Advancing Employment Opportunities for those with Mental Illness

By David T. Applegate, Research and Policy Assistant, National Initiatives on Poverty & Economic Opportunity

 Counselor

In recent months, mental illness and its repercussions have received an increasing amount of attention. This is in large part due to startling and public tragedies such as Robin Williams’ death and the spate of horrific mass shootings across the country. While these events deservedly garner a rush of headlines and national attention, it’s important to remember that millions of Americans struggle with the day-to-day impacts of mental illness. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that upwards of twenty percent of Americans suffer from some form of mental illness and 10 million of these individuals have a “serious mental illness.”

For many of these individuals, having a serious mental health condition acts a significant barrier to employment and economic well-being. This is especially true for already-vulnerable individuals, including people experiencing homelessness and people returning home from incarceration. At Heartland’s National Initiatives on Poverty & Economic Opportunity, we believe that every person deserves the opportunity to work and support themselves and their families. In recognition of World Mental Health Day on October 10 and Mental Illness Awareness Week (MIAW), the National Initiatives team is highlighting why it’s critical to address the employment needs of people with mental illness and offers some strategies for doing so.

In July 2014, the National Alliance on Mental Illness (NAMI) reported that among those suffering from severe mental illness, the employment rate decreased from 23 percent in 2003 to 17.8 percent in 2012. That’s compared to about a 60% employment rate among the general population as of September, 2014. This gap in employment rates isn’t because people with mental health conditions don’t want to work—as NAMI notes, studies show that most adults with mental illness express a desire to work.    

That’s not surprising, given that the deleterious effects of unemployment on individuals’ mental health are well-known. Importantly, employment is a key social determinant in an individual’s physical and mental health outcomes. We live in a society that places a very high value on work—a job and the earned income that comes from it are often central to an individual’s self-esteem and sense of identity. As the American Psychological Association points out, unemployed workers across the board are twice as likely as their employed counterparts to experience some level of psychological suffering.

For individuals already struggling to find or keep jobs as a result of symptoms associated with a mental health condition, this psychological suffering can become a vicious cycle in which lack of work exacerbates existing mental health issues, making it harder for a person to find a job and, in turn, making it more difficult to access needed treatment and healthcare. This cycle can easily exacerbate the risk of chronic unemployment, economic insecurity, and poverty among people with mental health conditions. Indeed, people with mental illness disproportionately experience economic hardship. For example, one-third to one-half of people with severe mental illness live at or below the poverty line, and twenty-six percent of people experiencing homelessness live with serious mental illness— more than four times the rate of serious mental illness in the general population.

Although individuals with mental illness face incredible stigma, discrimination, and misunderstanding—including the false believe that they are not ready or able to work—, the majority of people with mental health conditions can succeed in the workplace with the proper supports.  

There are numerous evidence-based and promising employment models and programs for people with mental illness, ranging from transitional jobs and internships to supported employment models such as Individual Placement and Support (IPS). As we’ve discussed in our resources for helping people experiencing homelessness succeed in employment, IPS in particular is an effective, evidence-based approach to serving the employment needs of individuals with mental illness in their efforts to obtain and keep a job. The key components of IPS include a rapid attachment to the competitive labor market in conjunction with the mental health services and ongoing, individualized support that continues for as long as a client wants and needs support. More generally, resources that discuss strategies and practices for best serving individuals with mental illness through employment programs are available for workforce development professionals.

Solutions exist to help people with mental illness succeed in work—but we can and must do more to better serve this population. In addition to the largely unquantifiable, day-to-day “cost” that mental illness incurs on individuals and their families, estimates of the economic cost of mental illness to the United States range from $148 billion to over $300 billion, with decreased productivity and loss of earnings being key contributors. If we are to mitigate the personal and societal costs of mental illness and confront problems such as chronic unemployment, poverty, and homelessness, it is imperative to address the employment needs of people with mental health conditions. This includes investing in employment solutions that work for this population, not decreasing government funding for mental health services. By opening doors to work for people with barriers to employment, including people with mental health conditions, we can help rebuild the foundation on which the American Dream is realized.

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About National Initiatives on Poverty & Economic Opportunity

Heartland Alliance’s National Initiatives on Poverty & Economic Opportunity is dedicated to ending chronic unemployment and poverty. We believe that every person deserves the opportunity to succeed in work and support themselves and their families. Through our field building, we provide support and guidance that fosters more effective and sustainable employment efforts. Our policy and advocacy work advances solutions to the systemic issues that drive chronic unemployment.

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