Wellness Benefits of a Social Security Exit Plan

I have been living with bipolar disorder for 36 years. In this account, I explain how taking the risk to create and pursue an exit plan from Social Security benefits has greatly affected my wellness, quality of life, and potential lifespan.

When I was 18, I encountered psychosis and the onset of symptoms that overwhelmed me and derailed my life plans while I was attending Rutgers University. During the campus hospitalization that immediately followed, I responded well to medication. The medical team responsible for my care and treatment advised me to temporarily attend classes while remaining an inpatient so they could monitor my progress. Against medical advice, I returned to my dormitory room for an unexpected sleepless night. That morning, scared and teary eyed, I called my father and withdrew from school. After many months of self-deprecating thoughts of perceived failure and concurrent idleness, I reluctantly enrolled at a community college.

I earned a criminal justice degree in four years and then worked as a substitute teacher in the town where I grew up. At the age of 24, I felt whole as a substitute teacher; my life was exciting. I had even subbed at my former elementary school and high school.

At the end of the school year, I decided to work rather than attend a psychiatrist appointment. Within several weeks, I began to experience delusions that resulted in a police charge for property destruction, and I was incarcerated and had a psychiatric hospitalization. I was angry that neither I nor the agency that was working with me had thought to schedule the psychiatrist appointment in the late afternoon. At that time, I failed to understand that clinical services often fail to support people’s vocational efforts. With feelings of worthlessness similar to what I had experienced before, I then attended a day treatment program.

At age 26, I met with a well-intentioned provider who encouraged me to apply for Social Security Disability Insurance. For many years after enrolling, I felt like a social outcast for receiving Social Security payments. With no shortage of self-derision, I lived among people gainfully working and fulfilling many valued social roles. My main role was as a patient, and sometimes I was a student. Not working eroded my self-confidence and self-esteem and deferred my hopes and dreams. Over many years I struggled, but thankfully in the back of my mind was a glimmer of hope that I could create an exit plan to transcend the Social Security poverty trap. Fortunately, my recovery began when a clinician invited a guest speaker from a consumer-operated agency, Collaborative Support Programs of New Jersey, Inc. (CSPNJ), to a meeting I attended.

This speaker was a person living with mental illness who worked full-time. His recovery narrative inspired me out of my cesspool of suicidal ideation and into practicing some self-care, such as adhering to a sleep schedule and a diet and walking regularly. I also met with people from CSPNJ about a possible position there. Despite not getting that position, I felt hopeful after the interview, and within one year I had earned an associate degree in psychology; and within five years, a bachelor’s in social work; and two years later, a graduate degree in social work.

In 2001, after earning my master’s, I worked 15–20 hours a week as a boarding home outreach worker, using public transportation to commute. Then the 9/11 attack on the World Trade Center (WTC) occurred in New York City, and a colleague advocated for me to volunteer as a crisis counselor. I helped counsel people at the Liberty State Park in Jersey City, New Jersey. I also accompanied families traveling from New Jersey to Ground Zero to mourn lost lives at the WTC site. After counseling people in grave pain who also demonstrated strength, resiliency, and courage, I started to envision an exit plan. I started to take steps to move my life forward. This was a turning point for me. My part-time position was not fulfilling my needs, so I contacted the Division of Vocational Rehabilitation Services (DVRS) for help.

The DVRS administrators thought my exit plan was unachievable and would lead to relapse. They stated that my work history gap and current part-time status were not predictors for success in a full-time competitive job. In frustration, I walked out of the DVRS meeting, but not before they reluctantly referred me to supported employment services, and I remained determined to proceed with my exit plan. Marrone and Golowka (1) proposed that “ultimately people with disabilities do, in fact, have to accept personal responsibility to choose employment as part of the social contract of citizenship.” I found my own full-time position.

Although I still lacked self-confidence and sometimes worried that DVRS was right about my lack of readiness for a full-time job, I crafted and refined my exit plan. I found a job coach who provided guidance and validation. As I proceeded, I took more steps forward than backward, and I stayed cautiously hopeful. There were barriers—I had not driven a car for approximately 16 years. My own negative self-perception was very often reinforced by providers who, from my perspective, got in my way. Also, I was repeatedly exposed to far too many other people in clinical settings who were frustrated about lost hopes and dreams. This drained me. A major setback came when I received a Social Security overpayment despite reporting that I was working.

Despite my efforts to rectify the situation, it was a financial mess; however, it served to further strengthen my resolve in executing my exit plan. I knew I no longer wanted to be dependent on a system that was so ineffectual and inefficient. In our field we want to know about outcomes. I am a “positive outcome” for having set and pursued a Social Security exit plan.

I have been free from the limitations of Social Security and entitlements since 2002 (2). The Social Security Administration needs to implement better measures for monitoring and overseeing taxpayer funds. Cohen et al. (3) stated, “Once individuals receive SSI or SSDI benefits, they may identify themselves as “sick” and may become unwilling or unable to proceed to financial independence.” The refuge in Social Security benefits seems to paralyze and dehumanize individuals. Historically, change has been led by oppressed people who address institutional thinking. You can join me as we make further contributions to our communities and society at large by supporting an exit plan to promote feelings of dignity and respect among persons with disability.

The exit plan has strengthened my wellness by helping me find and keep a job that has purpose and financial benefits (4). Self-help books, and peer self-help groups have helped me appreciate my strengths and address my tendency to focus on the negative. I have a safe and decent place to live (environment) and a nice office in which to work. Ironically my general health is affected by my mental illness, in terms of side effects of psychiatric medication, my tendency to be more vulnerable to stress, poor food choices, and my history of a lack of timely dental and medical care. Thankfully, I now have insurance and I am getting better at making medical and dental appointments and setting aside time to learn new methods of self-care wellness strategies, such as practicing yoga, drinking water, and eliminating soda. I know far too well the harmful effects of under- and unemployment of people served by the public mental health system. These negative effects are as devastating as the health impacts of substance misuse and tobacco dependence.

If we want to improve the chances of recovery, especially for younger persons encountering their first psychotic break, we should either offer services that prevent dependence on government benefits or discuss an exit plan when they apply for Social Security benefits. I believe strongly that quality and length of life will be positively affected for having done so. There are excellent evidence-based practices, such as individual placement and support (5), to help people pursue and achieve competitive employment. Supported employment services can help people manage the real and perceived stress, albeit positive, of earning a paycheck (6). However, employment practices do not include developing an exit plan so individuals can transcend the poverty trap that impedes wellness and recovery. I believe that professionals and family members should strongly consider the value of an exit plan to support recovery and wellness. For too many people Social Security becomes a pipeline of poverty that impedes the recovery process. Moving past that illness identity is crucial to the recovery experience (7). My exit plan was my ticket to recovery and wellness and was based on a strong work ethic and commitment to contribute to my community.