Does U.S. federal policy support employment and recovery for people with psychiatric disabilities?

Abstract

Evidence suggests that a high percentage of people with a psychiatric disability can recover--find meaningful work, develop positive relationships, and participate fully in their communities. Evidence also suggests that work is an essential component of recovery. However, few people with a serious psychiatric disability are actually employed and most of those who are employed work only part-time at barely minimum wages. To assess the impact of federal programs such as Social Security Disability Insurance, vocational rehabilitation, medical insurance, and psychiatric services upon employment, we conducted a qualitative study of 16 employed and 16 unemployed individuals with psychiatric disabilities. All of our participants had disabilities severe enough to qualify them for Social Security Disability benefits. They told us that current federal policies and practices encouraged employment and integration of only a few participants, in a particular stage of their recovery, and placed significant barriers in the employment path of others.

Receipt of employment services among Veterans Health Administration users with psychiatric diagnoses

“…This is consistent with a recent finding that service-connected disabilities of 50 percent or higher (but not necessarily lower levels) were associated with unemployment and not looking for employment [23]. Regulations associated with loss of Social Security Administration medical and financial benefits due to employment may act as a disincentive to return to competitive employment [36][37], though perhaps only at higher levels of service-connected disability [35]. Although Department of Veterans Affairs (VA) benefits are not reduced due to income earned through VHA employment services, whether the perception of a loss of VA benefits acts as a disincentive to even seeking VHA employment services is an important research and policy consideration.…”

Working, receiving disability benefits, and access to mental health care in individuals with bipolar disorder

“…It has been argued that working increases self‐esteem, is part of the healing process, and is an important goal for people with mental illness (12, 13). However, for those who are unable to work, disability benefits provide a certain level of income, as well as access to health care in the majority of cases.…”

“…Much has been written about the disincentives to work created by the provision of disability benefits and accompanying health care benefits, and it is well documented that, even with SSA work incentive programs that currently exist, SSA disability recipients are reluctant to work for fear of losing their health care benefits (13–15). In fact, the SSA itself considers the issue of work disincentives so important that it is funding a large randomized clinical trial to test the extent to which eliminating programmatic work disincentives and providing other services (accurate diagnosis and supported employment) will improve functioning and competitive employment among SSDI beneficiaries with a primary impairment of schizophrenia or affective disorder (16).…”

“…It is well‐recognized in the economic and social science literature that for many disabled populations, fear of losing health care coverage is a disincentive for working or working full‐time (13–15). In fact, SSA has created a wide array of employment supports in an attempt to overcome some of these disincentives and is currently funding a study of SSDI beneficiaries with schizophrenia or affective disorder to test an intervention for overcoming work disincentives (16).…”

Can SSDI and SSI Beneficiaries With Mental Illness Benefit From Evidence-Based Supported Employment?

“…For most beneficiaries, losing health insurance is a far greater worry than losing cash payments (7,(21)(22)(23)(24)(25). Most SSDI and SSI recipients receive health insurance in the form of Medicare, Medicaid, or both (8,23).…”