Employment,Employment,Evidence-Based Supported Evidence-Based Supported

EmploymentEmploymentand and

RecoveryRecovery

Employment,Employment,Evidence-Based Supported Evidence-Based Supported

EmploymentEmploymentand and

RecoveryRecovery

David Lynde, MSWDavid Lynde, MSW

Supported Employment ConsultantSupported Employment Consultant

David Lynde, MSWDavid Lynde, MSW

Supported Employment ConsultantSupported Employment Consultant

Which came first Which came first

employment employment

or or

mental health?mental health?

Which came first Which came first

employment employment

or or

mental health?mental health?

• Dorothea Lynde DixDorothea Lynde Dix

• Born, Hampden, Born, Hampden, Maine, 1802Maine, 1802

• Relentless advocate Relentless advocate and crusader for and crusader for people with mental people with mental illnessillness

• Dorothea Lynde DixDorothea Lynde Dix

• Born, Hampden, Born, Hampden, Maine, 1802Maine, 1802

• Relentless advocate Relentless advocate and crusader for and crusader for people with mental people with mental illnessillness

From the Biography of Dorothea From the Biography of Dorothea Lynde Dix…Lynde Dix…From the Biography of Dorothea From the Biography of Dorothea Lynde Dix…Lynde Dix…

• ““The indigent insane and feebleminded The indigent insane and feebleminded usually lived under the most shocking usually lived under the most shocking conditions of all. Some communities conditions of all. Some communities actually placed their "paupers" on the actually placed their "paupers" on the auction block. Leasing, in effect, "their auction block. Leasing, in effect, "their weak minds and strong bodies" to work for weak minds and strong bodies" to work for the bidder who made the most attractive the bidder who made the most attractive offer to the town or county.offer to the town or county.””

• ““The indigent insane and feebleminded The indigent insane and feebleminded usually lived under the most shocking usually lived under the most shocking conditions of all. Some communities conditions of all. Some communities actually placed their "paupers" on the actually placed their "paupers" on the auction block. Leasing, in effect, "their auction block. Leasing, in effect, "their weak minds and strong bodies" to work for weak minds and strong bodies" to work for the bidder who made the most attractive the bidder who made the most attractive offer to the town or county.offer to the town or county.””

From the Biography of Dorothea From the Biography of Dorothea Lynde Dix…Lynde Dix…From the Biography of Dorothea From the Biography of Dorothea Lynde Dix…Lynde Dix…

““Dorothea Dix traveled thousands of Dorothea Dix traveled thousands of miles from state to state - by train, miles from state to state - by train, coach, carriage and river boat - always coach, carriage and river boat - always systematically gathering facts which systematically gathering facts which she could use to try to convince those she could use to try to convince those in authority of the need of improvement in authority of the need of improvement in the care of the mentally ill.in the care of the mentally ill.””

““Dorothea Dix traveled thousands of Dorothea Dix traveled thousands of miles from state to state - by train, miles from state to state - by train, coach, carriage and river boat - always coach, carriage and river boat - always systematically gathering facts which systematically gathering facts which she could use to try to convince those she could use to try to convince those in authority of the need of improvement in authority of the need of improvement in the care of the mentally ill.in the care of the mentally ill.””

Is This You?Is This You?Is This You?Is This You?

““Superior functioning in a wide Superior functioning in a wide range of activities, life's problems range of activities, life's problems never seem to get out of hand, is never seem to get out of hand, is sought out by others because of sought out by others because of

his or her many qualities. No his or her many qualities. No symptoms.symptoms.””

““Superior functioning in a wide Superior functioning in a wide range of activities, life's problems range of activities, life's problems never seem to get out of hand, is never seem to get out of hand, is sought out by others because of sought out by others because of

his or her many qualities. No his or her many qualities. No symptoms.symptoms.””

Is This You?Is This You?Is This You?Is This You?

Competitively employedCompetitively employed

oror

Capable of being Competitively Capable of being Competitively Employed?Employed?

Competitively employedCompetitively employed

oror

Capable of being Competitively Capable of being Competitively Employed?Employed?

Where do Work Where do Work and Recovery Intersect?and Recovery Intersect?

Where do Work Where do Work and Recovery Intersect?and Recovery Intersect?

Where do Work Where do Work and Recovery Travel and Recovery Travel Common Pathways?Common Pathways?

Where do Work Where do Work and Recovery Travel and Recovery Travel Common Pathways?Common Pathways?

What is Recovery?What is Recovery?

What is What is notnot Recovery? Recovery?

What is Recovery?What is Recovery?

What is What is notnot Recovery? Recovery?

