Job Placement for People with Psychiatric Disabilities: A Literature Review on Current and Innovative Practices

Job Placement for People with Psychiatric Disabilities: A Literature Review on Current and Innovative Practices

Psychiatric or psychological disorders such as schizophrenia impair cognitive functioning and can lead to emotional instability and lack of social skills. Waghorn and Lloyd (2005) note that low energy levels and ideational fluency are also associated with such disorders. Moreover, such individuals tend to have attention problems while a majority also has low memory. Devoid of such skills and capabilities, people with psychiatric or psychological disorders tend to lack problem solving skills and may also suffer from low motivation. They may also lack a sense of interest and initiative (Waghorn & Lloyd, 2005; MacDonald et al. 2003). These are skills that are highly priced in the modern day job market. Highly interactive and motivated individuals who are interested in their work and beyond with proactive acuity are valued. People with psychiatric or psychological problems find it difficult to progress and hold down a job due to lack of such abilities. Becker et al. (1998) in a research study on some of the causes of job loss amongst people with psychiatric problems in paid work established that lack of interpersonal skills was the major contributor (58%).         

In many developed and developing societies including the United States, people with mental disabilities are usually maligned and stigmatized socially and economically. The practice is replicated in the corporate sector. In a research conducted for the John J. Heldrich Center for Workforce Development by Dixon, Kruse and van Horn published in 2003, it was established that only 25% of companies operating in the United States employed people with disabilities. Nearly a third of the employers (32%) held that the low number of disabled employees was down to the nature of their company’s activities “that cannot be effectively performed by workers with disabilities” (Dixon, Kruse & van Horn 2003). A further 17% of the employers noted that the lack of skills and experience amongst people with disabilities was the key barrier to their employability while 15% noted that it was just down to outright reluctance by the employers that the greatest barrier to job placement for people with disabilities (Dixon, Kruse & van Horn, 2003).  

Most companies employing the disabled do not fully appreciate what it means to employ them. They either do not train the disabled employees or failed to provide special accommodations and facilities for them and in some cases both. Only 40% of the employers interviewed trained their employees with disabilities or provided adequate accommodations or facilities for them. However, a staggering 73% of the surveyed employers held that the employees with disabilities did not require any special facilities or accommodations. Interestingly, 40% of them argued that making such adjustments to accommodate people with disabilities is financially costly with 35% of companies with people with disabilities responding that it impacts negatively on their profit margins. Majority of firms who held that training and accommodating people with disabilities within the workplace is costly were small firms (44%) with 32% of large firms sharing the same sentiments (Dixon, Kruse & van Horn 2003).

The World Health Organization (2000) notes that job placement is one the effective ways on reintegrating people suffering from mental problems into the society and not tools for alienating them. This is because the job keeps them occupied while the salary gives them an opportunity to be self-reliant while the resultant latent benefits enable them to feel a sense of belonging to the community. Moreover, getting a job will give them the satisfaction of self achievement which is integral in uplifting their morale, self-confidence and esteem (Rinaldi & Perkins 2004). 

            Warner (1994) and Lewis and Sloggett (1998) established that there is a significant correlation between self-inflicted pain or injury, suicide and severe mental health problems and unemployment amongst people with disabilities. Waghorn and Lloyd (2005) established that people with mental illness who cannot secure any form of employment especially paid work usually suffer from demoralization and negative social isolation. Moreover, the additional stigma also leads to social inactivity and hopelessness which relatively increases chances of suicide and other physical and mental health problems ((Waghorn & Lloyd, 2005). Conversely, Provencher et al. (2002) and Bond (2001) established that paid employment had a positive influence on people with mental disabilities.

In the study conducted by Provencher et al. in 2002, many of the respondents stated that paid employment was one of the most vital steps on their path to recovering from their mental condition. However, such results were attained in competitive job environments where the employees with mental disabilities were not placed under sheltered work environment (Bond, 2001). Such outcomes are only attainable in conditions where there are no special treatments such as lengthy job preparations which may set them apart. In a policy paper on the “Elements of an Effective Service” for job placement of job-seekers with disabilities, Barbara Murray and Robert Heron (1999) while writing for International Labor Organization (ILO), notes the challenges faced by people with disabilities are many folds. Other than facing stigmatization in job placement, they also must surmount the challenge of “difficulties in getting an education, and in accessing vocational training and further education” (Murray & Heron, 1999 p. iii).

Individuals with mental problems may lack the prerequisite skills, personality and/or education level that can enable them effectively compete with their non-disabled counterparts. Murray and Heron recommend that “measures to strengthen employment placement service for persons with disabilities must be set in a solid policy framework and if necessary backed by legislation” (Murray & Heron, 1999 p. iii). They further note that:

A clear operational strategy must be designed to guide implementation…while the employment service needs to form linkages with other government ministries and agencies at a policy level, to ensure that obstacles which disabled people may face are minimized, and that the skills which they offer are relevant to labor market opportunities ((Murray & Heron, 1999 p. iii).

