Tag Archives: social services

Dear Imprudence: Getting It Right! (For Once!)

s.e. smith recently passed on a question from a Dear Prudence column (3rd question down)┬áthat, well, actually gets things right. We were both pretty surprised! The question asked is shockingly similar to my own situation, but I swear I didn’t write in to ask it. The questioner writes:

I work in a social-services-related field and have bipolar disorder. I am open and honest about my diagnosis. … I have been having issues with one of our interns, who is in her mid-20s and pursuing a master’s degree in clinical psychology. On the surface, she is very pleasant. The problem is, anytime she and I disagree about something (which is often, because apparently she knows everything and I know nothing), she rolls her eyes, waves her hand, and declares that I am “just bipolar.” This is alarming to me because she intends to work with such populations, and though I can take it without becoming suicidal, many bipolar people can’t. Part of me wants to simply ignore her, but when I do, she continually asks me, “What’s wrong?” She is probably going to be with us for another year, and I want some peace and a little less condescension when I go to work.

Hey! I have bipolar, and I work in a social-services-related field! The difference is, if I ever encountered anyone who put a hand in my face and dismissed me as “just bipolar,” I would have a written warning in their file before they could even blink. This is not only because I don’t tolerate that kind of flip dismissal, but also because the attitudes of social services staff towards people with mental illness can have an enormous impact on the quality and effectiveness of services delivered to people with mental illness. It is damaging to the agency as a whole to have those attitudes expressed to clients by agency staff and it is an amazing disservice to approach people who need social services with such a dismissive, discriminatory, and oppressive attitude. To her credit, Prudence clearly sees this aspect of the issue:

Since she’s an intern and plans to go into your field, take seriously your duties to guide this obnoxious young person… If she doesn’t stop, or escalates her rude and dismissive behavior, keep your cool and explain to the higher-ups that while “Brittany” may have some promising qualities, she needs some serious attention paid to how she treats others.

This is exactly right. Social service agencies need to ensure that staff do not transmit these attitudes to agency clients. Unforutnately, based on my experience, it is not uncommon to encounter agency staff with these kinds of attitudes, primarily because agencies tend to provide little training or guidance to staff in dealing with clients with mental illness. Staff are then forced to rely on the (mis)information about mental health conditions they’ve accumulated through their lives to shape their opinions and actions, which can often lead to attitudes and behaviors like the one discussed by the questioner.

I’ve found that most people have a vague conception of what depression is and that it could be connected to suicide, but have little conception of how depression can affect a client’s everyday life. This is especially problematic when agency staff expectations for client’s behavior doesn’t account for the effects of their depression. For example, we often need to gather and review a client’s entire medical record to evaluate the merits of a potential disability claim. This can be a very complicated process – submitting medical records requests to every medical provider from which the client has ever received treatment, wrangling with records departments who want to charge exorbitant fees, following up with records departments who ignore, misplace, or deny records requests. Understanding the effects of depression is key for agency staff in how they instruct clients to gather these records, how they respond if or when a client fails to follow through, and the extent of assistance the staffer is willing to provide the client in this task. I’ve found that for a client with depression, an instruction to “gather all your medical records for us to review” can be so overwhelming and intimidating that they are unable to manage the task. Staff are likely to perceive this client as “not really committed to their case” and insufficiently willing to cooperate with the agency in pursuing their goals. This can mean the difference between providing the assistance a client needs to succeed and closing the case because the client “didn’t really want this benefit.”

Beyond depression, there is virtually no understanding of the variety of mental health disorders or the impact they can have on an individual’s functioning and ability to participate in their own advocacy. Schizophrenia and dissociative identity disorder are conflated and often ridiculed. Disorders on the autistic spectrum are not understood at all. Post Traumatic Stress Disorder is often dismissed as an overly sensitive reaction to trauma that “everyone has in their lives.”

This lack of understanding means that staff are completely unable to provide reasonable accommodations to clients with mental health disorders. Which in turn means that clients with mental illness, overall as a group, receive less effective and meaningful services from the agency as a whole. Which means that not only are agency resources more likely to benefit folks without mental health issues, but those expended on clients with mental illness are more likely to be wasted and not “land” effectively because they cannot effectively create the change the client is seeking. So, everybody loses.

