A Publication of WTVP

Founded more than 30 years ago, Human Service Center, a Fayette Companies agency, provides a comprehensive system of recovery treatment and support for adults with serious mental illnesses such as schizophrenia, bipolar disorder and major depression.

At Human Service Center, Individual Placement and Support Supervisor Trish Glenn manages a team of six women who work to help those with mental illness find employment in the community and become financially independent. The program was started under a U.S. Department of Labor grant, one of just three in the nation to receive the grant. It is now used by the State of Illinois as a “best practices” model.

iBi spoke with Ms. Glenn and Dr. David Loveland, director of research at Human Service Center, to learn more about mental illness in the workplace and the services they provide.

Discussion of mental illness in the workplace used to be taboo. Has this changed in recent years?
Most definitely! When the Supported Employment Service (SES) program began seven years ago, there was more stigma than there is today. While stigma still exists to some degree, educating employers through job development and presentations has been essential. Attitudes in the workplace regarding mental illness appear to be changing for the better.

From an employer’s perspective, what are the benefits of hiring those with mental health issues?
We are in the business of selling a person’s ability, not their disability. What we do is help individuals match their skills and interests to the needs of employers.

People with mental illness have the same needs and desires as others in the workforce. They are dependable and really want to work. When an employer works with our service, they are not just getting a person to fill a position. They are getting someone who wants to be there, an employment specialist who can assist and support the person while on the job, and a team of clinical specialists who strive to keep the person in reach of his or her goals. The SES team coordinates with the employer and consumer to make this a positive experience.

What services do you offer at the Human Service Center for those with mental illnesses who wish to obtain and/or hold jobs?
SES is a unique program offered to anyone enrolled in services at the Human Service Center. SES helps people overcome barriers, both physical and emotional, in an effort to get them back into the workforce and back into living a fulfilling life. We also help people and employers overcome the stigma of the mental illness label, which is often the only barrier standing in the way of employment for our clients.

SES provides follow-along supports; this means we work with people to help them prepare for employment and continually track their progress towards obtaining their desired goals. Our program is time unlimited. Once a person gets a job, we follow them very closely and offer support. Particularly in the first seven to 10 days, we like to see them, or at the very least, talk with them by phone daily, to see how the new job is working out. We are interested in how well the person likes the job, whether he or she feels as though the job is a good fit, the person’s level of anxiety, how well they are getting along with the supervisor and co-workers, and the parts of the job that may be difficult and why. Once a person gets a job, we actually work more closely with them until they feel comfortable enough on the job to lessen our support.

How did the Human Service Center decide to focus on offering employment assistance for persons with mental health problems?
In 2002, we were asked by the director of the Center for Psychiatric Rehabilitation at the University of Chicago to collaborate in applying for a U.S. Department of Labor grant focusing on employing persons with psychiatric problems. We won one of three projects, and the University of Chicago staff trained us on implementing the Individual Placement and Support employment model developed by researchers at Dartmouth Medical School.

Multiple clinical trials have demonstrated that this model is the most effective practice for helping people with a mental illness obtain and keep a job. Key components of the model include a rapid search for a competitive job of the person’s choosing, ongoing support after finding employment, and integration of the supportive employment services with any ongoing treatment services. The funding allowed us to hire six employment specialists, a job developer and a supervisor.

As the four years of federal support was ending, we developed a pilot with the Illinois Division of Rehabilitation Services to purchase the services based on employment outcomes. We are paid milestone payments for each person served as they reach 15, 45 and 90 days on a job. Thus, our incentive is for the individual to achieve success in their job.

What are some of your success stories?
Every time a person in our program inches towards an employment goal, it is successful. We appreciate the “small successes” a person takes towards their employment goals. The team celebrates with the consumer when they get a job, but we also cheer them on when they fill out an application or get an interview. So many people want to work but may have reservations because their past employment experiences may not have ended well. The only time we see failure is when a person doesn’t try.

We track the number of job starts, the type of industry and the actual position title. The past year has revealed much more diversity in the workforce. For example, we have assisted in the placement of construction workers, CNAs, a restoration worker, a welder, child care workers, dietary aides and personal assistants. We have successfully placed people in 515 jobs and have witnessed remarkable transformations in many of their lives.

At what point does mental illness impede one’s ability to complete their daily work?
Productive work often reduces the symptoms associated with mental illness. Many of the individuals enrolled in our program, as noted in research, experience a reduction in symptoms associated with a mental health problem after they reenter the workforce. Work helps individuals effectively use their mental and physical energy (work eliminates boredom), increase their sense of self-esteem (“I’m part of society again!”), and improve their financial stability (lowers stress and improves quality of life).

However, there have been times when the work environment has increased an individual’s levels of anxiety. We see this particularly with people who haven’t been in the workforce for a number of years. It’s not the mental illness, per se, that influences the anxiety, but the lack of familiarity with the work environment associated with years of isolation. Learning new skills, the pace of the job, getting along with the supervisor or co-workers can be challenging for those who have not worked for a while. That is why we provide extensive supports.

What effects do untreated mental illnesses have on businesses?
Like any untreated illness, the effects to a company’s bottom line can be negatively impacted. With lengthy absences, often there is a shift in job responsibilities, a loss in productivity, quicker burnout in those employees picking up the load for the absent employee, and so on.

