View Issue: Employment

Like the song says, work is "more than a paycheck" - employment and a career commitment to participating in the labor force. Sociologists tell us that the two most important human activities are work and family. People who have been sidetracked with long years of managing illness and disability systems too often have lost the thread of connection to the ordinary life experiences of discovering what kind of work or career is best for them. The experience of a mental illness may have prevented people from completing high school, college or other vocational preparation. Furthermore, years of focus on getting well and managing disability related services and systems could also have interfered with people's expectations about their own independence and abilities/talents. A community integration perspective includes the expectation that a person with a disability can still participate in the workforce and benefit from all of its rewards and challenges. Four important aspects of employment with respect to persons with psychiatric disabilities are discussed below:

Supported Employment Best Practices
Barriers to Employment
Policies Related to Employment
Career/Employment Decision Making Skills

(1) Supported Employment Best Practices Psychiatric rehabilitation services include a variety of supports to assist people in returning to employment in the community. After years of services research, best practices in supported employment are now available. Gary Bond et al (link to free download of this article) provide us with the following critical components of best practices in supported employment:

Focus of supported employment services should be on assisting people in achieving competitive employment rather than day treatment or sheltered work;
Supportive services assist people in helping people with obtaining a job (rapid job search) rather than providing lengthy pre-vocational and pre-employment programming before they assist the person with finding a job;
Supportive services work with each person based on his or her individual preferences for employment;
Supportive services provide follow-along, long term support; and
Employment supports can be more effective if conducted in partnership with mental health treatment services.

(2) Barriers to Employment There are considerable barriers to work for people with a psychiatric disability, including:

Service Systems Barriers

Lack of a recovery approach
Focus on "job placement" without much support for job maintenance
Limited interagency collaboration
Lack of staff training
Lack of employment support programming and resources
Lack of cross disability and cross cultural supports
Discouraged by medical and clinical professionals

Public Policy Barriers * Inadequate SSA "work incentives" * Lack of mental health funding for employment services * Lack of parity in health insurance for mental health services and treatment * Lack of resources for education about the Americans with Disabilities Act

Personal Barriers * Symptoms of the illness (cognitive, perceptual, affective and interpersonal) * Medication and treatment side effects * Episodic and unpredictable onset and recurrence of symptoms * Interruption of developmental experiences * Gaps in employment and educational history

Workplace Barriers * Lack of sensitivity and understanding about people with disabilities * Illegal discrimination by employers * Prejudicial behavior by co-workers * Lack of flexibility in workplace rules and schedules * Employer prejudicial concern about customer reactions * Fear of people who are different * Misunderstanding of the nature of the mental illness * Ongoing negative images by media * Lack of support in educational institutions * Overreaction to violence stereotype * Discouragement by family and friends.

This description of barriers to employment is not to say that people should avoid work. Rather, people who chose to pursue employment need to know that they might benefit from planning and support to challenge these barriers facilitating their return to the community.

(3) Policies Related to Employment There are considerable public policies that affect the quality of the employment experience and employment decision making for people with a psychiatric disability:

* The Vocational Rehabilitation Act provides funding and structure for state offices of vocational rehabilitation services to pay agencies for providing approved employment related services to their clients. Examples of these services include vocational assessments, pre-vocational services, job development, job coaching and post-employment services. These services are often made available to people through supported employment programs in a variety of psychiatric rehabilitation programs across the country.

* Work Incentives of the Social Security Act are a complex set of rules and procedures which are intended to people who receive Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) in making decisions to return to work while retaining partial benefits based on individual situations. Resources are available on the internet, through specialists in vocational programs and through state funded specialists who provide individual counseling for people with disabilities.

For more information about Work Incentives of the Social Security Act, please see the following websites: Social Security Administration - Work Incentives Work Incentives Transition Network

* The Americans with Disabilities Act (ADA), Title I prohibits discrimination in all employment practices including application procedures, hiring, firing, advancement, compensation, training and other terms, conditions and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment-related activities. Businesses of 15 or fewer employees are not subject to the ADA. For further description click here. Click here for a free download of a handbook that provides a Q&A format about Title I of the ADA.

For further information about the ADA, please see the following websites: ADA Technical Assistance Program Bazelon Center for Mental Health Law Association on Higher Education and Disability(AHEAD)

* Other policies include the Family & Medical Leave Act, which concerns "parity" in health insurance for mental health services and treatment that is offered to employees, and the Civil Rights Act. These policies and their attendant issues of implementation and funding provide varied incentives and disincentives to the many stakeholders concerned with employment as a part of civic responsibility and one's expected role in the community at large. As part of learning about disability management issues, it is important for people with psychiatric disabilities to be afforded opportunities to learn about these policy issues from both a personal and larger advocacy perspective.

(4) Career/Employment Decisions Making Skills With the emphasis on competitive employment as a valued expectation for people with psychiatric disabilities comes the importance of people learning how to make their own employment related decisions. Currently employment programs that provide supports for employment do not always take the time to assist with these employment decision skills. In a national study on job accommodations (Granger, 2000) it was found that overall people with psychiatric disabilities are:

not aware of their rights under Title I of the Americans with Disabilities Act,
rarely provided with skills building opportunities related to communicating with employers and co-workers about the risks and benefits of disclosing the fact that they have a disability, and
rarely provided with learning opportunities about how to analyze workplace cultures to determine whether or not job accommodations might be needed useful for them at this time.

Because long term supports have limited funding support, it is clearly important to make best use of the time that employment supports can be offered by adding to the usual job development and job coaching services opportunities to learn employment decision making. Indeed, employment support programs can benefit from reflecting on the ways that they can build into current programming activities opportunities for learning about employment related decision skills building.

For additional information on Employment issues, click the following link for the Department of Labor. These resources were developed as part of the production from the Matrix Research Institute's NIDRR funded RRTC on employment for people with psychiatric disabilities which was funded from 1994-2002. Matrix Research Institute is no longer in business, however, the research, training, technical assistance and dissemination activities continue in part through the work of The Matrix Center at Horizon House, Inc. in Philadelphia which is one of the three lead partners of this NIDRR funded RRTC on Promoting Community Integration for Individuals with Psychiatric Disabilities which includes employment as a significant part of community integration.

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