A recent report from the Bazelon Center for Mental Health Law on “Promoting Employment of People with Mental Illness” provided the same dreary picture that those of us working in mental health systems are familiar with: that people labeled with mental disorders are employed at a much lower rate than their non-disabled peers. The report calls for broader implementation of the evidence-based practice Supported Employment, which is scarcely available to any individuals across the nation served by public mental health systems which favor funding of other behavioral health services. The Bazelon Center advocates for wider implementation of Supported Employment programs, arguing that they save costs to society by reducing healthcare system costs by shifting the [lower] cost to funding Supported Employment programs and decreasing other service utilization. There is no substantial mention of the individual and societal economic benefits of earning a livable (and taxable) wage beyond saving healthcare system dollars.
In 2013, the U.S. Department of Labor published an amended regulation as part of Section 503 of the Rehab Act of 1973 requiring affirmative action to employ individuals with disabilities. The new regulation loosely encourages federal contractors and subcontractors to have at least 7% of their employees self-identify as people with disabilities (there is a reporting requirement but no penalty or “quota”). The DOL fact sheet cites that in 2012, the unemployment rate for people with disabilities was 15% compared to 8% of non-disabled peers, and that the poverty rate was more than double (28.8% vs. 12.5%).
That is a lot of unemployment and poverty across the board.
People with “mental disorders” make up 60% of SSI beneficiaries and those identified as having “mood” or “psychotic” disorders are over 20%. The reasons for this can be debated, as they can be with any obvious disparities. In the social welfare discourse, people with disabilities are the “deserving poor.” There are many injustices in this discourse and policy agenda against other people who are poor; one of the injustices against people with disabilities is that if you replace “poor” with “unemployed” we are a group of people who are identified as those who “legitimately” cannot work and need a public welfare system to survive. The Bazelon Center report also cites the messages of unending disability as a deterrent to work — that people who can work are told they never will.
I was one of those. It is unclear whether that was said as a means to get on SSDI, or whether it was said because my healthcare providers believed it to be true. We have no scientifically valid way of differentiating groups like this. I had difficulty working in my early 20s because I didn’t have a college degree, and was unable to obtain one through traditional means because of discrimination in the education system. As soon as I found an alternative means of completing a bachelor’s degree, I was gainfully employed ever after. The jobs I could get without a bachelor’s degree I found boring and degrading.
That is just my personal story, because overall I disagree with claims made by some that people who experience madness also experience “brilliance.” If we argue that people with disabilities are essentially the same as people without disabilities and are entitled to the same societal benefits, we cannot argue that we are also somehow “better” than the norm of the general population.
One Slice of an Overall Look at the Economy and Justice
In the 1990s, the term “New Economy” began to be used to describe the transition from a manufacturing-based economy to a service-based economy — particularly in regard to technology. I doubt you will find many people interested in labor economics who think that you can make a living in the United States without some skills related to at least social media, if not more advanced technological skills.
Recently there has been media attention to employee diversity in tech companies. These are pretty shocking statistics, even though the labor force participation rates for women are lower than men, and the unemployment rate is higher for African Americans than whites in the overall job market.
Even more shocking is that disability status isn’t mentioned. On Google’s diversity page, they list a number of different employee diversity resource groups, including a “Special Needs Network.” In their report that was prepared “according to the guidelines issued by the US government” there is no statistic on employees with so-called “special needs.” The reporting requirements are implemented by the Equal Employment Opportunity Commission under the authority of the Civil Rights Act of 1964. The EEOC instruction booklet mentions that the Commission can require additional reporting under the Americans with Disabilities Act.
When we hear employment statistics on gender and race, we think about equality. We think of the Constitution and the Civil Rights Act, and that while there are many ways to explain unemployment for these groups, they are all more morally flawed than we would like. When we talk about unemployment for people with disabilities, we have to make an argument based on assumptions about “ability” to work and contribute. Can we contribute? What do we contribute? How do we make a workplace where people with disabilities contribute? If disability is ever the focus, these are the points made. This and laws related to discrimination. Inequality is an afterthought if it’s even a thought.
Thinking Beyond the Metrics
Accountability in reporting to the Federal government is the lowest level of social change and improvement. For people with disabilities — perhaps in particular for people with psychiatric disabilities — this kind of reporting is only less efficacious in promoting equality in employment behind ADA-based lawsuits (given the low probability of success and the likely “positive” outcome being getting a job back in which you were discriminated against). Relying on regulatory reporting and lawsuits is less encouraging to me than arguing that the benefit of supporting people in employment is that they are not as much of a burden on the healthcare system. We need better goals than these to have a livable society.
We need creative data-driven solutions. Some important data points are the unemployment and poverty rates. Other important data include the failure to adapt employment interventions and policies to the economic reality in which we live, where there are not jobs for anyone in many industries and roles that we used to rely upon for “unskilled” workers — let alone people who struggle to get an education that is required for “skilled” jobs. Even more important data would include documented strategies for improvement.
After the passage of the Affordable Care Act, there was attention to the fact that increased insurance coverage might not expand access to behavioral healthcare services if there is a workforce shortage in behavioral health. Peer specialists have been seen as a way to expand the workforce while employing people with psychiatric disabilities.
Does everyone with a psychiatric history want to work in mental health services? The answer could be “yes,” and as someone who works in the mental health field (albeit as a researcher and not a provider), I can certainly understand why.
“Giving back” is a central tenet of recovery in behavioral health. So we need to look at the intersection of “recovery,” inequality, and economic realities.
A recent New Yorker article discusses harassment of a developer of a video game that addresses struggles associated with a depression diagnosis. I know that such games exist but I don’t know that much about them. My read of the article was that I thought it was really neat that the developer was both a woman (gaming being a slightly different industry than tech, although one that relies on technology) and a person with a psychiatric history. She created her own job without the use of Supported Employment or peer specialist training to make a difference for herself, and potentially other people with mental health issues. Some of the criticism of the game has been based on her socioeconomic status and the game’s use of this reality as detached from the reality of many people who experience depression (and other mental health issues). It is that way because it is based on her own experience. There is no rule that someone living in poverty who experiences psychosis could not create something that reflects another reality without such privilege. Obviously, there are barriers to this related to socioeconomic status — in particular access to education and technology.
Ours is not to report according to government regulations in order to reduce healthcare system costs and legal liability. Ours is not to replace psychiatrists with peer specialists any more than it is to create robots to displace workers.
Ours is to create opportunity that defies dismal statistics. Therefore, Live & Learn is calling upon businesses run by people with psychiatric histories and disabilities to go beyond Medicaid-funded evidence-based practices and EEOC reporting, and take a critical look at the economy to see opportunity rather than injustice.
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This post first appeared on Live & Learn
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.