Planet Money reporter Chana Joffe-Walt recently reported on her investigation of the rapid rise in the number of US citizens on federally funded disability, including Social Security Disability Insurance (SSD) and Supplemental Security Income (SSI).
In her story, she made a number of findings, including:
- There are parts of our country where 25% of working age adults are classified as disabled and receive government support;
- Many of those classified as disabled are underprepared for the work environment in which they find themselves, in part due to their low educational status and in part due to the movement of certain jobs to cheaper labor markets overseas;
- There has been a very rapid and sustained rise of children receiving disability payments over the past two decades, at least in part due to the reliance of their families on these payments for their own support;
- There are clear economic incentives for states to shift the poor from state-funded welfare systems to largely federally funded disability systems.
What, you ask, has this to do with the justice system?
The vast majority of individuals who find themselves involved in the justice system are not “disabled” in the classic sense of the word. Many people with whom I have interacted over the years are quite able to function in a work environment, but for any number of reasons they choose lines of work on which society frowns.
However, when it comes to individuals with serious illnesses such as schizophrenia, bipolar disorder, developmental/intellectual disabilities, head injuries or post-traumatic stress disorder, the disability system is a lifeline.
These benefits are by their nature reinforcing: a person receiving payments contingent on being unable to work is motivated to continue being unable to work in order to continue these payments. Many of the people receiving SSI or SSD with whom I have worked tell me—convincingly—that they are only prepared for jobs that pay low wages and do not come with health benefits.
“Why should I give up the SSI, and the Medicaid it comes with, for that sort of job?” they ask.
As the Planet Money report makes clear, then, the disability street is often one-way.
When a person receiving SSI or SSD is incarcerated, his/her benefit is suspended after a period of time. State health departments and local and state correctional facilities have developed mechanisms whereby the health department turns the benefit off upon notification by the correctional institution.
This ensures that individuals in custody are not also receiving benefits meant for daily living, which because of incarceration they do not need.
After a longer period of time, the person's eligibility for SSI is terminated, though this is not the case for SSD.
If the person is released while the benefit is in “suspension” status, he or she need only go to a local Social Security Field Office with release papers in hand, and the benefit will be turned back on the following month. Should the person be released after his or her eligibility has been terminated, a new application is required.
Jails and prisons may initiate a new application during the several months prior to release, though many practitioners in these settings are unaware that this is possible. Often, they do not have the resources to assist inmates in applying for these benefits. Even when correctional health personnel assist with these pre-release applications, it can be difficult to establish that a person is unable to work when this has not been a required part of the person's life for many months or years of incarceration—so such applications are likely to be denied.
In other words, while we have established that few people who receive disability later re-enter the workforce, upon incarceration the benefit is interrupted. Even in the best-case scenario, the person will be without benefits until the month following release.
How is such a person to support himself during the high-risk period immediately following release?
This is another example of unintended consequences arising from well-intended programmatic changes.
One of the highlights of the Clinton era was welfare reform, yet this reform has resulted in a rapidly expanding population of individuals labeled “disabled” rather than “poor.”
Fortunately, permitting the benefit to be suspended rather than immediately terminated upon incarceration has been a boon to the many people with disabilities jailed for relatively short times, but even this results in a period of time after release without coverage.
My takeaways from Ms. Joffe-Walt's story?
- The current expansion of the disability system is about much more than being unable to work due to medical or psychiatric impairments. It is about poverty, and it is about the failures of our education system. And it is about globalization (especially of lower paying jobs). Not addressing these problems will render it impossible for us to address the so-called disability-industrial complex.
- When people are truly unable to work due to medical or psychiatric reasons, their ability to access benefits is hindered by the ballooning of the disability system – and with it our collective skepticism regarding that system.
- In at least some instances, there is a direct and possibly causative relationship between a person's inability to obtain legal means of support and his subsequent involvement in the justice system.
- Finally, in recent years, we have learned more about ways to help people with serious psychiatric disorders to become more functional and able to work in the competitive labor market. Why are these services not strongly supported—or even required—by our disability systems that currently pay recipients to remain disabled?
I am no Pollyanna. Some of the people with whom I work likely will never be fullyself-sustaining.
But more of them will not be self-sustaining if we pay them to remain dependent on us.
Surely, if our community-based programs are not providing these services because there is no incentive to do so, corrections systems will never do so. They will remain poor, they will remain undereducated, they will remain unskilled for their local job environment, and they will remain justice-involved.
Erik Roskes, a regular blogger for The Crime Report, is a forensic psychiatrist and serves on the teaching faculty in the Psychiatry Department at the University of Maryland School of Medicine. The opinions expressed are those of the author only, and do not represent those of any of Dr. Roskes' employers or consultees, including the Maryland Department of Health and Mental Hygiene. He welcomes readers' comments. Dr. Roskes' website is http://mysite.verizon.net/eroskes