24 August 2006

Throwing People Away

What should society do with a mentally ill, multi-drug addicted, unemployable, homeless, 35 year old divorced mother of three children (who didn't live with her) with a long history of suicide attempts? Leave her to become a vagrant until she succeeds in killing herself, or help her with SSI payments and Medicaid care which she would qualify for if she is considered disabled?

The Social Security Administration insisted that she figure out how to free herself from alcohol and drugs, and doing so still fail dismally in efforts to obtain work because of her mental illness, before she could be treated as disabled as a result of her mental illness. The 10th Circuit,based in Denver, in its unpublished decision in the case of Julie Salazar, reversed that decision, ruling that compassion was a better choice.

Ms. Salazar ultimately prevailed largely because the evidence in her case showed that even after staying free of drugs and alcohol for 40 days in a substance abuse program she remained so deeply mentally ill that she had to be transferred directly to a hospital for inpatient mental health treatment.

(The Adminstrative Law Judge in the case misunderstood the medical records and thought that she had improved dramatically after those 40 days, failing to understand that she improved meaingfully only after five days of intensive inpatient psychiatric treatment following the 40 days of substance abuse treatment she had received.)

But, help for her was deferred for five years, which she was lucky to have survived at all.

Also, cases like this one cast into doubt the wisdom of "The Contract With America Advancement Act of 1996" (P.L. 104-121) which provides that:
An individual shall not be considered to be disabled . . . if alcoholism or drug addition would . . . be a contributing factor material to the . . . determination that the individual is disabled.
In other words, our national policy for the past decade has been to let alcoholics and drug addicts suffer without societal help, rather than to provide them the help they need to straighten their lives out.

Throwing people away has a price. Ms. Salazar, for example, broke her arm and it will be forever be a disability because she couldn't afford a doctor and didn't qualify for medical assistance.

Her experience with the system is also instructive. On numerous occasions, she missed meetings and other steps in the legal and bureaucratic process because she was mentally ill. At her final hearing on eligiblity for benefits, she was represented by a non-lawyer friend or family member, rather than by a lawyer. The administrative law judge interpreted some of the medical records to say the opposite of what they actually said, and ignored some of the proper procedures for handling claims like hers.

The quasi-adversary system in place now, that requires beneficiaries to make their own cases for eligiblity, doesn't make a lot of sense when the reason that the people need help is something that makes them inherently unqualified to meaningfully make their case to the government agencies involved.

It is one thing to routinely deny benefits to corporations that have their acts together because they can't meet deadlines and have trouble showing up for meetings. It is another to take the same approach to people who need benefits because they are so mentally ill that they can't hold down a job. In the case of the mentally ill person, an appplicant’s inability to process his or her own case tends to show exactly why that person needs help.

Ms. Salazar's longest period of employment in her life was one year as a pizza shop attendant, and her parenting was so bad that she did not receive any meaningful parenting time after her divorce.

Capitalism works very effectively to reward those who work, and deny help to those who aren't productive. But, it isn't perfect. Some people, like Ms. Salazar, are incapable of escaping their problems without a helping hand, no matter how great the incentives they have to do so.

Cross Posted at Colorado Confidential.

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