I was unemployed for many years while I was most ill. During that time, I felt worthless and dependent.
Why? Because of:
The debilitating impacts of mental illness.
The fear of having to explain my spotty resume due to multiple hospitalizations and depressive episodes.
The awareness that nothing I had done before I got sick seemed to count.
The prospect of having to start over.
The stigma that told me I could not work.
Stigma says to people with mental illness that we’re not ambitious, motivated, intelligent or able. It says we’re unable to handle stress, too sick and even potentially dangerous. However, these are all myths, and the common belief that people with mental illness cannot work, is a myth.
Sadly, these misconceptions combined with a lack of support keeps many people with mental illness from working. According to survey data from 2010, “employment rates decreased with increasing mental illness severity.” And “People with serious mental illness are less likely than people with no, mild or moderate mental illness to be employed after age 49.”
This is a problem that needs our attention. People with mental illness can, should and often need to work.
The social costs of the unemployment and underemployment of people living with mental illness are incalculable: deteriorated health, additional health care costs, financial struggle for families, among many others.
Additionally, work gives a source of purpose and allows us to contribute to our families and society.Sustained employment is an incredibly important factor for recovery. And the majority of those with mental illness can succeed with appropriate support.
Programs that Support Employment
Evidence of our ability to work is the existence of several employment support programs that help people like us get and keep jobs. NAMI’s Road to Recovery Report provides a good overview of these programs, which are all evidence-based. These include:
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American with Disabilities Act (ADA)
Employers may be required under the ADA to provide reasonable accommodations, when requested, to an employee with a disability as long as it does not cause undue hardship on the employer. Examples include telecommuting, scheduling flexibility, sick leave, breaks and noise reduction.
Many mental health workplace accommodations are low cost and easy to implement, but they can have a significant positive impact on both employees and employers. Accommodations that help people with disclosed mental illness might also help those with undisclosed mental illness feel more comfortable in the workplace. Additionally, it might encourage those that are not fully functioning in the workplace due to mental illness (presenteeism) to ask for accommodations as well. Presenteeism is very expensive to companies as it can cause significant productivity loss. And providing adequate accommodations to staff with disabilities has the potential to reduce those costs.
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Supported Employment – Individual Placement and Support (IPS)
IPS programs seek to help people with mental illness quickly choose, secure and keep competitive employment while providing ongoing individualized long-term support. They try to place people in jobs that match their talents and interests. IPS programs are highly effective. Competitive employment rates for individuals participating in IPS programs were close to 60% compared to 24% for individuals not in the programs. Yet, less than 2% of people served in state mental health systems received supported employment services.
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Assertive Community Treatment (ACT)
ACT provides intensive support services to people with serious mental illness in the community. The program includes components such as individualized treatment, community integration and job placement. Each ACT team includes an employment specialist. All the different pieces of the program, including employment activities, are incorporated into the person’s overall treatment plan.
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Clubhouses
Clubhouses, community-based centers open to individuals living with mental illness, offer supported employment programs. Members of Fountain House, the world’s leading clubhouse for people living with serious mental illness, achieve an employment rate of 42% versus only 15% for people with serious mental illness in the general population.
Some clubhouses also offer supported education programs. Supported education programs can help people living with mental illness enhance their job prospects. This is important as mental illness often onsets during prime academic years.
The challenge of many hardships related to mental illness is not knowing what to do. In the case of getting people with mental illness back to work or school, we have evidence-based solutions. What we need is greater awareness of, investment in, and expansion of these programs.
People with Mental Illness Can Be Successful
Mental illness doesn’t need to be an obstacle to employment. In fact, mental illness may be correlated with success in certain professions. For example, there are many successful entrepreneurs living with bipolar disorder. It makes sense as people with bipolar disorder are known to be highly creative and innovative. Also, the flexibility of work hours and locations offers conducive work conditions to people with mental illness.
Another example is working in the health care sector. Lived experience can be invaluable when working in health care, particularly in mental health. We understand what it’s like to live with mental illness and what it takes to reach recovery. Our perspective is different from that of clinicians and one that has proven to be highly beneficial as evidenced by the work of certified peer specialists (CPS).
CPSs are an emerging type of mental health care professional, a person with mental illness living in recovery who helps others reach recovery.They inspire hope by being a role model for recovery. They build confidence andempowerment through invaluable social connectedness. CPS work is considered a best practice by the Substance Abuse and Mental Health Services Administration and is Medicaid reimbursable in 39 states. Witnessing other peers in recovery inspired me to believe recovery was possible for me.This is why I proudly became a New York certified peer specialist-provisional.
In addition to working as a CPS, our lived experience can be extremely valuable and complementary to many mental health disciplines, including social work, therapy, psychology and psychiatry.
People with mental illness must be encouraged to enter or re-enter the workforce and offered reasonable support. We must advocate for the programs that support them getting jobs. We must hire them. And we must support businesses owned by them. These efforts benefit people living with mental illness, their families, workplaces and society. It benefits you and me. People with mental illness have so much to offer. Hopefully, one day we’ll have equal opportunities to participate in the workforce.
Author’s Note: I would like to dedicate this blog post to Certified Peer Specialists. I wish you meaningful full-time and part-time work, livable wages, good benefits, continuing education opportunities, career mobility, fair pay increases, safeguards against co-optation, supervisorial opportunities, competent supervision, and most importantly, much deserved respect as important members of behavioral health care teams. I wholeheartedly support you.
Katherine Ponte is a mental health advocate, writer and entrepreneur. She is the founder of ForLikeMinds, the first online peer-based support community dedicated to people living with or supporting someone with mental illness, and Bipolar Thriving, a recovery coaching service for caregivers and their loved ones affected by bipolar disorder. She is also the creator of the Psych Ward Greeting Cards program in which she personally shares her recovery experiences and distributes donated greeting cards to patients in psychiatric units. She is in recovery from severe bipolar I disorder with psychosis. She is also on the board of NAMI New York City.