Position Statement on Employment and Rehabilitation for Persons with Severe Psychiatric Disabilities

The National Association of State Mental Health Program Directors (NASMHPD) recognizes the fundamental importance of competitive, integrated, paid, and meaningful employment to the quality of life for persons with severe psychiatric disabilities. Chronic unemployment can lead to isolation, poverty, and a diminishing self worth in any adult, hindering efforts at recovery. In addition, one residual effect of chronic unemployment for persons with severe psychiatric disabilities is the perpetuation of homelessness for this population. Therefore, the current high rate of unemployment among people with severe psychiatric disabilities--estimated at 85% or more--must be lowered. The focus should not only be on employment opportunities, but also on habilitation and rehabilitation, including integrated, supported, competitive employment, to better enable individuals with mental illness to participate in the workforce.

The lack of jobs that provide flexibility for adults with serious mental illness is a major barrier to successful community living, a personal loss to people who wish to work, a societal loss to employers and taxpayers, and a barrier to successful recovery for those with mental illness. State mental health authorities should assume a leadership role in significantly increasing the rate of employment among individuals with psychiatric disabilities. Vocational rehabilitation agencies and SMHA's should collaborate and design program linkages and develop a range of employment options to increase rehabilitation opportunities for individuals requiring mental health services. Mental health policy makers should work to maximize the availability of community supports and case management efforts that focus on employment issues early in the rehabilitation process.

NASMHPD supports the goals of the Americans with Disabilities Act of 1990: to eliminate unfair treatment of and discrimination against qualified workers with disabilities, improve access to mainstream resources, and to mandate the assessment of disabled applicants' qualifications with consideration of accommodations and support services. However, we believe the Rehabilitation Act has failed to serve adequately the habilitation and rehabilitation needs of individuals with severe psychiatric disabilities, and should be amended accordingly. We acknowledge employment as an important route to recovery, economic empowerment, and independence for consumers of mental health services. We will work to increase their opportunities to become productive members of American society.

NASMHPD encourages the development of community-based employment services and vocational rehabilitation services that are tailored to meet the needs of persons with psychiatric disabilities and that are governed by individual skills, knowledge, abilities and preferences. Employment support and rehabilitation standards must be flexible to accommodate the episodic nature of mental illnesses. Effective employment services should offer long-term support both on & off the job in all phases of employment including, but not limited to:

  • career planning,
  • job goal selection,
  • job placement,
  • self-presentation in writing and in person during pre-employment screening,
  • negotiating reasonable accommodations,
  • acquiring specific job skills,
  • obtaining transportation & clothing appropriate to the work setting,
  • estimating how earnings will impact entitlements such as SSI, SSDI, Medicaid & Medicare,
  • education in using existing Social Security Administration work incentive programs to greatest advantage,
  • establishing positive relationships with co-workers and supervisors,
  • assistance in changing jobs,
  • job retention assistance,
  • supported education, and
  • consumer-run enterprises.

Effective rehabilitation services must view successful rehabilitation for individuals with mental illness differently than for others. While vocational rehabilitation agencies frequently define successful rehabilitation as leading to full-time competitive employment, the VR system should adapt to the needs of all individuals with severe psychiatric disabilities, whether or not they are in a stage of recovery that enables them to engage in full-time employment. The VR system should acknowledge the different needs and preferences of individuals with varying degrees of psychiatric disability. Such individuals should have access to the full range of choices, including volunteer and part-time work, full-time competitive employment and advanced training and education. Rehabilitation policies should provide incentives for rehabilitation agencies to coordinate their efforts with SMHA's and effectively serve individuals with psychiatric disabilities. While the focus of mental health has grown from removing and controlling symptoms to building active life roles and activities in institutional and community settings, state vocational rehabilitation systems must be encouraged to keep pace with this change.

Employment support must be an integral component of comprehensive community support programs. State mental health agencies should collaborate with state vocational rehabilitation agencies, consumers, family members, mental health professionals, private businesses, taxpayer groups, and other advocates to: focus existing public & private resources (such as the state/federal vocational rehabilitation program and state services for unemployed citizens) to better serve persons with psychiatric disabilities; expand supported employment opportunities; re-direct public funds away from segregated day programs and toward community-based employment programs; and reduce the disincentives still present in SSI/SSDI policies for recipients returning to work. Employers must be educated about the potential of persons with psychiatric disabilities to become valued workers. NASMHPD recognizes the disincentive to work created by flaws in the benefit structures of the SSI and SSDI programs and the risk posed by the potential loss of Medicaid benefits for those entering the workforce. Ultimately, the structure and availability of such benefits and the availability of adequate and appropriate private mental health insurance coverage will significantly impact many individuals' prospects for recovery and successful integrated, competitive employment.

NASMHPD believes that the growth of managed care both makes it necessary and provides an opportunity to more fully integrate employment and recovery goals with service delivery. State mental health agencies should work to develop tools for appropriate evaluation of plan success in moving covered individuals into employment or partial employment settings. In addition, SMHA's and other appropriate state agencies should examine the potential for cost effective cooperative agreements with managed care organizations to coordinate treatment, rehabilitation and vocational services.

Approved by the NASMHPD membership on December 10, 1996.