A voucher system that enables persons with severe mental illness to purchase community support services

Fragmentation in the delivery of community support services is often identified as a major barrier to persons with severe mental illness, preventing them from living productive lives in the community. In Nassau County, New York, in 1989 a voucher process was created to allow service users to develop individualized support networks by purchasing services directly and by pooling funds to start new services. The voucher process is part of an intensive case management program. Goals set in the individual service plans of users guide voucher purchases. The local Mental Health Association manages funds based on a bank credit card model. The user, the case manager, and a staff member from an agency designated by the user review expenditures quarterly. The first year of operation is described, and suggestions for developing a voucher process, such as the need for extensive retraining of users and providers, are offered.