Perceptions of Beneficiaries with Mental Illness and Family Representative Payees Regarding Satisfaction and Challenges

Abstract

This paper examines family representative payeeship provided to adults with mental illness.  In-depth interviews were conducted with five beneficiaries with mental illness who have a family representative payee and seven family representative payees for this population.  The qualitative descriptive method and thematic analysis were employed to examine satisfaction with, and conflict experienced in, family representative payeeship. 

The paper found that:

• Most participants described having a high level of satisfaction with representative payeeship.
• Most participants identified benefits of family vs. organizational representative payees being easier access to, and greater trust and closeness with, family representative payees.
• Some beneficiaries said one drawback of family vs. organizational representative payees is that family members may try to influence more of their decisions than would organizational representative payees.
• Most family representative payees provided assistance to beneficiaries beyond managing their money; some participants worried about the burden experienced by family representative payees.
• Considerable variation was described in how informed beneficiaries are of their finances and in their level of involvement in making financial decisions.
• Beneficiaries reported that not being involved in financial decision-making detracted from their satisfaction.
• Participants (beneficiaries and representative payees) who reported beneficiaries were less involved in making financial decisions tended to experience more financial arguments.   
• Some beneficiaries believed family representative payees were less skilled and/or knowledgeable than organizational representative payees about the rules and limits of representative payeeship; they suggested that family representative payees receive more education and training from the Social Security Administration (SSA). 
• A couple of beneficiaries reported misuse of funds by representative payees.  They wanted alternatives to formally filing a complaint to help resolve issues of misuse and financial disagreements, with one suggestion being to offer mediation.

The policy implications of the findings are:

• SSA may want to consider making additional efforts to educate and train family representative payees on financial matters and the rules and limits of representative payeeship.
• It may be helpful for SSA to further promote engaging in supported decision-making among family representative payees and beneficiaries; increasing the involvement of beneficiaries in financial decision-making may prevent conflicts and enhance satisfaction for both parties.
• SSA may want to consider alternative means of recourse for beneficiaries perceiving misuse of their funds or experiencing frequent financial disagreements.