Ambiguity in determining financial capability of SSI and SSDI beneficiaries with psychiatric disabilities.
OBJECTIVE
The liberty of individuals who receive Social Security disability payments is constrained if they are judged incapable of managing their payments and are assigned a payee or conservator to manage benefit payments on their behalf. Conversely, beneficiaries' well-being may be compromised if they misspend money that they need to survive. Several studies have shown that determinations of financial capability are made inconsistently and that capability guidelines appear to be applied inconsistently. This article describes ambiguities that remained for individuals even after a comprehensive assessment of financial capability was conducted by independent assessors.


METHODS
Trained, experienced assessors rated the financial capability of 118 individuals in intensive outpatient or inpatient psychiatric facilities who received Social Security Disability Insurance or Supplemental Security Income.


RESULTS
Ten individuals' cases were determined to be difficult to judge. Six sources of ambiguity were identified by case review: distinguishing incapability from the challenges of navigating poverty, the amount of nonessential spending that indicates incapability, the amount of spending on harmful things that indicates incapability, how to consider intermittent periods of capability and incapability, the relative weighting of past behavior and future plans to change, and discrepancies between different sources of information.


CONCLUSIONS
The cases raise fundamental questions about how to define and identify financial incapability, but they also illustrate how detailed consideration of beneficiaries' living situations and decision making can inform the difficult dichotomous decision about capability.
Ms. Lazar, Dr. Black, Dr. McMahon, and Dr. Rosen are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: christina.lazar@yale.edu ). Ms. Lazar, Dr. Black, and Dr. Rosen are also with the Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut. Dr. O'Shea is with the Institute of Living, Hartford Hospital, Hartford, Connecticut.
Christina M
CM
Lazar
Anne C
AC
Black
Thomas J
TJ
McMahon
Kevin
K
O'Shea
Marc I
MI
Rosen
D000328:Adult; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D018868:Insurance, Disability / Q000191:economics*; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000523:psychology*; D008875:Middle Aged; D012943:Social Security / Q000191:economics*; D014481:United States; D019131:United States Social Security Administration