In 1996 the U.S. severely restricted public support for low income people, ending “welfare as we know it.” This led to dramatic increases in medicalized forms of support for indigent people, who ...increasingly rely on disability benefits justified by psychiatric diagnoses of chronic mental illness. We present case studies drawn from ethnographic data involving daily participant-observation between 2005 and 2012 in public clinics and impoverished neighborhoods in New York City, to describe the subjective experience of structural stigma imposed by the increasing medicalization of public support for the poor through a diagnosis of permanent mental disability. In some cases, disability benefits enable recipients to fulfill important social roles (sustaining a vulnerable household and promoting stable parenting). The status of family members who receive a monthly disability check improves within their kin and neighborhood-based networks, counterbalancing the felt stigma of being identified by doctors as "crazy". When a diagnosis of mental pathology becomes a valuable survival strategy constituting the basis for fulfillment of household responsibilities, stigmatizing processes are structurally altered. Through the decades, the stigmatized labels applied to the poor have shifted: from being a symptom of racial weakness, to the culture of poverty, and now to permanent medical pathology. The neoliberal bureaucratic requirement that the poor must repeatedly prove their “disabled” status through therapy and psychotropic medication appears to be generating a national and policy-maker discourse condemning SSI malingerers, resurrecting the 16th century specter of the "unworthy poor".
•The first ethnographic examination of effects of US 1996 Welfare Reform and disability benefits on stigma.•Provides theoretical insight that structure and stigma shape each other bidirectionally.•Stigma among the poor may be structurally reinforced by local efforts to neutralize stigma.
What started as a call for a specific change to disability insurance programs for medical students turned into a lengthy debate about autonomy and policy details at the annual general council of the ...Canadian Medical Association (CMA). In the end, 62% of delegates voted against a motion for the CMA to support medical students getting disability insurance by default rather than having to choose their own coverage. Despite the good intentions behind the motion, some physicians and medical students weren't convinced it was a good idea. Several others at the session suggest that educating medical students about their choices, rather than forcing them to opt out of an imposed policy, was the better direction to take.
Objectives:
Concerns raised about the appropriateness of the National Disability Insurance Scheme (NDIS) in Australia for people with mental illness have not been given full weight due to a perceived ...lack of available evidence. In the Australian Capital Territory (ACT), one of the pilot sites of the Scheme, mental health care providers across all relevant sectors who were interviewed for a local Atlas of Mental Health Care described the impact of the scheme on their service provision.
Methods:
All mental health care providers from every sector in the ACT were contacted. The participation rate was 92%. We used the Description and Evaluation of Services and Directories for Long Term Care to assess all service provision at the local level.
Results:
Around one-third of services interviewed lacked funding stability for longer than 12 months. Nine of the 12 services who commented on the impact of the NDIS expressed deep concern over problems in planning and other issues.
Conclusions:
The transition to NDIS has had a major impact on ACT service providers. The ACT was a best-case scenario as it was one of the NDIS pilot sites.
Introduction: Reforms to Australia's disability and rehabilitation sectors have espoused the potential of assistive technology as an enabler. As new insurance systems are being developed it is timely ...to examine the structure of existing systems. This exploratory study examined the policies guiding assistive technology provision in the motor accident insurance sector of one Australian state.
Methods: Policy documents were analyzed iteratively with a set of qualitative questions to understand the intent and interpretation of policies guiding assistive technology provision. Content analysis identified relevant sections and meaningful terminology, and context analysis explored the dominant perspectives informing policy.
Results and discussion: The concepts and language of assistive technology are not part of the policy frameworks guiding rehabilitation practice in Queensland's motor accident insurance sector. The definition of rehabilitation in the legislation is consistent with contemporary international interpretations that focus on optimizing functioning in interaction with the environment. However, the supporting documents are focused on recovery from injuries where decisions are guided by clinical need and affordability.
Conclusion: The policies frame rehabilitation in a medical model that separates assistive technology provision from the rehabilitation plan. The legislative framework provides opportunities to develop and improve assistive technology provision as part of an integrated approach to rehabilitation.
Objective:Approval rates for first-time applications for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) among adults who are homeless can be as low as 10%. This ...study examined approval rates among applicants who were assisted by SSI/SSDI Outreach, Access, and Recovery (SOAR), a federal initiative to increase access to disability benefits among people who are homeless or at risk of homelessness and who have mental illness or other co-occurring disorders.
