NAMI St. Louis | Supported Employment

In Missouri, as elsewhere, people with mental illness in the public mental health system are unemployed in very high numbers, far higher than the general public, and also higher than other disability groups. Our reports from fiscal year 2008 indicated that only 13% of adult clients of the Department of Mental Health’s Comprehensive Psychiatric Services Division were employed. The interesting thing is that many surveys also show that more than 70% of this group says they want to work!

Mental Health and Rehabilitation Providers in Missouri have been providing employment services of various types over the years, and individual programs have had successes. They have done so in spite of policy barriers about what services can be provided under their funding sources (there is a strict federal rule about the use of Medicaid funding for purely “vocational” services); meager state funds to support Mental Health Centers in this activity, and lack of a clear evidence-based model upon which to build.

There is an approach that has demonstrated success in turning the tide of unemployment, one person at a time, called Supported Employment (SE), also known as Individual Placement and Support (IPS). In Missouri, we have six Mental Health Agencies who are engaged in implementing this practice that creates the greatest success in assisting people to get and keep jobs.

The Missouri Department of Mental Health, Comprehensive Psychiatric Services Division (DMH-CPS), and the Missouri Department of Elementary and Secondary Education, Vocational Rehabilitation Division (DESE-VR) are partnering for the J&J –Dartmouth implementation of Supported Employment.

The Johnson & Johnson-Dartmouth project on Family Advocacy for IPS supported employment has recently accepted Missouri as a member. The purpose of the project is:

1. To learn together about ways to increase family advocacy efforts for promoting employment as a key part of recovery and treatment for mental illness, and

1. Help families understand IPS supported employment and the role of work in their loved ones’ recovery.

2. Develop partnerships between family advocacy groups and IPS supported employment teams to provide outreach to families and engage them in advocating for and supporting IPS, at the state and community levels.

Dr. Virginia Selleck, Clinical Director, Comprehensive Psychiatric Services, Missouri Department of Mental Health

IF YOU ARE A FAMILY MEMBER WHO WOULD LIKE TO ASSIST NAMI IN THIS EFFORT, PLEASE CONTACT SHARON LYONS AT SHARON@NAMISTL.ORGOR 314-962-4670.

816-468-0400

www.tri-countymhs.org

BJC Behavioral Health

1430 Olive, Suite 500

St. Louis, MO 63103

314-729-4004

www.bjcbehavioralhealth.org

IndependenceCenter

4245 Forest Park Ave.

St. Louis, MO 63108

314-533-4245

www.independencecenter.org

Pathways Community Behavioral Healthcare, Inc.

1800 Community Drive

Clinton, MO 64735

660-885-8131

www.pathwaysonline.org

TrumanMedical Center

Behavioral Health

2211 Charlotte

Kansas City, MO 64111

816-404-5700

www.trumed.org

East Central MO Behavioral Health Services

321 West Promenade

Mexico, MO 65265

573-582-1234

Community Alternatives

PLEASE NOTE: IN ORDER TO RECEIVE IPS SUPPORTED EMPLOYMENT SERVICES, PERSONS WITH MENTAL ILLNESS MUST BE CLIENTS OF THE ABOVE-REFERENCED AGENCIES. FOR MORE INFORMATION ABOUT HOW TO BECOME A CLIENT, PLEASE CONTACT THEIR OFFICES DIRECTLY.

Supported Employment (SE) is driven by hope, optimism and the fundamental belief that consumers can create lives of well-being outside of the mental health system. SE practitioners cultivate respect for consumer goals and preferences, and push themselves beyond past practices.

Supported Employment yields a mainstream job in the community, in a work setting that includes people who are not disabled, that pays at least minimum wage. It is intended for people with the most severe disabilities, and includes on-going support from a service agency. Jobs in SE are the same jobs anyone could apply for and the wages and benefits are the same as what non-disabled people receive.

Supported Employment works! In 15 of 16 studies, SE had significantly better competitive employment outcomes than control groups. In summary, 60% of those receiving SE were employed compared with 24% who were not.

Research shows that some of the things one might imagine could predict ability to work, do not! Such things as diagnosis, hospitalization history, symptoms, medication history, and service “compliance” are NOT predictive of ability to work. One thing, however, does appear to matter, and that is the attitude of the professionals supporting the consumer who desires to work as part of their recovery.

Integration is important. Integration includes offering the employment service in the same agency as the mental health service; employment specialists participating in treatment team meetings; employment staff are thus informed of medication changes and can offer important information about the effects of work on other treatment aspects; all staff share in a work culture.

