Barriers to Employment for People with Schizophrenia

VISN 1 MIRECC researchers have demonstrated that both symptom severity and institutional factors contribute to unemployment for people with schizophrenia. In a study of over 1400 patients entering a study of antipsychotic medications, 72% were unemployed and only 15% were participating in competitive employment with an additional 13% engaged in supported employment. Not surprisingly, unemployed patients had more severe schizophrenia symptoms and poorer mental acuity.  More severe symptoms can be both a barrier to employment and also a result of inactivity associated with unemployment. The more disturbing findings of the study indicated that being black, receiving disability payments and having reduced access to rehabilitation services were also barriers to obtaining paid employment. The authors note that receiving disability payments can be a major disincentive for obtaining competitive employment because recipients fear the loss of benefits and of health insurance if they work for pay. Policy makers face a challenge of preserving employment incentives without jeopardizing the financial safety net required by many people with severe mental illness especially because their need for support is both long-term and intermittent. The authors call for changes in policies that provide a fair mechanism that preserves income support while allowing access to the rewards of employment. Access to employment by people with severe mentally illness was expected to be improved by the passage of the Americans With Disabilities Act in 1992. Instead, employment in this population dropped steadily in the 1990’s.Removing financial disincentives associated with disability payments and improving access to supported employment could reverse this trend. VISN 1 MIRECC researchers Robert Rosenheck and Douglas Leslie led a national group of investigators including Richard Keefe, Joseph McEvoy, Marvin Swartz, Diana Perkins, Scott Stroup, John Hsiao and Jeffrey Lieberman.