Job Programs for People With SMI Continue Through Economic Uncertainty

For people with serious mental illness (SMI), employment is often one of their top goals. “When these individuals go to work, it improves their self-esteem, it increases their quality of life, it gives them a structure to their days, and it provides them with a sense that they’re part of society,” said Robert Drake, M.D., Ph.D., co-director of the Individual Placement and Support (IPS) Employment Center at the Rockville Institute in Rockville, Md., and a retired professor at the Dartmouth Institute on Health Policy and Clinical Practice. “Working injects hope and meaning into their lives.”

St. Francis House

The COVID-19 pandemic has caused an economic crisis in the United States, with the unemployment rate reaching 14.7% in April 2020, a level not seen since data collection started in 1948, according to the Congressional Research Service. As of December 2020, the rate was 6.7%. Additionally, experts worry that the recent increase in COVID-19 cases could also slow an economic rebound. Programs that help people with mental illness find jobs have not been immune to the challenges, economic and otherwise, that the pandemic has created.

In Boston, St. Francis House, an organization aimed at helping adults experiencing homelessness and poverty rebuild their lives, had to cut class sizes in their longstanding employment readiness program, switch to some virtual services, and pause a new initiative that prepares participants for work in the dog care industry, said Andrea Farina, Ph.D., vice president of program strategy and initiatives at St. Francis House. More than 50% of the participants that St. Francis serves have a disabling mental illness, she said.

“When COVID hit, we had to very quickly figure out how to stay in contact with people who are typically very difficult to maintain contact with,” Farina said. For some participants, challenges with staying in touch played a factor in their disconnecting from programs. “In our Dog Care Academy, we had one student who was very involved and engaged, but when the pandemic hit, she fell off the radar pretty quickly no matter what our staff did to try to maintain contact. That was hard to see,” she said.

Some participants have been able to continue with their programs and find employment during the pandemic. But Farina is worried about the current economic reality, she said. “What I anticipate will happen at some point is the people we serve, who might have spotty work histories, less education, or criminal backgrounds, are going to be competing with people who are perceived as more qualified even for grocery store jobs,” she said. She is still hopeful that entry-level jobs are available, and St. Francis House has adjusted its curriculum to prepare its participants for the jobs that may be more prevalent, such as in delivery or warehouse work, and the new hiring environment by coaching them for virtual interviews.

St. Francis House

The IPS model is specifically designed for individuals with serious mental illness to find competitive, integrated employment. The IPS Employment Center tracks the number of people who have been served through such programs and who have found jobs within a network that includes organizations in 24 states. From January to March of last year, the employment rate was 43.1%, which is typical, said Deborah Becker, M.Ed., director of the International IPS Learning Community at the IPS Employment Center. From April to June, the rate fell to 40.6%.

“Frankly, I thought it was going to fall a lot more than that,” Becker said. The numbers give her hope that there are still areas in which people receiving IPS services can find meaningful employment. Encouragingly, the employment rate rose by almost 1% from July to September. “Work gives people an opportunity to focus on something else rather than stay at home all day or go to a day program,” she said.

The pandemic has created challenges for IPS programs, she said. The switch to providing services virtually can be difficult for some participants, and there have been fewer patient referrals from clinicians to IPS programs in recent months, she said. “We think that might have to do with people being nervous about going into work right now, but we also think some clinicians may want to protect their patients and not refer them to work programs,” she said. “We think it’s really important for practitioners to talk about it with their patients, discuss the advantages and disadvantages of going to work, and discuss how they can go to work safely.”

Drake said he is especially worried about the individuals who aren’t connected to IPS programs. “There are people who have become unemployed and developed mental health problems during the pandemic and don’t have access to IPS or any kind of support to get back into the workplace,” he said. “It’s going to be hard for people to rebuild their lives,” he said.

But how future waves of the pandemic and stay-at-home orders will impact job opportunities for people with mental illness, of course, remains to be seen.

“I still continue to worry and wonder about the impact all this will have on people who are most vulnerable,” Farina said. “Those we serve may be juggling a lot while dealing with their own substance use disorders or other mental health challenges, and I worry a lot about the toll that takes and how people will manage successfully.” ■