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On-the-job therapy

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

October 31, 2005|Daniel Costello | Times Staff Writer

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.

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