Policy Reform Dilemmas in Promoting Employment of Persons With Severe Mental Illnesses

Abstract

Recent evaluations by the U.S. General Accounting Office and the National Alliance for the Mentally Ill of reemployment efforts of the federal-state vocational rehabilitation program found that services offered by state vocational rehabilitation agencies do not produce long-term earnings for clients with emotional or physical disabilities. This paper examines reasons for these poor outcomes and the implications of recent policy reform recommendations. Congress must decide whether to take action at the federal level to upgrade programs affecting persons with severe mental illnesses or to continue to rely on state decision making. The federal-state program largely wastes an estimated $490 million annually on time-limited services to consumers with mental illnesses. Rechanneled into a variety of innovative and more appropriate integrated services models, the money could buy stable annual vocational rehabilitation funding for 62,000 to 90,000 consumers with severe mental illnesses. Larger macrosystem problems involve the dynamics of the labor market that limit job opportunities and the powerful work disincentives for consumers with severe disabilities now inherent in Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid.

What Predicts Supported Employment Program Outcomes?

“…While program leaders cannot affect the local unemployment rates, they can influence the degree of program fidelity. Hence, programs should resist falling into a trap of low expectations for employment outcomes in areas of high unemployment and focus (Noble, 1998). Close collaboration was expected as part of participating in the Johnson & Johnson program and was promoted through financial incentives and program monitoring.…”

Vocational intervention based on the Model of Human Occupation: a review of evidence

“…People with disabilities continue to face a variety of barriers to the labor marketplace and are underrepresented in the labor force (1)(2)(3). In the last few decades, legislation (4,5) and policy (6)(7)(8) have underscored the rights of disabled persons to have access to work and have created new opportunities for work-related practice.…”

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

“…Social Security programs that provide cash assistance to citizens with psychiatric and other disabilities contain financial incentives to encourage employment (SSA, 2001). However, these programs have not been particularly effective in promoting employment for people with disabilities and actually create barriers to employment by keeping people unemployed or in low-wage, low-status jobs (Lewin-VHI, 1995;Mashaw & Reno, 1996;National Council on Disability, 1997;Noble, 1998;O'Day, 1999;Polak & Warner, 1996;Rutman, 1994;U.S. General Accounting Office, 1987, 1996a, 1996b, 1996c.…”