Serving Jobseekers with Psychiatric Disabilities

DOL/CRC ConferenceWashington D.C.August 25, 2005

“ the right to employment is as much a symbol of full citizenship in modern society as is the right to vote” (Fabian, 1999)

“Our work, our recreational and leisure pursuits, our friendships, our membership in our community, all of these are linked to one another. What happens in one area affects the others. (Hagner, DiLeo, 1993)

The Value of Work

The Value of Work

“IT IS NEARLY IMPOSSIBLE TO MAKE YOUR OWN FUTURE WHEN

YOU ARE NOT PART OF THE ECONOMIC FABRIC OF THE CULTURE

YOU LIVE IN”

PATRICIA DEEGAN20th World Congress Rehab International: Oslo, Norway

JUNE 2004

Role of Work in Recovery

Individuals with severe and persistent mental illness who say that they want to work

60 - 70%

Are currently working = less than 15%

(The facts about Mental Illness and Work, Matrix Research Institute, Philadelphia, Pa)

Role of Work in Recovery (cont)

Mental health consumers spend 14% of the day in productive activity compared to 39% for the general population (Krupa, 2001)

Consumers who work utilize mental health services less and improve their social skills and presentation. It is tied to an increase in self esteem and self confidence

(Bond et al, 2001)

THE FACTS ABOUT MENTAL ILLNESS AND

WORK

There are over 3 million working age adults with psychiatric disabilities of whom 70% to 90% are not employed

Psychiatric disability is the largest single diagnostic category among working-age persons receiving Social Security Administration SSDI/SSI disability benefits (27%/36% as of 2001)

THE FACTS ABOUT MENTAL ILLNESS AND

WORK

Studies have shown that the great majority of people with serious mental illness want to work

A diagnosis of serious mental illness is not a reliable indicator that someone can not work

(Bond, 2004)

CHICAGO STATISTICS

Almost 75,000 people in the Chicago area have mental disabilities according to the 2000 census

Chicago area unemployment rate is 6.1%, but 77% of people with psychiatric disabilities are not working (2003)

Advancing Customized Employment

(Project ACE):

Funded by the U.S. Department of Labor, Office of Disability Employment Policy (DOL ODEP)

Designed to enrich the capacity of local One-Stops to provide customized employment (CE) services to people with psychiatric disabilities who are not regularly targeted for services by the One-Stop Center system

A Collaboration of:A Collaboration of: Chicago Workforce Board/Chicago One-Stop

Centers Thresholds, Inc. The Center for Mental Health Services Research

& Policy, University of Illinois at Chicago

Thresholds: Thresholds: The Agency’s Role in Community The Agency’s Role in Community

ServicesServices

Thresholds has been operating in the Chicagoland area since 1959

The agency is committed to helping individuals who want to work find opportunities to do so

Strong belief from past experience that individuals with mental illness recover and contribute

The Importance of a Recovery-Focused

Framework

RecoveryRecovery is a process, a way of life, an attitude, and a way of approaching the day’s challenges…The need is to meet the challenge of the disability and to reestablish a new and valued sense of integrity and purpose within and beyond the limits of the disability;…to live, work and love in a community. . . .”

Patricia E. Deegan, National Consumer LeaderPatricia E. Deegan, National Consumer Leader

The Model of Vocational Programming at Thresholds Individualized approach to job

development in keeping with customized employment concepts

Based on research, retention is enhanced when the job fits an individual’s preferences, interests and abilities

Vocational Programming (cont)

Review with individuals the barriers to employment and develop plans that address these issues

Approach employers as partners

Provide follow along supports – something research has demonstrated as a critical need, but also a service to employers

Supported Employment Model Eligibility is based on consumer choice Supported employment is integrated

with treatment Competitive employment is the goal Rapid job search is used Job finding is individualized Follow-along supports are continuous(Drake and Becker, 1993, Bond, 2001)

Supported Employment Concepts: Marketing Strategies

1. Employing people with disabilities is not different from employing anyone else

2. Businesses benefit when they exercise ownership and control over the employment process

3. Strategies and techniques available from supported employment programs are useful in working with all employees

Supported Employment Concepts: Marketing Strategies

4. Investment in human resources is the most important investment a business can make

5. Managing a diverse workforce is an increasingly critical business function

(Hanger & DiLeo, 1993)

Disclosure

5. Overt professional supports, similar to disclosure itself, have both potential benefits and drawbacks on the worker with mental illness and the relationships with the employer and co-workers

(Marrone,1998)

Disclosure ProsAccommodationsBurden liftedAbility for advocacy

by professional staff

More support from supervisor (Rollins,2002)

ConsStigma/

discriminationConcern about

scrutinyRelationships with

co-workers/supervisors

Advancement fears

Disclosure Issues around disclosure 1. Disability identity2. Job matching3. Lark of clarity about psychiatric

accommodations4. Concern about negative responses5. Assessment process for disclosure (Dalgin & Gilbride,

2003)

Disclosure

Questions to review with a consumer

Personal ethics Is the truth better Is the truth relevant Can the facts be checked Effect on job seeker Consequences Marrone, 1998

Disclosure

Program needs to review after the previous discussions what it means if the person does not want to disclose in terms of program support in terms of help getting a job and keeping a job

Always good to revisit the consumer decision as time goes on

Accommodations What are some accommodations that

can be asked for that might help?Fabian (1993) most frequent:1. Orientation and training to supervisors2. Modifying non-physical work

environment by providing job coaching3. Modification of work hours and

schedules

Accommodations

Mancuso (1990) listed out functional limitations

1. Screening out environmental stimuli

2. Sustaining concentration3. Maintaining stamina4. Handling time pressures and

multiple tasks

Accommodations

Mancuso (cont)

5. Interacting with others6. Responding to negative feedback7. Responding to change

ACE Program Description

Population description

ACE Program Description

Program offerings

ACE Program Description

Program issues

Development of Interface

Establishing interface between MH providers and One-Stop System partners is essential

Points of contact vary by the One Stop

Some Essential Elements

Flexibility of service delivery

development of regular communication

Understanding of partners’ roles and best points for interface

bringing resources to the partnership

A Provider’s View of Barriers to Services

Funding Streams

Performance Indicators

Need for Individualization of Services

Supports Available to Customers

Goals for Improved Services for Individuals with

Disabilities

Institutionalizing a system of interface between One-Stops and local social service providers

A national commitment to provide incentives to working with individuals with hidden disabilities, such as mental illnesses, in the employment area