Veterans who receive counseling and education about the implications of employment on their eligibility for psychiatric disability benefits appear to be more likely to work and to work more hours for pay than do those who do not receive benefits counseling.
Marc Rosen, M.D., lead author of a report published online August 1 in Psychiatric Services in Advance and an associate professor of psychiatry at Yale University, told Psychiatric News that veterans may worry that they will lose their benefits if they take a paying job, but after help in reviewing their options, they often decide to accept paid employment.
“The reality for veterans is that you are very unlikely to lose benefits for working,” he said. “Benefits counseling is a way to walk veterans through all of the complicated considerations that go into eligibility decisions. Clinicians should regard service connection [the term for seeking disability compensation for military service-related disabilities] as an opportunity for counseling.
“If a veteran becomes service connected for a psychiatric condition, it’s possible the people who are evaluating the claim will conclude that the mental health condition must be better and that because he is working he is entitled to less compensation—but they often conclude that the condition is still disabling and that the veteran is ‘soldiering on,’ ” Rosen said.
Eighty-four veterans who had applied for service-connected compensation for a psychiatric condition were randomly assigned to either four sessions of benefits counseling or to a control condition involving explanation of the Veterans Affairs health system and services. Days of paid work and work-related activities were assessed at follow-up visits by using a timeline follow-back calendar.
Rosen and colleagues found that veterans assigned to benefits counseling engaged in paid work significantly more days than did veterans in the control group, reflecting an average of three more days of paid employment during the 28 days preceding the six-month follow-up.
Benefits counseling was associated with increased use of mental health services as well, but this correlation did not mediate the effect of benefits counseling on working.
Many veterans are inclined to believe that if they work for pay, they will automatically lose their disability benefits, but there is much more variability in the way decisions are made than is commonly believed.
Benefits counseling is a form of education and motivational interviewing about policies associated with psychiatric disability benefits and the effect of work on eligibility.
Veterans assigned to benefits counseling worked for pay for significantly more days than did veterans in a control group.
Bottom Line: Clinicians should view the process of applying for psychiatric disability benefits as an opportunity for counseling patients about the relationship between work and benefits eligibility.
“These findings buttress the case for public policies that help veterans who have applied for service-connected compensation to stay in the workforce and obtain paid employment,” Rosen and colleagues said in their report. “The public-policy benefits are potentially substantial, given that sustained disability income reduces labor-force participation among veterans and their families. Benefits counseling might help veterans who have applied for disability because of a service connection obtain other evidence-based services that help them successfully find and maintain employment, such as supported employment.”
Rosen explained that benefits counseling was developed by Robert Drake, M.D., Ph.D., of Dartmouth University and others to address the perceived disincentive to work associated with receiving disability benefits. Drake is a long-time champion of supported employment for people with psychiatric conditions.
The benefits counseling consists of four 50-minute sessions of individual counseling using a motivational interviewing framework and techniques to increase veterans’ desire to engage in work and related activities. The counselor begins the first session by discussing the veteran’s experience of the claims process, the possible impact of working on the claim, and the veteran’s valuation of work vis-à-vis other concerns.
In the second session, the counselor directs discussion toward the veteran’s feelings about work and other vocational activities, exploring the veteran’s ambivalence with structured exercises, such as listing the pros and cons of working.
The third session focuses on the financial implications of working or not working. For veterans who are receptive, counselors provide information about work, vocational rehabilitation, and education opportunities.
“The literature has suggested that people who apply for Social Security and veterans disability have considerable ambivalence about imagining themselves as unable to work,” Rosen and colleagues noted. “Our findings suggest that attempts to steer applicants toward employment can be effective if begun early, around the time veterans first apply for service-connected disability.” ■