Methods:Data were collected in 37 states that had participated in SOAR for at least one year.
Results:Of 8,978 applications assisted by SOAR, 6,558 (73%) were approved. The average number of days between application and decision was 91. SOAR was associated with increased access to housing and cost savings through increased Medicaid reimbursement.
Conclusions:SOAR substantially increased access to SSI and SSDI entitlements for people with disabilities who experience or are at risk for homelessness. (Psychiatric Services 62:1373–1376, 2011)
We use a social experiment to estimate the impact of expanding health insurance coverage on the health and mortality of newly entitled SSDI beneficiaries who lacked health insurance. Our ...intent-to-treat estimates show that expanding health insurance has significant effects on self-reported health at one year following health insurance enrollment, positive effects on mental health and physical health at one year following health insurance enrollment, and no significant effects on mortality within our observation period. About 30% of control group members obtained health insurance coverage within one year following enrollment. We use two-stage least square models to estimate the impact on those who would not have obtained health insurance coverage without the demonstration project and find larger effects on self-reported health and mental health among these SSDI beneficiaries. Finally, we examine distributional impacts to show that mean impacts miss meaningful effects.
Mental disorders rank first amongst all causes for disability pensions and second in the field of medical rehabilitation. Especially alarming is the significantly lower age of entry of the mentally ...ill disability pensioners, compared to those with other indications. Mentally ill people often look back at a long history of diseases before getting in contact with the German pension insurance. In this regard the German pension insurance, which is obligated to effectively support people in order to keep them in working life until reaching the regular retirement age, is facing a big challenge, which stands right next to further demands, due to the demographic change, the increase of chronic diseases, multimorbidity, retirement age of 67 and changes in the working environment.With their activities in the field of medical rehabilitation the German pension insurance is aiming at the reintegration of people whose working capacity is endangered or reduced into the labor force or to prevent them from leaving it early. One of the main challenges notably in the field of mental diseases is to keep the success of the medical rehabilitation long-lasting. In this regard the post-rehabilitation provisions of the German pension insurances offer support according to § 31 I 1 Nr. 1 Social Insurance Code VI, if so required.On January 1st, 2016 the German pension insurance has adopted a new conceptual framework in the field of post rehabilitation which is presented in the following article, covering the range of psychosomatic indications. The aim of the new conceptual framework, which has to be implemented within the next three years, is to establish a nationwide, uniformed and preferably comprehensive follow-up care concept, which can be referred to by everyone, regardless which agency of the German pension insurance is in charge.
Abstract
Purpose: Substantial evidence supports assistive technology and environmental adaptations as key enablers to participation. In order to realise the potential of these interventions, they ...need to be both recognised in policy, and resourced in practice. This paper uses political theory to understand the complexities of assistive technology (AT) policy reform in Australia. AT research will not be influential in improving AT policy without consideration of political drivers. Method: Theories of policy formation are considered, with Kingdon's (2003) theory of multiple streams identified as a useful lens through which to understand government actions. This theory is applied to the case of current AT policy reformulation in Australia. Results: The convergence model of problem identification, policy formulation and political will is found to be an applicable construct with which to evaluate contemporary policy changes. This paper illustrates the cogency of this theory for the field of AT, in the case of Australia's recent disability and aged care reforms. Conclusions: Political theory provides a way of conceptualising the difficulties of consumers and AT practitioners experience in getting therapeutically valid solutions into public policy, and then getting policies prioritised and funded. It is suggested that AT practitioners must comprehend and consider political factors in working towards effective policies to support their practice.Implications for RehabilitationAT practitioners generally lack political awareness or an understanding of the drivers of policy.The effectiveness of AT practitioners at a systemic level will remain limited without consideration of policy drivers.AT practitioners must comprehend and consider political factors in working towards effective policies to support their practice.
The government has won a key vote in the House of Lords, defeating attempts to delay the introduction of new disability payments. The aim of the bill, Lord Freud said, was not to cut the present cost ...of allowances to disabled people, running at £12.6bn a year, but to try to limit future increases by ensuring that the benefit was paid only to those who needed it. The gap of 500000 was focused on by critics in the Lords as proof that the government was seeking to save money by denying benefits to many people who would otherwise have received them.
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