Avoiding the Tyranny of Low Expectations: Employment Support for People with a Mental Illness
Dan O’Brien is the Deputy Associate Commissioner for Social Security’s Employment Support Programs. Prior to joining Social Security, Mr. O’Brien managed return to work programs for people with serious mental illness for 27 years.
Since 1949, May has been recognized as Mental Health Month, to help raise awareness for mental health in America and to bring attention to services that support people with mental health issues. The National Institute of Mental Health (NIMH) estimates that one in four adults in the U.S. will experience mental illness per year. That translates to more than 57 million Americans. Serious mental illness is the leading cause of disability in the U.S. for people between the ages of 15 and 44.
Nationwide, one of the most pressing issues for young adults is making the transition from education to full time employment.This is a challenging transition for many, especially in these tough economic times. However for those with mental illness, additional resources and support may be required. As a family member of someone with mental illness, I’ve been concerned for some time that society does not create the same high career expectations for people with a mental illness as it does for those without mental illness. Unemployment rates for people with mental illness hover around 80 percent- the highest unemployment rate of any disability group and more than twice than that of young adults without a disability. While this can be partially attributed to the debilitating effect of multiple barriers, I believe it’s also a result of what I call the “tyranny of low expectations.”
This “tyranny of low expectations” was demonstrated by a state mental health department (who shall remain nameless). The department ran a high school transition program that focused exclusively on transitioning students with mental health diagnoses to Social Security disability benefits, not to employment or college. Transition programs should encourage participants to explore higher education or employment rather than social security benefits. By offering transition only to disability benefits, the not –so– subtle message is that there is no hope for the future but a life of poverty on government benefits. The negative effects of this approach are two-fold. Not only are many talented students denied options to explore higher education or employment, but the low expectations that have been imposed on them, can be damaging to their self-confidence and limit their expectations for themselves. Many advocates consider this “tyranny of low expectations” to be more debilitating than the mental illness itself.
Research repeatedly reinforces that high expectations from family, friends and helpers lead to better employment outcomes. Decades ago, the National Institute of Mental Health conducted a study that perfectly illustrates this point. The study was comprised of three subject groups, with each group consisting of adults with mental illness. The control group received standard case management; the experimental group received case management in addition to extensive employment services; and the third group received only one hour of vocational planning - no other services. Not surprisingly, the control group experienced substantially lower employment rates than the group that received support with employment services. More than half of the experimental group went to work. The surprise finding was that the third group (who received only an hour of vocational planning) experienced twice the employment rate of the control group. Curious, the researchers interviewed this group to determine the differentiating factor. A response from one gentleman, who started working in response to the vocational planning, summed it up in simple terms. “I have been coming to this mental health center for 10 years and no one ever asked me if I wanted to work.” The ‘tyranny of low expectations” strikes again!
Join me in my encouragement and support for individuals with a mental illness to explore the risks and rewards of work! We should invite everyone to explore how work could work for them as part of their recovery from mental illness. Ticket to Work can help. It’s a free and voluntary program available to anyone ages 18 through 64 on Social Security disability benefits. It’s supported by a network of more than 1,000 employment and career service providers who specialize in helping people with disabilities find employment.
Ticket to Work and Work Incentives encourage many individuals with mental health illness to pursue work. Participants can work and pursue financial independence and a better life. One beneficiary put it succinctly, “you can’t make a living on Social Security benefits.” Additionally, it offers the opportunity to meet new people, give back to the community and boost self-esteem. Collectively, the benefits of joining the work force through Ticket to Work have helped many participants find career success and transform their lives. Social Security offers a variety of supports in addition to the Ticket to Work program such as continuation of Medicaid and Medicare coverage and expedited reinstatement (for those who qualify). These make it easier for people to become employed and transition to financial independence without fear of being without vital healthcare coverage and cash benefits, should a job not work out, due to their disability.
Discover what the Ticket to Work program can do for you. For more information, visit www.socialsecurity.gov/work or email us at firstname.lastname@example.org or call (866) 968-7842 (V) or (866) 833-2967 (TTY/TDD).