Addressing Systemic Barriers to Employment

Policy and Program Recommendations

There are systemic and structural barriers to employment. Unemployment is an important barrier to the recovery and well-being of people with psychiatric disabilities. Between 50% and 70% of adults who receive services in the mental health system say they want to work. However, no more than 15% actually works. Why is it that so many people with psychiatric diagnoses and disabilities want to work but so few become employed? Is it that people with psychiatric disabilities cannot work? Research has shown that a large majority can achieve employment with adequate supports. The truth is that many of the barriers that people with psychiatric disabilities experience actually have to do with the structure and the system of employment and disability services. For instance, it is the problems in the system that seem to be responsible for low utilization of services and programs which help individuals to get employment (e.g., the Medicaid Buy-In and Ticket to Work programs), or the long waits for services and negative experiences and dissatisfaction with some vocational services.

Addressing Unemployment on a Systems Level

With the support of New York Makes Work Pay (the NYS Comprehensive Employment Services Medicaid Infrastructure Grant), NYAPRS partnered with the Institute for Community Inclusion on a project to identify the most important systemic barriers that limit the employment outcomes of people with psychiatric disabilities in New York State. The team also identified policy and program improvement recommendations to best address these systemic barriers. Findings were reported to the NYS- Medicaid Infrastructure Grant with the purpose of guiding future efforts to improve access of New Yorkers with psychiatric disabilities to more effective employment services.

The systemic barriers to employment among people with psychiatric disabilities in NYS

Between August and December of 2009, a research team reviewed literature and conducted interviews and focus groups with key informants. The informants were consumers of employment services, administrators of state agencies, and community providers in Albany, New York City, or Syracuse. This research revealed several systemic and structural barriers to employment:

Slow transition to a Recovery-oriented system: The public mental health system New York State continues to have a strong focus on helping people to survive with their illnesses rather than to recover and function with the rest of society. This system does not seem to fully embrace the belief that all people with psychiatric disabilities can work.
Employment is not a priority: The policies and practice standards of the public mental health system, vocational rehabilitation and workforce services do not recognize the harmful effects of long-term unemployment. Therefore, supporting employment has not been a priority.
Lack of a comprehensive system: The services and supports needed for employment are not organized into single system in which people looking for work can get all of the services they need to find and keep a job. Some of the signs of this "fragmentation" include: Service providers have little awareness of outside programs and agencies; Limited inter-agency collaboration leads to complex, repetitive processes to obtain services (e.g., applications, assessments); Poor referral and follow-up practices; Limited ability to combine resources and use funding efficiently.

Agenda for Change- Where to go from here

Based on the barriers that were identified, the research team created specific recommendations for the Office of Mental Health (OMH), Vocational and Educational Services for Individuals with Disabilities (VESID), the Department of Labor, and other state agencies. These recommendations have the main purpose of creating a workforce system for people with psychiatric disabilities that focuses on recovery and includes all the services individuals need to achieve employment. The recommendations include five principles to guide the creation of this system:

All People Can Work: Everyone with psychiatric disabilities is capable of working in competitive jobs in the community as employees or in self-employed roles.
Employment is a Key Recovery Indicator: Supporting individuals to go back to work should be a priority and can reflect progress in recovery.
Employment is a Right and Responsibility of Citizenship: It is the right and responsibility of all people to participate in the labor force and economic life of their communities.
Work is Everybody's Business: Work is "everybody's business," not only those directly involved in "employment services" (e.g. vocational counselors, job coaches).
Outcomes Are What Matters: The focus of the system should be ensuring that people with psychiatric disabilities achieve successful employment and increase their economic self-sufficiency, and not only on increasing participation in programs and availability of evidence based practices such as supported employment.

The recommendations also include four key actions for the state agencies to improve the workforce system for people with psychiatric disabilities:

Establish and Maintain a Policy Commitment: Put into practice a state policy that recognizes the harmful effects of long-term unemployment, recognizes that all people are capable of working, and creates a mandate to all state agencies to prioritize the improvement of employment outcomes.
Create an Integrated Workforce System: With leadership of OMH, create a workforce system that includes all agencies that work with people with psychiatric disabilities through policies and procedures. These policies and procedures should minimize duplication of services, create effective systems for referral and counter-referral of individuals, and provide a service environment that meets all employment needs through one system.
Integrate Funding to Achieve Outcomes: Create ways for the integrated workforce system to combine and maximize use of the resources of the contributing agencies.
Ensure Consumer Participation: Create a way to ensure that individuals with psychiatric disabilities are involved and "have a say" in all aspects of the system's transformation, increase the consumer's demand for employment, and improve the consumer's utilization of available services.