Dartmouth PRCDartmouth PRC 1212

Recovery?Recovery?Recovery?Recovery?

““I need to be I need to be given advice and given advice and guidance about guidance about work so I wonwork so I won’’t t

make any make any mistakes or failmistakes or fail””

““I need to be I need to be given advice and given advice and guidance about guidance about work so I wonwork so I won’’t t

make any make any mistakes or failmistakes or fail””

Recovery?Recovery?Recovery?Recovery?

““I have a dream I have a dream that someday I that someday I

will be will be treatment treatment adherentadherent””

““I have a dream I have a dream that someday I that someday I

will be will be treatment treatment adherentadherent””

Recovery?Recovery?Recovery?Recovery?

““Recovery Recovery means mental means mental illness is not the illness is not the center of my center of my world.world.””

““Recovery Recovery means mental means mental illness is not the illness is not the center of my center of my world.world.””

Dartmouth PRCDartmouth PRC 1515

Recovery?Recovery?Recovery?Recovery?

““My life has My life has enough meaning enough meaning now that I have now that I have a psychiatrist, a psychiatrist,

medications and medications and a case managea case manage

r.r.””

““My life has My life has enough meaning enough meaning now that I have now that I have a psychiatrist, a psychiatrist,

medications and medications and a case managea case manage

r.r.””

Recovery?Recovery?Recovery?Recovery?

““Someday, I Someday, I hope to be hope to be compliant and a compliant and a well managed well managed case.case.””

““Someday, I Someday, I hope to be hope to be compliant and a compliant and a well managed well managed case.case.””

1717

Recovery?Recovery?Recovery?Recovery?

““I want a I want a warm and warm and safe place safe place

for my for my family”family”

““I want a I want a warm and warm and safe place safe place

for my for my family”family”

Recovery?Recovery?Recovery?Recovery?

““Before I was Before I was really depressed really depressed but after I but after I started working, started working, it was a relief. I it was a relief. I feel better feel better workingworking……””

““Before I was Before I was really depressed really depressed but after I but after I started working, started working, it was a relief. I it was a relief. I feel better feel better workingworking……””

Recovery?Recovery?Recovery?Recovery?

““I want to be the I want to be the very best very best

mental health mental health client that I can client that I can

bebe””

““I want to be the I want to be the very best very best

mental health mental health client that I can client that I can

bebe””

2020

Recovery?Recovery?Recovery?Recovery?

““I want a good I want a good place to live, a place to live, a sweet car to sweet car to drive, a good drive, a good

job and a date job and a date on Friday nighton Friday night””

““I want a good I want a good place to live, a place to live, a sweet car to sweet car to drive, a good drive, a good

job and a date job and a date on Friday nighton Friday night””

Young Adults & RecoveryYoung Adults & RecoveryYoung Adults & RecoveryYoung Adults & Recovery• The aspirations of young people following a The aspirations of young people following a

first episode of psychosis appear to be first episode of psychosis appear to be similar to those of any other young person: similar to those of any other young person: wanting to be rich and powerful (Brady wanting to be rich and powerful (Brady 2008); to drive a sports car, live in a nice 2008); to drive a sports car, live in a nice house, to have a job and a career, and be house, to have a job and a career, and be totally self-sufficienttotally self-sufficient (BGW, 2002); wanting (BGW, 2002); wanting to lead a life free of symptoms of illness with to lead a life free of symptoms of illness with a partner, a family and a career (Parker a partner, a family and a career (Parker 2001)2001)

– Rinaldi, Miles, Killackey, Eoin; et al. First episode psychosis and Rinaldi, Miles, Killackey, Eoin; et al. First episode psychosis and employment: A review. International Review of Psychiatry (Submitted employment: A review. International Review of Psychiatry (Submitted 2010)2010)

• The aspirations of young people following a The aspirations of young people following a first episode of psychosis appear to be first episode of psychosis appear to be similar to those of any other young person: similar to those of any other young person: wanting to be rich and powerful (Brady wanting to be rich and powerful (Brady 2008); to drive a sports car, live in a nice 2008); to drive a sports car, live in a nice house, to have a job and a career, and be house, to have a job and a career, and be totally self-sufficienttotally self-sufficient (BGW, 2002); wanting (BGW, 2002); wanting to lead a life free of symptoms of illness with to lead a life free of symptoms of illness with a partner, a family and a career (Parker a partner, a family and a career (Parker 2001)2001)

– Rinaldi, Miles, Killackey, Eoin; et al. First episode psychosis and Rinaldi, Miles, Killackey, Eoin; et al. First episode psychosis and employment: A review. International Review of Psychiatry (Submitted employment: A review. International Review of Psychiatry (Submitted 2010)2010)

