Social Security and General Relief Income Study: The community feedback period for this idea began on 8/30/2019 and will end on 10/29/2019

What is the problem that needs to be addressed? Please describe how it is related to mental health.
This is a request for a clinical study of the Social Security Administration (SSA) Social Security Disability (SSDI), Supplemental Security Income (SSI) and Orange County General Relief (GR) programs. This submission mirrors the bankruptcy submission previously posted. The US Federal Court Central District of California publishes success rates for bankruptcy and most common reasons for failure. The Federal Court also publishes a brief overview of the process that includes submission of papers, training requirements/documentation, meetings required, etc. Unfortunately, SSDI/SSI/GR programs don’t publish success rates (ideally based upon diagnosis), most common reasons for failure, nor what the process looks like. The general idea is that a person experiencing severe, possibly untreated, mental illness isn’t able to successfully complete the paperwork with the answers that successfully award GR. The risk of falsifying documents and possible future legal issues based upon this de-facto procedure seems quite high. Furthermore, anyone receiving housing in Orange County may be obtaining an “in-kind” or barter type income that possibly precludes qualifying for GR and Orange County Behavioral Health Services. Historically, people experiencing mental illness fall into the fringes of law and society. Thus, these processes really do require legal representation to avoid falsification of documents. While not an issue now, if the general public ever decides to turn on the population experiencing mental illness, any falsification of records will likely be used to incarcerate/punish.

Why is this a concern for Orange County? What can Orange County and other counties learn from this project?
Orange County spends quite a bit of money on GR benefits and probably, even more, money staffing/administering the GR benefits and on Outreach and Engagement staff to facilitate a person with Serious Mental Illness through the process. The current website for GR states “To be eligible for GR you must be a U.S. citizen or a documented non-citizen, reside in Orange County, and meet certain income and property requirements as well as other criteria. In addition, all General Relief applicants and recipients must be fingerprinted as a condition of eligibility. You need to file an application to find out if you are eligible.” Essentially – we have this program but we won’t tell you if you qualify unless you expend transportation and time resources to visit our office, bringing whatever documentation you guess we might need (verification of ANY property in addition to “Other necessary verifications may be requested as specified in the GR Regulations Manual”). No link is provided to the most current GR Regulations Manual and even if one were provided it probably requires legal representation to understand. Once in the office, one is provided numerous forms that must be filled out which creates a psychological pressure to get it done at that moment (otherwise it is another day of expending transportation and time resources). That psychological pressure doesn’t likely foster correct answers. As for SSI/SSDI, knowing what the process looks like based upon primary diagnosis, how many years it will take to complete (mean, median and standard deviation), and the success rate is important to know for decision making. Is it worth my time to go through the process? Anecdotally the process takes 5 years, multiple appeals, hiring legal representation and quite a bit of emotional capital with an unknown success rate based upon diagnosis.

What is currently being done to resolve this problem in our county and throughout the United States? If applicable: Is it working; why or why not?
Unknown.

What is new or different about this project idea? Please describe how this differs from what is already being done (Question 6). Please list any research that was done on this topic.
Look around. Does a clinical trial of SSDI/SSI/GR exist where people were randomized to either an apply group or a no-apply group by diagnosis? Minimum meaningful metric endpoints broken out by diagnosis include life-expectancy, suicide rate, the time required to undergo the process, the resources required to undergo process (money, transportation, legal representation, documentation burden), success rate, most common reasons of failure and future legal risk for prosecution/punishment/incarceration for falsification of documents or similar issues. See the US Federal Court Central California District metrics for bankruptcy to get an idea of what those metrics look like.

What is the project idea? Please describe how this project will operate.
See the bankruptcy submission for the criteria of a clinical study. Conduct a clinical study of SSDI/SSI/GR for publication. Additionally, legal review of the GR paperwork to answer the open legal questions a person who is homeless/experiencing mental illness will encounter about accounting for non-monetary “in-kind”, barter or charity income. Such income based upon market rates for housing is quite hi

Additional Information:
Respondent skipped this question

August 16, 2019

2 comments

A few studies hint at the link between suicidality and employment/income issues.

https://www.ncbi.nlm.nih.gov/pubmed/28404500 cites low job control, job insecurity, unfair pay, and casual/fixed term contracts.
https://www.ncbi.nlm.nih.gov/pubmed/28851757 cites poor supervisor/colleague support, low job control,
https://www.ncbi.nlm.nih.gov/pubmed/21186340: suggests that transitioning from bankruptcy to SSI/SSDI/Ticket to Work may be no better than unemployment/NEET.
Anecdotally, applying for SSI/SSDI/GR is a low-control experience with much insecurity, and poor support.

Thank you for your submission. The Innovation team will review this idea and post comments and updates when available.

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