OBJECTIVE:Although representative payee arrangements are common among people with psychiatric disabilities, only a small body of research has investigated how consumers feel about representative payees' use of disability funds to attempt to improve treatment adherence. METHODS:Consumers who were in treatment for a recently documented diagnosis of schizophrenia or a related disorder (N=104) were interviewed to assess their perceptions of the use of disability funds and other legal pressures to attempt to improve treatment adherence. RESULTS:Most consumers in the sample (65 percent) did not agree that withholding money was a useful method to improve treatment adherence. Multivariate analyses indicated that participants were more likely to agree that use of money as leverage was helpful if they also felt that other legal pressures were helpful for improving adherence and if they felt free to do as they wanted regarding their mental health treatment. On the other hand, participants were less likely to endorse the benefits of money used as leverage if they had at least a high school education and if they reported abusing substances in the past month. CONCLUSIONS:The results of this study point to factors that mediate the potentially negative effects of perceived coercion that are sometimes associated with representative payee arrangements. Leverage of disability funds will likely have an optimal effect if combined with efforts to enhance a sense of self-determination. Conversely, consumers with more education may be less open to this practice, possibly because of perceived stigma related to not being able to control their own finances.

译文

目的:尽管精神病患者的代表收款人安排很普遍,但只有一小部分研究调查了消费者对代表收款人使用残疾基金来改善治疗依从性的看法。
方法:对接受过最近诊断为精神分裂症或相关疾病诊断的治疗中的消费者(N = 104)进行了访谈,以评估他们对使用残疾基金的看法以及其他法律压力,以试图改善治疗依从性。
结果:样本中的大多数消费者(65%)不同意预扣款是提高治疗依从性的有用方法。多变量分析表明,如果参与者还认为其他法律压力有助于改善依从性,并且愿意根据自己的意愿进行心理健康治疗,则他们更有可能同意使用金钱作为杠杆作用会有所帮助。另一方面,如果参与者至少受过高中学历,并且在过去一个月内报告滥用药物,则他们不太可能认可用作杠杆的金钱的好处。
结论:本研究的结果指出了一些因素,这些因素介导了有时与典型的收款人安排相关的强迫感的潜在负面影响。如果与努力增强自我决定意识相结合,那么利用残疾基金将可能产生最佳效果。相反,受过更多教育的消费者可能不太愿意接受这种做法,这可能是由于与无法控制自己的财务状况有关的可耻污名。

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