Recipients of Representative Payeeship with Mental Illness: Financial Leverage, Conflict, and Satisfaction

Background and Purpose: The Social Security Administration (SSA) provides benefits to more than 69 million adults and children through Old-Age and Survivors Insurance and Supplemental Security Income. When beneficiaries are unable to manage their finances, the SSA appoints a legal representative payee who is tasked with managing these benefits in a manner that ensures beneficiaries’ basic needs are met. More than one-quarter of all adult beneficiaries with mental illness—nearly 700,000 people—have their benefits managed by a representative payee. While representative payeeship is associated with benefits, evidence indicates that it may also be associated with dissatisfaction, financial leverage, conflict, and even violence—especially toward family members serving as payees. Unfortunately, no quantitative study has examined representative payeeship for persons with mental illness in the past decade. Furthermore, with few exceptions, existing studies on the topic have examined representative payeeship provided by professionals, resulting in a lack of knowledge regarding representative payeeship delivered by the most common providers: family members. To help fill these gaps, utilizing a sample of persons with mental illness receiving representative payeeship provided primarily by family members, the objectives of this study are to 1) describe levels of financial leverage, conflict, and satisfaction regarding representative payeeship and 2) examine if characteristics pertaining to recipients and the representative payee arrangement are associated with financial leverage, conflict, and satisfaction.

Methods: Between 2016 and 2017, sixty adults who reported having a mental illness and a representative payee completed an online survey, with most (n = 50) having a family representative payee. Participants resided in 20 states in the U.S. and were recruited from the following sources: National Alliance on Mental Illness (n = 23), Depression and Bipolar Support Alliance (n = 13), Facebook groups pertaining to mental illness/health (n = 8), mental health treatment facilities (n = 7), associations for peer support specialists (n = 3), and other/unknown (n = 6). All variables were measured with straightforward questions. The survey was pretested with two psychiatric professionals and three persons meeting the study eligibility criteria. We computed descriptive statistics, Wilcoxon-Mann Whitney tests, and Spearman correlations.

Results: Approximately, one-third of participants reported experiencing financial leverage and conflict “sometimes” or more often and were “somewhat” or “very” dissatisfied with their representative payee arrangement. Alcohol and/or drug use among participants was associated with experiencing greater financial leverage and conflict. While significant differences in experiencing conflict and satisfaction were not found by type of payeeship (family vs. professional), participants reported experiencing greater financial leverage when their representative payee was a family member. Financial leverage and conflict were positively associated with each other and negatively associated with satisfaction.

Conclusions and Implications: A sizable minority of participants reported experiencing financial leverage, conflict, and dissatisfaction pertaining to representative payeeship. Given the high prevalence of representative payeeship among persons with mental illness, it is critical that steps be taken to enhance satisfaction and decrease conflict. Supporting family and professional representative payees in decreasing their use of financial leverage and engaging in shared-decision making may assist in enhancing satisfaction and preventing conflict.