Supported Employment (SE)

The unemployment rate among people with serious mental illnesses (SMI) is the highest among all disability groups in the US. Research and personal accounts support the positive effects of work. Employment enhances quality of life, increases one’s self-esteem, provides access to goods and services, and has a positive effect on overall physical health. Unfortunately, individuals with SMI have interrupted developmental experiences due to the common onset of illness during adolescence and young adulthood and often never fully, if at all, realize the goal of embarking on careers. Limited access to quality employment services, specifically the evidence based model of Supported Employment (SE) contributes significantly to the very low employment rate among people with SMI. Access may be further impeded by mental health service providers who lack the adequate skills and resources needed to support individuals in their employment goals.

 

The federal definition of Supported Employment is: 

“Competitive work in integrated work settings . . . consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individuals, for individuals with the most significant disabilities for whom competitive employment has not traditionally occurred; or for whom competitive employment has been interrupted or intermittent as a result of a significant disability” (Rehabilitation Act Amendments of 1998: Title IV of the Workforce Investment Act of 1998, Pub Law 105-220, 112 Stat 936).

 

Supported Employment is based on eight principles developed by researchers from Dartmouth University. The eight principles of the Individual Placement and Support (IPS) model of SE include:

  1. Every person with severe mental illness who wants to work is eligible for supported employment.
  2. Employment services are integrated with mental health treatment services.
  3. Competitive employment is the goal.
  4. Personalized benefits counseling is provided.
  5. The job search starts soon after a person expresses interest in working.
  6. Employment specialists systematically develop relationships with employers based upon
  7. Job supports are continuous.
  8. Client preferences are honored

 

Evidence for the Effectiveness of SE:

Employment services that incorporate the IPS principles achieve enhanced employment outcomes compared to other vocational services. In one of the largest multisite randomized trials of SE interventions, individuals who received SE were more likely to become competitively employed and work 40 or more hours per month, as well as have higher monthly earnings compared to those who received services as usual. Participants in SE services also experience improvements in non-vocational outcomes including, decreases in symptom distress, substance abuse, service utilization, and crises, as well as increases of housing stability, self-esteem, and overall quality of life.

 

Resources:

Click here for SAMHSA’s SE toolkit that provides resources and research supporting the implementation of SE services. 

Click here to view SAMHSA’s brief video on SE. Program characteristics as well as perspectives from individuals who have received SE services are presented.

Click here to view a webinar of SAMHSA’s Program to Achieve Wellness which identifies strategies to support individuals with serious mental illness in the workplace. Providers and employers will find the current research on employers’ views and perspectives helpful in creating more opportunities for community employment.                          

Click here to learn more about how work impacts Social Security with these resources from SAMHSA’s SSI/SSDI Outreach, Access, and Recovery (SOAR) website.                         

Employment has been linked to recovery for many individuals. Click here to hear individuals and providers’ views on the role of work in recovery and check out the personal stories on the Rutgers Integrated Employment Institute’s blog, vocational voice.

Click here to learn more from NJ’s Wellness Institute providing an overview of the eight wellness dimensions, including occupational wellness. Worksheets and resources are provided to encourage individuals to begin exploring their wellness in each of the eight domains. 

 

Role of the MHTTC

The Northeast Caribbean MHTTC is well positioned to assist systems and providers of mental health services in implementing evidence-based SE in their current settings and promoting the importance of employment in recovery for individuals with mental health conditions.

For more information or to learn more about our trainings:

Email: northeastcaribbean@mhttcnetwork.org or Call: 908-889-2552

 

 

References

Bond, G. R. (2004) Supported employment: Evidence for an evidence-based practice. Psychiatric Rehabilitation Journal, 27(4), 345–359. doi:10.2975/27.2004.345.359

Bond, G. R., Drake, R. E., & Becker, D. R. (2008). An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal, 31(4), 280-290.  doi: 10.2975/31.4.2008.280

Bureau of Labor Statistics (BLS, 2018). Unites States department of Labor. Labor Force statistics from the current population survey. Data on the employment status of people with a disability. Retrieved from https://www.bls.gov/news.release/empsit.t06.htm

Burke-Miller, J. K., Cook, J. A., Grey, D. D., Razzano, L. A., Blyler, C. R., Leff, H. S., et al. (2006). Demographic characteristics and employment among people with severe mental illness in a multisite study. Community Mental Health Journal, 42(2), 143-159.

Burns, T., Catty, J., White, S., Becker, T., Koletsi, M., Fioritti, A., et.al. (2009). The impact of supported employment and working on clinical and social functioning:  Results of an international study of individual placement and support.  Schizophrenia Bulletin, 35, 949-958.

Burt, M. R. (2012). Impact of housing and work supports on outcomes for chronically homeless adults with mental illness: LA’s hope. Psychiatric Services, 63(3) 209-215. doi: 10.1176/appi.ps.201100100

Burns, T., Catty, J., White, S., Becker, T., Koletsi, M., Fioritti, A., et.al. (2009). The impact of supported employment and working on clinical and social functioning:  Results of an international study of individual placement and support. Schizophrenia Bulletin, 35, 949-958.

Campbell, K., Bond, G. R., & Drake, R. E. (2011). Who benefits from supported employment: A meta-analytic study. Schizophrenia Bulletin, 37, 370-380.

Cook, J. A. (2006). Employment barriers for persons with psychiatric disabilities: Update of a report for the President’s Commission. Psychiatric Services, 57, 1391-1405.

Drake, R. E., McHugo, G. J., Becker, D. R., Anthony, W. A., & Clark, R. E. (1996). The New Hampshire study of supported employment for people with severe mental illness. Journal of Consulting and Clinical Psychology, 64(2), 391-399.

Drake R. E. & Bond, G. (2011). IPS Supported Employment: A 20 year update. American Journal of Psychiatric Rehabilitation, 14(3), 155-164. https://doi.org/10.1080/15487768.2011.598090

Kukla, M., Bond, G. R., & Xie, H. (2012). A prospective investigation of work and non-vocational outcomes in adults with severe mental illness. The Journal of Nervous and Mental Disease, 200(3), 214-218.

Modini, M., Tan, L., Brinchmann, B., Wang, M., Killackey, E., Glozier, N., Mykletun, A., & Harvey, S. B. (2016). Supported Employment for people with severe mental illness: Systematic review and meta-analysis of the international evidence. The British Journal of Psychiatry, doi: 10.1192/bjp.bp.115.165092.

Xie, H., Drake, R.E., McHugo, G.J., Xie, L., & Mohandas, A. (2010). The 10-year course of remission, abstinence, and recovery in dual diagnosis. Journal of Substance Abuse Treatment, 39, 132-140.