Maryland health practitioners and advocates are helping a growing number of adults with severe mental illness achieve more independence through an approach that combines treatment with employment.
As recently as 10 years ago, adults with mental illness were told they could not handle the stress and expectations of the workplace.
Today, anyone who wants to work is encouraged to find a mainstream job.
The practice - known as supported employment - has grown in Maryland since it was started four years ago. Since then, the number of state-funded, not-for-profit service providers that participate in this treatment model has grown from five to 20. And about 1,000 adults with severe mental illness are expected to use the service during the 2007 fiscal year, compared with 98 four years ago, according to the Maryland State Department of Education's Division of Rehabilitation Services.
"Employment is central to recovery and helping people live a satisfying life," said Jeff Richardson, executive director of Timonium-based Mosaic Community Services, which joined the state's shift toward supported employment a year ago.
The employment rate among those with psychiatric disabilities, such as bipolar disorder and schizophrenia, is as low as 15 percent, mental health experts say. And many face barriers to employment, including lack of skills or education, discrimination, stigma and some hiring managers who don't fully understand the illness. Some employers have safety concerns and worries about interaction between workers with mental illness and colleagues or customers.
Yet, there is a national movement toward helping the mentally ill find mainstream jobs as part of their recovery. Those who work feel more fulfilled in their lives, mental health experts say. And a growing body of research has found that supported employment is more effective than traditional vocational services, say, practicing job skills in sheltered work settings.
"Not working creates additional stigma for people," said Robert Burns, the assistant state superintendent in rehabilitation services. "So the belief is and evidence has shown that the sooner somebody is in recovery and sooner you could work with that individual on issues such as employment, it really reduces both the person's own feeling about their chronic condition and the community's use of the stigma to label and limit these individuals from a lot of opportunities."
In a two-year, federally funded study that followed nearly 1,300 workers with mental illness in seven states, researcher Judith A. Cook found that 55 percent of those receiving supported employment found competitive jobs compared with 34 percent in a control group that received traditional vocational services.And separate research found employers who hired people with mental illness feel these workers are equally productive, committed and dependable.
"There is no question we could help people with severe mental illnesses go back to work," said Cook, a professor and director of the Center on Mental Health Services Research and Policy at the University of Illinois at Chicago.
The idea of supported employment was first introduced for people with developmental disabilities in the 1980s. Over the next decade, the approach spread and was modified to help people with severe mental illness. Besides Maryland, several other states, including South Carolina and Delaware and the District of Columbia, have implemented the approach in recent years.
At St. Luke's House in Bethesda, 273 clients sought employment help and 76 percent found jobs in the 2006 fiscal year, said Larry Abramson, director of vocational services for the comprehensive mental health service provider. These workers collectively earned $1.7 million during the same period, he said.
St. Luke's House was among the first community service providers to convert to the supported employment model four years ago. The group, which had been using basic principles of the approach since 1996, has seen on average a 5 percent increase in its employment rate. "We believe that anyone in our program is capable of getting and keeping a paid job in this model," Abramson said.
Under supported employment, career specialists help clients find jobs based on their interests, skills and experience and they provide workplace support. The specialists also work with clinical professionals to coordinate employment efforts with mental health treatment. This kind of support continues as long as the mental health clients need and want it, service providers say.
The quasi-job coaches also support employers by providing additional vocational training and assistance in obtaining tax credits and deductions.
And many employers are finding that these workers are assets. Besides local and small businesses, mental health providers work with large companies to find jobs for clients. Safeway, for instance, has hired qualified workers through groups such as St. Luke's House and Mosaic Community Services for several years.
Hiring workers of all disabilities is standard practice at the supermarket giant, said Greg Ten Eyck, director of public affairs for the chain's eastern division.
"It makes good business sense," Ten Eyck said. "These people are dedicated, hardworking employees, and they want to work and they want to do a good job."
Delroy Tinsley, 48, of Catonsville, who was diagnosed with a mental illness in 1994, has been working at a Safeway in Catonsville for the past six months. Tinsley said he enjoys his work as a courtesy clerk, packing groceries, bringing back shopping carts and doing some maintenance work.
"The employees like me, and the management likes me," he said.
Tinsley, who has had only a few short-term jobs, said he applied for a position at Safeway because the supermarket chain offers good benefits.
Carolyn Jean Dyson, an employment specialist at Mosaic Community Services, helped Tinsley fill out an online application and prepare for the job interview at Safeway. Now, she checks in with Tinsley on a weekly basis, and Tinsley can turn to Dyson for help if any problems arise.
For Mosaic, the biggest challenge has been meeting the increasing demand for supported employment services, said Richardson. The group tries to keep the caseload for its employment specialist low, and state funding for supported employment has been relatively modest over the years.
When Maryland began implementing its supported employment treatment model four years ago, a $180,000 private grant spread over three years supplemented state funding and was used to provide technical and training assistance to mental health officials and community service providers.
In the 2007 fiscal year, the state has budgeted $806,658 for supported employment services, money that is filtered to the service providers. Burns, the assistant superintendent in rehabilitation services, said the Division of Rehabilitation Services will likely spend more than $1 million to meet the increasing demand.
About 85 individuals participate in Mosaic's one-year-old supported employment program, and about 60 percent are employed, Richardson said. The employment rate among its clients has improved because the program is open to anyone who's interested in working.
The organization, an affiliate of the Sheppard Pratt Foundation, celebrated its success in using the supported employment model by recognizing clients and employers at a luncheon last month. Mosaic has career centers at its Catonsville and Baltimore offices.
On the advice of a local official, Dr. Arthur Vail, beautification chairman for the Arbutus Business and Professional Association, turned to Mosaic for a part-time worker to clean and maintain the business district on East Drive.
Nearly three years later, Tom Anderson, a 45-year-old Catonsville resident who suffers from schizophrenia, is still on the job.
"He's a very hard worker," said Vail, a dentist. "He takes a lot of pride in what he does."
Anderson also holds a second part-time job doing similar streetscape work for the Catonsville Chamber of Commerce.
After difficult periods earlier in his life, Anderson said his life is good. His illness is under control with medication, and he enjoys working outside, beautifying the community.
"I love it," he said. "I get a sense of accomplishment."