A collaboration between a well-known corporation and a research center in New Hampshire is helping people with mental illness across the country to become productive members of the workforce.

The Johnson & Johnson-Dartmouth Community Mental Health Program began in July 2001 when Johnson & Johnson, the Brunswick, N.J.—based health care product manufacturer, approached researchers at the New Hampshire-Dartmouth Psychiatric Research Center (PRC) with the desire to assist people with mental illness in the recovery process.

Dartmouth had long been a source of research on supported employment services for people with serious mental illness. Researchers such as PRC Director Robert Drake, M.D., and Deborah Becker, M.Ed., senior project director, conducted a number of studies on supported employment services and developed a model for supported employment based on their findings. For instance, when asked about competitive employment, 70 percent of people with mental illness say they want to work, yet only 15 percent are employed, and people with mental illness who have received supported employment services report better self-esteem and feel more able to manage their symptoms.

According to Rick Martinez, M.D., the medical advisor to Johnson & Johnson’s Office of Corporate Contributions and Community Relations, "We selected the Dartmouth Psychiatric Research Center because the researchers there have been so successful in establishing an evidence base for the supported employment of people with serious mental illness—an intervention that can help people turn disability checks into paychecks."

The joint venture began with a $200,000 grant to develop pilot programs in supported employment at community mental health centers at three sites: Montpelier, Vt., Hartford, Conn., and Sumter, S.C. Since that time, Johnson & Johnson has donated more than $1 million to the program, which has expanded to include four additional sites in Maryland, Kansas, Washington, D.C., and Oregon. States are asked to match funding from Johnson & Johnson to help run sites, but this is not always possible.

The sites adhere to the six principles of supported employment (see box) that have been shown to produce good employment outcomes and forge a close relationship between vocational rehabilitation programs and community mental health centers in those states.

According to David Lynde, M.S.W., program manager for the New Hampshire-Dartmouth PRC, the close collaboration is part of an integrated approach in which the mental health treatment team at each site, usually including a psychiatrist, psychiatric nurse, social worker, and case manager, works with an employment specialist from the mental health center or a state vocational rehabilitation program to find jobs for people with mental illness.

"The members of the team support the client’s employment goals and communicate with one another about the client’s needs and strengths," he said. "Together, they problem solve and address any problems that may come up with the client in his or her work situation."

When a client of the community mental health center expresses an interest in finding work, the employment specialist completes a "vocational profile" on that person by first inquiring about his or her needs, strengths, employment history, and job preferences, for instance. Not all clients receiving services at the community mental health centers opt for employment, however. Employment specialists in the program typically offer their support at all stages of the employment process. They may accompany the client to job interviews, submit job applications to the prospective employer, or talk to prospective employers about the program and clients ahead of time with or without the client.

"We develop jobs," said Jeemy Grate-Pearson, who is an employment specialist at the site in Sumter, S.C.—better known as the Assertive Community Treatment/Individual Placement and Support program under the Santee-Wateree Department of Mental Health. "We usually don’t have a job waiting for a client when he or she walks in the door."

Grate-Pearson explained that if there is a full-time position open somewhere but the client does not want to work on a full-time basis, job sharing among two people is possible. Or if someone wants to work in a certain store but has difficulty with lots of commotion and noise, "we might talk to the employer about the possibility of having the client come in and perform one or two tasks a couple of days per week. But the job is not advertised that way. It wasn’t a job someone was working already—we went in and made the job."

Deborah Becker acknowledged that few of the clients work full-time jobs, but said this isn’t necessarily due to the severity of their psychiatric illness. The most common reason that the clients work on a part-time basis, she said, is that full-time work could disrupt Social Security disability payments and Medicaid benefits.

Of the 42 clients receiving services at the Santee-Wateree program, 14 are currently employed, said Grate-Pearson. While about three to five clients are unable to search for work because of health or other reasons, the remaining clients are actively involved in a job search.

She has clients who work at a local Air Force base—one as a mail clerk and the other as a janitor; another who cleans rooms at a local hotel "loves to get out of the house each day" to go to work and is heavily praised by the hotel management team.

"Even though some of them make as little as $16 a week," said Grate-Pearson, "the clients are ecstatic when they get their first paychecks."

More information about the Johnson & Johnson-Dartmouth Community Mental Health Program can be obtained by contacting David Lynde by e-mail at David.Lynde@Dartmouth.edu. ▪