Tuesday, February 25, 2014

Your Taxpayer Dollars

One of the interesting and irritating things I learn by working at the psychiatric hospital is how tax payer dollars are spent.  For this post, I'll talk about Supplemental Security Income, or SSI.

Most of my patients collect between $400-$600 per month.  Additional funding is available based on housing costs, if living independently.

People who are disabled but have not worked can be eligible to receive SSI.  In the mental health arena, where disabilities are not always physically obvious, the SSI program can be appropriate for someone with schizophrenia because symptoms start in teen years, before someone is likely to work gainfully, and then becomes full-blown in the early 20s, which usually precludes establishment of a productive working life.  For other mental illnesses, the merits of claims become murkier.

I've had patients tell me, "You're so stupid for going to work.  I just sit at home and collect my money.  It's free."

I've also had patients tell me, "I wish I could work like you.  I wanted to be a nurse, but I got sick.  Nobody will let me work.  The money they send me just covers the rent.  I have nothing.  There must be some kind of work I can do."

On one hand, I am glad that this country has a system in place to fund disabled people so that they do not need to live on the street and beg for food.

On the other hand, we have created a section of the population who could work but instead collect benefits for being "disabled."  They are physically able to make babies that they cannot financially support while they manage to have enough money to spend on drugs, cigarettes, and alcohol that lands them in the emergency department and psych wards on a regular basis.  This is the population from which most of my patients are drawn.

Once they reach my hospital, we have one of two ridiculous and costly scenarios.

In the first, a person is collecting SSI while living with relatives and becomes hospitalized.  While the government is footing the bill for the patient to stay in the hospital, the family continues to collect the SSI checks.  This is understandable in a short-term hospitalization.  The problem is when families outright refuse to allow the patient to return home, even when hospitalization is no longer clinically justified, and they continue to receive the check.  This situation can persist for YEARS because the hospital has to find alternative housing for the patient, which is scarce, and then fight the family to sign the checks over to the new residence.  Without a source of income to pay for room and board, a group home or boarding home will not accept a new resident, so the hospital is stuck with the patient until the monthly check is wrested from the family.  Taxpayers are not only paying for a hospital bed for someone who doesn't need one, but they are also handing over hundreds of dollars a month to a group of people who feel entitled to collect this money no matter what.

The second scenario is when a patient arrives at the hospital without any benefits.  SSI must be awarded in order for the patient to be accepted into a group or boarding home.  Being awarded SSI benefits takes at least a year; sometimes several years.  In the meantime, the person sits in an expensive hospital bed which is not conducive for someone who is no longer acutely ill AND this costs so much more money than handing someone an SSI check each month.

The system is so broken and wasteful.

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