Letters

To the Editor: In the article entitled "Can SSDI and SSI Beneficiaries With Mental Illness Benefit From Evidence-Based Supported Employment?" in the November 2007 issue, Bond and colleagues ( 1 ) concluded by stating that persons with severe mental illness who receive Social Security Administration (SSA) benefits have "excellent potential to return to competitive employment." Sadly, the data the authors present do not support this conclusion. In their study, during a 78-week follow-up period, Supplemental Security Income (SSI) recipients who received individual placement and support services worked an average of 18 weeks and persons who received Social Security Disability Insurance (SSDI) worked an average of 21 weeks. If the periods of employment were scattered over the 78-week follow-up period, this rate of employment hardly demonstrates that the services they received were able to overcome the disincentives for employment in the SSA disability system.

On the other hand, if further analysis of the data revealed that study participants receiving individual placement and support services had a significantly higher rate of employment in the final 26 weeks of the follow-up period, this would provide evidence that the interventions launched many SSA recipients into a long-term trajectory of competitive employment. I look forward to further research efforts along these lines.

Finally, as a practicing social worker, I've found that any employment interventions for persons with severe mental illnesses should involve very specific counseling about how SSI and SSDI affect future employment prospects. For persons who do not receive SSA benefits, the study's findings that nonbeneficiaries had nearly double the rate of employment might suggest that avoiding SSI or SSDI benefits can make the objective of competitive employment more achievable.

Clinicians should inform SSI recipients that they can retain their Medicaid coverage in most states even if they are employed full-time at a modest wage. In addition, clinicians should inform SSDI recipients that they can earn a significant amount each month ($940 in 2007) without any impact on their benefits or Medicare coverage. For SSDI recipients, part-time employment is often the wisest objective. However, for SSI recipients, part-time employment is not nearly as advantageous.

Mr. Kanter is in private practice in Silver Spring, Maryland.