Defendants With Mental Illness Diverted to Social Security System

Court officials in Miami have expanded a federal support program for homeless people with disabilities to help those with mental illness who are involved with the criminal justice system return successfully to the community.

The use of the SSI/SSDI Outreach, Access, and Recovery (SOAR) program is appropriate because many people with mental illness who are in jail facing charges or are to be released from prisons are likely to become homeless without some initial support.

Aaron Levin

“SOAR is a tool for people to move toward recovery,” said Cindy Schwartz, M.S., M.B.A., who runs the Miami SOAR program, in an interview with Psychiatric News. “You can’t move ahead without a roof over your head and some money in your pocket.”

Nationally, only 29 percent of first-time applicants are granted Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), but 65 percent of SOAR-assisted initial applications nationwide are approved within 100 days, according to information covering 2006 to 2013 from the Substance Abuse and Mental Health Services Administration (SAMHSA), which funds technical assistance for the program.

The Miami SOAR program does even better, however, racking up a 94 percent record of approvals in an average of 27 days, in part because it is integrated with the Eleventh Judicial Circuit Mental Health Project (CMHP) in Miami-Dade County. Since 2000, the project has diverted people with serious mental illness from the criminal justice system to community-based treatment and other services.

“Miami’s success comes from a dedicated staff who follow through from beginning to end,” said Dazara Ware, M.P.C., a senior project associate at the SAMHSA SOAR Technical Assistance Center, run by Policy Research Associates in Delmar, N.Y., which trains SOAR workers. “They are a model for all localities.”

In the Miami program, all incoming misdemeanor or felony candidates for diversion are screened for eligibility for federal entitlement benefits. Project staff members then help those who are eligible gather and present needed documentation.

“Once I spoke with the head of the Social Security Administration office in Miami, we were able to collaborate closely,” said CMHP founder Steven Leifman, J.D., the Eleventh Circuit’s associate administrative judge and a member of the board of the American Psychiatric Foundation (Psychiatric News, March 7).

Over the last three years, the program has screened 445 people of whom 220 were eligible and 207 were approved, said Schwartz.

More recently, SOAR has been expanded to include people reentering the community after they finish their jail sentences.

Psychiatrists and doctoral-level psychologists play an important role in the process, said Schwartz. “We need clear, well-documented information about the patient’s diagnosis,” she said. “That includes the illness, symptoms, medications, and prognosis.”

Once the patient is approved for benefits by the Social Security Administration, the evaluating doctor can bill for services rendered as much as three months prior to the application date, she said.

“Our goal is to do [the applications process] right the first time,” she said. “We may ask them to drop their own cases or appeals because otherwise we have no control over the timing of the decision. We just can’t afford to wait and support them until a final disposition.”

SSI provides a basic income for the claimants, income that gets them quickly out of shelters or jails or hospital forensic units and into real housing, an important first step for community reintegration. That allows other funds to be used for treatment at area clinics.

“Most recidivism occurs within 25 days of release so we need to get them into the system as soon as possible,” said Schwartz. “With SOAR, the numbers of rebookings and jail days after the approval of benefits were statistically significantly lower than in the one- and two-year period before the approval of benefits.”

However, she was careful to note that other factors in addition to SOAR—like treatment, housing, or care management—may also contribute to that outcome.

Five employees run the program in Miami. Funding comes from several sources, including a share of a statewide one-cent tax on drinks at large restaurants and a three-year reinvestment grant from the state. That grant will run out in July, but the funding will be picked up by the South Florida Behavioral Health Network.

Schwartz practices what she preaches about recovery. The program employs two part-time peer counselors and three full-time employees. Two of the three full-timers are people who were once disabled by mental illness, she noted.

“They’re doing a fabulous job,” said Schwartz of the latter. “Their background helps them be more sensitive to stigma, trauma, and the human experience.” ■