Monday, July 14, 2014

Employment and Mental Illness: Investing in Programs that Work

By Dania Douglas, NAMI State Advocacy Manager

“My mental condition was horribly debilitating for many years. I had no reason to get out of bed in the morning….I had no direction and no purpose. Now, when my feet hit the floor, I get to go to work every day and practice my passion.” – Stephanie Joseph, CPA, Office Administrator NAMI, Montgomery County.

Ask 100 different people what work means to them, and you are likely to get 100 different responses. It can simply mean a source of income; it can provide a purpose; it can create order in life; it can be an opportunity for creativity and building something new; it can be a chance to help others.

People with mental illness work successfully in a range of professions: at artists, scientists, famers, engineers, lawyers, construction, workers, chefs. Look anywhere and you will find people with mental illness leading and innovating.

Yet, the reality in America is that many people with mental illness are either unemployed or underemployed. Bouts of illness, difficulty concentrating, trouble communicating with co-workers, medical appointments and absences from work can make getting and keeping a job difficult. Stigma and discrimination can also be great barriers to overcome.

NAMI just released a report, Road to Recovery: Employment and Mental Illness, which explores the current state of mental illness and employment in the United States. It examines the reasons for low unemployment rates among people with mental health conditions, and describes the most effective supported employment programs that have been developed to date. The report is also a call to action for policymakers and advocates. It includes policy recommendations and model legislation that leaders could use to make supported employment programs available to the people who need them.

Almost 80 percent of the nearly 7 million individuals served by the public mental health system in this country are unemployed. About 60 to 70 percent of these same people want to work and would work if they had appropriate support. The current employment support systems we have in place are simply not effective for most people with mental health conditions. It is time for a change.

The good news is that there are employment programs that have been studied, tested, and shown to help people with mental illness choose, get and keep a job.

Individual Placement and Support (IPS) Supported Employment is a system that focuses on rapid placement in competitive employment and in jobs that match an individual’s talents and interests. IPS has a strong evidence-base shown to significantly improve the opportunities for people with mental illness to find and keep employment.

Clubhouses are community centers open to anyone with a mental illness. Clubhouses offer a variety of employment services including transitional employment and independent employment programs. Both have been proven through research to help improve opportunities to find and keep employment.

Assertive Community Treatment (ACT) is a team-based system that provides intensive support services to people with serious mental illness in the community whenever and wherever they are needed 24/7. Every ACT team should include a vocational specialist. ACT has a proven track record of helping people find and keep employment.

When we invest in programs that work, we invest in real lives, in real people, in real success and real recovery.


Joe Patriot said...

I am 53, with 14 years developing, suffering with, and presently overcoming a diagnosis of Major Clinical Depression. After 5 years of downhill descent, my body and mind shut down and I was hospitalized. After 7.5 years of major effort to turn it around, I was fired from my job. I had become a major people-pleaser, had done all I could to overcome hateful people, etc. Nothing had worked, and going into a hospital was for me the final act of failure. I was convinced my life was over.

However in there I had a 'spark of hope' in a class on black and white thinking, and one item the person said triggered my belief I could recover. For 9 years now I have sought career recovery in conjunction with overcoming depression. I've driven all over CA and NV, literally thousands of miles for a 1/2 hr interview or 2-hour test. My intense desire to work and get out of the same circumstance year after year has driven me to attempted suicide once.

I've failed many interviews, but also had city jobs, electric utility jobs, IT management jobs (my core career) and have even worked at Pep Boys. None have worked out to date, and have included shutdowns, layoffs, unhealthy environments, and even firings (stupid mistakes on my part, one hired over my qualifications), troubles I have never experienced before. I mean, I worked at my first job ever for 15 years. My second job was 7.5 years.

I've encountered 'in your face' age discrimination 3 times, with looks, sarcasm, and actual words regarding how "young our team is", a VERY humiliating experience.

Still unemployed, and now with no income at all, I now have 5 months mental health volunteering, am a certified Peer Support Specialist, have a Business degree and well-developed career skills and work ethic. I have interviewed twice now for county mental health jobs, and got none yet.