““Now that I Now that I have served have served my country I my country I want to collect want to collect disability disability income to income to support my support my family”family”

““Now that I Now that I have served have served my country I my country I want to collect want to collect disability disability income to income to support my support my family”family”

National Consensus National Consensus Statement on Mental Health Statement on Mental Health

RecoveryRecovery

National Consensus National Consensus Statement on Mental Health Statement on Mental Health

RecoveryRecovery

www.SAMHSA.govwww.SAMHSA.gov

Self-DirectionSelf-DirectionSelf-DirectionSelf-Direction

Consumers lead, control, exercise choice Consumers lead, control, exercise choice over, and determine their own path of over, and determine their own path of recovery by optimizing autonomy, recovery by optimizing autonomy, independence, and control of resources to independence, and control of resources to achieve a self-determined life. By achieve a self-determined life. By definition, the recovery process must be definition, the recovery process must be self-directed by the individual, who defines self-directed by the individual, who defines his or her own life goals and designs a his or her own life goals and designs a unique path towards those goals.unique path towards those goals.

Consumers lead, control, exercise choice Consumers lead, control, exercise choice over, and determine their own path of over, and determine their own path of recovery by optimizing autonomy, recovery by optimizing autonomy, independence, and control of resources to independence, and control of resources to achieve a self-determined life. By achieve a self-determined life. By definition, the recovery process must be definition, the recovery process must be self-directed by the individual, who defines self-directed by the individual, who defines his or her own life goals and designs a his or her own life goals and designs a unique path towards those goals.unique path towards those goals.

Individualized and Person-CenteredIndividualized and Person-CenteredIndividualized and Person-CenteredIndividualized and Person-Centered

There are multiple pathways to recovery There are multiple pathways to recovery based on an individualbased on an individual’’s unique strengths s unique strengths and resiliencies as well as his or her and resiliencies as well as his or her needs, preferences, experiences needs, preferences, experiences (including past trauma), and cultural (including past trauma), and cultural background in all of its diverse background in all of its diverse representations….representations….

There are multiple pathways to recovery There are multiple pathways to recovery based on an individualbased on an individual’’s unique strengths s unique strengths and resiliencies as well as his or her and resiliencies as well as his or her needs, preferences, experiences needs, preferences, experiences (including past trauma), and cultural (including past trauma), and cultural background in all of its diverse background in all of its diverse representations….representations….

EmpowermentEmpowermentEmpowermentEmpowerment

Consumers have the authority to choose Consumers have the authority to choose from a range of options and to participate from a range of options and to participate in all decisions—including the allocation of in all decisions—including the allocation of resources—that will affect their lives, and resources—that will affect their lives, and are educated and supported in so doing….are educated and supported in so doing….

Consumers have the authority to choose Consumers have the authority to choose from a range of options and to participate from a range of options and to participate in all decisions—including the allocation of in all decisions—including the allocation of resources—that will affect their lives, and resources—that will affect their lives, and are educated and supported in so doing….are educated and supported in so doing….

HolisticHolisticHolisticHolistic

Recovery encompasses an individualRecovery encompasses an individual’’s whole s whole life, including mind, body, spirit, and community. life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including Recovery embraces all aspects of life, including housing, employment, education, mental health housing, employment, education, mental health and healthcare treatment and services, and healthcare treatment and services, complementary and naturalistic services, complementary and naturalistic services, addictions treatment, spirituality, creativity, addictions treatment, spirituality, creativity, social networks, community participation, and social networks, community participation, and family supports as determined by the person….family supports as determined by the person….

Recovery encompasses an individualRecovery encompasses an individual’’s whole s whole life, including mind, body, spirit, and community. life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including Recovery embraces all aspects of life, including housing, employment, education, mental health housing, employment, education, mental health and healthcare treatment and services, and healthcare treatment and services, complementary and naturalistic services, complementary and naturalistic services, addictions treatment, spirituality, creativity, addictions treatment, spirituality, creativity, social networks, community participation, and social networks, community participation, and family supports as determined by the person….family supports as determined by the person….

Non-LinearNon-LinearNon-LinearNon-Linear

Recovery is not a step-by-step process Recovery is not a step-by-step process but one based on continual growth, but one based on continual growth, occasional setbacks, and learning from occasional setbacks, and learning from experience. Recovery begins with an initial experience. Recovery begins with an initial stage of awareness in which a person stage of awareness in which a person recognizes that positive change is recognizes that positive change is possible….possible….

