'Bleak picture' for mentally ill: 80% are jobless

Eighty percent of people with mental illness are unemployed, a statistic that says more about the lack of support for this group of people than it does about the economy, according to a new study.

As in so many other areas of mental health, solutions to this problem exist, but simply aren't utilized, says Mary Giliberti, executive director of NAMI, the National Alliance on Mental Illness.

"These statistics paint a pretty bleak picture," she says. "We think we can do a lot better."

About 60% of people with mental illness want to work. And two-thirds can successfully hold down a job, if they're given appropriate support, the report says. Yet fewer than 2% of people in the public mental health system receive this help, a cost-effective program called supported employment, which has been studied in 20 high-quality clinical trials over the past 25 years.

Yet supported employment programs are rare, partly because of the difficulty of cobbling together sufficient funding, says Robert Drake, a professor at the Dartmouth Psychiatric Research Center in New Hampshire. Unlike medication, which is covered by health insurance plans, there's no central funding source for employment support.

Although the payoffs to helping people with mental illness succeed in the workplace are enormous, achieving that goal will "take both leadership and resources," Giliberti says.

Unemployment among those with mental illness dwarfs the overall rate in the USA, currently at 6.1%. Yet the new report probably underestimates the true size of the problem because researchers didn't factor in the more than half a million people with mental illness who are homeless or in jail, Giliberti says.

In a series of stories over the coming months, USA TODAY will explore the human and financial costs that the country pays for not caring more about the nearly 10 million Americans with serious mental illness.

The benefits of work

Beyond allowing people to support themselves, work is also a powerful form of therapy, Giliberti says.

People with mental illness who find competitive jobs have higher quality of life, fewer symptoms and lower mental health care costs, studies show.

A year of supported employment – in which job coaches help people cope with the demands of their new jobs – costs about $4,000, Drake says. But it can save the mental health system tens of thousands of dollars over the course of a person's lifetime, because participants use fewer services.

"Work is critical to identity, to dignity, to who you are," Giliberti says. "When we are funding work, we are decreasing the cost of future treatment."

Unemployment costs the entire country.

About two-thirds of the $444 billion cost of mental illness in the USA comes from lost earnings and disability payments, says Thomas Insel, director of the National Institute of Mental Health. Nearly half of those receiving federal disability income – 44% of the total – have a mental illness.

That makes people with mental illness the largest and fastest growing group of people on disability, according to the NAMI report.

Many factors keep people with mental illness out of the workforce, including discrimination. In a 2006 survey, 62% of Americans said they were unwilling to work with someone with schizophrenia.

Diane Volpe says her sister, a survivor of a violent crime, was fired from her job as medical technician after she began to show signs of bipolar disorder. "They never gave her the option of medical leave or short-term disability" to get treatment, says Volpe, of Warren, Vt. "Maybe that would have prevented her from spiraling out of control."

Disability payments and federal health insurance programs, such as Medicaid and Medicare, can provide vital help to people too sick to work. But some people with mental illness find that they can't afford to work for fear of losing these payments, Giliberti says.

"We have state-enforced poverty," says Judge Milton Mack, a member of the Michigan Mental Health Commission in 2004 who has presided over guardianship hearings for people with mental illness for many years. "If they get a job, they lose their benefits."

A helping hand

Stephanie Joseph, who suffers from major depression and attention deficit disorder, says she works only 25 hours a week, mostly to avoid losing her benefits.

Yet Joseph – a certified public accountant working on a master's degree in business at Johns Hopkins University in Maryland – is one of the few people with mental illness lucky enough to enroll in a supported employment program.

Joseph, 50, lost a string of jobs over the years, sometimes after as little as a few days, because she would oversleep – a symptom of her debilitating depression and fatigue caused by breast cancer treatment. One day, after her father's suicide, Joseph overslept again and became overwhelmed by the fear of losing her job. "I made a snap decision to swallow a bottle of pills and follow my father," Joseph says.

Joseph survived but continued to struggle with depression.

Her prospects improved after she found Cornerstone Montgomery, in suburban Maryland, which offers supported employment. She was accepted after 10 months on the waiting list and has been working as an office administrator at NAMI's office in Montgomery County, Md., since August.

Cornerstone assigned Joseph a job coach who trained with her. When Joseph was too nervous to ask her supervisor questions about her job, she turned to her job coach, who had taken detailed notes. When Joseph had trouble remembering all of her daily tasks, he reminded her to make a list.

Her job coach also stepped in when Joseph became too overwhelmed by depression to go to work for two days. She didn't return phone calls or e-mails and was on the verge of losing another job. Her job coach asked Joseph's therapist to call her, which finally prompted her to respond.

Joseph says she would have been too ashamed to return to work on her own. Her coach accompanied her, however, and helped break the ice with her boss.

"Work helps me stay healthy and grounded," Joseph says. "It gives me a reason to swing my legs over the side of the bed and get up in the morning."

Joseph's supervisor, Stephanie Rosen, says that working with her has been a "100% positive experience."

Rosen encourages other employers to give people with mental illness a chance and says that hiring Joseph was not an act of charity. "We're a non-profit, but we're also a place of business," says Rosen, executive director of the Montgomery County office. "People give us donations in good faith that we will use their money efficiently, so all of our employees need to be efficient and reliable."

Steven Manning says his experience also shows the value of supported employment.

Manning, of Fort Wayne, Ind., lost his job after developing bipolar disorder at age 38. At one point, he was even homeless.

"Depression is like torture," says Manning, now 56. "I tried to commit suicide because I wanted out of that."

Yet Manning found a full-time job through an employment program offered by the Carriage House clubhouse in Fort Wayne, part of Clubhouse International. The group offers places for people with mental illness to socialize, as well as find work.

Today, Manning says, "I'm enjoying my life, every moment of it. I never thought I would go back to work."

The clubhouse helped place Manning in a 6-month job in the mail room of an attorney's office. A clubhouse staff person trained with him on the job. In the event that Manning couldn't report to work, the clubhouse staffer would have reported to work for him.

Manning's mail-room job led to a part-time job at a radio station. Manning also began producing videos for the clubhouse. Today, he runs his own video production company, Manning Video Productions, shooting everything from TV commercials to weddings. He takes medication and sees a mental health provider every three months.

"On this side of my illness," Manning says, "my life is about 10 times better than before."