Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities

Prepared for
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation

Many people with psychiatric disorders rely on public benefits, and relatively few receive services they need to help them become or stay employed. Along with financial disadvantages, unemployment can lead to social isolation and low self-esteem, which can place people at an increased risk for further mental health problems. The U.S. Department of Health and Human Services funded the Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities Project to identify effective programs that help individuals with psychiatric disorders find and retain employment. The project also explored how these programs can be funded through the Affordable Care Act and other sources.

Mathematica conducted a comprehensive literature review of services and supports that facilitate employment for people with psychiatric disorders. The review focused on three subgroups: (1) long-term clients of mental health services, (2) workers at risk of job loss due to a mental health condition, and (3) those in need of early intervention services, such as transition-age youth. We drew on new information from recent demonstration projects, as well as from the growing body of literature on early intervention to prevent psychosis. We also analyzed data from the Survey of Income and Program Participation to examine service-use trajectories of vulnerable populations who might be expected to apply for Social Security Disability Insurance (SSDI) benefits. The project culminated in three policy briefs and a full report.

Key findings include:

  • Evidence-based supported employment has been shown to be more effective than traditional vocational programs for helping people with serious mental illness to find work. Supported employment aims to help people with disabilities participate in the labor market, in a job of their choosing, with professional support.
  • Those who received supported employment and obtained employment found only part-time jobs with low wages, and we found little strong evidence for positive long-term outcomes. The absence of improved long-term outcomes may result from the lack of programmatic emphasis on job tenure and economic self-sufficiency, or work disincentives built into Social Security disability and other financial-support programs that discourage more than minimal levels of work.
  • Evidence suggests that intervening early may help prevent full-blown psychosis and long-term involvement with the mental health and disability systems, especially when the intervention includes a supported employment component.
  • There is a consistent decline in employment as early as three years before individuals receive SSDI benefits.