Recovery is not a step-by-step process Recovery is not a step-by-step process but one based on continual growth, but one based on continual growth, occasional setbacks, and learning from occasional setbacks, and learning from experience. Recovery begins with an initial experience. Recovery begins with an initial stage of awareness in which a person stage of awareness in which a person recognizes that positive change is recognizes that positive change is possible….possible….

Strengths-BasedStrengths-BasedStrengths-BasedStrengths-Based

Recovery focuses on valuing and building Recovery focuses on valuing and building on the multiple capacities, resiliencies, on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth talents, coping abilities, and inherent worth of individuals. By building on these of individuals. By building on these strengths, consumers leave stymied life strengths, consumers leave stymied life roles behind and engage in new life roles roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, (e.g., partner, caregiver, friend, student, employee)….employee)….

Recovery focuses on valuing and building Recovery focuses on valuing and building on the multiple capacities, resiliencies, on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth talents, coping abilities, and inherent worth of individuals. By building on these of individuals. By building on these strengths, consumers leave stymied life strengths, consumers leave stymied life roles behind and engage in new life roles roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, (e.g., partner, caregiver, friend, student, employee)….employee)….

Peer SupportPeer SupportPeer SupportPeer Support

Mutual support—including the sharing of Mutual support—including the sharing of experiential knowledge and skills and experiential knowledge and skills and social learning—plays an invaluable role in social learning—plays an invaluable role in recovery. Consumers encourage and recovery. Consumers encourage and engage other consumers in recovery and engage other consumers in recovery and provide each other with a sense of provide each other with a sense of belonging, supportive relationships, valued belonging, supportive relationships, valued roles, and community.roles, and community.

Mutual support—including the sharing of Mutual support—including the sharing of experiential knowledge and skills and experiential knowledge and skills and social learning—plays an invaluable role in social learning—plays an invaluable role in recovery. Consumers encourage and recovery. Consumers encourage and engage other consumers in recovery and engage other consumers in recovery and provide each other with a sense of provide each other with a sense of belonging, supportive relationships, valued belonging, supportive relationships, valued roles, and community.roles, and community.

RespectRespectRespectRespect

Community, systems, and societal acceptance Community, systems, and societal acceptance and appreciation of consumers —including and appreciation of consumers —including protecting their rights and eliminating protecting their rights and eliminating discrimination and stigma—are crucial in discrimination and stigma—are crucial in achieving recovery. Self-acceptance and achieving recovery. Self-acceptance and regaining belief in oneregaining belief in one’’s self are particularly vital. s self are particularly vital. Respect ensures the inclusion and full Respect ensures the inclusion and full participation of consumers in all aspects of their participation of consumers in all aspects of their lives.lives.

Community, systems, and societal acceptance Community, systems, and societal acceptance and appreciation of consumers —including and appreciation of consumers —including protecting their rights and eliminating protecting their rights and eliminating discrimination and stigma—are crucial in discrimination and stigma—are crucial in achieving recovery. Self-acceptance and achieving recovery. Self-acceptance and regaining belief in oneregaining belief in one’’s self are particularly vital. s self are particularly vital. Respect ensures the inclusion and full Respect ensures the inclusion and full participation of consumers in all aspects of their participation of consumers in all aspects of their lives.lives.

ResponsibilityResponsibilityResponsibilityResponsibility

Consumers have a personal responsibility Consumers have a personal responsibility for their own self-care and journeys of for their own self-care and journeys of recovery. Taking steps towards their goals recovery. Taking steps towards their goals may require great courage. Consumers may require great courage. Consumers must strive to understand and give must strive to understand and give meaning to their experiences and identify meaning to their experiences and identify coping strategies and healing processes to coping strategies and healing processes to promote their own wellness. promote their own wellness.

Consumers have a personal responsibility Consumers have a personal responsibility for their own self-care and journeys of for their own self-care and journeys of recovery. Taking steps towards their goals recovery. Taking steps towards their goals may require great courage. Consumers may require great courage. Consumers must strive to understand and give must strive to understand and give meaning to their experiences and identify meaning to their experiences and identify coping strategies and healing processes to coping strategies and healing processes to promote their own wellness. promote their own wellness.

HopeHopeHopeHope

Recovery provides the essential and Recovery provides the essential and motivating message of a better future— motivating message of a better future— that people can and do overcome the that people can and do overcome the barriers and obstacles that confront them. barriers and obstacles that confront them. Hope is internalized; but can be fostered Hope is internalized; but can be fostered by peers, families, friends, providers, and by peers, families, friends, providers, and others. Hope is the catalyst of the recovery others. Hope is the catalyst of the recovery process….process….

