Representative payee practices of community mental health centers in Washington State

OBJECTIVE: A survey was conducted to evaluate the representative payee practices of community mental health centers (CMHCs) in Washington State, with emphasis on whether and how benefit disbursement practices were linked to patients' clinical behaviors, especially substance use. METHODS: A survey was pilot tested with several clinicians and sent to all 80 licensed CMHCs in Washington State. Data were analyzed using t tests, Pearson r correlations, and regression analysis. RESULTS: Of 41 responding agencies, 30 (73 percent) reported providing payee services for at least some of their patients, approximately one-third of whom had a dual diagnosis of a mental illness plus an alcohol or drug disorder. The frequency of benefit disbursement, but not the overall amount of funds disbursed, was moderately to highly linked by contingency management to patients' money management skills, substance use, and level of functioning; it was less tightly linked to treatment attendance. Larger and more experienced programs reported tighter linkage between benefit disbursement frequency and patients' behavior than did smaller programs. Responses also indicated a significant need for more clearly articulated guidelines for payee benefit management. CONCLUSIONS: Despite a lack of studies demonstrating the effectiveness of representative payee practices, CMHCs appear to be using contingency techniques to link benefit disbursement to clinical behaviors. Further studies of these practices, their outcomes, and associated ethical issues are needed.