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Supported Employment: A Road to Recovery

Employment is a critical component of recovery for people living with serious mental illnesses. Sadly, 60-80 percent of people who live with mental illness are unemployed and, for people living with the most severe mental illness, unemployment rates are as high as 90 percent.

Supported employment is recognized as the most effective approach for helping people living with mental illness and other disabilities gain competitive employment. The story of Janice,* below, illustrates the benefits of supported employment and the positive impact it can have on recovery. Janice's story and the supported employment practice principals accompanying it was submitted by Paul Gorman, Ed.D, a faculty member with the Dartmouth Supported Employment Center. Since 1988, the center has developed resources, provided technical assistance and conducted studies on supported employment.

Janice's* Story

not real name
Supported Employment Practice Principles:

Janice says that she loves her job at a catering company in a small city in Minnesota. "It's kind of quiet, but I can handle space. I tell my boss that I like working for him. I come in not because I have to, but because I want to."

The focus is on paying jobs in the community.

Before Janice found this job a year ago, she hadn't worked in over 20 years. She had anxiety that sometimes made it hard to concentrate and also had delusional thoughts. But her case manager thought that Janice might enjoy working. "My social worker said, 'Aren't you ever going to get a job? You're never around people because they're working all day.' I said, Okay. I want to get a job so I can feel handy and wanted and needed." Janice's social worker referred her to the supported employment program at her mental health center.

Every individual who wants employment is eligible.

Janice met with an employment specialist who helped her get information about how her benefits would be affected by a return to work. The employment specialist also spoke to Janice about her preferences for a job. Because Janice hadn't worked in a long time, she preferred to begin with a small number of work hours each week. She also wanted a job that was close to her group home.

Personalized benefits counseling is provided.

Individual preferences are important.

The employment specialist didn't ask Janice to go through any type of evaluation or job training program. Instead, she began looking around Janice's neighborhood for the types of businesses that she thought might be a good fit for Janice. She spoke to employers about Janice's strengths. For instance, Janice is a conscientious person. Eventually, she found an employer who was interested in hiring someone to work one morning each week. In addition, this employer was located just one block from Janice's home. The specialist arranged a meeting with Janice and the employer.

The job search starts soon after the person expresses interest in working.

When Janice first began working, she experienced some anxiety about being in a new situation. In fact, she was worried that the building would fly away. Janice's employment specialist spoke to Janice's boss and co-workers. She said that if Janice expressed this fear, they could help by reassuring her that she was safe. Janice reports that the supports were helpful, "She (employment specialist) showed up at every corner. She told me, if you have any questions, just ask." Almost a year later, the employment specialist continues to make weekly visits to the workplace to provide support.

Job supports are provided for as long as the person desires.

Janice's employment specialist works closely with her mental health team and reports that they have also provided job supports. "They have been helping with anxiety and intrusive thoughts." The group home staff has also become involved. Initially, they were discouraging Janice from using her "as needed" medications. But the team asked them to offer the medication before work if they notice that Janice is having a bad day.

Supported employment services are integrated with treatment.

Finally, the mental health team and employment specialist meet with Janice and her family from time to time. Janice's parents are happy that Janice has somewhere to go during the week and are impressed that she is able to manage her symptoms out in the community.

Janice's co-workers appear to like Janice as much as she likes them. When Janice started the job, they asked her to stay and have lunch with them after she finished her shift, but Janice declined the offer saying that she ought to get home. So her co-workers tried moving their lunchtime back to noon, and eventually to 11 a.m. so that lunch would occur in the middle of Janice's work shift. Now Janice eats with them each day she works. "I love working with them. They hustle around and do their thing. I'm back to working two mornings a week now. So, I guess I'll keep on trucking!"

Supported employment attempts to include family members in the employment plan.

This is the first of a series of articles about the evidence-based practice of supported employment.

For more information about Supported Employment: Individual Placement and Support, please go to http://dms.dartmouth.edu/dsec.

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