Cash and Counseling: A Model for Self-Directed Care Programs to Empower Individuals With Serious Mental Illnesses

Mental illness is the country's leading cause of disability. However, approximately 60 percent of individuals with serious mental illness (SMI) are not receiving stable, ongoing treatment (Carper, 2005 Carper, T. 2005. Mental health reform. Blueprint, 2005(3): 41 [Google Scholar]). One approach to combat this problem is to actively involve consumers in their treatment. Personal assistance services (PAS) assist individuals with disabilities with their daily living activities, and some, such as cash and counseling (C&C), empower individuals to make their own treatment decisions. Self-directed care programs have recently adapted from C&C programs targeting individuals with physical disabilities to models targeting individuals with SMI. The purpose of this article is to examine the effectiveness of these programs, explore their impact on individuals with SMI, and discuss the role of social workers in this new service delivery approach.