Financial Service Model for Individuals Living with Mental Illness

Margaret Swarbrick, PhD, OTR, CPRPⁱ

A diagnosis of mental illness is too often a "pack­age plan" that includes a life of pov­erty and being disenfranchised, unemployed, and stigmatized, as well as being designated by society as a second-class citizen. When diagnosed with a mental illness the individual can become devastated and this impacts their personal life goals, dreams and social relationships. There is a significant financial burden for society due to the untapped potential of these individuals to contribute to the economic fabric of our society. Poverty is one of the most pervasive, significant, and debilitating barriers that individuals diagnosed with a mental illness face that prevents them from participating full in the community. In addition individuals living with mental illnesses often live in substandard housing, lack oppor­tunities for meaningful activity and daily structure, have limited social and recreational resources, and have difficulty gaining access to quality health care, and experi­ence alienation and loneliness. They can feel unproductive and powerless to make decisions and effect change in their own lives. The effect of poverty on the lives and recovery of people diag­nosed with a mental illness has nor been fully addressed by the traditional mental health service delivery system. Well intentioned professionals encourage individuals to access public health benefits without educating them on the fact that a life on SSDI or SSI is a life of poverty, social isolation, and social stigma, and will likely lead to poorer health outcomes (e.g., lower life expectancy and poorer physical and emotional health status).

Individuals diagnosed with mental illness face the same despair experienced by other people living in poverty. They become dependent and learn that their well-being depends on their being in a dependent client role. They begin to see themselves as people whose needs can be met only by outsider, generally in the mental health and social service system. They become consum­ers of services and have no incen­tive to be productive. They expend vast amounts of creativity and intelligence on surviving. They are not generally supported in any effort to find their way out of poverty.

The traditional mental health system tends to focus services around mental and emotional needs. Services are rarely geared toward helping people develop the life skills needed for success, nor does it provide opportunities that foster self-sufficiency. The tra­ditional mental health service delivery system focuses primar­ily on the signs, symptoms, and behaviors associated with mental illnesses. Little is done to identify an individual’s personal strengths and capacities (or capabilities) or to address the larger system issues, which profoundly affect people’s lives. For many individuals the prospect of completing an education, de­termining career goals, obtaining and maintaining employment, and participating in mainstream societal roles and activities seems unattainable (Swarbrick, 2006). Failure to acquire critical independent-living skills, coupled with poverty, often re­sults in the loss of productive lives for themselves, their fami­lies, and society as a whole (Swarbrick, 2006).

Some mental health services attempt to offer skills building and money-management programs. Generally they offer a payee-type program in which a representative is designated and responsible for managing a re­cipient’s benefit payments when the recipient is judged incapable of managing them on his or her own. Programs generally link the dis­bursement of funds to treatment adherence or place restrictions on consumers’ freedom, both of which consumers find coercive (Swarbrick, 2006).

These type of money-management pro­grams are designed to take care of individuals’ extremely limited budgets to ensure bills are paid, eviction avoided, and so forth. Services are generally geared toward help­ing consumers retain their abil­ity to acquire basic needs, such as housing, food, and psychiatric and other medications (Swarbrick, 2006). These methods do not promote independent finan­cial management skills nor view people as capable of developing such skills. This approach to money management can contribute to power struggles between consumers and program staff (Swarbrick, 2006).

A consumer-operated agency in New Jersey, the Collaborative Support Programs of New Jersey (CSP-NJ) (in collaboration with their subsidiary organization Community Enterprise Corporation, CEC) has successfully developed a sup­portive housing model and now serves more than 380 consumers. Despite liv­ing in decent, affordable, and supportive housing, many resi­dents struggle with inadequate incomes and financial stressors. Over the years we have observed that despite securing adequate housing, people continue to feel depressed, angry and frustrated because they are living in poverty. As a consumer-operated and managed agency we have been able to create employment opportunities and see people lives change dramatically when they are able to become employed full time. Individuals who once lived in a boarding home or rooming house who are able to earn an income start to change their lives in dramatic ways.

As we observed the adverse impacts of poverty, staff from CSP-NJ and CEC began researching national models of asset building for low income communities. Over time through the collaborative efforts of individuals we serve and review of model programs, we developed a financial service model. We developed and now offer many financial services aimed at promoting fi­nancial literacy, responsibility for money management, develop­ment of long-term savings skills and habits, and acquisition of as­sets. These programs are designed to enhance recovery from mental illness through eco­nomic gains and financial inde­pendence. The following are brief descriptions of some of the services offered.

Client Trust Accounts

This is a personalized money management service intended to teach and promote consumer re­sponsibility in managing personal finances and expenses. For very few participants, it involves the agency serving as the person’s represen­tative payee for Social Security benefits. For others, it is modeled after bill-paying services offered through commercial banks, and CSP-NJ works in partnership with the customer to identify and pay monthly expenses, bills, and other budget items. The program is voluntary. For those in jeopardy of losing their housing due to financial mismanagement, par­ticipation may be required by CSP-NJ Housing Services to pre­vent eviction or homelessness. In these situations, a plan to return control of finances to the con­sumer is established at the onset.

