Work as a Priority: A Resource for Employing People who have Serious Mental Illnesses and are Homeless

Introduction

This guidebook is intended to provide both a conceptual and practical foundation to increase employment among people who are homeless and who also have serious mental illnesses. Throughout the 1990s, as the U.S. enjoyed one of its longest periods of economic growth, the gap continued to grow between those who were benefiting from this prosperity and those who remained on the sidelines. Sweeping changes in American society were taking place as welfare reform impelled more and more Americans to enter the labor market. Yet nearly 90% of people who have serious mental illnesses are unemployed^[1] and an estimated 200,000 individuals with serious mental illnesses are homeless. Recent Federal policy initiatives, including the creation of the Presidential Task Force on the Employment of Adults with Disabilities, and the New Freedom Initiative issued by President Bush, underscore the societal and economic importance of engaging people with significant barriers to work in meaningful, growth-oriented employment.^[2],[3]

A large number of programs and services have been developed during the past two decades to address the employment needs of people with serious mental illnesses. However, program adaptations and approaches to assist individuals who are homeless and have serious mental illnesses are less well known. Significant sections of this guidebook are derived from papers prepared for a September, 1999, meeting convened by Substance Abuse and Mental Health Services Administration (SAMHSA) to explore issues and factors related to increasing employment for consumers who are homeless. Additional material has been adapted from "Employing Homeless People with Mental Illness,"^[4] a training curriculum sponsored by SAMHSA’s Center for Mental Health Services (CMHS) Projects for Assistance in Transition from Homelessness (PATH) program.

Further, providers of mental health and homeless services across the country were surveyed for this guidebook. Brief summaries of their employment programs have been included in the text. While each provider is using different program models to help people with serious mental illness who are homeless obtain and keep jobs, two constant themes emerged:

Belief in the value of work at the earliest possible stages of recovery, as an aid to the recovery process.
Recognition that a job can help people develop motivation to change, dignity and self-respect, and hope for the future.

Paid employment, however, may not be the right opportunity for everyone. Helping people make good choices about their futures, that may or may not include paid work, is an important part of the recovery and reintegration process.

This guidebook was developed to aid all stakeholders, including service providers and policymakers, as well as program managers, case managers, and employment specialists. This guidebook will be complemented by the forthcoming publication of a supported employment toolkit. The toolkit will address in more detail how to implement supported employment services for people who have serious mental illnesses.

For consumers and recipients of services, this document is intended to help establish or extend their knowledge and increase their ability to navigate service systems. In the following pages, the reader will find a general review of the relevant literature, a summary of promising employment programs, and a discussion of policies and laws that address the provision of employment support services to people who are homeless and have a serious mental illness.

The information in this guidebook is arranged as follows:

What We Know So Far. A brief review of the literature and research studies on employment of people who are homeless and have serious mental illnesses is offered. This background material presents preliminary findings that link mental health recovery and homelessness reduction to the ability to obtain and retain a job.

A Recovery-based Foundation. People with serious mental illnesses face a dual challenge: recovery from mental illness itself, and recovery of the skills and aptitudes needed to acquire or re-acquire a valued role in the community, including that of worker. An orientation to the principles of recovery—considered to be the foundation for the development of employment services for people with serious mental illnesses—is reviewed. The essential service elements that guide worker role recovery are also discussed.

Employment Approaches. A variety of employment models and approaches developed for people with mental impairments are summarized. Models that also focus on meeting the needs of individuals who are or who recently have been homeless can help facilitate recovery and provide the skills and opportunities needed for employment success.

The Impact of Homelessness. The consequences of homelessness create distinct challenges for people with a serious mental illness. This chapter addresses personal, program, and system-level challenges to employment for people who face these dual challenges.

Helping People Obtain Work. Overcoming the challenges that homelessness and mental illness create often requires augmentation or adaptation of traditional employment services. This chapter includes examples of programs throughout the country in agencies that have elevated work to a priority. Also included are key factors to consider when developing employment services for people with serious mental illnesses who are homeless.

The State Office of Vocational Rehabilitation (VR). This chapter reviews employment-related services available through State VR systems, and issues and recommendations related to access, availability, and appropriateness for people with mental illnesses who are homeless. Examples of ways various State VRs are working with homeless people with serious mental illnesses, as well as recent VR/mental health integration efforts, are also included.

The Right to Work. This chapter reviews the statutory framework supporting employment for people with disabilities, including the Americans with Disabilities Act (ADA), the Workforce Investment Act, and the Ticket to Work/Work Incentives Improvement Act. Implications of these important laws regarding the acquisition of employment by people with disabilities are discussed.

Introduction Notes

^[1] Anthony, W.A., and Blanch, A. Supported employment for people who are psychiatrically disabled: An historical and conceptual perspective. Psychosocial Rehabilitation Journal 11(2): 5-19, 1987.

^[2] Presidential Task Force on the Employment of Adults with Disabilities. Re-Charting the Course: Turning Points-The Third Report of the Presidential Task Force. Washington, DC: Presidential Task Force on the Employment of Adults with Disabilities, 2000.

^[3] President George W. Bush. "New Freedom Initiative." Washington, DC: Office of the President of the United States, 2001.

^[4] Bianco, C., and Shaheen, G. Employing Homeless People with Mental Illness: Principles, Practices and Possibilities. Unpublished draft prepared for the CMHS PATH Program. Albany, NY: Advocates for Human Potential, July 1999.

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