These are jobs available to anyone, and consumers receive commensurate wages and benefits, and are not artificially time limited in duration.

Of all the barriers to employment, fear of losing medical insurance ranks very high for consumers and family members. Social Security and Medicaid are highly complex systems requiring special training to navigate, most especially when using the work incentives that are available. Missouri is providing trained benefits specialists to be available to assist people with feeling confident that they know what effects work will have on their medical benefits and other subsidies for low income individuals. Individualized benefits planning can help people work their way to independence!

5 - Rapid job search: Job search starts soon after a consumer expresses interest in working.

Key to SE is the absence of lengthy pre-employment activities, assessments, and the like. Research has shown that these activities are of minimal value when seeking a competitive employment outcome. Part of the practice of SE is individualized work with consumers to determine their strengths, interests, challenges and previous experiences with employment, both good and bad, to craft a plan that will honor the consumer’s goals. Clearly, as with all people, long term goals often start with small steps, but the art of SE is to use motivational approaches with clients to formulate action plans that create forward momentum.

We know that people have longer job retention in jobs they have chosen. SE does not advocate developing consumers for jobs, but rather developing jobs for consumers! The art of job development includes matching clients to jobs where they can “work around” particular issues, while providing value to their employers.

Information on how local employers can participate in this effort. In the meantime, you may contact St. Louis Area IPS SE Providers listed below.

Supported Employment: A Resource for Employers

Johnson & Johnson-Dartmouth supported employment programs are designed to provide employment assistance to adults with mental illness. Twelve states and the District of Columbia are assisting thousands of people return to the workforce.

Individuals who enter a supported employment program do so because they want to work. Each person is assigned an employment specialist. Many job seekers begin with a part-time position, but almost everyone reports that working has helped them feel better about themselves.

“Work gives me a good feeling about myself. It makes me feel good to have something to do. I want to support myself.” Kevin

Mental illness can mean having problems with mood, difficulties with perceptions or with interpersonal relationships. But no two people are the same. Regardless of diagnosis, each person has their own unique experience with mental illness that is tempered by their strengths, personality, response to treatment and personal supports.

There are various myths about people with mental illness, in part because movies and the media have grossly distorted our understanding of mental illness. The truth is that people who are receiving treatment are no more dangerous than the general population. They also have a wide range of talents, training and work experiences.

About six percent of the population has a serious mental illness, while about 26 % experience some sort of mental health problem at some time in their lives. People with mental illness are your neighbors, co-workers, and family members.

Employment specialists can help employers by getting to know their business and hiring-preferences. These specialists understand that employers are in business to make a profit and they try to help by introducing employers to jobseekers who match the needs of their business. For example one employer stated:

“There can be a lot of pressure working in a large kitchen. I need people who can get along well with others when the tension is high, but who are also able to work independently. I also look for people who are dependable and punctual. Kevin (from the supported employment program) is always here and he is always pleasant. If Kevin is on the schedule, I know everything is ok. That isn’t the situation with all of the people I have hired in the past!”

Further, employment specialists from these programs support employers even after the person is hired. For example:

“I think the difference with this program (supported employment) is the continued support of the employment specialist. In the past, we have been working with different organizations. They find a job for someone and the services basically end. It has been my experience with supported employment that once they get a person placed, there is follow up by the employment specialist. I meet briefly with the employment specialist to discuss how things are going, what areas if any need improvement, or what they can do to support us, the employer.”

Employers only agree to hire people whom they believe to be a good fit for their organization. Further, they expect supported employment workers to be able to perform their jobs well. If a person has significant difficulties with the job, the employer is not expected to continue the employment relationship.

Most employers begin by hiring one person. Occasionally, some employers decide to hire a second worker. Employment specialists are looking for a customized fit for each person—the right type of work, environment, hours, location, etc. So it is unlikely that they will know more than a couple of people who are a good fit for a single employer.

It is common for employment specialists to ask for brief appointments or phone calls with employers after a person is hired. The employment specialist will ask about the person’s performance and if there is something he can do to support the employer.

Employers can find out if there is a Johnson & Johnson-Dartmouth supported employment program in their area by calling:

“I believe that we have to assist the people who come to the hotel as well as the people in our community. Everybody has the right to work. If a job seeker has a disability, but can help us fulfill our mission, then that is a person I want to hire. Further, I’ve had two good experiences with the program so I would consider calling the employment specialist again.”