A new movement advocating employment for the mentally ill is gaining momentum.

The greatest analgesic, soporific, stimulant, tranquilizer, narcotic, and to some extent even antibiotic -- in short, the closest thing to a genuine panacea -- known to medical science is work. -- Thomas Szasz

(No, this quote wasn't with the Times article.)

-----------
On-the-job therapy
A new movement advocating employment for the mentally ill is gaining momentum.
By Daniel Costello
Times Staff Writer

October 31, 2005

YOU'LL never work again.

That's what those diagnosed with schizophrenia or other severe mental illnesses were told as recently as 10 years ago.

Today, they're getting different advice: Get a job. Doctors and treatment experts are recommending work — as security guards, bank tellers or teachers — as a powerful form of therapy.

This dramatic shift has been enabled by a new generation of antipsychotic drugs and a growing belief among experts that people with mental illness should try to "recover." That is, they should live their lives as normally as possible.

Most of those who work show improvement in their mental health and feel more satisfied with their lives, said Gary Bond, a psychology professor at Indiana University-Purdue University at Indianapolis.

"If we had a pill that was successful as work is for some people with mental illness, we'd give it to all of them," he said.

Steven Merriman, an athletic 49-year-old with schizophrenia, is one of the people thriving with help from new supported employment programs.

Merriman has had a difficult time holding a job since he was diagnosed with schizophrenia 25 years ago. Medication helps control his symptoms, such as anxiety and paranoia. Over the years, he's worked off and on in fast food, for a delivery company and at a hardware store.

Since last fall, however, the Torrance resident has been working a steady 20 hours a week at Lowe's Home Improvement as a customer service representative. He helps shoppers locate items in the store and loads packages into their cars. He recently got an excellent performance review and said he has had no problems with co-workers or customers.

As he walked through the wide aisles of the warehouse-size store recently, occasionally helping customers with questions, Merriman explained how making his own money and having a place to go makes him feel more worthwhile. "Work is a good therapy for someone like me," he said. "It helps you have a more satisfying life."

So far, the movement, called supported employment, has been held back by strict government rules. More than half the people with severe mental illnesses receive some government support; if they earned too much money, they could lose payments or health insurance.

But that, too, is starting to change. Last month, the U.S. Social Security Administration announced pilot supported employment projects in 20 cities. Under the new programs, people will be able to earn regular salaries without jeopardizing their benefits.

California is making similar changes. The state's Department of Mental Health recently announced plans to make supported employment a benchmark of its treatment programs. The state will fund the new work programs with money from Proposition 63, a state ballot initiative passed last year that could raise $280 million for new mental health services by the end of the decade.

"Helping people with mental illness find work can be a major step in their recovery and an important part in helping them develop a healthy psychological life," said Deborah Becker, a research professor at Dartmouth Medical School and a national expert on employment issues with the mentally ill.

Becker predicts up to a third of the 8 million Americans with a severe mental illness may eventually work alongside the general public. Currently 5% to 10% hold jobs.

Some caution

To be sure, mental health experts say mainstream jobs aren't for everyone. A recent case involving a schizophrenic woman who allegedly threw her three children in the San Francisco Bay has raised concerns that some people with mental illness are simply too sick to manage their daily lives, much less manage a job.

The new antipsychotic drugs that have significantly helped some patients haven't worked for everyone. And a significant portion of people with mental illness don't take their medication regularly. In an 18-month study released by the National Institute of Mental Health last month, three-fourths of the patients stopped taking their medications at least once.

Additionally, the mentally ill have higher rates of substance abuse than the general population, which can clearly cause havoc in the workplace.

"We have to be careful here," said Dr. Neal Adams, a Santa Cruz psychiatrist. "The important thing is that people don't feel that they have to work."

Doctors and counselors have long discouraged most mental health clients from working, fearing that the stress of bosses, co-workers or deadlines would overwhelm them. Clients who did work tended to volunteer at local charities or in group settings with other mentally ill people doing administrative or janitorial jobs.

Encouraging more of the mentally ill to find jobs could one day save the mental health system a considerable amount of money. But treatment providers say financial savings isn't their motivation. A growing body of research shows that people with mental illness fare better when they work. They also do better on the job than the general public might assume.

Dr. Judith Cook, a professor of psychiatry at the University of Illinois at Chicago, headed one the largest studies on the topic, which was released this year in the Archives of American Psychiatry. Cook followed 1,300 people with mental illness in seven cities over two years and found that up to 64% of them worked — several times the norm. There were no reports of anyone being violent or disruptive at work.

