By Rebecca A. Clay
Very few people with the most serious mental illnesses
have jobs, according to Crystal R. Blyler, Ph.D., a social
science analyst in the Division of Service and Systems
Improvement at SAMHSA's Center for Mental Health
Services (CMHS). Yet despite the fact that these individuals
want to work, they rarely receive vocational services
that could help them find and keep jobs.
A CMHS-funded study called the Employment Intervention
Demonstration Program (EIDP) explored ways of helping
people with serious mental illnesses fulfill their employment
dreams. Launched in 1995, the 5-year, multi-site study
sought to answer questions about the kind of services
that would be most useful in helping people with serious
psychiatric diagnoses obtain and retain jobs (see
SAMHSA News, Vol. 10, No. 1).
Now the answers are in, and they're already informing
the field. Several major journal articles have recently
emerged from the study, with more on the way.
"SAMHSA's vision is a life in the community
for everyone, and that includes jobs for people with
serious mental illnesses," said CMHS Director A.
Kathryn Power, M.Ed. "This study gives us the information
we need to help make that vision a reality."
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An Overview of Findings
With eight sites in Arizona, Connecticut, Maine, Maryland,
Massachusetts, Pennsylvania, South Carolina, and Texas,
the EIDP examined the impact of innovative employment
services for more than 1,600 unemployed people who had
schizophrenia, bipolar disorder, major depression, or
other serious mental illnesses.
The researchers randomly assigned the participants either
to services-as-usual programs or to innovative "supported
employment" programs combining vocational rehabilitation
with clinical services and other supports. Using uniform
data collection methods, the researchers then tracked
participants for 2 years to see whether they were able
to get and keep jobs.
The jobs weren't the kind people typically associate
with disabled job-seekers, emphasized Dr. Blyler. Instead
of the sheltered workshops and similar programs that
were once common, the participants sought what the researchers
call "competitive employment"—regular
jobs open to anyone. "People with mental illnesses
want to work in the mainstream with everybody else and
have the same pay and the same career advancement opportunities,"
she said.
To help participants achieve that goal, the EIDP offered
various kinds of supported employment interventions.
All of the services were based on the following common
principles:
Integrated services. The programs integrate
employment services and mental health treatment, with
co-location of services at the same agency, a single
case record, and face-to-face interaction between psychiatric
and vocational staff at least three times a week.
Consumer preference. The programs focus
on getting participants the competitive jobs they want,
with job development tailored to their own career interests
and capabilities. Job hunts begin immediately after participants
announce their intention to start working.
Ongoing support. Unlike some vocational
services, the support doesn't stop once participants
get jobs. Instead, the program provides support for as
long as needed.
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"Research
shows that supported employment works," said
Judith A. Cook, Principal Investigator for the
Employment Intervention Demonstration Program's
Coordinating Center.
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The EIDP's major finding? According to Judith
A. Cook, Ph.D., Principal Investigator of the EIDP Coordinating
Center and a professor of psychiatry at the University
of Illinois at Chicago (UIC), supported employment works.
In an American Journal of Psychiatry article
co-authored by Dr. Cook, the researchers reported that
participants in supported employment programs did a lot
better than those in the services-as-usual comparison
group.
After taking into account differences in such factors
as work history and clinical status, the researchers
found that participants in programs integrating psychiatric
and vocational services were more than twice as likely
to have competitive employment than those in the comparison
group. They were also nearly 1.5 times as likely to work
at least 40 hours a month. And the more vocational services
they received, the better their employment outcomes.
Participants in supported employment programs also earned
significantly more than their counterparts in services-as-usual
programs, Dr. Cook and her co-authors reported in an
article in the Archives of General Psychiatry.
Those in supported employment programs made an average
of $122 a month, compared to $99 a month for those in
the comparison group.
And all of these advantages increased during the 2-year
study period.
According to Dr. Cook, the EIDP study's value
lay in its size. Thanks to its multi-site nature, she
explained, the study was big enough to allow the researchers
to examine the impact of supported employment on different
subpopulations, something that can be difficult to do
in smaller, single-site studies. In doing so, she added,
the researchers were able to challenge some long-held
beliefs in the field.
The idea that individuals with schizophrenia can't
work is one example. "There's still a very
entrenched belief that people with schizophrenia can't
work—that somehow that diagnosis and the impairments
that accompany it make it the one diagnosis where supported
employment isn't effective," said Dr. Cook.
"We found that wasn't the case."
Another myth the study dispelled was the common belief
that parents with mental illnesses who have young children
shouldn't work. "There's been some
talk that work is too stressful for parents who have
a mental illness," said Dr. Cook, noting that 22
percent of the study participants had children under
18 living with them. The study found that supported employment
does help parents get competitive employment, just like
it does every other subpopulation—men and women,
members of different racial and ethnic minorities, people
with various diagnoses, individuals with a lot of work
experience and those without, residents of high-unemployment
areas, and those in low-unemployment areas.
See
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