Structural vulnerability and supplemental security income

Abstract

Supplemental Security Income (SSI) is a United States federal welfare program examined here as emblematic of the sociostructural configurations of welfare-related deservingness and punitive governance within social welfare. We operationalize Quesada, Mart, and Bourgois' (2011) framework of structural vulnerability to ethnographically examine people's experience with applying for and receiving SSI in the context of a mixed-method intervention study. Our study population is comprised of HIV-positive people who use drugs and live at the nexus of extreme poverty and housing instability, serious mental illness, past or current experiences of violence and/or trauma, repeated incarceration, and lack of access to health care and social services. We found that people navigating SSI application procedures were subject to exclusionary practices at the front end of the process and punitive tactics once approved. Policies and procedures embedded within this system of social welfare not only functioned to compound existing vulnerabilities but imposed new forms of disorder, tension, and harm on individuals and their families, impacting health and mental health. We critically examine how these seemingly mundane institutional procedures are forms of structural violence that contribute to deepened vulnerability among already highly marginalized populations and the policy and programmatic recommendations resulting from applied research.