Social Security Administration (SSA) disability programs were originally designed for people who had no realistic chance of returning to the workforce because of age and severity of disability. Since that time, numerous changes have occurred. The population deemed eligible for disability benefits has expanded dramatically, the potential of medical and vocational assistance to improve employment prospects has greatly increased, the nature of available work opportunities has changed considerably, the majority of people with serious long-term mental illnesses have consistently expressed their aspirations to work as part of recovery, the federal commitment to support people’s aspirations to work and be independent has been formalized in the Americans with Disabilities Act (ADA, PL 101–336), the extent to which disability policies can themselves be disabling has been recognized, and the financial problems of Social Security have become prominent. Together, these changes constitute a clarion call for reform.
In this paper, the authors address these issues in relation to the largest group of Social Security beneficiaries: people with psychiatric disabilities. They describe and analyze the current situation for people with psychiatric disabilities; propose providing supported employment, mental health services, and health insurance to current and potential beneficiaries; and present the outcome of economic modeling. The authors conclude by recommending several specific reforms.