Disabled on Welfare Face Pressure to Work

By David Abel, Boston Globe, 6/17/02

As Congress presses states to put more of their welfare recipients to work, Massachusetts may be forced to change regulations on the largest pool of people now exempt from work requirements: the disabled.

And the state will likely look first at those suffering from the increasingly treatable diseases of depression and anxiety disorders, who make up roughly half of the nearly 14,000 people receiving work exemptions for disabilities, according to those overseeing the state's welfare program.

With only 6 percent of the Commonwealth's welfare recipients now holding jobs, and the proposed rules in Congress requiring 70 percent to work, "The Legislature's going to have to consider it," said Dick Powers, a spokesman for the state's Department of Transitional Assistance.

The possible move has revived a longstanding debate among specialists dealing with low-income people. Some argue it would be either cruel or impractical to force the clinically depressed to work, but others contend it could be therapeutic, a means of evading their isolation at home and infusing their lives with a sense of accomplishment.

Ellie Thillet knows firsthand both sides of the debate.

For years, the 46-year-old single mother of three wrestled with the opposing arguments in her own head. The Springfield resident likes to work, she says, and often has sacrificed her welfare checks to earn more money as everything from a nurse's aide to a real estate agent to a ticket collector at amusement parks.

But years of depression caught up with her two years ago. As feelings of inadequacy, a short temper, and a desire to kill herself built up, she had a nervous breakdown - at work. Since then, she has collected Social Security Income benefits, which have no time limit and no work requirement.

"I would love to work, and I miss it - but I just can't," she said. "I can't be around a lot of people; I just can't deal with them, and I don't think I could handle a job."

The problem, say those who have studied cases like Thillet's, begins with an inadequate intake system. Welfare case managers in Massachusetts and around the country don't ask those seeking welfare whether they suffer from a mental illness - and some don't know they're depressed.

The result is that many of those who suffer from depression, anxiety, or other mental illnesses often end up on welfare without any awareness that they're eligible for the work exemptions. Nationally, while only 1 in every 5 welfare recipients is diagnosed with depression, fully half show symptoms of the condition, according to Mary Clare Lennon, director of social science research at Columbia University's National Center for Children and Poverty.

Putting the depressed to work could succeed, Lennon and others say, but it requires a rigorous medical screening process, as well as the proper treatment, including drugs and therapy, and a support system that gives more job flexibility to those suffering mental illnesses than the general welfare population.

"Having a job is important to most people, regardless of severity of disability," said Lennon, who recently wrote a paper on depression and welfare. "Being engaged in productive activities certainly helps with self esteem, especially for many who suffer from depression - but without support, I don't think it could work."

In Massachusetts, welfare recipients must report their mental illness to be eligible for the work exemption. Then they must present documentation from a doctor about their condition. In all, according to current figures, about 30 percent of people receiving work exemptions are disabled, and half of those are suffering from anxiety or depression.

After filing for the exemption, their cases are reviewed by Disability Evaluation Services at the University of Massachusetts Medical School, which affirms exemptions only if the welfare recipient's depression is "a prolonged emotion that colors the whole psychic life" and includes symptoms such as sleep problems, significant weight changes, or antisocial behavior. Three out of every 10 who claim depression are rejected for the work exemption, said Kristin Johnson, acting director at the UMass center.

As depression is confirmed by asking subjective and hard-to-prove questions - anything from "Do you have feelings of guilt or worthlessness?" to "Do you think about suicide" - some try to cheat the system. But researchers say the numbers are few and don't compare to those who are depressed and unaware of the exemptions.

"People always ask: Aren't these people lying?" said Mary Ellen Colten, director of the Center for Survey Research at the University of Massachusetts at Boston. "The answer is no, they usually aren't. Just because some people run red lights, doesn't mean most people do."

Those doubts, some welfare advocates suggest, fuel misguided reforms - such as requiring the mentally ill to work. Rather than pushing the depressed into work, they say, it would make more sense to offer them training and education programs.

"By putting people with mental disabilities to work, no one can predict with certainly when there will be a crisis - and whether they'll stay at their jobs," said Melanie Malherbe, managing attorney of the welfare-law unit at Greater Boston Legal Services.

For Ellie Thillet, now on a tight regimen of antidepressants and meeting once a week with a therapist, a job wouldn't be a burden. It would be nice, she says, but only if she can overcome her depression.

"I've worked most of my life, and I'd like to work again," she said. "But if I'm always crying, I'm agitated, and I'm feeling down, who would want to hire me?"

David Abel can be reached by e-mail at dabel@globe.com.

This story ran on page A1 of the Boston Globe on 6/17/2002.

Source: Boston Globe

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