Cook also noted that participants in the study earned a total of $4.7 million during the two-year period.

Currently, even though many get government support, 70% of the mentally ill live on less than $20,000 a year, according to the National Alliance on Mental Illness. The majority of those who receive state and federal disability assistance — typically $800 to $900 a month — are allowed to earn only a minimal amount of additional money. If they earn more, they risk losing both their payments and the equally important health insurance provided under Medicaid.

On the career track

Under the new treatment approach, anyone who wants to work is encouraged to find a career that interests them and fits their skill set.

Depending on the severity of their illness, some are pursuing careers they abandoned when they got sick and are going back to work as teachers or flight attendants. Others are finding entry-level jobs in fast-food restaurants or as salespeople in department stores. Still, it's not easy to match up clients with jobs, said Paul Barry, associate director of the Village, a mental health center in Long Beach that finds housing and work for people with mental illness.

"Our biggest obstacle for our folks is not their mental illness, but the fact they may be 35 years old but vocationally act more like they're 16," he said.

Signs of schizophrenia and bipolar disorder typically appear in the late teens or early 20s, leaving many people unable to finish school or begin a career. As a result, many aren't attuned to how to act on the job, keep a schedule or deal with delicate office politics.

Barry said many clients got the hang of it after a few years but often switched jobs several times in the process.

It's illegal for employers to ask job applicants about their medical history, and experts say a significant number of mentally ill workers don't inform their employer about their illness.

The Village, like a growing number of mental health clinics, has its own job placement agency. It advertises as a general employment service and doesn't necessarily inform its clients that their workers have a mental illness.

But the counselors often go a step beyond those at a regular employment agency. The counselor from Merriman's clinic, for instance, drove him around to look for openings. (Merriman is an avid cyclist, but does not drive.) She helped him fill out the application at Lowe's. She sat in with him during his interview and later gave him advice about what to wear on his first day of work.

Once someone is hired, the state may provide a stipend for clothes and transportation. Workers typically talk with counselors weekly — in person or over the phone — to sort through any problems that pop up.

Until 2004, Harvey Cochran of Long Beach was serially unemployed. Cochran, 40, who suffers from bipolar disorder, understands why he was repeatedly fired. He showed up late. He forgot to show up at all. During bouts of depression, he often didn't leave his room.

Cochran now works at a movie theater as an usher and behind the concession stand 15 hours a week. His job counselor has helped him better manage his schedule, as well as his relationships with bosses and co-workers. He recently got a raise from $6.75 to $7.15 an hour; and he has saved $1,000 in the last year.

Cochran also says he's more outgoing, and he likes being able to buy things he wasn't able to afford. For his recent 40th birthday, he bought himself a 36-inch television and a DVD set of the "Karate Kid" movies. "They're my favorite," he said.

Corporate aid

Employers are embracing the concept rather easily. The majority of clinics place individual clients with local businesses, but a number of larger companies also are signing on. Among them: Best Buy, Johnson & Johnson and Trader Joe's. All are hiring applicants with histories of mental illness as long as doctors say they are able to work.

In certain cases, employers are seeking out a small number of mentally ill workers as part of an overall effort to support the mentally ill.

Merriman's manager at Lowe's, Koko Ingram, says he is a "great employee." Lowe's uses anonymous shoppers to judge how often workers greet customers and how well they answer questions. "The last time, we got extra points because of how well Steven did," Ingram said.

Mental health advocates hope the public will become more sensitive and more comfortable around people with mental illness as they move into the mainstream workforce.

Mental health professionals also are encouraging more of their clients to go to college, hopeful that they will find long-term careers. Brenda Lee Riley, a 47-year-old Long Beach resident who suffers from paranoid schizophrenia, has finished six semesters at Cal State Long Beach. For years, Riley hardly left her apartment. Like many people with mental illness, she also battles a drinking problem. But her self-confidence has soared since enrolling in college.

One of the things she most likes about being on campus is the conversation. "People in college talk about things other people don't talk about," she said. "They talk about that DeLay guy getting arrested. They talk about politics and what's going on around the world."

She takes three classes a semester and has earned a 4.0 grade point average. Riley hopes to become an English professor.

Her main goal, in the meantime, is to stay focused.

"I understand it will be several years before I become a college professor," she said. But "I want to use my head. I want to help people and I want to work. I want to contribute."