Social Determinants Of Health: Employment

Where We Stand

NAMI believes that all people with mental health conditions deserve access to supports that promote wellness. NAMI supports public policies and laws that help address social determinants of health, including supporting employment for individuals with mental health conditions.

Why We Care

Employment is a critical social determinant of health, whether it provides a source of income, health insurance coverage, social connections or sense of pride. However, a variety of barriers can make finding and maintaining a job more difficult for people with mental illness, and these may be further compounded by aspects of race, gender, and age. For example, many people are concerned that disclosing their mental illness has a negative effect on hiring and career advancement. Symptoms of mental illness may put certain kinds of jobs or minimum work hours out of reach, and people with mental illness have an increased risk of employment termination and both voluntary and involuntary job loss. Fewer than 7% of adults with schizophrenia who receive community mental health services are competitively employed. Another concern is that additional income from employment can jeopardize eligibility for other vital income supports and medical benefits, which are critical tools for maintaining wellness.

Employment opportunities may be even more limited for people with mental illness who are justice-involved or who enter the workforce without necessary supports. About two in five people who are incarcerated have a history of mental illness — including 37% in state and federal prisons and 44% held in local jails. People who are formerly incarcerated and have convictions are subject to many laws and statutes that impact opportunities for basic employment, housing, education, and other life needs. Previous state work requirements for Medicaid coverage have led to a loss of health coverage with no increases in employment.

Employment is a critical part of a person’s identify and sense of pride. People with mental health conditions deserve the opportunity to work, especially as employment is associated with improved self-esteem and reductions in outpatient psychiatric treatment. Like anyone else, people with mental health conditions value paid employment opportunities for reasons like income, financial security, socializing and sense of achievement. Consequently, we need policies that support both the health and employment needs of people with mental illness. Research shows that supported employment programs can help people with mental illness find competitive employment, put in more time on the job and earn higher wages.

Supported employment programs have proven benefits for people with mental illness. However, limited expansion or lack of funding sources means they serve just a fraction of individuals with mental illness who are willing and able to join the workforce. When we invest in programs that work, we are also investing in success and recovery. NAMI supports public policies and laws that fund and implement effective supported employment programs to provide employment options for people with mental health needs.

How We Talk About It

• Social determinants of health are factors in a person’s life, like the conditions in the places where a person lives, learns, works and plays, that impact their health risks and outcomes, including their mental health.
• Employment can be a critical source of not only income, but also health insurance coverage, social connections and a sense of worth and purpose.
• A serious mental health condition may impact a person’s ability to get or maintain a job — which can further be affected by a person’s age, gender, race or past justice system involvement.
• Paid employment can play a critical role in people’s recovery, but people with mental health conditions often struggle to get or keep a job due to symptoms they may be experiencing.
• Lack of income — or related health insurance coverage — also impacts a person’s ability to access and engage in mental health care, putting their overall wellness at risk.
• Research shows that supported employment programs can help people with mental illness find competitive employment, put in more time on the job, and earn higher wages.
• Supported employment programs address mental health and employment simultaneously to meet the unique needs of a person with mental illness.
• People living with mental illness want to work and deserve opportunities to do so. Yet, effective programs that support employment for people with mental health conditions are not widely available.
• NAMI believes it is critical that public policies address employment and related social determinants of health to help people with mental health conditions meet their employment goals and to support their overall wellness.

What We’ve Done

• NAMI report “Road to Recovery: Employment and Mental Illness”
• NAMI April 2021 coalition letter expressing support for increasing the funding for the Social Determinants of Health Program at the Centers for Disease Control and Prevention’s (CDC) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) to $50 million.
• NAMI public policy positions related to Medicaid: Work Requirements and Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI)