Murder in the Cathedral Revisited: President Reagan and the Mentally Disabled

Psychiatric Illness and Income Support

“…TO THE EDITOR: In their commentary published in the April 2009 issue of the Journal, Sheldon Danziger, Ph.D., et al (1) noted that the percentage of Social Security awards to people with diagnoses of mental illness has increased substantially since 1984. The authors raised the question as to whether these increased numbers reflect good or bad policy in the approval of Social Security awards.…”

“…For example, the stringent Continuing Disability Review policies of the early 1980s led to the disproportionate termination of disability cases among individuals with mental illness (1). Scott and Borenstein argue that Social Security disability caseloads reflect far more than Social Security policy.…”

A Policy of Inclusion for the Mentally Ill

“…Similarly, escalating disability costs led Congress to require states to review SSI and SSDI awards, a process intensified by the Reagan administration. 27 Between 1981 and 1983, half a million people lost benefits. 28 Reviews of Social Security eligibility targeted younger recipients, disproportionately disenrolling mentally ill persons, who are on average much younger than those with chronic medical conditions.…”

Mental Health Policy for the 1990s: Tinkering in the Interstices

“…Nearly half of the cases reviewed led to determinations of ineligibility, and the mentally ill were disproportionately hard hit. Their difficulties with complicated paperwork and other, unforgiving procedural requirements made them particularly vulnerable (Goldman and Gattozzi 1988). The number of chronically mentally ill SSI and SSDI recipients denied benefits nationwide as a result of the SSA's redetermination program is unknown.…”

“…Stricter standards of disability were also applied to first-time determinations of eligibility, through policy manual changes not submitted to the administrative rulemaking process (ibid.). Eventually, adverse court action, l6 publicity about personal tragedies, and a firestorm of public criticism forced the SSA to back away from its harsh approach (Goldman and Gattozzi 1988). But eligibility for SSI (and SSDI) remains more difficult to achieve and to maintain than it was before 1981.…”