Recovery provides the essential and Recovery provides the essential and motivating message of a better future— motivating message of a better future— that people can and do overcome the that people can and do overcome the barriers and obstacles that confront them. barriers and obstacles that confront them. Hope is internalized; but can be fostered Hope is internalized; but can be fostered by peers, families, friends, providers, and by peers, families, friends, providers, and others. Hope is the catalyst of the recovery others. Hope is the catalyst of the recovery process….process….

3434

Recovery Concepts in Recovery Concepts in Supported EmploymentSupported EmploymentRecovery Concepts in Recovery Concepts in Supported EmploymentSupported Employment

Self-directedSelf-directed IndividualizedIndividualized EmpoweringEmpowering HolisticHolistic Non-LinearNon-Linear Strengths-BasedStrengths-Based Peer SupportsPeer Supports RespectRespect ResponsibilityResponsibility HopeHope

Self-directedSelf-directed IndividualizedIndividualized EmpoweringEmpowering HolisticHolistic Non-LinearNon-Linear Strengths-BasedStrengths-Based Peer SupportsPeer Supports RespectRespect ResponsibilityResponsibility HopeHope

Personal Factors That Predict Personal Factors That Predict Better Employment OutcomesBetter Employment OutcomesPersonal Factors That Predict Personal Factors That Predict Better Employment OutcomesBetter Employment Outcomes

• DiagnosisDiagnosis• SymptomsSymptoms• Medication Medication

““ComplianceCompliance””• Hospitalization Hospitalization

HistoryHistory• Treatment Treatment

““ComplianceCompliance””• GenderGender

• DiagnosisDiagnosis• SymptomsSymptoms• Medication Medication

““ComplianceCompliance””• Hospitalization Hospitalization

HistoryHistory• Treatment Treatment

““ComplianceCompliance””• GenderGender

Better Employment Outcomes

Supporting People Supporting People ““ThinkingThinking”” About WorkAbout WorkSupporting People Supporting People ““ThinkingThinking”” About WorkAbout Work

Have conversations about:Have conversations about:• What are your goals?What are your goals?• Have you thought about how work may help with Have you thought about how work may help with

your goals?your goals?• Do you have goals related to employment or a Do you have goals related to employment or a

career?career?• What types of work have you done in the past?What types of work have you done in the past?

Have conversations about:Have conversations about:• What are your goals?What are your goals?• Have you thought about how work may help with Have you thought about how work may help with

your goals?your goals?• Do you have goals related to employment or a Do you have goals related to employment or a

career?career?• What types of work have you done in the past?What types of work have you done in the past?

Supporting People Supporting People ““ThinkingThinking”” About WorkAbout WorkSupporting People Supporting People ““ThinkingThinking”” About WorkAbout Work

Have conversations about:Have conversations about:

• What types of jobs do your family members or What types of jobs do your family members or friends have?friends have?

• What types of hobbies do you enjoy?What types of hobbies do you enjoy?

• Which people do you respect or admire? What Which people do you respect or admire? What do they do for work?do they do for work?

Have conversations about:Have conversations about:

• What types of jobs do your family members or What types of jobs do your family members or friends have?friends have?

• What types of hobbies do you enjoy?What types of hobbies do you enjoy?

• Which people do you respect or admire? What Which people do you respect or admire? What do they do for work?do they do for work?

Employment Myth BustingEmployment Myth BustingEmployment Myth BustingEmployment Myth Busting

““People should only apply for jobs People should only apply for jobs when they know that they will when they know that they will definitely like the job and when they definitely like the job and when they are absolutely sure that they will be are absolutely sure that they will be successful at the jobsuccessful at the job””

““People should only apply for jobs People should only apply for jobs when they know that they will when they know that they will definitely like the job and when they definitely like the job and when they are absolutely sure that they will be are absolutely sure that they will be successful at the jobsuccessful at the job””

Employment Myth BustingEmployment Myth BustingEmployment Myth BustingEmployment Myth Busting

““There is evidence that, when it There is evidence that, when it comes to mental health, we can comes to mental health, we can predict who will and who will not predict who will and who will not be a successful employeebe a successful employee””

““There is evidence that, when it There is evidence that, when it comes to mental health, we can comes to mental health, we can predict who will and who will not predict who will and who will not be a successful employeebe a successful employee””

Low ExpectationsLow ExpectationsLow ExpectationsLow Expectations

Research about the Research about the low expectations of mental low expectations of mental health professionals in relation to people with health professionals in relation to people with mental health conditionsmental health conditions gaining employment is gaining employment is now very well documented. These expectations now very well documented. These expectations are often underpinned by concern about issues of are often underpinned by concern about issues of risk, stress and relapse. risk, stress and relapse. Such low expectations … Such low expectations … can result in them and their families receiving very can result in them and their families receiving very cautious messages from mental health cautious messages from mental health professionals about gaining employment. professionals about gaining employment.