The solution is more training, education, support, and guidance for agency staff on understanding these issues and providing effective services to this community. While attitudes like those of the intern in the question are unfortunate and disappointing, some of the blame has to be laid at the foot of the agency itself for failing to provide training, policies, and protocols to ensure staff are educated on these issues and know better. So while Prudie’s recognition that the intern’s attitude is fundamentally unacceptable and must be addressed if she hopes to continue in that area of work, I would go one step further and advise the questioner to push for training and support for all staff at her agency to ensure everyone has the information and tools they need to provide effective services to clients with mental illness.

Medicaid: I’m Sorry, Did You Want Social Services With That?

While doing some unrelated research for work recently, I happened upon some information about Medicaid transportation services in Oregon which I found rather fascinating. And also rather annoying. Medicaid will, it turns out, pay for medical transportation for appointments covered by Medicaid (of course, this assumes that “transportation” can take any number of forms, including buses, taxis, and so forth), if other options aren’t available and the recipient is “eligible.” This does not include transport for medical appointments and evaluations which are not covered by Medicaid; you’re on your own there, apparently.

And, while I would hope that Medicaid would not, say, force a wheelchair user to use transportation which is not accessible by wheelchair, I could see them forcing someone with social anxiety to take the bus, or insisting that someone with PTSD from a traumatic car accident take a taxi, even if this is triggering. Let’s not think that Medicaid would be too generous, here, when it comes to covering transportation.

What’s really interesting to me is Medicaid’s approach to non-medical transportation.

Non-medical transportation falls into the category of anything not related to medical appointments and medical care. Which includes things like buying groceries, attending school, taking yoga classes, going to social events, heading to work, whatever. Living your life, in other words. Medicaid apparently will cover some types of non-medical transportation, for “certain” clients, although the site doesn’t go into detail about who might qualify for this magnanimous benefit. Which is, honestly, more than I would have expected of them, although it’s less than Medicaid should be doing.

The framing of this informational page intrigues me. It seems to be stressing that people should try to arrange for themselves whenever possible; it assumes, for example, that people will/should get prescriptions by mail, or that they should rely on their friends for transportation, including medical transportation, with transportation being covered only grudgingly. Presumably it also thinks that people should always order groceries and other things they need for delivery, rather than going out, and that people on Medicaid should not do things like going to dance classes or socializing at the coffeehouse or going to work or anything, really, other than sitting at home.

It’s also important to note that paid transport has to be preauthorized. People should not assume, in other words, that Medicaid will pay for transport.

This seems to me to be a deliberate ignorance of class issues, and of day to day life for people with disabilities.

It’s a class problem because it assumes that most people have friends with cars (and schedules flexible enough for them to take time out of their day to provide transport), and because it assumes that everyone has access to safe, accessible transit. Neither of these things is the case. In fact, for Medicaid beneficiaries, both of these things are actually seriously in question. Friends might have cars, for example, but they might not be safe or accessible. Or those friends might not be able to provide transport when it’s needed. Likewise, assuming a bus route goes close enough to get someone where ou needs to go, that doesn’t mean the bus is safe.

A friend might be able to go along on the bus ride for safety and to help carry things, but not necessarily. Again, friends might not be able to take time off from work to accompany someone to a medical appointment. Or friends might have very limited schedules, which means that if an appointment runs over, the friend has to leave. Even if that means that there is now no safe ride home.

And, of course, it ignores the fact that some people with disabilities are isolated, and that many of us are running out of favors. When you’re temporarily sick, friends are usually willing to pitch in and help out. They imagine themselves in that position and they figure what goes around comes around. But when you are disabled, and you have been for years, friends are less and less willing to help out. They’re tired, you’ve drifted apart, they feel like they’ve already given too much. In turn, there’s awkwardness when it comes to asking people for help when it feels like one is always asking for help, and when you’ve been constantly reminded that you need to be a good cripple and be nice and well behaved and not be a bother.

And that means that no, it’s actually not at all reasonable to demand that Medicaid recipients ask their friends for rides. It’s also not really reasonable to insist that they restrict their social lives because non-medical transportation is only available for a limited list of things. Medicaid focuses on providing the narrowest and most limited set of benefits possible, and on denying those benefits whenever it can see a way to do so.

That contributes to isolation in a pretty major way. If leaving your house is a huge production which involves a great deal of work, you’re less inclined to do it. And that means that you are less inclined to spend time with other people, to attend events which look interesting, to do things that you want to do. And, of course, over time that means that your friends assume that you can’t leave. Policies like this effectively trap people in their homes.

That’s not social services. That’s just injustice.

The Perils of Social Media: How Insurance Companies Use Twitter, Facebook, and the Rest of the Internet to Deny Benefits

Insurance companies are very fond of finding ways to avoid paying out any money on behalf of their customers. In fact, they employ people who are actually specialists at that sort of thing, and these people will go to great lengths to prevent their employers from having to pony up.

