Lesson 11: Vocational Factors Impacted by Psychiatric Conditions

Attention

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

• Understand and apply the research that shows that most people with psychiatric disabilities want to pursue employment opportunities and that a consumer can be successful in competitive employment regardless of diagnosis, symptoms, disability status, prior hospitalizations, or co-occurring substance abuse.    
• Identify the specific factors in the vocational profile that will require accommodation and strategic service planning.
• Apply the use of the vocational profile of an individual diagnosed with substance abuse to develop and facilitate a supported employment plan.
• Discuss the presence of potential reactions to Stigma in the workplace.

Teaching

FACTS ABOUT MENTAL ILLNESS AND WORK

Most people with serious mental illness live in our communities. They are our family members, neighbors, co-workers, and friends. More than 5 million people in the United States are diagnosed with a serious and persistent mental illness. With treatment and rehabilitation, many people are on the road to recovery and are leading productive and satisfying lives. For practitioners, consumers and family members, understanding mental illness can be a fundamental step on the road back to a normal life.

Some of the more prevalent characteristics of serious mental illnesses may include: a feeling of worthlessness, a limited tolerance for stress, lack of assertiveness in routine interactions, lack of spontaneity, withdrawn and avoidant social behavior, inability to form and sustain intimate relationships, vulnerability to exploitation, and poor judgment.

Fact #1: There are 3 million working-age adults with severe mental illness in the nation’s communities, of whom 70%-90% --- about 2 million people --- are unemployed.  The National Institute of Mental Health estimates that there are a little over 3 million adults ages 18-69 who have a serious mental illness. Estimates of unemployment among this group are startling: between 70% and 90% are unemployed, a rate higher than for any other group of people with disabilities in the nation.

Fact #2: A diagnosis of serious mental illness is not a reliable indicator that someone cannot work: indeed, many people are able to work successfully despite their symptoms.  Several years of study report only a small relationship between diagnosis and work capacity, or between psychiatric symptoms and work capacity. While it is true that some of the symptoms of mental illness---its often unpredictable nature and its impact on both cognitive and interpersonal functioning---make work a real challenge, these symptoms vary from person to person.

Fact #3: On-the-job accommodations that make it possible for people with serious mental illness to succeed at work are proving relatively straight-forward and inexpensive: most job accommodations involve flexible scheduling and job description modifications.  Recent surveys indicate that job accommodations for people with disabilities of all kinds are not difficult or costly to implement: 68% of all accommodations cost less than $500. The changes at work that people with serious mental illness request most often---alterations in work schedules, or modifications in job descriptions, clear communication patterns or additional training for supervisors---are generally low-cost or no-cost to employers.

Fact #4: Researchers stress that successful careers for people with serious mental illness, which depend in part upon a good match between an individual’s work skills and the specific requirements of the job, also reduce the use of costly mental health services and hospitalizations.  Many of those people with mental illness who do work---often those with milder symptoms, stronger self esteem, more independent functioning skills, and less need for emergency hospitalizations---are able to continue at work because personal capacities and interests fit well with those demanded by their job. Recent studies suggest that those involved in innovative supported employment programs make less use of the most expensive mental health services.

Fact #5: Innovative rehabilitation programs that help people with the most serious mental illnesses are placing more than 50% of their clients into paid employment.  A number of innovative programs that move clients into ‘real jobs for real pay’ as quickly as possible and then provide extensive supports for them either on-the-job or off-the-job, are reporting considerable success. An in depth analysis of Supported Employment outcomes, for instance, found 52% of people still working after a year. Intensive case management and individual placement and support models that emphasize employment regularly report significant increases in wages, hours worked, work tenure, and career advancement.

Fact #6: People with serious mental illness work at all kinds of jobs in the labor market, although nearly 75% of job placements are in entry-level positions, the rest are in technical and professional roles.  People who go to work through transitional and supported employment programs can be found in all sectors of the economy (e.g. manufacturing, service industry, rehabilitation programs, etc.) And in both low-pay and low-benefit positions, but an increasing effort is being made to open more responsible and better paying opportunities.

Fact #7: Employers who have hired persons with serious mental illness in the past are generally very positive about their experiences.  Many employers throughout the country have hired people with serious mental illness, and for a variety of profit-based and altruistic motives: over 70% of these employers report their willingness to continue working with rehabilitation programs that place and support people with serious mental illness. Employers who are involved with rehabilitation programs are less likely to share the public’s concerns and fears about people with mental illness, particularly with regard to violent behavior. In fact, a recent study of “mental disorder and violent behavior” reported only a modest relationship between the two: 90% of people with mental illness are not violent, and, the study reported that “having experienced psychotic symptoms in the past bears no direct relationship to violence” in the future.

Reprinted from material completed by the Research and Training Center on Mental Illness & Work at the Matrix Research Institute and the University of Pennsylvania.

Success CAN Happen

Despite the challenges of mental illness, successful transition to employment can happen. It is, however, a journey. The video below documents Kevin's journey. Thank you to Kevin and to Valerie Lambert for sharing this story!

Click HERE to view Kevin's Journey to a Meaninful Life

Assessment

Lesson 11 Discussion

This is the set of conditions most relevant to your work in the mental health field. Based on your knowledge, experience and materials covered thus far in this course please discuss barriers that individuals with mental illness encounter related to work. (If referring to info offered in a previous lesson, please state the lesson number.)

Lesson 11 Assignment

In this assignment you are going to construct a detailed presentation with pictures, text, and links that outline what you have learned from the following articles:

Click HERE to download the following article:

Jones, A.M. (2011). Disclosure of mental illness in the workplace: A literature review. American Journal of Psychiatric Rehabilitation. 14(3). 212-229.

Click HERE to download an article about Fictitious Disorders.

To complete this assignment you will be using any one of the options outlined in the iPad integration document below.