Hiring Individuals With Mental Illnesses: Coaxing the Mental Health System Toward a Recovery-Based Model

Posted on October 2, 2000

Arlington, VA - The National Alliance for the Mentally Ill (NAMI) says it's time to remove one of the last remaining vestiges of discrimination-unemployment--and begin hiring more people in recovery from mental illnesses within the mental healthcare system.

This challenge comes during the advocacy group's nationwide observance of Mental Illness Awareness Week, October 1-7, 2000.

More than 85 percent of persons with severe and persistent mental illnesses are unemployed. "That's a staggering and sobering statistic that reflects a resistance by the public mental health system to fully embrace the concept and reality of recovery," said NAMI Executive Director Laurie Flynn. "We believe the system that has the primary responsibility for caring for individuals with serious mental illnesses should be a leader in providing consumers of mental health services with meaningful employment opportunities."

NAMI points to its own experience of hiring consumers in highlighting the valuable contributions these employees make. "Consumer employees possess an enormous wealth of first-hand experience about mental health services, medications, providers, and more," said Flynn. "They educate other staff about what mental illnesses are really like and are terrific role models to other consumers who become inspired when they see the level of recovery that is possible. They also bring a tremendously high level of commitment and interest in improving the quality of life of other consumers and their families."

"People with major mental illness are a tremendous untapped resource for our mental health system," said NAMI Board member Moe Armstrong, who has had schizophrenia for more than 30 years and works full-time with Vinfen Corporation, an agency that supports the recovery and reintegration of consumers into society. "Employment recruitment and retention of consumers in mental health services is an idea whose time has come."

Armstrong firmly believes that the future hope of the public mental health system firmly rests in hiring consumer employees at all levels and categories of jobs. In his work with state mental health agencies, he stresses the importance of integrating consumers within the organization and creating more accessible career ladders for employees with disabilities.

"Hiring consumer employees begins to counteract some of the stereotypes and stigma present in the workplace itself, misconceptions that healthcare providers hold themselves," said Armstrong. "Perhaps, more important, the voices of consumer staff will be increasingly heard in areas that affect overall organizational policies and procedures related to service delivery and staff development. The end result will be a better system with more people achieving higher levels of recovery than ever before."

NAMI's Recommendations To Increase Consumer Employment

In calling for increased hiring of consumers, NAMI is recommending that state mental health agencies take the following measures:

• Collect more precise employment data. For example, state mental health agencies should:
  • Assess the number of self-identified consumers in paid positions with state mental health agencies and their contractors, and counties or districts that are receiving funding assistance from the state mental health agency.
  • Determine what types of positions are held by consumers (for example, consumer relations/advocacy roles; administrative support roles; administrative decision-making roles; clinical roles; residential counselors; and program managers).
  • Identify efforts currently in place to encourage consumer recruitment, employment and retention.
• Adopt and enforce nondiscriminatory policies in hiring practices. Mental health systems should publicly display statements that, "people with mental disabilities are encouraged to apply for all job offerings." Such statements should be included with all mental health job announcements.
• Set employment hiring targets. Every state mental health agency should set a consumer-hiring target. For example, the Ohio State mental health agency has called for a "five-fold increase in consumer employment in the next five years". Targets should apply to state contractors and counties or districts that are receiving funding assistance from the state mental health agency.
• Develop specific plans for promoting employment opportunities for consumers. Plans should include specific identifiable measures for recruiting, mentoring and supporting employees with psychiatric disabilities to work in a broad range of positions at all levels within the mental health system. Plans should also incorporate training programs for consumers and hiring supervisors.
• Take leadership role in full implementation of The Ticket to Work and Work Incentives Improvement Act of 1999. Specifically, state mental health commissioners should actively engage state elected officials and Medicaid administrators to establish Medicaid buy-in programs, as stipulated in the new federal law.
• Earmark funding for consumer-run organizations. Where well funded as a percentage of a state's overall mental health budget, consumer-run programs have proven to significantly empower those involved, and to enhance treatment outcomes.

"Without this level of commitment by our state mental health agencies, we will continue to have far too many consumers neglected and abandoned, left out of the mainstream," said NAMI Board member Fred Frese, Ph.D. "As someone with schizophrenia who ultimately became a psychology director in the same mental health system where I once was hospitalized, I know personally how critical employment is to one's recovery and re-integration into society as a whole."

"There also should be a push to have persons in recovery from mental illnesses appointed as commissioners on the various state rehabilitation services commission boards," said Frese. "Until we are given representation on boards and commissions that make decisions concerning our well being we can expect the neglect to continue. 'Nothing about us without us' as the refrain goes."

In addition to sending letters outlining these recommendations to all 55 state and territorial mental health commissioners, NAMI will continue to devote considerable organizational resources to encouraging consumer employment.

PACT Across America

NAMI is pushing consumer employment through its PACT Across America campaign, which hopes to establish assertive community treatment programs in every state by the end of 2002.

Programs of assertive community treatment (PACT) teams include a minimum of one peer specialist who provide highly individualized assistance and support to consumers in the community. Many PACT teams also include employment specialists who help their clients get jobs.

With more than 28 years of documented success, these recovery-oriented programs hire individuals with direct mental illness experience who provide essential expertise and consultation to the entire PACT team. According to John Allen, president of the National Association of State Consumer and Survivor Mental Health Administrators, "PACT programs are among the best vehicles currently used to promote employment within mental health systems."

NAMI's PACT initiative is currently active in most states, from Alaska to South Florida, including the largest states of California, Pennsylvania, New York, and Ohio.

NAMI Pushes Implementation Of New Federal Work Incentives Law

NAMI also will continue efforts on the Ticket to Work and Work Incentives Improvement Act of 1999 by supporting state legislation and changes in federal administration policy to ensure that this new law is fully implemented. This new measure is intended to protect consumers from having to choose between healthcare coverage and a job.

Supreme Court Urged To Uphold Protections Against Employment Discrimination

During Mental Illness Awareness Week, on October 3 in Washington, D.C., disability advocates will hold a March for Justice in support of full implementation of the Americans with Disabilities Act (ADA). NAMI fought hard for passage of the ADA and has fought equally hard to advocate for its effective implementation. Later this month, the U.S. Supreme Court will hear a case, Garrett v. Alabama, that challenges the right of individuals to file ADA lawsuits against states. NAMI has joined with other disability organizations in submitting a friend-of-the-court brief that argues that the ADA is needed to combat deeply rooted prejudices held by many toward persons with mental illnesses.