What’s in a name?
For Shakespeare, using Juliet as the surrogate tongue of his worldview, a name is merely an arbitrary label, no more reflective of one’s essence than the color of your shirt. Juliet implores Romeo to understand her love for him is not contingent on a designation like his family’s name, but rather on the content of his character, his true essence as an individual. However, more than four centuries later, in a world replete with definitions, how do we define ourselves as individuals? We might discuss our hobbies, our faith, our friends and family—those social determinants of health we rely upon to remain active, healthy participants in life and community. These are all valid categories from which to derive our sense of self. In a contemporary world, however, we would be remiss to ignore employment as a powerful arbiter of both our self-identity and our overarching worldview.
What’s in a Job?
Employment, at least in American society, is often paralleled with notions of responsibility, drive, resilience, stability—purpose. When we make an acquaintance, we often first ask: “What do you do?” These words are so entrenched in our idiolect of casual conversation, we know exactly what someone means when these four words are posed in this sequence. But do we know why we ask? I would posit that we ask because we prioritize employment as a society. Employment, or more specifically the freedom to exchange one’s labor in an open market in return for a means to subsist, is solidly an American virtue. American culture has evolved upward alongside a hard-woven lattice of activism, mobilization, and public policy formulation for the civil liberties. Workforce participation can be an ingress through which the individual realizes their distinct connection to this lattice. Through our work, or what we give and create, we are exercising one of the most basic and important instances of our autonomy—and autonomy is very American.
Why then, when 75 percent of individuals diagnosed with a serious mental illness (SMI) declare their desire to work, are only 15 percent employed at any given time? We know people diagnosed with an SMI can work successfully, and some would argue if one can work, then one should, lest we relinquish one of the most ostensible conduits for our own self-government. There are several reasons why such a chasm exists between the desire to work and actual employment outcomes for those living with an SMI diagnosis. Stigma is perhaps the most obvious reason, but stigma can be overcome with continued education and outreach to employers who might be on the fence about hiring someone with a disabling condition. Another reason may be the job seeker’s confidence (or lack thereof) in their own ability to work. Perhaps they never heard from anyone else that they are capable and that the terminus of their recovery hopes need not amount to a life relegated to isolation and idle hands.
For decades, the consensus among behavioral health professionals was that such isolation and inactivity (in tandem with medication compliance) was, indeed, recovery. Now, contemporary behavioral health science paints a different picture, a more complete picture, including healthy and holistic pursuits like socialization, recreation, education, and yes—economic stability via employment.
Additionally, in the realm of public behavioral health policy, employment programs offer a rare opportunity to reach across political aisles. In a time when support for public programs is met with growing contention, cost-effectiveness analyses have already confirmed that supporting people in their employment journeys can have an immense return on each invested tax dollar—manifest by fewer inpatient hospitalizations, decreased prevalence of substance use, and lower justice system involvement and recidivism rates among people employed in competitive, integrated work settings. Many individuals who obtain long-term, steady employment through supported employment programs (e.g., IPS team services) eventually elect to opt out of any public assistance they were receiving prior to employment.
What’s in a Jobs Program?
Individual Placement and Support (IPS) is an evidenced-based supported employment framework. IPS programs in Alabama are embedded within the state’s community behavioral health network, designed to support individuals diagnosed with an SMI or co-occurring substance use while they pursue meaningful, integrated employment based on their unique preferences. Many of the individuals who find jobs of their choosing through IPS services report that they initially lacked the confidence or autonomy of choice necessary to feel comfortable pursuing employment as a goal in their recovery. In some cases, even immediate family members might doubt the individual’s ability to maintain successful employment, or they might fear that holding a job could exacerbate symptoms related to the job seeker’s diagnosis. Clinicians often relay the same concerns. IPS teams invite families, often rightfully protective of their loved ones living with a diagnosis, to participate as equal and valued consumers of IPS service delivery. Clinicians, some of whom were once cynical of employment’s potential as a mechanism for recovery, often become proponents of the model when they witness the resultant decline in adverse symptomology.
When IPS teams help a job seeker overcome barriers, the job seeker and their supporters often realize how much innate potential was lying just under the surface, waiting to be unlocked. Gainful employment leads to an individual’s increased sense of fulfillment, and being productive is a basic human need. Alongside the inaugural moment when a newly employed consumer deposits their first earned income, they often report sensations of pride and achievement, but also the recognition that employment has led them toward increased economic stability and better control of their own destiny.
Stressors related to economic instability are often associated with increased symptomology in persons diagnosed with an SMI, which is why two of the IPS tenets we promote are rapid job search and zero exclusion. Individuals are not turned away from IPS services on the basis of symptom severity and once enrolled, IPS employment specialists work fast to begin job developing on behalf of the job seeker. Benefits counseling services also go hand-in-hand with IPS team services, so if an individual is hesitant about pursuing employment because of their benefits status, a certified benefits counselor is on duty and ready to offer professional advice about how (or if) work hours and wages might affect their benefits. And again, once the job seeker finds the right job match, they often enjoy the increased quality of life that accompanies a better paycheck. This in turn, in an abundance of successful cases, has led to a voluntary withdraw from public assistance programs.
This concept is no longer new to program developers in public behavioral health systems, and now, we can say it’s no longer new to the commercial world either. This movement has gained momentum with larger-than-life partners like Publix, Walmart, and Walgreens among many others. The cat is officially out of the bag. People with disabling conditions want to work, and they can work, and what’s more—they can work quite well when surrounded by integrated supports and daily encouragement. One hiring manager in the state of Alabama said of her employee, an IPS service recipient, “An employment specialist recommended a person who is one of my best employees. She takes pride in her work; it’s more than just a job to her.” Employing individuals with an SMI diagnosis not only contributes to their continued recovery and economic wellbeing, but it gives the individual a chance to become part of the fabric of their community. For this, your community will always be better off.
Please visit VitALalabama.com/projects/ips-works for more information about IPS service access in Alabama.