Individual Placement and Support Helps Those with Mental Illness Get, Keep Jobs
By Janet Shouse and Mark Liverman
Generally, when we think about employment of people with disabilities, we think about people with physical disabilities or those who are blind or deaf. Working at the Vanderbilt Kennedy Center, much of our work is focused on people with intellectual and developmental disabilities. One group, however, is too often left out of the conversation. That group is people with mental illness.
The Governor’s Employment First Task Force continues to try to improve the employment landscape in Tennessee for people with disabilities, and that includes people with mental illness. As a part of that task force, I get to work with Mark Liverman, director of Wellness and Employment for the Tennessee Department of Mental Health and Substance Abuse Services. I asked Mark to discuss some of the issues and options for those with mental illness who are interested in getting and keeping a job. Mark was kind enough to answer my questions.
Question: Why is it important to address employment for people with mental illness?
Answer: Work is the best treatment we have for serious mental illness (i.e., people with schizophrenia spectrum disorder, bipolar, or depression). Two-thirds of people with serious mental illness want to work but only 15% are employed. They see work as an essential part of recovery. Being productive is a basic human need. Working can both be a way out of poverty and prevent entry into the disability system, such as Social Security Disability Income. Competitive employment has a positive impact on self-esteem, life satisfaction, and reducing symptoms, according to a 2014 study by Luciano, Bond, and Drake. The number of studies showing the effectiveness of Individual Placement and Support continues to grow. Individual Placement and Support is an employment service that helps more people with mental illness obtain employment than any other type of vocational program.
To date, 27 randomized controlled trials of Individual Placement and Support have showed a significant advantage for IPS. Across the 27 studies, IPS showed an average competitive employment rate of 56% compared to 23% of controls. A 2016 analysis of 17 randomized controlled trials found that people receiving IPS services were 2.4 times more likely to be employed than controls.
Q: What is IPS exactly?
A: Individual Placement and Support is a model of supported employment for people with serious mental illness (e.g., schizophrenia spectrum disorder, bipolar, depression). IPS supported employment helps people living with behavioral health conditions work at regular jobs of their choosing. Although variations of supported employment exist, IPS refers to the evidence-based practice of supported employment. Mainstream education and technical training are included as ways to advance career paths. IPS is based on eight principles.
Those eight principles are:
- Competitive integrated employment—Jobs anyone can apply for, pay at least minimum wage/same pay as coworkers with similar duties.
- Systematic job development–Employment specialists systematically visit employers, who are selected based on the job seeker’s preferences, to learn about their business needs and hiring preferences.
- Rapid job search–IPS programs use a rapid job search approach to help job seekers obtain jobs rather than focusing on assessments, training, and counseling. The first face-to-face contact with the employer occurs within 30 days.
- Integrated services–IPS programs are integrated with mental health treatment teams.
- Benefits planning–Employment specialists help people obtain personalized and accurate information about how employment may affect their benefits through Social Security, Medicaid/TennCare, and other government programs in which they participate.
- Zero exclusion–People are not excluded on the basis of readiness, diagnoses, symptoms, substance use history, psychiatric hospitalizations, homelessness, level of disability, or legal system involvement.
- Time-unlimited supports–Job supports are individualized and continue for as long as each worker wants and needs the support. Employment Specialist have face-to-face contact at least monthly.
- Worker preferences–Services are based on each job seeker’s preferences and choices rather than the employment specialist’s and supervisor’s judgments.
Q: Why does IPS work? And how?
A: Individuals with behavioral health conditions seeking employment want to work as soon as possible, as any of us would. IPS promotes the notion of a rapid job search, a concept colloquially known as “strike while the iron is hot.” Soon after the person expresses interest in working the job search process begins.
Q: Who qualifies for IPS?
A: Qualification is based upon the person’s desire to work. What we know is, “practitioners cannot predict who will be successful in IPS.” During research trials, people who wanted to work were able to succeed in spite of problems with drugs/alcohol, ongoing symptoms, homelessness, and other issues. Therefore, IPS programs practice the philosophy of “zero exclusion.” As mentioned earlier, this means that anyone who expresses a desire to work is eligible to participate in the program. There are no predetermining factors (such as legal histories, symptoms of mental illness, current substance use, missed appointments, etc.) that would disqualify them from receiving IPS services. Employment Specialists focus on the job seeker’s strengths, supports, and interests to create individualized support services to assist the person with being successful on the job. No more waiting until someone is “stable”!
Q: How does someone get IPS services?
- Currently there are 23 IPS teams across Tennessee, from Memphis to Johnson City. The best way to determine where IPS teams are located in Tennessee is to visit the Department of Mental Health and Substance Abuse Services website at IPS Supported Employment.
Q: Why are YOU so passionate about IPS?
A: Having supported people using this model in their search for work, I have personally experienced the life-changing aspect of how employment can forever alter the life of the person who begins working in a competitive integrated setting. Additionally, employment directly impacts the lives who touch the person who begins working, and employment can have generational positive affects in a person’s life.
Q: What are the statistics about how many people have attained employment in Tennessee using IPS?
A: In Fiscal Year 2018, the international IPS average for those who worked at least one day was 44%, with a total of 19,206 clients served. In Tennessee, 46% of those supported worked at least one day, with a total of 956 clients served, and 26% of those individuals worked 90 days or more. In Fiscal Year 2019, the international IPS average for those who worked at least one day was 44%, with a total of 19,005 clients served. In Tennessee, 43% of those supported worked at least one day, with a total of 983 clients served, and 23% of those individuals worked 90 days or more.
Q: What would you say to possible employers who have concerns about hiring someone with a mental illness?
A: Hire the person’s strengths, not the things they do not do well. Every person, regardless of their vocation, does not succeed at work by focusing on their inabilities, but rather their abilities. Employers should hire the people who can do the job, but unfortunately many people with disabilities, including those with mental health diagnoses, are not given opportunity to showcase their capabilities.
I appreciate Mark so much for his enthusiasm for supported employment, and for our work together on the Employment First Task Force. Mark is upbeat and positive, yet in a realistic way, and his enthusiasm is infectious. If you have a significant mental health condition and you want to work, or you have a loved one with a mental health condition in need of employment assistance, please check out Individual Placement and Support and see if there’s a program in your area. It’s the best way for people with mental illness to get the supports and services they need to get and keep a job. If you have questions, you are welcome to email me at firstname.lastname@example.org.
Mark Liverman is the director of Wellness and Employment for the Tennessee Department of Mental Health and Substance Abuse Services. Mark’s 30-plus years of professional experience began as a team leader in the U.S. Army. Mark also worked for the Tennessee Board of Probation and Parole as a parole officer and as a hearings officer, offering recommendations to the Board of Parole regarding whether a person should remain incarcerated or be released. Mark has a bachelor’s degree in sociology, a master’s degree in human development and leadership, and an education specialist post-master’s degree. Mark taught criminal justice and general education classes in higher education and later became campus director at a local college. He now works with community mental health providers who use the My Health, My Choice, My Life peer-led health and wellness initiative and the Individual Placement and Support model to help individuals improve their health and find competitive integrated jobs.
February 13, 2020