From street outreach to community mental health services to housing placements, PATH providers strive to take care of the whole individual. Through this holistic approach, providers help individuals address their immediate needs and stabilize their lives. Financial planning and money management is an area of support some PATH providers include in their array of services. For many individuals who are enrolled in PATH, effectively managing money is a crucial step towards taking control of their lives and achieving long term goals.

Many individuals who are enrolled in PATH receive, or are eligible for, Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), Veterans benefits, and/or state benefits. A person receiving any one of these benefits is often referred to as a “grantee.” When a grantee is unable to manage these funds, an individual can be appointed by the agency granting the benefit to manage the funds. The appointed individual is referred to as a representative payee or “payee.”

The primary responsibility of the payee is to ensure that public benefits are used to secure the basic needs of the grantee. The payee receives the benefit checks on behalf of the grantee and is responsible for using the funds to cover the grantee’s housing, food, medication, clothing, and other necessities. Any remaining money can then be distributed to the grantee.

From the Research

There are risks and challenges to serving as a payee. For example, managing a grantee’s finances can be construed as parental or even punitive by the grantee (Cogswell, 1996). Serving as a payee can also put undue strain on a therapeutic relationship when a case manager, counselor, or therapist also serves as the payee (Elbogen, Wilder, Swartz, & Swanson, 2008).

Keeping the risks in mind, there are situations where payee services are appropriate and beneficial to the grantee. These scenarios could include: mismanagement of funds due to substance use; unavailability of sufficient funds to meet basic needs; repeated victimization of the grantee; and/or availability of a payee whose efforts would increase the likelihood that mismanagement of funds would be curtailed (Luchins, Roberts, & Hanrahan, 2001).

A study conducted by Pathways to Housing in New York City revealed that money management services reduced the risk of homelessness (Tsemberis, Gulcur, & Nakae, 2004). Another study of individuals with severe mental illness and co-occurring substance use disorders found that individuals whose benefits were managed through their mental health center showed less alcohol and drug use and superior money management compared to their counterparts who did not receive payee services (Ries, Dyck, & Short, 2004).

The research reveals payees provide substantial benefits to individuals with serious mental illness and/or co-occurring disorders who may be homeless. The Greater Wheeling Coalition for the Homeless, a PATH agency in Wheeling, West Virginia, is an example of how payee services are provided in the PATH community.

From the Field

The Greater Wheeling Coalition for the Homeless (GWCH) is an agency-appointed representative payee for all residents of the agency’s residential program. The residential program currently houses eleven adults with serious mental illness. When individuals apply for a bed at GWCH, they meet with Janet Boyuk, the case manager in charge of the Residential Housing Program, to discuss the guidelines of the program. Janet makes it clear that one contingency of program admission is to allow her to serve as their representative payee. Individuals accepted into the program enter on a thirty-day trial basis. If an individual commits to staying at GWCH after the probation period, Janet becomes their representative payee.

Janet asserts the residents benefit greatly from the payee service at GWCH. During their time in the program, Janet meets with residents two or three times per week, including one home visit. As part of her case management services, she works with each resident to develop a monthly budget. After achieving the goals of their monthly budget, Janet works with the resident to relate their cost of living in the program to the cost of housing in the private market. This allows residents to work towards the goal of living on their own.

GWCH understands the need for residents to have spending money for their own leisure. After a resident is able to budget to meet their basic needs, Janet works with them to save money to do something enjoyable, such as taking a trip to visit family members.

Janet cites resident involvement as the reason for the successful payee program. Residents are involved in their financial decisions upon entering GWCH; decisions are not made without consulting with them. Additionally, the monthly participant advisory groups provide opportunities for resident feedback. These groups create a constant feedback loop between residents and GWCH staff where concerns about services, including the payee services, are shared. Janet has not received negative feedback about the payee services from the group.

In the future, Janet hopes to change the payee program by ending her payee services several months before residents exit the program. This change would enable residents the opportunity to financially manage their benefits while still in a supportive environment.

For individuals enrolled in PATH who need a high level of financial support, payee services can be a beneficial service for PATH programs. If providers involve individuals in the planning and budgeting, payee services can be a stepping-stone towards independence. Payee services are not for all PATH programs, but as Janet explains, payee services are often “a route to economic empowerment, self confidence, and personal responsibility.”

References

Luchins, D.J., Roberts, D.L., & Hanrahan, P. (2001). Provision of protective payee status: A guideline developed for the Behavioral Health Recovery Management Project. University of Chicago Center for Psychiatric Rehabilitation: Chicago, IL.

Cogswell, S.H. (1996). Entitlements, payees, and coercion, in Coercion and Aggressive Community Treatment: A New Frontier in Mental Health Law. Edited by Dennis DL, Monahan J. New York: Springer-Verlag.

Elbogen, E.B., Wilder, C., Swartz, M.S., & Swanson, J.W. (2008). Caregivers as money managers for adults with severe mental illness: How treatment providers can help. Academic Psychiatry, 32, 104.110.

Ries, R.K., Dyck, D.G., Short R., et al (2004). Outcomes of managing disability benefits among patients with substance dependence and severe mental illness. Psychiatric Services, 55, 445–447.

Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first: patient choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94, 651–656

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