Major depression is very common among workers, and 67 percent of those suffering depression are in the workforce. Studies have shown 8.8 million sick days are used annually due to depression, and the National Institute of Mental Health places the cost of these sick days at $23 billion. More disability payments are the result of depression than heart disease, hypertension or diabetes. The U.S. Surgeon General’s Report on Mental Health places the total cost of major depression to businesses at $79 billion per year.

While those figures are staggering, the fact is that depression can be effectively treated by both medications and cognitive behavioral treatments. Thus, prompting employees and their families to seek treatment for mental health problems can be a very effective cost-saving measure for employers. Persons served in our employment services have or are receiving these treatments and are recovering.

Are certain jobs or industries better suited to those with mental illnesses than others?
A person’s qualifications for a particular job are what make them suited to an industry, not a mental illness. Mental illness is not what keeps people from working. Lack of education, isolation and years of institutionalization are what keep people from employment.

Mental illness does not discriminate. People with mental illness have a variety of skill sets and levels of education; from a general entry type of position to those with graduate and post-graduate degrees. The SES team works with consumers to find qualifications and compatibility in order to partner with matching businesses.

How many of those with mental health issues disclose that information to their employers or co-workers?
Disclosure of one’s disability, psychiatric or otherwise, is an individual choice based on the requirements of the job and the potential interaction of specific symptoms and functions in the workplace. Further, disclosure is an ongoing and evolving conversation over time. In other words, disclosure is a process, not a single event. Most individuals do not need to disclose a diagnostic category, but rather identify specific symptoms of their mental illness or side effects of their medication, which require workplace adjustments.

That said, as we have entered an “employer’s market” regarding hiring, we have found that disclosure can be valuable. For example, employers can receive tax credits for hiring someone who has a physical or psychiatric disability. As noted, our clients are hired for their skills and abilities for the job, but the employer may like the added bonus of receiving a tax credit, in addition to hiring a good employee. Through the SES team’s job development activities, we have established solid relationships with several of this area’s businesses. Disclosure of a disability is a person’s choice, and we respect their decision if they choose not to tell a prospective employer. However, we thoroughly explain the benefits of disclosing to employers.

What are the pros and cons of such a disclosure?
Most often, people choose to disclose out of respect to the employer—honesty from the beginning. They appreciate the opportunity offered by the employer. Those who disclose in SES sign releases giving us permission to talk to an employer on their behalf. We work closely with the employer to ensure job satisfaction. We can go onsite, have meetings with the employer and consumer, work side-by-side with the consumer, etc.

Cons arise when the employee waits too long to disclose. If disciplinary action has already occurred, chances are, disclosing at that point may be too late.

SES uses a cost/benefit analysis with everyone in our program if disclosing is a grey area. The outcome of this tool offers the whole picture and can better help a person make an informed decision. We do recommend that if a person wants to disclose, they talk to their HR department and the supervisor. Telling a co-worker may not be a good first choice.

What is the most common misperception by employers about those with mental health issues?
Probably that people with mental illness cannot work. This belief extends to society in general and historically includes the mental health treatment profession. People were told by the physicians and counselors that they had a mental health diagnosis, would never be able to recover, and therefore could never be able to have employment and pursue the dreams we all have. At best, the belief was that people with a serious mental illness would only be able to work in a structured workshop setting and would need to be protected and cared for for life.

The last 15 years of research on the Individual Placement and Support model of employment has clearly shown these beliefs to be false and actually held people back from recovery. Again, this is where education and stigma reduction are effective. We have had to re-educate and change the beliefs of some of our staff members at Human Service Center. Seeing people obtain jobs and recover is the best way to change beliefs.

You discuss “recovery.” Can people who have serious mental health conditions recover?
Absolutely. Studies from the World Health Organization (WHO) reveal that about a third of persons with a serious mental illness fully recover and another third may still have symptoms but learn to manage these in a manner to lead a fulfilling, normal life. An example of this latter group is the mathematics professor featured in the film A Beautiful Mind, who returned to teaching and won the Nobel Prize. Unfortunately, the symptoms remain severe and very limiting in the remaining third. Hopefully, the development of new medications and treatments will benefit this group in the near-future.

Of interest, the WHO research reveals people in developing countries appear to recover faster than in industrialized nations. This seems counter-intuitive, since more developed nations have greater access to newer medications. One possible reason is that people in developing countries must rapidly return to productive activities to support their families and are re-integrated in the mainstream of daily life.

What are some employers currently doing to aid employees with mental illnesses?
Recently, we talked to a business owner who “carved” a job for one of the people in our program. The owner hired the man to come in each morning for four hours before the store opened to prepare it for customers. Other businesses are aware of transportation barriers. A few businesses have scheduled the consumer to work during hours of bus operation. Another business linked a consumer to her co-worker so they can carpool.

Other accommodations are usually small. Often the medication prescribed can lead to dry-mouth, so something as simple as allowing consumers to keep a glass of water with them is all that is needed. We have had employers who will let the consumer take an extra break, particularly in the beginning of a new job, as anxiety levels may be elevated. iBi