By Linda Carlson, LMSW, Supported Employment EBP Consultant and Trainer

Too frequently, we hear skepticism with regard to the employability of people with serious psychiatric disabilities.  Professionals say, “he/she will never be hired because employers will not hire someone with a criminal record”, “this person is too ill”, “we are setting them up to fail because they have tried before and not succeeded”, or consumers themselves may say, “I can’t do this because I am afraid”.   It matters not whether it comes from professionals, family members, or the consumer of services.  The voice of impossibility is everywhere.  However, time and time again we are proven wrong.  The person who we never thought in a million years could work, does.  The employers that we think won’t hire consumers because of the stigma of mental illness, do.  The consumer who does not think they can get through an interview, does and gets the job. 

Kansas has now been involved in the implementation of evidence-based practice of supported employment for six years with fifteen mental health programs participating.  Of these fifteen programs, thirteen have achieved high fidelity to the practice.  Supported employment is based on seven principles:

1.      Eligibility is based on consumer choice

2.      Integration with mental health treatment

3.      The goal is competitive employment

4.      Job search starts soon after the consumer expresses interest in work

5.      Follow-along supports are continuous

6.      Consumer preferences are important

7.      Personal benefits planning is provided

Each day these principles are being enacted in the programs across Kansas.  And, each day the impossible turns into the possible.  One of the best ways to see the possible is to hear the stories from the field.  The following are a collection of stories from consumers being served in Kansas Supported Employment Programs that have implemented the evidence-based practice.  In each case, years of “the voice of impossibility” was overcome.

Zero Exclusion and the Belief That People Can Work

Susan very much wanted to work, but her mental health providers all thought she was unable to work because her symptoms would increase whenever she tried to work.  Even her husband discouraged her from working because he though work would make her sick.  Still, Susan was determined to work and asked her case manager to refer her to supported employment services.  Her case manager was concerned about her ability to work, but made the referral.

Her supported employment specialist, Amy, talked with Susan’s other mental health treatment providers and listened to their concerns that Susan should not work because working would increase her symptoms.  Amy then reviewed with Susan her past work history and discovered that she gains weight and get very sleepy taking her medications.  Each time she attempted to work in the past, she would stop taking her medications so that she would look and feel better around her peers at work.  However, her symptoms would also increase and she would lose her job within a month of employment.

Amy went to her supervisor to discuss the situation.  The supervisor of Supported Employment Services stated that it was not work that was making her symptoms increase, but the fact that she stopped taking her medications for other reasons.  They made a plan.  Amy spoke with the rest of the rest of the mental health treatment team about supporting Susan’s goal to work and needing assistance from the rest of the team with looking at adjusting her medications and finding ways to help her keep the weight off.  Amy worked with the case manager to support the client’s involvement in a fitness program and with the psychiatrist and nurse to adjust her medications.

Susan works as a bi-lingual customer service representative for a well-known corporation, working full-time with benefits. 

Jobs for People with Criminal Backgrounds:  Randy & John’s Story

Randy

Randy has had many challenges.  He is an individual who is diagnosed as having schizophrenia and has been incarcerated for shooting someone.  He entered the supported employment program about a year after he was released from prison.  His goal was to find a job where he did not have to look over his shoulder – where he could feel safe.  To him, that meant a place where there were not a lot of people and where his supervisor would not be breathing down his neck.

Mary (Randy’s employment specialist) was exploring options for Randy by doing job development.  She dove by a furniture store that she was not familiar with.  It was a smaller store and Mary wondered where the warehouse for the store was.  She stopped by the store and spoke with one of the owners.  The store was small, quaint and family owned by a husband and wife team.  Mary found out about the culture and environment of the company as well as describing the program’s services and function.  It felt like a good environment for Randy.  The owner said to have Randy come by and fill out an application which he did.

A few days later, the employment specialist followed-up on the application with the husband who managed the warehouse.  He said that they really liked Randy, but he did not have any positions available.  Mary felt that, although there were no positions available, the setting and work environment would be a good match for Randy.  A week later, Mary called the owner again and asked if he would do an informational interview with Randy to give him some experience interviewing.  She also prepared Randy for the informational interview, letting him know that there was not a position available, but that this would be an opportunity to learn from. 

Randy and Mary went in to speak with the owner (Jack) for the informational interview.  Jack asked Randy why he thought he should hire him.  Randy said that he had done similar work in the past, he is a hard worker and would love the opportunity to work at his company.  Jack then asked Randy if he has a criminal background.  Randy said yes, but asked if he could tell the story of what happened.  Randy proceeded to honestly tell the story of what led to his conviction.  Jack, the company owner, offered Randy a job, starting out one day a week.  Randy started work two days later.  Within a month, Randy was working 24 hours a week at the warehouse.  Randy enjoys his work and the owners of the company value Randy’s work.  In fact, at one point, the company had to lay off several workers.  Randy was one of the workers they retained.

John

Five years ago John had been homeless and unemployed.  He had spent over three years in shared living with 24 hour attendant care.   John had a dream of returning to janitorial work in a school or nursing home setting because he loves working with people. 

