The committee’s charge directed it to examine the barriers or disincentives to recovery and to “directly assess how PTSD compensation might influence beneficiaries’ attitudes and behaviors in ways that might serve as barriers to recovery.” This section addresses the general topic of barriers or disincentives to recovery, while the section that follows presents the literature on the effect of compensation on recovery and the committee’s conclusions and recommendations regarding this issue. Many of the studies on the barriers to recovery for persons with mental disorders have been conducted on civilian populations receiving support from programs administered by the Social Security Administration (SSA). As such, this chapter examines a broader range of research than other parts of the report.

Recovery can be defined in various ways. In the context of this report, the committee considered recovery to be a reduction in the frequency and intensity of symptoms accompanied by an increase in social and occupational function. The research reviewed and cited in this section often used return to work as the specific measure of recovery.

Research from the fields of disability, economics, health care, and labor studies has documented the wide variety of barriers to recovery and more broadly, to career advancement and economic security that can affect people with disabling mental disorders. In the civilian population, these barriers include low educational attainment, unfavorable labor market dynamics, low productivity, lack of appropriate vocational and clinical services, stigma in seeking services, labor force discrimination due to disabling conditions or race and ethnicity, failure of protective legislation, work disincentives caused by private and public disability policies, linkage of health care access to disability beneficiary status, and ineffective work incentive programs. Several notable barriers are discussed in more detail below.

Barriers Encountered by Veterans and Members of the General Population

One major barrier to recovery for many veterans who leave activeduty service is that they lack the necessary postsecondary education and training required to build careers. The original GI Bill was created, in part, to compensate veterans whose educational and career opportunities were interrupted by military service (Angrist, 1993). Research has shown that users of veterans’ benefits do increase their levels of education, resulting in corresponding increases in earning power (O’Neill, 1977), and that the largest benefits accrue to those who attend college or graduate school (Angrist, 1993). It has been suggested that PTSD is more likely to oc-

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