I suffer the struggle to maintain hope and continued perseverance. I have no income and my savings are running out. Every day I have mild panic attacks, have to manage my thoughts that trigger anger, frustration, etc., all normal feelings to an extent when you fear homelessness for the first time in your life.

With so many groups getting special hiring treatment, sometimes I wish states / feds would create a program supporting the over-40 age group. If not over-40, then over-50. I know many older people are sadly killing themselves because they can't get a job, and based on my experience, I know some, perhaps many, are experiencing age discrimination. "Old" people are really looked down upon in this culture, and I believe it is a MAJOR issue.

I don't share these things in bitterness, but as harsh realities of this world. I honestly believe all my suffering has purpose, has brought me into the peer / mental health field so I can help others like me. I talk to many employed peers, and they share much the same understanding. I know I have the experience and skills to excel in peer support. I just need the opportunity.

I know other peers who have had similar interviewing trials, and that has been comforting. I'm not the only one struggling with the interview process.

I hope this will help others. The ups/downs are extremely difficult for some of us to handle. Depression, and all its symptoms, is a horrible affliction. I get confused, I don't know if I am on the right path at times, don't know what is going to happen to me, but I am doing something by volunteering at the clinic. I am doing the best I can to control my life.

My continued hope, my choice to keep believing regardless how I feel, is that someone will realize what an excellent employee I am, and see how my career experience, talents and skills, education, and MH experience can contribute in a major way to their organization, but especially to the consumer / client.

If you know of an organization seeking an intelligent, educated, ethical, people-oriented, genuinely caring person, please forward my email to them --

Francis Kittredge said...

We need legal protection under the ADA. We have some, but what protection we had was gutted by the SCOTUS several years ago. Today, if you have a mental illness and are working, you can be targeted for harassment and your illness can be used against you.

Anonymous said...

The article gives contradictory information. In one paragraph, the author states that reasons are being searched for low unemployment among the mentally ill. The next paragraph states that there is an 80% unemployment rate among the 70 million mentally ill people.

Canada Bear said...

I have very severe mental illness, and it was very hard for me to find a job that I am able to do and KEEP. I now have a job that I got through the Vocational Rehabilitation program, and I have had my job for about a year and a half now. I am so grateful for this program, bc now I do not live paycheck to paycheck, I no longer have to go to food pantries just to have food in my house, I am able to buy clothes for myself for the first time in YEARS, and I am able to go and do fun things w my friends such as see a movie from time to time. I am now saving up money to use as a down payment on a HOUSE that I am hoping to buy in the next few years. Without the Vocational Rehabilitation program, none of these things would even be remotely possible, so again, I am REALLY grateful for this program!

Susan Inman said...

This report is very valuable but it ignores the plight of the most vulnerable people with the most severe mental illnesses. As NIMH states, the largest factor in the ongoing disability of people with schizophrenia arises from the significant cognitive losses associated with the illness. I couldn't find any reference to these cognitive losses in this report. And there are no references to the the cognitive remediation programs which provide the greatest hope for these people.

One obstacle to progress is the lack of awareness of these well-researched problems within the mental health community. This report could have helped build awareness of this population's needs and could have, at least, discussed the value of supported volunteer programs.

It seems like this report focuses on needs of all other groups except the ones the NAMI was originally created to meet.

Finished At Fifty said...

One of the hardest things is trying to balance hope with reality.

I believe that there clearly is a moment when people over 50 who don't have jobs give up looking, accept their fate and find other ways to make life meaningful.

Anonymous said...

I am in full support of the clubhouse model and the ACT teams. They work well in communities with professionals to support them for the majority population. What is lacking are funds to support Deaf/Hard of Hearing and Deaf Blind individuals who suffer from higher unemployment, mental heatlh and addiction rates due to isolation, challenges in accessing health care and communication ~ being the biggest barrier all around. I would like to see an ACT team to be able to help in crisis situations and a REAL clubhouse model in our community for this population and Deaf Can Inc is the program to do it!

