provider relationship.
OBJECTIVE
Although representative payeeship provided within clinical settings is believed to have therapeutic benefits, its potential negative impact on the therapeutic alliance or client-provider relationship is of concern. This study examined the effects of payeeship and perceived financial leverage on positive and negative dimensions of the client-provider relationship.


METHODS
The sample consisted of 205 adults ages 18 to 65 with axis I disorders who were receiving mental health services from a large urban community mental health clinic. Information about money management characteristics and ratings of the client-provider relationship were collected via face-to-face interview.


RESULTS
Fifty-three percent of the sample had a payee or money manager, and 79% of this group had a clinician payee. Respondents with co-occurring psychotic and substance use disorders, lower functioning, and lower insight about their illness were more likely to have a clinician payee. Forty percent of those with a clinician payee reported perceived financial leverage. Having a clinician payee was also associated with perceived financial leverage and with higher levels of conflict in the case management relationship. When examined in combination, financial leverage was found to mediate the effects of payeeship on conflict in the case management relationship (mean+/-SE=2.37+/-1.33, 95% confidence interval=16-5.52, p<.05). That is, payeeship appeared to increase conflict in the therapeutic alliance when used as a source of treatment leverage.


CONCLUSIONS
Although payeeship provides important support and may enhance functional outcomes for the patient, decisions about using the mechanism for promoting treatment adherence should take into account the potential disruption to the client-provider relationship.
Angell
Beth
B
School of Social Service Administration, University of Chicago, 969 E. 60th St., Chicago, IL 60637, USA. angell@uchicago.edu
Martinez
Noriko I
NI
Mahoney
Colleen A
CA
Corrigan
Patrick W
PW
D000293:Adolescent; D000328:Adult; D000368:Aged; D019090:Case Management; D003156:Community Mental Health Services / Q000191:economics*; D003220:Conflict, Psychological; D005376:Financial Management / Q000379:methods*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D008875:Middle Aged; D011369:Professional-Patient Relations; D014481:United States / Q000453:epidemiology