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Health Care Economics
Job Picture Begins to Brighten For Those With Severe Mental Illness
Psychiatric News
Volume 36 Number 19 page 21-30

"Too often, people with serious mental illness are relegated to 4F jobs: food, filth, filing, and flowers," said Ray Bridges, president of the board of directors of the Laurie Mitchell Employment Center, a consumer-run jobs training program in Virginia. He explained that those job categories refer to "hamburger flipping, janitorial work, clerical work, and landscaping."

Actually, according to some advocates, it is more likely that a person with a serious mental illness will have no job at all. In 2000, the National Alliance for the Mentally Ill (NAMI) claimed that more than 85 percent of persons with severe mental illnesses were unemployed.

The National Mental Health Association (NMHA) offered a similar analysis, stating that only 10 percent to 15 percent of those with severe mental illness are competitively employed.

Signs of hope are visible, however, in this bleak picture. The need for more employment opportunities is being recognized at the federal level, where the Center for Mental Health Services (CMHS) and the Presidential Task Force on the Employment of Adults With Disabilities at the U.S. Department of Labor are cosponsoring a national summit on employment of persons with psychiatric disabilities.

Psychiatrist Bernard S. Arons, M.D., CMHS’s director, told Psychiatric News, "A number of factors led to the convening of this summit. In our conversations with consumers, they always rank employment opportunities at the top of their list of needs. And we know that more people are becoming capable of work because of improvements in psychosocial therapy and medication."

"Also, CMHS is just completing our five-year Employment Intervention Demonstration Program in which we looked at innovative employment models combining vocational rehabilitation with clinical services and supports. Finally, on June 18, President Bush issued an executive order that commits the United States to community-based alternatives for individuals with disabilities."

The summit, which was scheduled to take place October 9, is projected to draw 500 representatives from business, government, consumer groups, and the health care professions. Attendees will learn about model projects, recruitment techniques, consumer-operated businesses, skills necessary for supervisors, and issues related to health insurance and Medicaid.

Meanwhile, at the local level, Bridges and others have long been engaged in daily struggles to identify and implement strategies that address some of the problems to be considered at the summit. At the Laurie Mitchell Employment Center, for example, program developers steered clear of any of the 4Fs. Instead, they offer a training program in computer use that combines class instruction with self-paced learning modules.

They also provide a supportive environment and highly visible role models. Most of the members of the board of directors have had some form of mental illness, as have all of the program’s staff members. The program requires no fees or referrals and has no restrictions based on income or residence and no time limit in terms of program completion. It is open during the evening and on weekends and is funded with state, county, and private grants.

Moe Armstrong, who has been diagnosed with schizophrenia and spent several years living on the streets, helped initiate an early effort to employ consumers in mental health agencies. He was recruited by Vinfen in 1991, a not-for-profit human services agency based in Cambridge, Mass., when that organization made a commitment to hire consumer staff members for a project to serve people being discharged from a state mental hospital. Armstrong serves as director of consumer and family affairs and codirector of the peer education project.

He and others found that effective training of both supervisors and consumers was critical to the project’s success, as were efforts to take steps to reduce role conflict. Recruitment turned out to be surprisingly difficult because many consumers were suspicious of the organization’s motives and intimidated by the prospect of employment.

Armstrong identified another problem, noting that "Living with this condition is a full-time job." The evening before his telephone interview with Psychiatric News, for example, he said he had awakened at 2 a.m. and been unable to get back to sleep. "Job sharing and part-time work are extremely important, because consumers are not always able to hold full-time positions," he added.

Consumers, however, bring important strengths to mental health agencies. "We’ve had to learn coping skills, which we can share with others," he said. In fact, Armstrong recently admonished a consumer in one of his support groups who was threatening another group member. "We can be mentally ill, but we don’t have to act crazy."

Richard Baron, M.A., former executive director of the Matrix Research Institute, sounded a similar cautionary note in a report delivered at a 1998 conference sponsored by the University of Illinois at Chicago National Research and Training Center for Psychiatric Disability.

"Many consumers have been encouraged to believe that the only goal worth achieving is for them to function ‘just like everyone else’ on the job—and to make the leap to that kind of normality very quickly."

He wrote that careers might be characterized by part-time work, intermittent work, supported employment, and significant accommodations on the job. Baron believes that success might be better defined as "dealing well with your individual challenges: working as hard as you can work, staying on the job as long as you can manage. . . ."

Arons pointed out that the needs of persons with mental illness for flexible employment opportunities are no different from those of the rest of the population. "When I entered the workplace more than 30 years ago, it was full time or nothing," he said. "Today, there is an incredible variety of work schedules and arrangements. People telecommute; offices operate around the clock and offer all kinds of different time schedules."

"For anyone interested in mental health," he added, "it’s important to remember that recovery is enhanced by opportunities for employment. And, for the sake of the society, we need to make full use of the skills and talents of all our people."

The Web address of the Matrix Institute is www.matrixresearch.org; the Web address for the National Research and Training Center on Psychiatric Disability is www.psych.uic.edu/uicnrtc

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