            One of the approaches that have been effectively used to help people with disabilities including those with mental health problems get and progress in gainful employment is individual placement and support (IPS). Also known as evidence-based supported employment, it is based on the philosophy that “anyone is capable of working competitively in the community if the right kind of job and work environment can be found and the right kind of support provided” (Rinaldi et al, 2008). The key of this approach is therefore not altering the individual to suit the work conditions; rather, it is based on [finding] a natural match between the individual’s strengths and experiences and a job in the community” (Rinaldi et al, 2008).

Burns et al (2007) note that IPS is based on eight evidenced-based principles: individual choice is the overriding qualification while the employment must also be as competitive as in the case of non-disabled individuals. Moreover, success is further enhanced with the integration of treatment of the mental condition within the supported employment program. However, the job placement must be rapid while each job and all related help towards integration must be customized to meet the special needs of the individuals. Because of their mental conditions, it is imperative that the employers, agencies and healthcare operators work together to help with financial planning for these individuals (Burns et al, 2007).       

            Becker and Drake (2003), who were the first to suggest this approach, note that up to 58% of people living with disabilities but receiving job placement under the evidence-based practice got paid employment within their communities compared to a 21% enrolled under the traditional vocational rehabilitation. Therefore, IPS provides a better job placement approach to the between 60 to 70 percent of people living with disabilities who would to have meaningful employment. Because of its ‘train then place’ model, vocal rehabilitation id less efficacious as the individuals are given vocational training and career development which are sheltered from the realities of normal work environments. They are therefore ill-prepared to face the challenges of the normal work environment. This has the potential of demoralizing, stigmatizing and can even lead to hopelessness or resistance because some of the mental health problems are innate and irreversible (Becker & Drake, 2003).

Retrospectively, IPS relies on the ‘place then train’ model where, through rapid job search, individuals with disabilities are hired within the competitive work environment. This is then followed by on-job training support in order to acclimatize them to the hassles of the competitive work environment. Support includes provision of special accommodations and training while also integrating their treatment with the program. The traditional vocational rehabilitation more or less treats their disability as an inability. Bond (2001) noted that it is such sense of belonging to the community that gives people with mental problems and those living with disabilities in general a sense of self-worth. It is through such equal treatment that enables them to forge their identity and boost their self-esteem and look far beyond their disability. This is why this model has been successfully used with people suffering from various forms of mental problems and of various ages including those with criminal history or ex-prisoners (Hartfree et al, 2008) and even youths.

   However, IPS has inherent challenges that Murray and Heron (1999) hold that, can only be addressed through effective legislation and cooperation between all stakeholders. They note that an effective legislation to address job placement for people with disabilities must be not only “clear and unambiguous” but also “sufficiently detailed to clearly identify who is covered by the law and who is excluded.” Such laws must “not provide for too many exceptions or exemptions” and must “stipulate the agency responsible for enforcement” (Murray & Heron, 1999 p. 14). In the United States, only 2.1% of people with mental illnesses had access to IPS in 2009 (Substance Abuse and Mental Health Services Administration, 2009). This is despite the program being available almost all across the country. Moreover, since its success is based on the willingness of the employers to take in people with special needs and provide accommodations and training, the success IPS relies heavily yet unfairly on the shoulders of the employers and not policymakers and enforcers.

References

Becker, D. R. & Drake, R. E. 2003. A Working Life for People with Severe Mental Illness. New York: Oxford University Press, Inc.

Bond, G. R., et al. 2001. “Does competitive employment improve non-vocational outcomes for people with severe mental illness?” Journal of Consulting and Clinical Psychology, 69, 489–501.

Burns, T., Catty, J., Becker, T., et al. 2007. The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. The Lancet, 370, 1146-1152.

Dixon, K.A., Kruse, D. & Van Horn, K. 2003. “Restricted Access: A Survey of Employers About People with Disabilities and Lowering Barriers to Work.” John J. Heldrich Center for Workforce Development.

Hartfree et al. 2008. “High hopes: Supporting ex-prisoners in their lives after prison.” Research report (Great Britain. Dept. for Work and Pensions); 509.

MacDonald, K.L. 2003. “Identifying relationships between functional limitations, job accommodations, and demographic characteristics of persons with psychiatric disabilities.” Journal of Vocational Rehabilitation 18:15-24.

Murray, B. & Heron, R. 1999. “Placement of job-seekers with disabilities: Elements of an effective service.” International Labor Office.

Provencher, H.L. et al. 2002. “The role of work in the recovery of persons with psychiatric disability.” Psychiatric Rehabilitation Journal 26:132 – 144.

Rinaldi, M. et al. 2008. “Individual placement and support: from research to practice.” Advances in Psychiatric Treatment 14: 50-60.

Rinaldi, M. & Perkins, R. (2004). “Vocational rehabilitation.” Psychiatry 3:54-56.

Waghorn, G. & Lloyd, C. 2005. “The employment of people with mental illness.” Australian e-Journal for the Advancement of Mental Health 4:2.

Warner, R. 1994. Recovery from Schizophrenia: Psychiatry and Political Economy (2nd ed). New York: Oxford University Press.

World Health Organization. 2000. “Mental Health and Work: Impact, Issues and Good Practices.” World Health Organization.