Elbogen Eric B, Soriano Catherine, Van Dorn Richard, Swartz Marvin S, Swanson Jeffrey W
Duke University Medical Center, DUMC 3071, Durham, NC 27710, USA.
Psychiatr Serv. 2005 Jan;56(1):45-9. doi: 10.1176/appi.ps.56.1.45.
Although representative payee arrangements are common among people with psychiatric disabilities, only a small body of research has investigated how consumers feel about representative payees' use of disability funds to attempt to improve treatment adherence.
Consumers who were in treatment for a recently documented diagnosis of schizophrenia or a related disorder (N=104) were interviewed to assess their perceptions of the use of disability funds and other legal pressures to attempt to improve treatment adherence.
Most consumers in the sample (65 percent) did not agree that withholding money was a useful method to improve treatment adherence. Multivariate analyses indicated that participants were more likely to agree that use of money as leverage was helpful if they also felt that other legal pressures were helpful for improving adherence and if they felt free to do as they wanted regarding their mental health treatment. On the other hand, participants were less likely to endorse the benefits of money used as leverage if they had at least a high school education and if they reported abusing substances in the past month.
The results of this study point to factors that mediate the potentially negative effects of perceived coercion that are sometimes associated with representative payee arrangements. Leverage of disability funds will likely have an optimal effect if combined with efforts to enhance a sense of self-determination. Conversely, consumers with more education may be less open to this practice, possibly because of perceived stigma related to not being able to control their own finances.
尽管代付人安排在患有精神疾病的人群中很常见，但仅有少量研究调查了消费者对于代付人使用残疾资金以试图提高治疗依从性的看法。
对近期被诊断患有精神分裂症或相关障碍且正在接受治疗的消费者（N = 104）进行访谈，以评估他们对使用残疾资金及其他法律手段来试图提高治疗依从性的看法。
样本中的大多数消费者（65%）不同意扣留资金是提高治疗依从性的有效方法。多变量分析表明，如果参与者还认为其他法律手段有助于提高依从性，并且在心理健康治疗方面感觉可以自由行事，那么他们更有可能同意将资金用作手段是有帮助的。另一方面，如果参与者至少接受过高中教育，并且报告在过去一个月内有物质滥用情况，那么他们不太可能认可将资金用作手段的益处。
本研究结果指出了一些因素，这些因素可调节有时与代付人安排相关的感知胁迫的潜在负面影响。如果将残疾资金的手段与增强自我决定权的努力相结合，可能会产生最佳效果。相反，受教育程度较高的消费者可能对此做法不太接受，这可能是因为他们感觉到与无法控制自己的财务相关的污名。
