Dixon L, Turner J, Krauss N, Scott J, McNary S
Center for Mental Health Services Research, Department of Psychiatry, University of Maryland, Baltimore, USA.
Psychiatr Serv. 1999 Jun;50(6):781-6. doi: 10.1176/ps.50.6.781.
Clients with severe and persistent mental illnesses often require a representative payee to help manage benefit funds. This study compared the perceptions of clients and clinical case managers about the benefits of and problems with the representative payee relationship.
Fifty-four clients receiving assertive community treatment completed an interview that assessed satisfaction with their experience of having a representative payee and the resulting impact on their substance use, budgeting, and housing. The clients' clinical case managers completed a similar questionnaire. Analyses examined associations between providers' and clients' responses and clients' gender, race, diagnosis, previous experience with a representative payee, and duration of the current representative payeeship.
Clients and case managers recognized benefits of the representative payeeship in the areas of housing, substance use, and budgeting. Although little evidence was found that the payeeship pervasively interfered with the therapeutic relationship, 44 percent of case managers reported incidents in which clients verbally abused them over management of their funds. Clients' satisfaction with the representative payeeship was initially low but grew over time. Longer duration of the current payeeship and clients' previous experience with representative payeeship were associated with greater satisfaction and fewer problems. Case managers overestimated clients' initial satisfaction and underestimated their current satisfaction.
Findings suggest that both mental health professionals and clients value the representative payee process as helpful in improving outcomes, although the benefits of the arrangement may be more evident with time and experience.
患有严重且持续性精神疾病的患者通常需要一位代领款项人来帮助管理福利资金。本研究比较了患者和临床个案管理员对代领款项人关系的益处及问题的看法。
54名接受积极社区治疗的患者完成了一项访谈，该访谈评估了他们对有代领款项人的经历的满意度以及这对他们的物质使用、预算管理和住房情况产生的影响。患者的临床个案管理员完成了一份类似的问卷。分析考察了提供者和患者的回答之间的关联，以及患者的性别、种族、诊断、以前有代领款项人的经历，和当前代领款项关系的持续时间。
患者和个案管理员认识到代领款项在住房、物质使用和预算管理方面的益处。虽然几乎没有证据表明代领款项普遍干扰治疗关系，但44%的个案管理员报告了患者因资金管理问题对他们进行言语辱骂的事件。患者对代领款项的满意度最初较低，但随着时间推移有所提高。当前代领款项关系持续时间较长以及患者以前有代领款项的经历与更高的满意度和更少的问题相关。个案管理员高估了患者最初的满意度，低估了他们当前的满意度。
研究结果表明，心理健康专业人员和患者都重视代领款项流程，认为其有助于改善结果，尽管随着时间推移和经验积累，这种安排的益处可能会更加明显。
