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Schizophrenia Bulletin Advance Access published online on November 17, 2005
Schizophrenia Bulletin, doi:10.1093/schbul/sbj027
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© The Author 2005. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Article

Financial Capacity in Persons with Schizophrenia and Serious Mental Illness: Clinical and Research Ethics Aspects

Daniel C. Marson J.D., Ph.D. 1 *, Robert Savage Ph.D. 2, and Jacqueline Phillips Ph.D. 1
1 Department of Neurology, University of Alabama at Birmingham; Alzheimer's Disease Research Center, University of Alabama at Birmingham
2 Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham

* To whom correspondence should be addressed.
Daniel C. Marson, E-mail: dmarson{at}uab.edu


  Abstract

In contrast with issues of consent capacity, financial capacity has received surprisingly little clinical or ethical attention in the psychiatric literature. Issues of financial capacity emerge frequently regarding clients with serious mental illness (SMI), and their resolution has practical and ethical significance for clients, their families, and mental health professionals. These issues include whether a client has sufficient financial skills and judgment to live independently, whether a client requires a representative payee, and what goals for community reintegration should be established with a client. Similar to informed consent, issues of financial capacity raise ethical challenges for clinicians, caseworkers, and agencies. The present article addresses clinical and research ethics questions related to financial capacity in clients with schizophrenia and SMI. Clinical questions concern evaluation of financial capacity in clients with SMI, whether to seek assignment of a mandatory representative payee, whether to leverage treatment compliance through a representative payee arrangement, and whether a mental health professional should also serve as a client's representative payee. The research ethics question addresses implications of providing financial compensation for research participation to individuals with SMI and limited financial capacity and means. The ultimate goal of this article is to focus clinical and ethical attention on a neglected decisional capacity in SMI that is of fundamental importance for clients, families, clinicians, and researchers.

Keywords: financial capacity; ethics; schizophrenia; SMI; representative payee.
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