Talking Points: Employment Supports for Persons with Mental Illness
Employment is a key determinant of health and well-being. There are compelling reasons to focus on improving the availability and access to employment support programs and services. (June, 2009)
Employment is a key determinant of health and well-being. There are compelling reasons to focus on improving the availability and access to employment support programs and services.
Work is central to mental health recovery
Work provides a sense of personal identity and social role.
Work is central to recovery for many people and supported employment programs and workplace accommodations increase the likelihood of successfully finding and keeping work. Job seekers with serious mental illness are frequently marginalized in the labour market due to barriers that exclude them from competitive employment. For example, experiencing a mental illness can seriously interrupt a person’s education or career path and result in diminished opportunities for employment. The cyclic nature of mental illness can also make job retention a challenge.
Work is a vital strategy for reducing poverty.
Employment rates remain low for persons with mental illness in comparison to their non-disabled peers. According to the Canadian Community Health Survey, 30% of people with a diagnosed mental illness in Ontario did not work in 2003.1 This is a conservative figure because the survey did not include persons with a diagnosis of psychosis who were unemployed.
Work reduces health and social assistance expenditures, and strengthens the workforce
Employing people with mental illness can save Ontario millions of dollars in health care costs and lost productivity, because working is associated with improved functioning, resulting in a reduction in symptoms.2 Working also reduces social assistance costs.
People with disabilities represent a large pool of untapped labour. Employing people with mental illness can address labour market shortages.
Employment assistance that provides the right resources at the right time is needed to ensure workers with mental illnesses can become valued members of the workforce. These services are typically delivered through a supported employment approach.
Supported employment has been identified as a best practice for people with serious mental illness that helps them secure and retain employment.
Supported employment programs combine two key elements:
- employment assistance, including resume writing, interviewing skills, and job search
- mental health support, including monitoring medication and job coaching activities.
There are different models of supported employment. The individual Placement and Support Model (IPS) is the most widely used in North America.3 Using this approach, commonly referred to as the “place and train” approach, individuals are placed into a competitive work paying at least minimum wage, without pre-vocational training. Despite the strength of this model, it is not effective for those with higher education or more severe mental illness. Other models have been developed and show promising outcomes, such as the “Choose-Get-Keep” model.4
Mental health consumers have options to access employment supports programs through community mental health agencies, hospital programs, cross-disability and mainstream employment agencies. Employment services are also offered by private, for-profit companies.
The Ministry of Health and Long-Term Care, Ministry of Community and Social Services, through its Ontario Disability Support Program [ODSP] employment program, and the Ministry of Training Colleges and Universities are the three key Ministry funding sources for service providers that offer employment support services to persons with serious mental illness.
In an environmental scan completed by CMHA Ontario with its branches in Fall 2007, there were five identified sources of funding for employment support programs: Ministry of Health and Long-Term Care, Ministry of Training Colleges and Universities, Human Resources and Skills Development Canada (Opportunities Fund), Ministry of Community and Social Services (ODSP and OW each have their own employment programs) and Trillium project by project funding.
Job seekers who have a serious mental illness are best served by recovery-oriented models of delivery that are based on incremental successes and long-term strategies.
In contrast, the current system of employment support services in Ontario is dictated by a results-based funding model that values placement over job preference and quality employment. There is a growing body of research that identifies lack of education and the rapid (job) placement as the main barriers to securing sustainable employment in the mainstream job market.5 Moreover, evidence shows that supported employment programs that provide a comprehensive range of employment training and supports for persons with mental illness, such as job readiness and job coaching, and reflect preferred employment, result in sustained employment at higher wages.6 Recommendations call for a wide range of employment support options that align with an emphasis on recovery, which is characterized by a long term approach that builds in a training and pre-employment component.7
Developing an Integrated System of Employment Supports
Necessary resources are often difficult to access because they are scattered across multiple ministries, each operating in isolation from the other. The resulting silo effect has unintentional consequences for programs that are intended to assist the individual to move from government dependence to self-reliance. A number of reports address the need to break down silos between ministries that are responsible for employment services to persons with mental health issues.8 Silos can be broken down by changing intersecting program rules that create conflicting eligibility criteria and, in so doing, eliminate negative consequences and foster self-reliance for Ontarians accessing these services.
Employment Ontario (Ministry of Training, Colleges and Universities), the Ministry of Community and Social Services, and the Ministry of Health and Long Term Care must invest in supported education and employment programs that are based on recovery principles that support incremental success. This means allowing more time and flexibility to complete an educational program or to conduct an extended job search that will result in a better skills/employer match.
These Ontario ministries have recently acknowledged the importance of offering an integrated system of employment support to job seekers with mental health issues. They have formed a cross-ministerial table to discuss how they can respect their individual mandates, while at the same time developing a more integrated system of delivery that meets the needs and expectations of job seekers with mental illness. CMHA Ontario is prepared to assist them in their efforts to create this system.
- Statistics Canada, Canadian Community Health Survey, Cycle 2.1, 2003,www.statcan.ca
- Public Health Agency of Canada, The Economic Burden of Mental Health Problems in Canada, Vol. 22, No. 1, 2001, www.phac-aspc.gc.ca
- Bond et al. (2008), “Fidelity of Supported Employment: Lessons Learned from the National Evidence-Based Practice Project,” Psychiatric Rehabilitation Journal 31(4).
- Rogers et al. (2006). “The choose-get-keep model of psychiatric rehabilitation: A synopsis of recent studies,” Rehabilitation Psychology 51(3).
- Gates et al. (2005), “Outcome Based Funding for Vocational Services and Employment of People with Mental Health Conditions,” Psychiatric Services 56 (11), and Boyce et al. (2008), “Factors Influencing the Delivery of Evidence-Based Supported Employment in England,” Psychiatric Rehabilitation Journal31(4).
- Judith Cook (2006), “Employment Barriers for Persons with Psychiatric Disabilities: Update of a Report for the President’s Commission,” Psychiatric Services 57(10).
- Mental Health Implementation Task Force (MHITF) Reports (2002/2003), Ministry of Health and Long Term Care, www.health.gov.on.ca
- Deb Matthews, “Review of Employment Assistance Programs in Ontario Works and Ontario Disability Support Program,” Report to the Honourable Sandra Pupatello, Minister of Community and Social Services, December 2004,www.mcss.gov.on.ca