My post this week is a little different! Movie-watching has been at a minimum since school and work have been keeping me busy. But I don’t want to just review movies here! I also want to get the word out about important issues in mental health. And there are some proposed changes to the disability process that I want to talk about today.
First, a little background about my interest in this issue. Last year, I did my field placement with a Critical Time Intervention (CTI) team. CTI is an evidence-based practice that provides intensive, time-limited case management services to some of the most vulnerable people in our country. Specifically, CTI is for individuals undergoing a “critical transition.” Usually, this means someone who is being discharged from an inpatient psychiatric hospitalization, released from jail, or transitioning from homelessness to being housed. In addition to this transition, the person must also have a diagnosis of a serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, etc.).
The goal of CTI is to set up as many services as possible (SSI/SSDI, food stamps, insurance, temporary or permanent housing, outpatient medical and psych providers, etc.) while encouraging the client to participate in this process as much as possible. Over the nine months of CTI, the clinician slowly pulls back and allows the client to take over advocating for themselves. The evidence for this intervention has shown that, nine months after the completion of CTI, individuals had more stability and kept more of their resources intact than those who had treatment-as-usual.
My experience with the CTI team taught me a lot about what it means to be trapped in an ineffectual mental health system. Many of the clients I worked with had been shuffled between dozens of services for years, without finding someone who could guide them through the process of accessing resources. And let me tell you, some of these resources are nearly impossible to access.
One of the most difficult application processes to complete is for Supplemental Security Income (SSI), known colloquially as “disability.” The process is long, complex, and I didn’t even fully understand it until I attended a training specifically designed to help caseworkers do a specific type of application for homeless individuals, called SOAR. Below is a video that explains the difference between a typical SSI application and the expedited SOAR application:
Which brings me to the point of the post: The Social Security Administration is currently seeking comments regarding a potential change in the SSI application process.
Currently, physicians are the only acceptable source of medical evidence for someone applying for disability. This causes problems for both applicants and providers. Many people applying for disability do not have regular access to an MD who knows their full history, so trying to find a physician who is available and willing to participate in the process is difficult. And of course, all of these barriers to obtaining a doctor’s exam increase when the applicant is homeless or transient, as mentioned in the video.
Additionally, much of the medical care in rural areas is provided by other professionals, such as nurse practitioners and physician assistants. In North Carolina, this is especially relevant. An August 2015 report notes that, “between 1990 and 2013, the NP and PA workforce increased by 498% and 284% respectively, compared to a 42% cumulative growth rate for physicians.” From the side of the MD, writing a medical summary report can be incredibly burdensome, especially when the MD has hundreds of other responsibilities to attend to and is already stretched thin.
The SSA has proposed a change that would allow NPs to be an additional source of medical evidence in the SSI application process. This change would greatly help those who are applying for SSI obtain the medical evidence needed for their applications. The SSA is also seeking comments about whether or not they should add PAs to their list of acceptable medical sources, to which I would also say, yes! Please!
I know lots of folks who work in the medical field who are intimidated by the disability process, and this would help take some of the pressure off of MDs. I know lots of social workers who may have assisted someone in applying for SSI, and this would help ease the process. Even if you don’t work in either of these fields, your voice as a civilian is important.
Reel Psych 