Psychiatric Disability,the Use of Financial Leverage,and Perceived Coercion in Mental Health Services

Abstract

Although the use of representative payees has proliferated in the past decade, little is known about whether clinicians or family members of people with mental illness use their control of clients' money to leverage treatment adherence or whether persons with psychiatric disabilities perceive that if they are noncompliant, their money will be withheld. The purpose of this study was to examine clinical and demographic variables associated with perceived financial coercion and warnings involving control of money in the context of mental health services. 258 involuntarily admitted inpatients with severe mental illness were followed for one year and interviewed, as were their clinicians and family members. Results showed that nearly 30% of participants perceived financial coercion whereas a smaller fraction of participants' clinicians and family members reported giving money warnings. However, some factors, including ethnicity and being subject to other legal mechanisms, predicted both—actual warnings and perceived coercion. Implications of these findings are discussed in terms of gaining understanding of the ways which financial arrangements facilitate or thwart delivery of effective mental health services.