Consumer Savings Club

This service addresses consumers’ needs and desires to save toward the pur­chase of assets that have lasting value, such as computers, trans­portation vehicles (e.g., bicycles, cars), and quality furniture. It is modeled after Christmas Clubs in commercial banking. In rec­ognition of the extreme poverty faced by most consumers and the resulting barriers to saving, the agency created a pool of funds to pro­vide a $1-for-$1 matched savings program.

Individualized Development Accounts

This is a national financial in­centive program for low-income families to promote savings to­ward critical economic goals of homeownership, education, or starting a business. CSP-NJ was one of the first individualized development account programs nationwide to offer this service to very-low-income people diag­nosed with a mental illness. In partnership with the New Jersey Department of Commu­nity Affairs and through the As­sets For Independence Act con­sumers in this program receive a $2-for-$1 match and must save their earned income toward ho­meownership, education, or busi­ness start-up. Individuals in this program must participate in 10 sessions on general financial lit­eracy education and 3 sessions on asset-specific training.

Micro-Loan Program

One common obstacle to suc­cessful, consistent saving is un­expected financial crises or situ­ations. Through the micro-loan program, we offer consum­ers a no-interest loan of up to $500 for such situations, as well as for security deposits.

Our Experiences and Challenges

Our experience developing and now implementing the financial services described above has been very positive. This approach is extremely differ­ent from traditional money-management programs because it helps individuals shift their thinking and encourages them to see themselves as moving from a person who is de­pendent and need to be taken care of, towards a person who has strengths and deserves the rights and privileges of citi­zenship. Our goal is to help individuals participate in the economic mar­ketplace and to dream and real­ize individual goals by providing incentives, support, and informa­tion to achieve these goals. We aim to help individuals break the cycle of pov­erty and dependency and move toward greater self-sufficiency by providing access to opportunities and experiences that engender hope and self-reliance.

It has been our experience that individuals we serve face substantial obstacles to saving, including living from benefit check to benefit check, lacking skills in budgeting and money management, and having a hopeless view of their ability to improve their futures. We do believe and have found that poor people who are diagnosed with a mental illness can save money. Our program is designed with an understanding of the barriers individuals face. We provide the support, encouragement and flexibility to help individuals persevere towards their personal economic self-sufficiency goals. We have found that with the right incentives, support, and education, individuals can save money. Three key program components are vital to individuals’ success in participating in our financial self-management program have been:

• Savings incentives
• Financial literacy training and financial counseling
• Ongoing monitoring and support of savings account bal­ances and activities

We have found that it is a disservice to only focus on helping people maintain themselves on social security and public entitlements. We realize that that income maintenance policies on which many individuals living with mental illness rely raise people only to the poverty line. Providing low-income individu­als with food, shelter, and cloth­ing is important however this will not produce viable exits routes from poverty. It is important that service providers find innovative ways to help individuals diagnosed with mental illness connect with a viable, hopeful future.

There have been challenges to implementing this program. When an individual experiences significant stress and has a significant relapse of symptoms it can become difficult for the individuals to remain focused on their financial goals. This is when we offer additional support and help the person remain connected to the program. In NJ we started the IDA at the same time when the housing market escalated. This has made it very difficult for all participants to achieve their housing goal, yet we have had success! We have had individuals successfully start their own business, purchase their own home as well as return to college to complete an academic degree.

This program has been very successful in helping individuals once plagued by debt to connect with credit repair programs so they now can purchase a car, computer of other valued asset (Swarbrick, 2006). We have found that when people earn income and are supported to accumulate assets, they begin to see themselves very differently and act much more confidently (Swarbrick, 2006). Many start the program feeling like a patient or in a dependent role; yet, joining the financial literacy training and being part of a group of people saving, they begin to see themselves as members and contributors to the larger community.

CSP-NJ has experienced secondary benefits to financial training for program staff in the way staff approach participants and the handling of their own finances (Swarbrick, 2006). In our supportive hous­ing program, a dramatic improve­ment has been seen in individuals’ ability to handle their finances when they have received train­ing and support. Account holders assume greater responsibility for managing their own money, making timely with­drawals, paying bills, and plan­ning for expenditures. Staff is being trained to support the individual in a coaching rather than adviser role.

Summary

The array of financial services developed by and for individuals living with mental illness represents an in­novative approach to traditional money-management services. These financial services have positively impacted the recovery, self-sufficiency, and community integration for many individuals CSP-NJ and CEC serves. It is our hope and dream that this model will become an important component of systems mental health systems transformation so we can help individuals realize their dreams of homeownership, employment, achievement of educational goals and full community integration.

References

Swarbrick, M. (2006). Asset-building financial self-management support model: A promising practice. Journal of Psychosocial Nursing, 44(10), 22-26.

i Dr. Swarbrick is the Director of the Institute for Wellness and Recovery Initiatives, CSP-NJ and a post doctoral fellow, National Institute on Disability and Rehabilitation Research (H133PO50006) Advanced Training and Research fellowship, Department of Psychiatric Rehabilitation, School of Health Related Professions, University of Medicine and Dentistry.