Incentives

As a social worker, I do not feel I have done my job properly until my client has all of the resources to which she is entitled. But is my job also to gauge whether or not a person truly needs those resources? For instance, should I help a person in poverty whose depression is not very severe apply for SSI monthly income (which is based on a mental health diagnosis) while they look for work in this terrible economy? Is it my job to advocate as forcefully as possible to assist that person in getting whatever income and assistance I can? Or is it my job to use my clinical judgment to asses what they truly need?

The answer to me and all others I have spoken with about this is that it would be immoral to not inform or not assist someone regarding a program that could potentially help them, even if their eligibility for that program is suspect. The burden for judging whether that person is deserving of aid or not is made by someone far away in a government oversight office. Their determination, in turn, is based on an application I fill out with that client. If my incentive is to get them as much as possible, I am going to make them look as needy as I can (without lying) in order to ensure that they receive assistance. If I don't do this, I risk making that same immoral mistake of not helping them as best I can.

In the current system, the people who are judging whether or not to administer aid to a person knows almost nothing about them, has never met them, and only has a minimal amount of information colored by the bias of self-report and my incentive to assist the consumer. In the case of SSI, most of the questions are the forms are irrelevant to people with mental illness as they have to do with physical limitations. Some questions are more specific and the 3rd party reporting form for psychiatrists definitely goes into some detail; however, the information given is cursory, based on self-report or biased report.

The assistance that is offered (with notable exceptions) is largely an all-or-nothing proposition. A social security administrator cannot, for instance, provide greater assistance based on financial status. There are some gradations in difference between housing status and health status, but generally there is only one fixed amount that is given to the lion's share of mental health consumers. Bureaucrats must then judge whether a person meets the minimum requirements (whatever those are, as they are not published), and then say "yes" or "no."

Their incentives are to deny as many people as possible to contain costs. My incentives are to get as many people on assistance as possible (otherwise, life gets REALLY hard). The client has similar incentives but very little agency throughout the whole process. Once received, the client has little motivation to look for work. Working part-time will reduce your SSI payment by an amount dictated by some arcane formula. Working full-time will eliminate it. Both of these will adversely impact other entitlements such as Medicaid status and Food Stamps. SSA, meanwhile, often will not react to changes in work status quickly, leaving clients with overpayments (which have to be paid back later) or underpayments (which clients have to lobby forcefully to rectify).

Because these programs are administered so far from the individual, they adjust poorly to changing conditions. They cannot be tailored to the client's individual needs which change over time. They incentivize individuals to be dishonest in order to receive help. They put up barriers to self-sufficiency. Are the incentives in these programs really the ones that we want for our clients and social workers?