– Rinaldi, Miles, Killackey, Eoin; et al. First episode psychosis and Rinaldi, Miles, Killackey, Eoin; et al. First episode psychosis and employment: A review. International Review of Psychiatry (Submitted 2010employment: A review. International Review of Psychiatry (Submitted 2010))

Research about the Research about the low expectations of mental low expectations of mental health professionals in relation to people with health professionals in relation to people with mental health conditionsmental health conditions gaining employment is gaining employment is now very well documented. These expectations now very well documented. These expectations are often underpinned by concern about issues of are often underpinned by concern about issues of risk, stress and relapse. risk, stress and relapse. Such low expectations … Such low expectations … can result in them and their families receiving very can result in them and their families receiving very cautious messages from mental health cautious messages from mental health professionals about gaining employment. professionals about gaining employment.

– Rinaldi, Miles, Killackey, Eoin; et al. First episode psychosis and Rinaldi, Miles, Killackey, Eoin; et al. First episode psychosis and employment: A review. International Review of Psychiatry (Submitted 2010employment: A review. International Review of Psychiatry (Submitted 2010))

4040

Does It Matter How We See Does It Matter How We See People When It Comes to People When It Comes to

Employment?Employment?

Does It Matter How We See Does It Matter How We See People When It Comes to People When It Comes to

Employment?Employment?

Can we see an employee with Can we see an employee with these on?these on?

Can we see an employee with Can we see an employee with these on?these on?

Recovery Lenses?Recovery Lenses?Recovery Lenses?Recovery Lenses?

Can we see an employee with Can we see an employee with these on?these on?

Can we see an employee with Can we see an employee with these on?these on?

Recovery Lenses?Recovery Lenses?Recovery Lenses?Recovery Lenses?

““I want to live my life not my I want to live my life not my disabilitydisability””

–Pat DeeganPat Deegan

““I want to live my life not my I want to live my life not my disabilitydisability””

–Pat DeeganPat Deegan

Which is most stressful?Which is most stressful?Which is most stressful?Which is most stressful?

•EmploymentEmploymentOrOr

•UnemploymentUnemployment

•EmploymentEmploymentOrOr

•UnemploymentUnemployment

How many of us have managed the How many of us have managed the stress of…stress of…

• Poverty?Poverty?

• Discrimination?Discrimination?

• Homelessness?Homelessness?

• Hallucinations?Hallucinations?

• Involuntary treatment commitment?Involuntary treatment commitment?

How many of us have managed the How many of us have managed the stress of…stress of…

• Poverty?Poverty?

• Discrimination?Discrimination?

• Homelessness?Homelessness?

• Hallucinations?Hallucinations?

• Involuntary treatment commitment?Involuntary treatment commitment?

How many people with mental How many people with mental illness have managed the stress illness have managed the stress of…of…

• Poverty?Poverty?

• Discrimination?Discrimination?

• Homelessness?Homelessness?

• Hallucinations?Hallucinations?

• Involuntary treatment commitment?Involuntary treatment commitment?

How many people with mental How many people with mental illness have managed the stress illness have managed the stress of…of…

• Poverty?Poverty?

• Discrimination?Discrimination?

• Homelessness?Homelessness?

• Hallucinations?Hallucinations?

• Involuntary treatment commitment?Involuntary treatment commitment?

Simple Stress TestSimple Stress TestSimple Stress TestSimple Stress Test

•The following is a picture of two The following is a picture of two identical dolphinsidentical dolphins

•If you are struggling with managing If you are struggling with managing stress you will see stress you will see differencesdifferences in in these two dolphinsthese two dolphins

Employment Myth BustingEmployment Myth BustingEmployment Myth BustingEmployment Myth Busting

““Employment is far too stressful Employment is far too stressful for a person with a mental illnessfor a person with a mental illness””““Employment is far too stressful Employment is far too stressful for a person with a mental illnessfor a person with a mental illness””

Extra, ExtraExtra, Extra

There is Scientific EvidenceThere is Scientific EvidenceExtra, ExtraExtra, Extra

There is Scientific EvidenceThere is Scientific Evidence

Supported EmploymentSupported Employment

An Evidence-Based PracticeAn Evidence-Based Practice

Supported EmploymentSupported Employment

An Evidence-Based PracticeAn Evidence-Based Practice

Evidence Based Practice Evidence Based Practice DefinitionDefinitionEvidence Based Practice Evidence Based Practice DefinitionDefinition

1.1. The practice is clearly defined in a manual The practice is clearly defined in a manual or other method to train practitionersor other method to train practitioners

