By Michael Morris, Executive Director, National Disability Institute
Working-age people with disabilities are less likely to be employed than those without disabilities. They are also more likely to have depression, anxiety and chronic health challenges. Lack of employment exacerbates disability, and disability becomes one of multiple barriers to employment.
A number of studies have shown that employment can improve mental health in two ways:
Financial Benefits: Employment increases household income and decreases economic hardship, both of which improve physical and psychological well-being. Numerous studies have demonstrated that poverty leads to poor health status. Well-paying work provides individuals with the financial means to access safe housing, nutritious food and health care, all of which impact mental health directly. The stress of trying to pay bills and feed and clothe a family on an inadequate household income generates psychological distress and susceptibility to health conditions which can become chronic.
Psychological Benefits: Employment has long been associated with key components of mental health including self-esteem, self-worth, purpose and identity. Some psychologists ascribe to the theory that work provides relationships and social connections; a time structure on the working day; the assignment of social status; regular productive activity; and the opportunity to engage in collective efforts greater than could be achieved alone. Other psychologists contend that unemployment affects self-concept because occupation is often an important component of an individual’s personal identity. Thus, unemployment threatens that identity and can damage an individual’s sense of self-worth. Quantitative evidence substantiates that when people lose their jobs, they tend to experience a significant deterioration in mental health, and when unemployed persons find new jobs, their mental health improves significantly.
Work is therapeutic; promotes recovery and rehabilitation; leads to better health outcomes; minimizes the harmful physical, mental and social effects of long-term unemployment; promotes full participation in society and independence; reduces poverty; and improves quality of life and well-being.
Unfortunately, getting and keeping a job can be challenging for people with mental health disabilities. Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that fewer than one in five people receiving services through the public mental health system are working.
Supporting people with mental health disabilities may be good for federal and state budgets also. Researchers at Dartmouth Medical School found that individuals with a serious mental illness, who maintained work with an average of 13.8 hours per week (5,060 hours per year), had lower mental health care costs than those who were unemployed or not steadily employed. Over the course of the study’s 10 years, individuals who maintained steady employment had mental health medical costs that were $166,350 less per person than the group that was unable to maintain consistent employment.
Although policy makers know how to provide employment services, very few people with disabilities ultimately benefit. The National Association of Mental Illness (NAMI) reports that fewer than two percent of people using public mental health services receive supported employment services.
Excellent research and demonstration programs provide evidence that supported employment works. Supported employment is a person-centered process where an individual is assisted in identifying and securing a job. A specialist provides ongoing support as needed. This is all integrated with an individual’s mental health rehabilitation plan. Also, in addition to supported employment, customized employment ties in a non-traditional assessment with a discovery process to identify critical individual strengths and interests. Customized employment embraces the concept of negotiation with employers to identify and negotiate a match between employer needs and an individual’s strengths and skills. For more information, read the LEAD Center brief on customized employment.
Like other evidence-based practices that promote employment for people with disabilities, supported and customized employment require that policy makers believe what research shows – people with disabilities can work and want to work.
Collaboration among multiple agencies at the federal and state levels, such as the U.S. Department of Labor, Vocational Rehabilitation, Medicaid and State Mental Health Agencies is critical to successful employment outcomes for people with mental health challenges. It also requires that these agencies have the ability to combine different funding streams (known as braided funding). Unfortunately, conflicting rules about “payer of last resort” make state agencies cautious about braided funding.
In order to move forward with implementing evidence-based employment practices for people with mental health and other disabilities, federal agencies must come together and provide clear guidance on how funds from different agencies can be braided to afford people with mental health disabilities the opportunity to work and succeed.
Since its inception in 2005, National Disability Institute (NDI) remains the first and only national nonprofit organization dedicated exclusively to designing pathways to economic stability and mobility for persons with disabilities. Through public policy research and development and customized training and technical assistance, NDI has become a recognized leader nationwide demonstrating that individuals across the spectrum of disabilities can work, save for the future and advance their financial capability and economic stability.
To learn more, visit www.nationaldisabilityinstitute.org.