Pathways to disability income among persons with severe, persistent psychiatric disorders.

Excerpt] Harsh skepticism pervades current public debate about who deserves public support and on what basis, particularly regarding the claims of individuals with disabling illness and injury. Heretofore, these claims were accepted, even reservedly, and the needs of such individuals were considered to be legitimate even when they were monitored closely. The Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) programs and their recipients have been among the most visible and vulnerable targets of increased scrutiny and shrinking public beneficence. In 1997, congressional legislation redefined SSI eligibility for children, sparked largely by concerns that children have been deployed to engage in a type of public begging by "acting crazy" in order to secure benefits for their families. "Maladaptive behaviors" was removed from the mental disorder listings, and the Social Security Administration (SSA) estimates that 135,000 children will lose their benefits after review. In March 1996, Congress eliminated SSI, SSDI, Medicare, and Medicaid benefits for persons whose drug addiction or alcoholism is a prominent cause of disability, and as a result 141,000 recipients have been terminated. The SSA also was ordered to begin another sweeping review of all recipients of disability income. SSA officials reportedly expect this process to produce a termination rate of 14 percent, resulting in an estimated 196,000 additional individuals who would cease to receive SSI and SSDI.