Anonymous said...

Most people who do well have family that employ them, take them under their wing and support them.

I have a few acquaintances who had to make it on their own they went into recycling, were able to succeed with their musical ability and one person I met sold bottles of water to commuters in on a heavy traveled road at the stop light.

Work is more than money it is socialization and for some a feeling of accomplishment. For some the medicine makes much fatigue and people don't get it. I found the Employment Commission in North Carolina very supportive and helped my buddy get part time work.

James Morgan said...

Many unemployed consumers are looking for their wanted find jobs opportunities but you just a limited number of people obtain the work opportunities that they prefer the almost all.

Anonymous said...

I Worked for a year at Peer Center. The work is rewarding I have BA and my own mental health challenge. I saw dome of the staff as educated and trained. The center's or clubhouses are underfunded. The commitment from county programs for peer centers they created just is not their. I am bipolar and have been in remission for a few years. I was able to go to college and work. I am going to work on a my MFT, It is sad other professionals doubt me and others like me. If mental professionals can't see the value in the whole person how will the community ever learn to likewise.

help said...

How do you keep the job you have?

John Doe said...

A major well-known global corporation I worked for refuse to accommodate my disability. I had to take extra meds in the morning which forced me to sleep longer. I requested to come in at 10am instead of 9am and they didn't approve. I left in good terms instead of getting into trouble for coming in late. This was my first "private-sector" job and I will never work for another private company again. Now I am jobless.

Jeffrey Whittaker said...

So many jobs are meaningless! If the source of National law is weapons sales then work means a life and death struggle, not some dwarflike frvolity! Capitalists" insensitivity drives the economy off the road again and again! People become disabled because their jobs are meaningless! More meaningless jobs won't solve the problem!

Kathy's Blog said...

I still am baffled by the lack of acknowledgement for Fairweather Lodges in helping people with severe and persistent mental illness find, obtain employment, and live in housing that improves overall quality of life. We need to overlook some of the politics in promoting evidenced based practices. Thanks for reading and take a look for yourself by searching using the term "Coalition for Community Living Fairweather Lodge"

Anonymous said...

There are so many people who have not educated themselves about mental illness. I tried to explain my depression and anxiety to two friends I have known over 30 years. They still don't understand mental illness and how devastating it can be. Sometimes I just want to give up on them ..... I do plan on being an advocate for those with mental illness of all kinds and hope to be a mentor too.

Cb said...

I suppose I am one of the more fortunate types, although on a particularly difficult day (full of paralyzing rumination) it's difficult to see any good fortune. I have held many jobs and my vocation is teaching, tutoring. It wasn't till I was 34 that I received my diagnosis of bipolar. My illness has not kept me from obtaining fulfilling employment. It's holding a job outside of the home that makes a huge positive difference to my health. Being gainfully employed brings structure, social opportunity (I'm an extrovert), paychecks, and justification for putting on make-up and wearing my cute shoes. I may have this "monster" to live with for the rest of my life, but I'm going to live with it on my terms as much as possible.

Nathan Carlson said...

I contacted my senator about an Idea that has been on my mind for some time. We should have the benefits system offer permanent selective coverage for disability related services regardless of a persons work status. People get to keep their Medicaid and Medicare benefits while working, but ONLY for their disability related issues. They have to buy insurance like everyone else for the rest of their health issues. Insurance companies could then be required to offer the same plans regardless of disability because they don't have to worry about covering the things they know they have to cover under the current system; while on the other side, the federal government saves 100's of millions of dollars by allowing disabled individuals to get their own insurance and income through employment. The person covers as much as they can, the government covers the rest. 80% insurance, 20% government. And it would give hospitals an incentive to find the root issue for people who are chronic emergency room visitors (who are often suffering a panic attack, and not a heart attack, stroke, pulmonary disorders, etc.) If the insurance won't cover ER visits for disability related services, and the government is liable for disablity related issues, then the government is (finally at long last) incentivized to investigate the claims that these people are making. I am referring to family here, I've witnessed this, and it costs tax-payers thousands of dollars.

