Recovery From Schizophrenia: Psychiatry And Political Economy

TREATMENT 263• raise the minimum wage but not raise disability pensions; or• substitute guaranteed jobs at a non-poverty wage for the disability pension forall but the most disabled.Adjust the minimum wageWe could keep disability pensions at a lower level than the minimum wage byraising the minimum wage but not pensions. Our surveys show that, in Boulder,a wage that is a dollar or more above the current minimum (plushealth insurance) would encourage many more people on disability benefits tochoose work. There are, however, problems with this approach. Raising theminimum wage would be expensive, although it is bound to happen eventually.More importantly, in the US both minimum-wage work and disability pensions arebelow the poverty level; it would be hard to justify leaving the disabled inpoverty if other Americans were advancing financially. One could get around thisproblem by paying a larger disability pension to the most severely disabled whohave little or no chance of holding down a job.Guaranteed jobsWe could replace disability pensions for all but the most disabled with guaranteedjobs at a non-poverty wage.One reason for the success of the worker cooperatives in northern Italy, is thegreater work incentive resulting from limited access to disability pensions. InTrieste and Pordenone, only the most severely disabled mentally ill (those with 80per cent disability) receive a disability pension; the remainder of the mentally illmust work for pay. Less productive patients work half-time as trainees in thecooperatives and receive a small rehabilitation stipend. Fully productive workers areemployed full-time and earn substantially more.The contrast in the income gradient for people with mental illness in Trieste,Italy, and Boulder, Colorado, is clear from these monthly cash income figuresfrom the mid 1990s:The income gradient is much more gradual for Boulder patients entering parttimeemployment (and is even more gradual when non-cash benefits areincluded). Clearly, the mentally ill in Boulder do not have as great an economicincentive to begin part-time work. The Italian model works well with the