Information Center Bulletin
Volume 3, No. 2

Employment Program Shows Promising Results for People With Mental Illness

For many Americans, work represents more than a paycheck. Work is a measure of our independence and a large part of our identities. As Studs Terkel, the oral historian, said, “Work is about daily meaning as well as daily bread.” Yet meaningful work for a livable wage remains elusive for many people with severe mental illnesses.

It wasn’t until the 1980s that the mental health field recognized that most people with severe mental illnesses could hold productive jobs. The Center for Mental Health Services (CMHS) is helping to advance this premise. It is funding both the research and the services for the first multi-site study using labor force participation data to investigate employment interventions for people with severe mental illnesses.

The CMHS Employment Intervention Demonstration Program (EIDP) is rigorously testing approaches to help people with severe mental illnesses get, and keep, competitive jobs. Approaches being tested include an employer consortium, supported employment, the Clubhouse model, and family-aided assertive community treatment. Perhaps most importantly, this project is evaluating how well these approaches work, for whom they work, and under what conditions.

“Anecdotal evidence suggests that different programs appear to work better for some people than others,” says Judith Cook, Ph.D., principal investigator with the EIDP Coordinating Center. For example, a person who has spent several years in an institution and has no job history may benefit most from a transitional employment program. On the other hand, a person with considerable skills and education whose psychiatric disability is being successfully managed with medications may be able to go directly into a supported employment program.

Program results appear promising. In preliminary day from the first 3 years of the EIDP, 51 percents of those receiving services for at least 12 months attained employment compared with an overall employment rate of 26 percent among a nationally representative sample of persons with severe disabilities. What's more, program participants held 2,234 jobs (an average of 23 jobs per worker), earned $4.2 million, and worked 793,577 hours. "Given these levels of productivity, the untapped potential for society is enormous," Cook says.

While the numbers are encouraging, they don't tell the full story. "There's something almost magical about the transformation a person undergoes when he or she is working in the right job, gaining respect from co-workers, and perhaps most importantly, gaining a newfound sense of self-respect," Cook adds. For example, an African American man in Connecticut found a job at a wholesale club and received ongoing support thought the EIDP. When he learned that the company was relocating, he assumed he would lose his job. Instead, his boss asked him to transfer with the company and offered him a raise. In addition to better pay, this career move brought about improved psychological stability, increased self-confidence and enhanced family relations.

In Massachusetts, one 28-year-old participant was homeless when he entered the EIDP. He had experienced 18 hospitalizations since age 21 and had been unable to complete high school or hold a job for more than a few weeks. He now has his own apartment and works in a maintenance job at a local sports arena.

Part of the EIDP’s success can be attributed to its highly innovative approaches that not only provide integrated services, but also address larger issues. In Maine, for example, members of the Employer Consortium are introducing training on multiple disabilities, including psychiatric disabilities, to the employees of their companies. This is part of an effort to combat stigma and create a more hospitable work environment for all employees with disabilities.

In addition, ongoing job support that changes with level of need appears to be essential for success. Surprisingly, a person may need more support when doing well, which was the case with a program participant in Pennsylvania. While his boss was satisfied, the participant requested help from EIDP staff to negotiate part-time employment, because a full-time workload adversely affected his mental health.

Factors other than an individual’s threshold for the stressors of full- or part-time employment may affect how much, or even whether, that person works. In a supplemental study, Cook and her colleagues are looking at the disincentives to work. “People with severe mental illnesses depend on Social Security Income (SSI),” Cook notes. That means much more than a monthly paycheck. It also means health insurance for people whose disabilities usually require the continuous use of expensive medications to manage symptoms and who sometimes require hospitalization. “To take a low-paying position without benefits, only to lose health insurance, would be disastrous for someone with a severe and persistent mental illness,” Cook adds. “Until we see a change in some of the SSI regulations, we’re unlikely to see as many people working who could and want to. Recent passage of the Federal Work Incentives Improvement Act will lead to such regulatory changes, making it possible for more people to work without losing crucial health insurance benefits.”

For more information, contact Judith Cook, Ph.D., EIDP Coordinating Center, at 312-422-8180, or visit the EIDP web site at http://www.psych.uic.edu/eidp.

Information Center Bulletin
Volume 3, No. 2