2.2. The practice has a well-defined and The practice has a well-defined and operationalized fidelity scaleoperationalized fidelity scale

3.3. The practice has demonstrated positive The practice has demonstrated positive outcomes in a outcomes in a ““RCTRCT””

4.4. The practice has demonstrated positive The practice has demonstrated positive outcomes with different investigators in outcomes with different investigators in repeated research trialsrepeated research trials

1.1. The practice is clearly defined in a manual The practice is clearly defined in a manual or other method to train practitionersor other method to train practitioners

2.2. The practice has a well-defined and The practice has a well-defined and operationalized fidelity scaleoperationalized fidelity scale

3.3. The practice has demonstrated positive The practice has demonstrated positive outcomes in a outcomes in a ““RCTRCT””

4.4. The practice has demonstrated positive The practice has demonstrated positive outcomes with different investigators in outcomes with different investigators in repeated research trialsrepeated research trials

16 Randomized Controlled Trials 16 Randomized Controlled Trials of Supported Employmentof Supported Employment16 Randomized Controlled Trials 16 Randomized Controlled Trials of Supported Employmentof Supported Employment

• 4 conducted before Individual 4 conducted before Individual Placement and Support (IPS) model Placement and Support (IPS) model was developedwas developed

• 11 used full implementation of IPS 11 used full implementation of IPS • 1 studied supported employment on an 1 studied supported employment on an

ACT teamACT team

• 4 conducted before Individual 4 conducted before Individual Placement and Support (IPS) model Placement and Support (IPS) model was developedwas developed

• 11 used full implementation of IPS 11 used full implementation of IPS • 1 studied supported employment on an 1 studied supported employment on an

ACT teamACT team

RCTs: RCTs: ““Pre IPSPre IPS””RCTs: RCTs: ““Pre IPSPre IPS””

RCTs: IPS StudiesRCTs: IPS StudiesRCTs: IPS StudiesRCTs: IPS Studies

Summary: Randomized Controlled Summary: Randomized Controlled Trials of Supported Employment (SE)Trials of Supported Employment (SE)Summary: Randomized Controlled Summary: Randomized Controlled Trials of Supported Employment (SE)Trials of Supported Employment (SE)

• In 15 of 16 studies, SE had significantly In 15 of 16 studies, SE had significantly better competitive employment outcomes better competitive employment outcomes than controls than controls

• Mean across studies of consumers working Mean across studies of consumers working competitively at some time:competitively at some time:–60% for supported employment60% for supported employment–24% for controls24% for controls

• Effect size (d) = .77Effect size (d) = .77

• In 15 of 16 studies, SE had significantly In 15 of 16 studies, SE had significantly better competitive employment outcomes better competitive employment outcomes than controls than controls

• Mean across studies of consumers working Mean across studies of consumers working competitively at some time:competitively at some time:–60% for supported employment60% for supported employment–24% for controls24% for controls

• Effect size (d) = .77Effect size (d) = .77

6161

When food is scarce, we donWhen food is scarce, we don’’t think t think malnutrition is okaymalnutrition is okay

When housing is hard to find, we donWhen housing is hard to find, we don’’t think t think homelessness is okayhomelessness is okay

When healthcare is difficult to obtain, we When healthcare is difficult to obtain, we dondon’’t think sickness is okayt think sickness is okay

Then why, when jobs are scarce, do we Then why, when jobs are scarce, do we begin to think that unemployment is okay?begin to think that unemployment is okay?

When food is scarce, we donWhen food is scarce, we don’’t think t think malnutrition is okaymalnutrition is okay

When housing is hard to find, we donWhen housing is hard to find, we don’’t think t think homelessness is okayhomelessness is okay

When healthcare is difficult to obtain, we When healthcare is difficult to obtain, we dondon’’t think sickness is okayt think sickness is okay

Then why, when jobs are scarce, do we Then why, when jobs are scarce, do we begin to think that unemployment is okay?begin to think that unemployment is okay?

Dartmouth Supported Dartmouth Supported Employment Web SiteEmployment Web SiteDartmouth Supported Dartmouth Supported Employment Web SiteEmployment Web Site

http://www.dartmouth.edu/~ips/http://www.dartmouth.edu/~ips/

Helping People Helping People ““ThinkingThinking”” About WorkAbout WorkHelping People Helping People ““ThinkingThinking”” About WorkAbout Work

Have conversations about:Have conversations about:• What are the potential benefits or What are the potential benefits or

drawbacks to employment for you?drawbacks to employment for you?• Did you know that people who have Did you know that people who have

symptoms are able to work?symptoms are able to work?• Did you know that work actually helps Did you know that work actually helps

reduce substance use?reduce substance use?

