Sunday, November 06, 2005

The Power of a Job in Mental Illness Recovery

One month ago, I received the phone call we had been anxiously awaiting. It was a call from the Minnesota Department of Employment and Economic Development (DEED) announcing the funding of our interagency project to provide employment services in support of adults with mental health disabilities. The grant award was cause for celebration among our many partners who are excited by the opportunity to transform a strongly-held vision into direct service practice here in Minnesota.

The RISE Project was jointly conceived by Rise, Incorporated and the Mental Health Consumer Survivor Network (CSN) of Minnesota. This interagency initiative will also collaborate its efforts with other organizational partners including regional Adult Mental Health Initiatives in Minnesota, State and county mental health agencies, community case management teams, community mental health centers, Workforce Center partners including Minnesota Rehabilitation Services (RS), community support programs, business associations, secondary and post-secondary schools, mental health day treatment centers, and other community service organizations.

All collaborating organizations have agreed to contribute their expertise and resources to support the launch of a new mental illness self-management (MISM) and employability project. This multi-agency collaborative will serve adults with serious mental illnesses (SMI) and serious and persistent mental illnesses (SPMI) living within a wide geographic area of Minnesota. This includes a 12 county region that encompasses the Twin Cities' metropolitan area, East Central Minnesota, and Central Minnesota.

The RISE Project is named after core principles driving our operational philosophies and direct service practices--Recovery, Individual Choice, Self-Management, and Evidence-Based Employment Practices. Our program will introduce a career development model that incorporates researched fidelity standards for mental health employability practices, peer-to-peer illness recovery and self-management education, and access to multiple funding streams to increase job placement, mental illness recovery, and community integration outcomes.

The RISE Project will serve 200 Minnesotans, ages 18 and older, who live with serious mental illness symptoms and have experienced significant employability challenges. Our target service population includes three sub-groups of unemployed, underemployed, and employed individuals. The project is designed to obtain individualized employment and illness recovery outcomes for 110 associates (our term used for project participants).

Until recently, a prevailing wisdom in mental health included a belief that people with psychiatric disabilities needed to recover from their mental illness symptoms before they could succeed in going to work in the community's labor force. This common but flawed philosophy led to the development of poorly designed systems of institutional care and community mental health day treatment programs. A majority of these conventional treatment programs have done far too little to encourage and support people in obtaining competitive employment and economic self-sufficiency. For this reason, the national unemployment rate for adults with SMI/SPMI in the United States is embarrassingly high.

To illustrate, national studies document an unemployment rate of 70% to 90% for persons living with SMI/SPMI (President's New Freedom Commission on Mental Health, 2002; Louis Harris/NOD Poll, 2000; Ridgeway & Rapp, 1998). Also, adults with SMI/SPMI who work are often considered underemployed because they hold jobs well below their levels of education and training (Journal of Psychosocial Rehabilitation, IAPRS, Issue 4, 1996). Why is joblessness so common for people with SMI/SPMI? And why is underemployment so prevalent?

The unemployment and underemployment challenges of adults with mental health disabilities are not grounded in facts, but rather a number of commonly held myths. These include false assumptions that adults with SMI or SPMI: (1) don’t want to work; (2) can’t work because of their illness symptoms; (3) can’t work because they will lose their basic living and health care entitlements; and (4) can only work in low-paying jobs that require minimal stress and skill sets. None of these stubbornly held myths can stand the test of objective scrutiny.

Most adults struggle in managing illness symptoms by themselves and seem to benefit from access to responsive mental health treatment and community support. However, a majority do not have access to evidence-based practices (EBPs) in mental health services. This includes peer-to-peer illness recovery education, community mental health treatment, and supported employment services. An EBP is a specific mental health intervention for which there is strong scientific evidence about its effectiveness based on random clinical trials. National research has validated supported employment to be one of six EBPs known to be effective in the recovery process from mental illness.

In other words, we now have scientific evidence that adults recover from mental illness BECAUSE they go to work, have structure in their lives, earn money, have opportunities to connect with other people, and gain a sense of self-respect through career achievement. Supported employment programs throughout the United States (and around the world) are proving that people with mental health disabilities can be work and thrive in the workforce if:

  • they choose to work
  • develop a customized employment plan
  • have access to rapid, individualized job placement services
  • find an interested employer
  • have access to responsive, clinical mental health treatment
  • receive expert guidance about their disability benefits and health care needs
  • have access to ongoing supported employment services.

As partners, Rise and CSN will co-manage this new project and jointly field-test two fundamental hypotheses:

Hypothesis 1: Project associates who participate in a peer-to-peer, wellness recovery action plan (WRAP) are the mostly likely to obtain individualized employment outcomes including desired jobs and wages, increased hours worked, career advancement opportunities, higher job retention rates, etc; and

Hypothesis 2: Project associates who participate in supported employment programs that incorporate specific evidence-based practices are most likely to obtain individualized employment outcomes and illness recovery success.

The RISE project will engage a peer-to-peer illness recovery and self-management program called the Wellness Recovery Action Plan (WRAP). Our project will observe fidelity standards for presenting WRAP. This means that we will only employ qualified, consumer recovery specialists to facilitate peer-to-peer instruction and recovery support services. WRAP is "a structured system for monitoring uncomfortable and distressing symptoms and, through planned responses, reducing, modifying, or eliminating those symptoms. WRAP also includes plans for responses and support from others when mental illness symptoms make it impossible for a consumer to continue to make decisions and take care of themselves" (Copeland, 2000).

CSN is Minnesota's regional expert on WRAP and actively trains recovery specialists and consumer participants throughout all regions of our State. Rise and CSN have collaborated with the use of WRAP for two federal grant demonstrations with outstanding results. In fact, CSN’s recovery specialists have retooled WRAP with new features to support the recovery education and response needs of consumers with vocational or career development goals.

The RISE Project will offer vocational WRAP services to unemployed, underemployed, and employed individuals who have specific job placement, career advancement, and job retention objectives. Our goal is to increase the number of associates who experience wellness recovery over longer periods of time to enhance their job skills, retention, and career development. We are also interested in teaching illness self-management skills so associates are able to reduce their symptoms and need for mental health crisis interventions. In our view, WRAP is fundamental to enhancing employment stability, productivity, and overall satisfaction.

The RISE Project will also introduce a menu of competitive employment, customized employment, supported employment, self-employment, and career ladder strategies at each program location. These employment opportunities will be self-directed and driven by the job goals and personal choices of associates. Rise, Incorporated will provide professional career planning, individual job placement, and other employability services as so directed by associates. This includes the negotiation of job accommodations, customization of job duties, and other work supports needed by associates to obtain employment outcomes and illness recovery success.

Ideology matters. However, a progressive vision is useless unless it is backed by action and translated into effective practice. Minnesota is on the threshold of fully transforming its community mental health care and service delivery system. And this transformation is being powered by new ideas about mental illness recovery and evidenced-based mental health practices. On October 1, 2005, the RISE Project officially began its operations and is proudly demonstrating the power of a good job in mental illness recovery.

My friend and colleague Joe Maronne, a mental health employment and training consultant from the University of Massachusetts' Institute on Community Inclusion, said it best when asked about this topic: "If you think that working is too stressful, you should try a lifetime of unemployment and poverty!" Amen, Joe.

For more information about the Mental Health Consumer/Survivor Network of Minnesota or Wellness Action Recovery Planning (WRAP) for consumers with employability goals, please visit their web site at For more information about employment services available through the RISE Project, please contact Amy Moog, our Project Coordinator at


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