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Helping the mentally ill join the workforce

By Michael Ollove

Stateline.org (MCT)

Published: Tuesday, July 15 2014 7:24 a.m. MDT

By his own admission, for many years Cyrus Napolitano’s mental illness — bipolar disorder — did not make him an ideal employee. Perhaps the worst moment came when he walked into the Brooklyn McDonald’s he was managing to discover some now-forgotten worker infractions.

“Whatever it was,” he said last week, “it triggered an explosion where I was screaming at the top of my lungs and beating a path of destruction all the way to the back, knocking everything off shelves and kicking the back door with my boot.”

He left the job at McDonald’s, as he did various other jobs over the decades — as a waiter, a bartender, a concierge at a luxury condo building. During one eight-year period in the 2000s, after his third suicide attempt, he could barely work at all.

But that was some time ago. Thanks to his eventual involvement with Fountain House, a community mental health center in Manhattan, Napolitano, now 53, is in his fourth year of steady, part-time employment as the “scanning clerk” at an international law firm, a stress-free job he credits with helping him manage his illness.

“For me, it goes back to stability, structure, support and acceptance,” he said.

Because of poor funding from state and other sources, the “supportive employment” that benefited Napolitano is unavailable to most of those with serious mental illness. According to one study, only 1.7 percent of those served by state mental health systems received supported employment services in 2012, even though it has proven to be the most effective way to keep the mentally ill in steady jobs.

Soon that situation may change. Under the Affordable Care Act (ACA), states can apply to use Medicaid funds to train and employ the seriously mentally ill, under the theory that steady employment is a form of treatment.

The unemployment rate in that group is strikingly high, about 80 percent in 2012 among those receiving state mental health services, according to the federal Substance Abuse and Mental Health Services Administration (SAMHSA). The range among the states is broad. Maine, West Virginia, Hawaii, Pennsylvania and California all had unemployment rates for the mentally ill above 90 percent. Wyoming had the lowest rate at 56 percent.

Sita Diehl, director of state policy and advocacy at the National Alliance on Mental Illness, which hosted a presentation with an accompanying report in Washington last week to highlight the issue, said the variation among the states is less a reflection of policy differences than the overall condition of the economy in each state. The reality, she said, is that programs to help the mentally ill obtain and maintain employment are so scarce they wouldn’t register significantly in unemployment statistics.

Surveys have shown that as many as seven out of 10 people with severe mental illness would like to work. Robert Drake, a Dartmouth psychiatrist who develops and evaluates community mental health programs, said the benefits of work for the mentally ill are multiple.

“First of all, of course, it provides them with money,” Drake said. “It makes them feel better about themselves. It integrates them more into their communities. And often, they do better in managing their illnesses.”

Drake said the old “step-wise” models for helping the mentally ill obtain and retain employment often failed. In these programs, people would train in some sort of sheltered job program and then, if deemed ready, released to the market to find jobs. Mostly, Drake said, it didn’t work.

Under the supportive employment model, an employment specialist is part of the patient’s mental health team. The specialist, who may have a degree in vocational rehabilitation counseling, social work, psychology, counseling or divinity, helps plot a job-seeking strategy with the patient. Then the specialist remains involved once the patient has a job to help with any problems that arise.

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