Have conversations about:Have conversations about:• What are the potential benefits or What are the potential benefits or

drawbacks to employment for you?drawbacks to employment for you?• Did you know that people who have Did you know that people who have

symptoms are able to work?symptoms are able to work?• Did you know that work actually helps Did you know that work actually helps

reduce substance use?reduce substance use?

Helping People Helping People ““ThinkingThinking”” About WorkAbout WorkHelping People Helping People ““ThinkingThinking”” About WorkAbout Work

Have conversations about:Have conversations about:

• What concerns do you have about What concerns do you have about employment?employment?

• Is there anyone in your family or group of Is there anyone in your family or group of friends that may be supportive of your friends that may be supportive of your work goals?work goals?

Have conversations about:Have conversations about:

• What concerns do you have about What concerns do you have about employment?employment?

• Is there anyone in your family or group of Is there anyone in your family or group of friends that may be supportive of your friends that may be supportive of your work goals?work goals?

ProsPros

ConsCons

Being EmployedBeing Employed Being UnemployedBeing Unemployed

More income

Don’t like relying so much on others

Bored

Don’t know what to say to co-workers

Worried about benefits

Keep my disability income

Feel better about myself

Employment Myth BustingEmployment Myth BustingEmployment Myth BustingEmployment Myth Busting

““Employers donEmployers don’’t hire people who have t hire people who have mental health symptoms, they only hire mental health symptoms, they only hire mentally healthy, well adjusted and non-mentally healthy, well adjusted and non-disabled employeesdisabled employees””

““Employers donEmployers don’’t hire people who have t hire people who have mental health symptoms, they only hire mental health symptoms, they only hire mentally healthy, well adjusted and non-mentally healthy, well adjusted and non-disabled employeesdisabled employees””

Employment Myth BustingEmployment Myth BustingEmployment Myth BustingEmployment Myth Busting

““Employment is something that people Employment is something that people should begin to think about only when they should begin to think about only when they are stable and free of mental health are stable and free of mental health symptomssymptoms””

““Employment is something that people Employment is something that people should begin to think about only when they should begin to think about only when they are stable and free of mental health are stable and free of mental health symptomssymptoms””

Employment Myth BustingEmployment Myth BustingEmployment Myth BustingEmployment Myth Busting

““The Americans with Disabilities Act will The Americans with Disabilities Act will provide you with complete protection provide you with complete protection against stigma and discrimination in the against stigma and discrimination in the work place if you decide to discuss your work place if you decide to discuss your mental health with any of your supervisors mental health with any of your supervisors or colleaguesor colleagues””

““The Americans with Disabilities Act will The Americans with Disabilities Act will provide you with complete protection provide you with complete protection against stigma and discrimination in the against stigma and discrimination in the work place if you decide to discuss your work place if you decide to discuss your mental health with any of your supervisors mental health with any of your supervisors or colleaguesor colleagues””

Supporting People Who Are Supporting People Who Are Searching for WorkSearching for WorkSupporting People Who Are Supporting People Who Are Searching for WorkSearching for Work

Have conversations about:Have conversations about:• Areas at work where coping strategies and Areas at work where coping strategies and

skills may be useful for the personskills may be useful for the person• Plans for the first day of work, help the Plans for the first day of work, help the

person identify and use structured person identify and use structured problem-solving to work out seemingly problem-solving to work out seemingly ““littlelittle”” things things

Have conversations about:Have conversations about:• Areas at work where coping strategies and Areas at work where coping strategies and

skills may be useful for the personskills may be useful for the person• Plans for the first day of work, help the Plans for the first day of work, help the

person identify and use structured person identify and use structured problem-solving to work out seemingly problem-solving to work out seemingly ““littlelittle”” things things

””I thought ‘Oh No’, what will my I thought ‘Oh No’, what will my son do now.son do now.””

• Mother, Detroit MichiganMother, Detroit Michigan

””I thought ‘Oh No’, what will my I thought ‘Oh No’, what will my son do now.son do now.””

• Mother, Detroit MichiganMother, Detroit Michigan

Recovery & HopeRecovery & HopeRecovery & HopeRecovery & Hope

““If people are treated as capable, If people are treated as capable, they often surprise everyone they often surprise everyone and live up to expectations.and live up to expectations.””

• Ken Steele Ken Steele ““The Day the Voices Stopped.The Day the Voices Stopped.””

““If people are treated as capable, If people are treated as capable, they often surprise everyone they often surprise everyone and live up to expectations.and live up to expectations.””

• Ken Steele Ken Steele ““The Day the Voices Stopped.The Day the Voices Stopped.””