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ideastream Focus on Mental Health: Consumers Struggling For Independence

Tuesday, April 29, 2003 at 3:18 PM

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Studies have suggested that poverty can increase your risk for developing mental illness. It's also true that mental illness can increase your risk of poverty. Every day, people from all walks of life are diagnosed with mental illness. The one thing they all have in common is a fear of becoming less independent. According to the Ohio Department of Mental Health, seventy eight percent of people receiving government assistance for mental disabilities are living below the poverty level. Ironically, some choose not to work, having found they simply can not afford to become more independent. ideastream's April Baer reports.

For most people, financial planning is a fairly straightforward process: begin with your income and expenses. Build toward your goals, with insurance, investments, and savings. But for people with mental illness, making life decisions is a much different - and more difficult - process.

One young woman, who we’ll call Susan, is 20 years old , with a wide smile and soft brown hair. She’s diagnosed with depression, anxiety, and a few related conditions, but is living on her own.

Susan: It’s gotten a lot better but the whole financial responsibility has been kicking my butt recently.

Susan was 14 when she first started showing signs of emotional trouble. The days she cut classes, the nights she didn’t come home, was at first written off as rebellious teen behavior. But by the time she turned 19, she and her father, who we’ll call Steve, came to terms with the fact that they’d have to re-evaluate her future plans. Their decisions were complicated by the fact that Susan’s mother was dying.

Steve: I was extremely scared what would happen to Susan because of her mom’s passing on, she and her mom would be basically talking to each other and her mom would be helping her through these difficulties.

The financial struggles that make mental illness so difficult often begin in this period-the late teens-when the protections of childhood life give way to the responsibilities of the adult world. During this period many will fall behind in their studies. Over half of all U.S. schoolchildren diagnosed with severe mental illness never finish school, according to researchers at the University of Illinois. Many others lose medical benefits they received as part of their parents’ health insurance. Like Susan, they enter the adult world lacking a high school diploma, or health insurance, hoping their condition will let them work enough to get by.

Susan’s solution was to move in with a friend, and get an hourly job. Between this and a monthly check from Social Security, she’s getting by. She’s gone back to school to get her GED - a decision she hopes will help over the long term. But her classes have forced her to drop from full- time to part-time status at work, decreasing her income.

Susan’s also keeping an eye on another problem that’s common among people with mental illness--trying not to work too much. Her hourly job does not provide health insurance. She’s signed up for Medicaid, but there’s a catch: Medicaid will cover her medical expenses only as long as her income remains below a certain level.

Susan: I can’t - with the Medicaid that you’re on I really can’t work that much because they penalize you. For the more hours, they take away, like your food stamps, and there’s a spend down that goes way up. I can never meet them, and then I can’t get my medications at the end of the month and I won’t be able to go to my doctors.

Steve says the more complicated his daughter’s fiscal situation becomes, the harder it is for him to know how to help. If he tries to set up a trust fund or insurance policy for her, Medicaid will credit those investments toward her income. She would make too much to qualify for medical coverage. Right now they’re trying to decide whether Susan should apply for financial aid to go to college.

Steve: For her it would be a great opportunity because she wants to become further educated. But, I’m afraid that, what if this illness gets worse? What if this illness is right now in a hold pattern and due to either stress or due to changes later on, she needs to be part of the program. If I’m gone, or I’m not here to help and she falls ill again, will she end up on the street as a homeless person, just bouncing around?

There is no single formula or plan that’s guaranteed to help people with mental illness live independently. Shawna Stockdale is a licensed independent Social Worker at the Nord Center in Lorain County. She notes that Social Security’s monthly check is the mainstay for thousands of people. But the payments aren’t enough to live on.

Shawna Stockdale: You think about $500, even if you only had to pay $100 or $120 in rent. Then you have the cost of transportation for the month. Most places charge utilities. So you can see that $500 get eaten up very quickly.

Stockdale says any major reform would have to account for the lack of health insurance for people who choose to work, entering the workforce in a fragile condition. The most successful programs are the ones that have supported working consumer-either in traditional jobs, or in volunteer positions, with payments to supplement.

Shawna Stockdale: I have to tell you I’ve been in mental health for 30 years, and there’s never been a time that I’m not taken by surprise. I just went to a restaurant over the Easter holidays and happened to see a consumer I was working. And he was probably the last person I would think of. And he was doing a very good job!

There is some evidence that many people with mental illness reach a plateau when they reach late middle age. Some find their symptoms receding slightly, others are simply more practiced at managing their affairs. But before they find that respite, they must navigate around the poverty that claims eighty seven percent of independent consumers early in life. Stockdale says those who can’t connect with a dedicated caseworker are much less likely to survive. In Cleveland, April Baer, 90.3.

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