John’s employment specialist, Becky, was aware of the difficulty in pursing his dream in light of the consumer’s felony record.    As Becky was looking at opportunities for John, she did job development at a new nursing home that was opening in the community.  Becky told John about the job and John was enthusiastic about his interview and they discussed talking to the employer about his record.  Becky accompanied John to the interview to provide support.  John decided to disclose his felony record as well as his desire and reasons for wanting to work in a nursing home specifically.  Becky highlighted John’s strengths including the skills he brought to the job and that he is reliable, motivated, and efficient.   John was offered the position and was thrilled to accept a janitorial position working 15 hours a week, in five hour shifts, three evenings a week.  As an accommodation, John was able to wear headphones at work to help him with voices.

In a recent follow-up contact by Becky, the administrator of the nursing home described the consumer as the most reliable employee on the roster, whose smile lit up the day for co-workers and residents alike.  She said his joy was evident in the wide strides he made down the hall while dust mopping with gusto. 

John said that working with Becky had given him the confidence he needed to succeed. In a period of six months, John moved into an apartment, started working at the nursing home, obtained a driver’s license, purchased new furniture, and took a long awaited bus trip out of state to reunite with his family.  John no longer wears headphones to combat symptoms at work because he deems them “unprofessional”.

The Fear of the First Job

Carrie is twenty-two years old with an infectious smile.  As a youth, Carrie’s parents split and she began to act out her anger and became withdrawn. She went to live with her grandmother who took over her parenting.  As her anger and withdrawal grew worse and Carrie began to hear voices, her grandmother decided it was time to reach out for some help at their local Mental Health Center. Carrie was diagnosed as a youth with serious emotional disturbance. Later, as the symptoms increased she was diagnosed with schizophrenia and an anxiety disorder.

For a period of time, Carrie did not have much aspiration and she remained a loner.  Her grandmother did everything for her.   But Carrie wanted more independence and she began to talk about living independently away from grandmother.  The difficulty for Carrie was how she would take care of herself with no income, no job, no experience, and no skills. This is when Carrie requested help from her case manager who referred her to supported employment.

Carrie began working with her supported employment specialist, Paul.  Carrie was eager and motivated but had no work experience.  However, Paul found out that Carrie had done some volunteer work at the local community assistance center along with her grandmother and that she enjoyed the work. Paul used this information to begin looking for a good job match. Paul contacted the manager of a newly opened Goodwill Store and began building a relationship. He presented Carrie as a potential job candidate. Along with presenting his own experience of working with Carrie, Paul also contacted Carrie’s volunteer supervisor at the community assistance center and obtained a letter of recommendation. The Good will Store manager was impressed and agreed to an interview.

As Paul and Carrie were driving to the interview, Carrie’s anxiety elevated.  Since Carrie had never had a job before, she was scared which heightened her anxiety to a level that she felt she could not do the interview so it was canceled.  Paul worked with Carrie to build her confidence and did not apply pressure, just gently began to build on Carrie’s strengths especially about being a competent volunteer worker. Another interview was arranged and this time it was a success! Carrie was hired as a backroom stock person.

Carrie has been working for over 3 years and has never looked back. Carrie says, “I love my work and I have my own apartment and the extra income has allowed me to furnish it and live independently. The Goodwill Store and the people have become my family. And oh, by the way that’s where I met my boyfriend!” Carrie’s eyes sparkle and she is clearly smitten!

Finding the Right Job Match

Susan is a middle-aged woman whose history includes childhood abuse.  When Susan entered the mental health system she had left an abusive relationship, had three adolescent girls to care for and was homeless.  Her mental health service provider immediately found temporary shelter for her and her three children.

Susan wanted a job so she could afford an apartment for her family even though she felt emotionally and mentally unstable. She spoke to her case manager about the need of finding some kind of work and was referred to supported employment. Her supported employment specialist, Alice, began to meet with her to get to know her and her situation. Alice learned that Susan had some experience as a certified nursing assistant; however, Susan did not want to return to that kind of work. Although Susan did indicate she enjoyed the helping professions.

Alice began to look into prospective employers and Susan also began her own intensive search for work. Almost immediately Susan found work on a military base in a deli. Alice discussed Susan’s distrust and anxiety about being around men.  Still, Susan wanted to take the job. While Susan was a good worker, her boss did not appear to be at all appreciative.  Susan describes her boss as being really hard on her – so much that her anxiety was almost unbearable at times. She had to leave sometimes and go to the backroom to calm down.  Alice and her case manager provided Susan with emotional support and the employment specialist continued to look for work that would suit Susan better.

Within a couple of months a position opened up for a respite care worker in a youth group home. Susan looked at the application and hesitated to fill it out, indicating she did not want to complete it. Alice then said, “Why don’t you take an hour to change your destiny.” Susan said that she found this statement quite profound and took this as a sign, completing the application. Susan was selected for an interview and was offered the position.

Susan’s new job fits her perfectly. She now has the opportunity to impact and make a difference in the lives of the young people she cares for, many who have experiences similar to her own and her children’s. Her new job also affords her benefits —health care, vacation, etc.  Susan isn’t stopping here and she now has new goals. She ultimately wants to become a spokes person for the rights of the mentally ill and victims of domestic violence. Susan has enrolled in junior college and has taken on additional responsibilities at the agency.

Thanks to all the mental health professionals, supported employment specialists, consumers, and family members that, each day, work to overcome the skepticism of others and the voice of impossibility.  Those that believe that it is possible and know the success that can be achieved.