Employment Directions for Persons with Psychiatric Disabilities

1
Employment Directions for Persons with
Psychiatric Disabilities

• Presented by the National Association of Mental
  Health Planning Advisory Councils

2

• Poverty is one of the most pervasive,
  significant, and debilitating barriers that
  individuals diagnosed with a mental illness face
  that prevents them from participating fully in
  the community (Swarbrick, 2007)

3
Competitive Employment for People with Severe
Mental Illness

• Say they want to work 70
• Are currently working lt15
• Current access to supported employment lt5

4
BARRIERS

• Barriers to employment for persons with mental
  illnesses
• Multiple, mixed symptoms with different illnesses
• Cognitive and behavioral symptoms
• Episodic nature of many illnesses
• Challenges of poverty, lack of housing,
  transportation

5
BARRIERS

• Stigma
• Limited expectations for persons with mental
  illnesses
• Continued paternalism by mental health
  professionals
• Asset limitations in Medicaid and SSI and other
  benefits programs

6
Barriers

• Limited knowledge about Medicaid work incentives
• Misinformation concerning the loss of medical
  services if a person goes back to work
• Medicaid work incentives going unused

7
Biggest fear of those with MI returning to work

• Loss of medical benefits
• PASS
• ERWE
• 1619 B
• Medicaid buy-in
• 5 of people with psychiatric disabilities
• Get off Medicaid benefits

8
Definition of Supported Employment

• Mainstream job in community
• Pays at least minimum wage
• Work setting includes people who dont have a
  disability
• Service agency provides ongoing support
• Intended for people with most severe disabilities

9
Impact on Other Outcomes

• Improved self-esteem, symptom control, quality of
  life
• Related to sustained competitive employment
• No changes with sustained sheltered employment
• (Bond, 2001)

10

• For some persons, supported and competitive
  employment do not work well
• Must meet needs of people who may have symptoms
  (e.g., anxiety, depression) that may interfere
  with competitive employment

11
Micro-Enterprise Development

• Hammis and Griffin
• Montana Rural Institute
• Created close to 500 businesses for people with
  disabilites
• Used Medicaid work incentives

12
Going Beyond the Usual

• Pair Employment Options with Savings and Asset
  Building Strategies
• Educate consumers and mental health providers
  about Individual Development Accounts (IDAs),
  financial literacy training, and other savings
  strategies

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What is an Individual Development Account?

• Individual Development Accounts (IDAs) are
  matched savings accounts designed to promote
  asset building and change savings behaviors
• Participation involves at least 10 hours of
  general financial education, plus additional
  asset-specific education

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What can IDAs be used for?

• Primary uses of IDAs
• Homeownership down payment and/or acquisition
  costs
• Microenterprise seed capital for entrepreneurs
  to start up their own businesses
• Education tuition for post-secondary education
  for accountholder or dependent

15
State Policy Recommendations

• End Medicaid asset tests on all IDAs, for both
  parents and children
• Disregard any income directly deposited in an IDA
  as income for the purposes of determining
  eligibility for Medicaid, SCHIP, or SSI
  supplemental benefits
• Exclude assets in IDAs and PASS accounts from
  determining SSI supplemental benefits

16
Create a comprehensive asset building and
financial education agenda

• Improving and expanding access to financial
  education
• Increasing affordable homeownership opportunities
• Promoting state-level Earned Income Tax Credit
  (EITC) legislation and expanding use of the
  federal EITC
• Creating new savings opportunities for higher
  education
• Supporting childrens savings accounts
• Increasing access to retirement savings
  opportunities
• Implementing anti-predatory lending measures

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Research Directions

• Implement pilot sites to determine utility of
  using IDAs and micro-enterprise development for
  persons with emotional disturbances and mental
  illnesses

18
Research Directions

• Analyze existing financial literacy curricula and
  test modifications that would make the materials
  more appropriate for persons with mental
  illnesses who may have cognitive and/or
  attentional challenges

19
Research Directions

• Develop models for training mental health staff
  to work with consumers to develop greater
  financial literacy
• Are mental health case workers more effective in
  learning financial literacy curriculum and
  training consumers, or should consumers be
  referred to other resources for training?
• How must training materials be modified to meet
  the needs of persons with mental illnesses?

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Research Directions

• Analyze factors that predict success for mental
  health consumers who develop micro-enterprises
• Develop training packages based on these factors
  to allow for maximum success

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• Must integrate the concept that there is a
  therapeutic value to work within the mindset of
  consumers as well as mental health providers
• Solidify the value of work in recovery for
  persons with mental illnesses