RESEARCH WEEKLY: Employment and Economic Independence with a Severe Mental Illness
People with serious mental illness often have difficulty gaining employment, in part due to disabling symptoms that impair their ability to enter into the workforce. As a result, employment rates among people with severe mental illness are remarkably low, with estimates that as few as 12% of people with schizophrenia in the public mental health system are employed.
Without employment to generate income, many people with severe mental illness rely on public assistance programs and have difficulties achieving economic independence. In the United States, this includes assistance through Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) for those with previous employment history. Almost one in four of individuals who receive SSI or SSDI receive this financial assistance due to the impairments of a mental illness.
In a series of articles published this month in Psychiatric Services, researchers examined the impact of serious mental illness on employment and evaluated a supportive employment program to improve economic independence among this population.
Employment after the onset of a severe mental illness
To understand the factors involved in participation in the labor market for individuals with severe mental illness, an analysis of employment status and income before and after the onset of the illness will allow for control for other factors that may impact the magnitude of the issues.
Utilizing population registrar data sets in Finland, researchers analyzed more than 50,000 individuals who had been hospitalized with a severe mental illness between 1988 and 2015. They matched each individual with five other individuals who had similar demographic characteristics but did not have a severe mental illness to control for external factors.
They found that people with severe mental illness had low-levels of employment, both before and after their first hospitalization and diagnosis. The higher the reported severity of the illness, the lower rates of employment those individuals had. The authors also found that although people with severe mental illness had some income prior to a first hospitalization, after the onset of the illness, government financial assistance was their main source of income. The long-term economic well-being for people with serious mental illness is largely dependent on these payments, according to their results.
Supported employment and economic independence
In the United States, a randomized trial of a supported employment program for people with psychiatric disorders was conducted by the Social Security Administration in the late 2000’s. Half of individuals in the study received individual placement and support (IPS), a demonstrated model of supported employment, whereas half received treatment and support as usual. Although there are countless research studies showing the efficacy of IPS in improving employment outcomes in individuals with serious mental illness, the long-term effects of these programs on employment and economic independence were not known.
Researchers linked the results from the initial trial to administrative records from the Social Security Administration. They found that people who received IPS were more likely to be employed than those who did not, even five years after the program ended. In addition, the average income of individuals increased more over time for people who received the supported employment program.
The authors conclude that when IPS is delivered in addition to medication management and other supports for individuals with serious mental illness, it can have long-term positive effects on their employment and earnings, leading to economic independence.