Many people are aware that private insurance companies as well as government agencies which provide social services conduct investigations on people enrolled in their plans, looking for evidence to deny benefits, and that these organizations will go to great lengths to find information to support their investigations. This is something which many people with disabilities must be aware of, or risk having disability insurance, health insurance, and social services denied on the grounds of the results of such investigations.

The Internet, in particular, has proved to be quite the goldmine for insurance industry snooping, as Nathalie Blanchard learned recently. This Canadian woman lost her health insurance benefits because the insurance company found photographs of her looking happy. On Facebook. And decided that these images were evidence that she was not actually depressed, and therefore was not entitled to benefits.

This cautionary tale is one among many; insurance companies are clearly Internet savvy and becoming more so all the time, and it’s an important thing to bear in mind when deciding how much personal information to disclose on the Internet. Historically, the primary concern has been about personal safety, but for people with disabilities, we also need to think about the safety of our benefits, because a single blog post, comment, or photograph could become evidence which is used to deny an insurance claim or to refuse to provide coverage.

True privacy is a short commodity on the Internet. Even private, password-protected spaces can be penetrated, and pseudonyms can be broken. For people like me, who make our own names common knowledge, the relatively thin veil of privacy doesn’t even exist. I often fall into the trap of thinking of the Internet as a safe place, forgetting that other people are actually on the Internet, and that not all of them are my friends, and I know that many others do the same.

Social attitudes about disability mean that if someone with a disability dares to say “I had a great day today,” or “I’m in minimal pain tonight,” or “I’m having fun and enjoying my life,” it’s read to suggest that this person is no longer disabled. No longer needs benefits and assistance. This is really frustrating, because we like to talk about our good days and accomplishments and the things that make us happy. A huge part of disability activism is about pointing out that disability is not a tragedy, and that it’s possible to have fun! While disabled! To enjoy life, even!

Yet, we run up against the problem that our very advocacy can be used as evidence to hurt people by organizations which have a vested interest in cutting down on benefits payments. Participating in a march, writing on a disability activism website, being outspoken, leaving a simple comment somewhere on the Internet, sticking your neck out, these are all things which put us in danger because they can be used to gather evidence against us. Even as we advocate, we run the risks of compromising ourselves and others. Even as we work to change social attitudes, those attitudes are weaponized to deny benefits and claims. To drop us from insurance policies. To inform us that no, we are not entitled to social services.

Insurance companies seize upon these social attitudes, and comb through the Internet to find evidence that their customers might have the audacity to have fun while being disabled. That photograph of you skiing with a grin on your face must mean that you don’t really have [condition]. The fact that you update a sporadic blog means that you can’t possibly have [condition]. That you admit to [something] must mean that [condition] is your fault and you violated [clause] in your insurance policy. The very fact that you do anything other than bemoaning your lot in life must mean that you’re not really disabled.

It’s hard to think like insurance companies are looking over your shoulder, reading everything you write. But it’s important to think that way; it’s important to remember that the Internet is a public place. Controlling the release of personal and identifying information about yourself is critical for self-protection. You can’t control whether or not you get investigated, but you can try to limit what investigators see, and you can try to think about how an outsider might read a comment, photograph, post, or other activity.

And being aware of the dangers to others is important too. If I talk about my “hypothetical” friend with [condition] who [did something], am I inadvertently outing my friend? Can the insurance company connect me to [friend] and use what I wrote as evidence that [friend’s] benefits should be denied? Can family members of [friend] figure out who I am talking about and draw conclusions of their own from what I wrote? That picture I posted on [site] with [friend] smiling and laughing, is that going to become the cornerstone of a case used to argue that [friend] doesn’t have a chronic pain condition?

A few examples of the large cost of small things:

In Toronto, a doctor’s voicemail said he was on holiday, so it was decided that his signature on benefits forms was forged, and benefits were denied: “Hundreds protest suspension of social assistance health benefit.”

Profiles on social networking sites are used as evidence by insurance companies in benefits litigation: “Think Before You ‘Tweet’: The Perils of Social Utility Networks on Disability and Personal Injury Litigation.”

The specifics of Nathalie Blanchard’s story: “Insurance Company Revokes Depressed Woman’s Benefits Over Facebook Photos.”

In new Jersey, several teens were denied eating disorder coverage because of content on their MySpace and Facebook profiles: “Did Facebook lead to health insurance denial?