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Integrated services help ADULTS


The ranks of the unemployed have swelled in the current economic downturn, and people from all walks of life have found themselves coping with the reality of job loss. For some workers, though, being without a job is nothing new.

Less than 20 percent of people with mental illness are employed, and many of those who do not work would like to do so but need assistance to obtain jobs. A new report by Case Western Reserve University researchers has found that individuals who receive integrated mental health and employment assistance through their local mental health agencies improve their employment prospects.

“Our goal was to identify the barriers that keep individuals from being referred for employment services and subsequent employment,” says David Biegel, Ph.D., of Case Western Reserve’s Mandel School of Applied Social Sciences. “By sharing these findings with the participating mental health agencies, we can improve the practice and services delivered to adults with co-occurring mental and substance use disorders.”

Biegel and Patrick Boyle, also of the Mandel School of Applied Social Sciences, along with colleague Robert Ronis, M.D., M.P.H., of the university’s School of Medicine, found that if previously employed, mental health consumers had better chances of receiving referrals. Those who perceived themselves as disabled or had substance-dependence issues were less likely to be referred to job counseling.

“The lower number of referrals for services by consumers that self-identify as disabled also may be related to their viewing themselves as not—or less—capable of employment or that they or their families might be concerned about jeopardizing their benefits status,” Biegel says, adding that agencies may be able to address some of these concerns through benefits counseling and psychosocial programs designed to increase self-reliance and empowerment.

Biegel said the study found that 46.9 percent of those referred for employment counseling successfully obtained competitive employment. Consumers worked an average of 352 hours (slightly less than half-time per week) with average wages of $8.16 per hour over the course of the one-year study. Biegel notes that those referred for employment counseling were employed for an average of four months. However, 43 percent of participants were employed for two months or less, and that retention is an ongoing area of focus for supported employment programs.

“Supported employment” services, or on-the-job support, is a relatively new model for providing job-search assistance to consumers with mental illness, says Biegel. It marks a shift from a philosophy centered on training in a sheltered environment before job placement.

“It was a former system of work training to employment, and now the model is competitive employment with on-the-job training,” said Biegel.

The study included 194 individuals—113 referred to supported employment services and 81 consumers who were not referred for employment. All individuals were using mental health and/or employment services at four mental health agencies throughout the state and in a variety of locations from urban to rural areas. Participants were surveyed about their employment history and employment assistance referral history and were then tracked to see how their work situations changed.

The benefits of employment for someone with mental illness and substance dependence issues go beyond a paycheck, Biegel says.

“A job can aid in recovering a new life,” he says.

Findings from the study, “The Impact of Supported Employment for Consumers with Co-Occurring Mental and Substance Use Disorders,” which was funded by the Ohio Department of Mental Health, will be published in the journal Research on Social Work Practice.

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