Anonymous said...

I think they may have meant they are researching the reasons for success for those with mental illness who ARE employed. Trying to see why/what is working for them so they may implement feedback for those who are unemployed. I Think they want some insight from those studies to try and obtain programs for people like me who struggle severely with employment issues.

Anonymous said...

I have complex PTSD (non combat related). Since the age of 16 (now 37) I have held over 80 jobs. I can get them, but not KEEP them. I have only been fired once. I have quit all others due to mental illness. no matter how hard I try I eventually can't take anymore at some point. it is never a conscious decision to leave. it is always on a whim and sudden. I also have major attendance issues due to mental state and appointmentsI think these are the types of issues they are facing.

Anonymous said...

I would like to see more employers work with the mentally ill providing feasible and reasonable accommodations. (More time off would be a great help) My partner gets 26 days off per year and is allowed to make the hours up...for instance. Not to mention holidays and occasional added days along with bonuses and good insurance that is affordable.

Sandy Friedeck said...

I am a mother of a child who was diagnosed 5 years ago with schizophrenia. I am very fortunate that I am educated in this field, but at the same time I am so very frustrated with the Mental health system. I have been employed at the local, county and state level and talk about insanity. I have observed and witnessed the pitfalls and set backs that have and continue to take place within our society. Its like my son says, "not everybody has a sandy in their pocket" and how true that is. My son calls me his "angel" that go sent to him. I can't even begin to tell you what not only my son has endured and his friends who suffer with this condition are going through or continue to go through. It is devastating. We don't need more institutions, as I have heard over and over again to solve this problem. (lock them up and throw away the key/out of sight out of mind)I am sick of it!! We need resources!! I can whole heartily say this would stop the revolving door at the county and state level. Now I know why the prisons and state hospitals are over crowded. As long as you push the paperwork and not voice your concerns or opinion you'll be successful, but if you are like me and give a damn its very difficult to work under the conditions in order to help the mentally ill. We need huge funding to mainstream those who suffer with mental illness back out into society. the list goes on and on!!
thanks for listening

Jeffrey Whittaker said...

I also am educated in the field of mental illness and I have been a recipient of the uncivilized treatment supported by insecure graduates of American Universities. I have simplified the problem to one word which describes the process of abuse practiced on people who are suffering mental illness and other diseases: bias! Those who selfishly challenge the world to submit, no matter the negative consequences, fail to appreciate the needs of others! So called "doctors" ignore the needs of sufferers to satisfy their own urge to appear strong!

Anonymous said...

I was on stress medical leave for a week because of an incident where my coworker/manager were mandating the dept to work a weekend a month which led to the coworker lashing out at me and my manager not addressing the issue.
My manager has now gone and told coworkers that I have a "Personality Disorder". I never confronted her but have resented what she has done by placing a Stigma of mental illness over me.
I want to go to HR with this along with many other unprofessional statements that she has said to me and certain coworkers. Will I find protection from a medical organization in California or will they project this back at me and terminate me?
Fearful, depressed and anxiety everyday.

Anonymous said...

People are going to find it harder to find "competitive" employment now that employers are using the OMB "accommodations" form (that is supposed to be used post-hire) as part of the application process. This form lists such conditions as "bipolar," "obsessive compulsive disorder" and "autism" among the "disabilities" that might require accommodation, even though ADA does not protect persons with these conditions. So you can say "Yes, I have a disability" and not get hired; "No, I don't have a disability" and preclude any future request for accommodation (because then you'd have lied on your application and be subject to termination); or "I choose not to answer" and fly a red flag. Every way you answer, your application goes into the circular file or you place yourself at future legal risk.

Beverly Scott said...

There are tried and true methods of finding suitable employment for consumers. The problem is that many state DOR agencies either do not have properly trained staff and/or "don't have the will" to provide the necessary, evidence based services.