Let’s Talk Employment
A Guide for Family Members of Individuals in Mental Health Recovery
To Work or Not to Work?
Questions your family member are likely to ask:
It may be helpful to look at questions that are likely to occur to your family member when considering employment. There are many factors that a person will think about when deciding whether or not to work, or if they want to delay working until a future date.
A. Can I see myself as an employee?
What you should know:
It is common that those with mental health conditions think of themselves as a “disabled person,” which often overshadows their identity as a successful employee. It is possible to develop a stronger worker identity before pursuing an actual job. If this is not an issue, the “preparing for work” step often can be skipped, allowing the job seeker to go directly to supported employment.
Some of the steps that may be helpful in building worker identity and confidence are:
- Complete a skills development curriculum in high school
- Complete a self-assessment e.g. work history, interests and skills
- Complete an internship or volunteer work to experience what it is like to have the routine of working
- Participate in a rehabilitation clubhouse program that is based on the work-ordered day. Paid work opportunities often emerge from this (in 46 states and not all communities)
- Complete a workbook or guidebook to discover what steps would be meaningful or helpful in developing a career
As a supportive family member, you might find out what would be needed in order to complete a through e above. You also may simply talk to your family member about their interests, dreams, and hopes about working. This might give you an idea about what their worries are or what they see as barriers to employment. Consider using a resource, such as:
IPS Employment Resource Book. Center for Practice Innovations. Columbia University, (2014). A workbook for job seekers; See especially pages 17-28 for some factors job seekers would consider prior to a decision to work, some sample conversations with family and cultural factors. Free download in English and Spanish. Searching for internships online and at job fairs.
Center for Parent Information and Resources while family member is still in school; most relevant if the family member has an Individualized Education Program (IEP) as a special education student.
Savickas, M. L., & Hartung, P. J. (2012). My Career Story: An autobiographical workbook for Life-Career success. http://www.vocopher.com/CSI/CCI_workbook.pdf
B. Do I have the energy and personal resources to work successfully?
This is an important question for those who are not particularly active in the community or who may have limited networks of support. In this situation, the focus is on building energy and the network of potentially supportive people.
What you should know
It is helpful for your family member to have a daily routine that requires the completion of tasks or projects both at home and/or outside of the home. This can help to determine how they are doing and what help might be needed to move forward.
The idea is to evaluate and build readiness for the responsibility of employment. When your family member is struggling with the issue of whether they are able to work, one of the most important roles of families is reflective listening rather than direct advice.
You can borrow principles from an approach called “Motivational Interviewing,” a strategy for helping others to change. You could ask open-ended questions, then reflect back to your family member what you think they were trying to say (without judging or directing). The idea is that helping someone to change is really helping them to reflect on what they already know, rather than telling them how to “fix it.” Here are some examples of how it works:
- Open-ended questions
Example: What kind of held do you think you need to go back to work?
Example: Great. You really have been giving some thought about your choice and doing your research.
- Reflective Listening
Example: So you think that you need more training to be able to work at the job you want.
- Summary Statements
Example: I think I understand. You really want to work, you know the pros and cons, but you want to find a want to get additional training first. Is that right?
Here is a video example of Motivational Interviewing and Employment session with OARS labeled, you can watch a video with a potential job seeker.
When someone can commit a certain number of hours per day to a fixed schedule of activities, this is a big step toward self-knowledge and answering the big question: “Can I do it?”
When completing tasks (such as doing laundry, raking leaves, painting a room, shoveling snow) or projects (such as tending a garden or training a dog), your family member is helping to build readiness. It is possible to build the capacity for activity a little at a time. Your family member may begin to notice at what point energy or attention improves and interest increases. One strategy is to break down a task into smaller steps, then gradually increase the size of the steps until there is a sense of accomplishment. Families can help by identifying tasks or activities that need to be done, encouraging participation in the activities, and acknowledging a job well done.
Developing wellness is another aspect of preparing for work. In other words, if your family member does not yet have a worker identity, structuring time during the day for wellness activities also can help with building readiness. Your family member can develop a daily structure including some exercise, meditation, yoga, walking, or other wellness activities that contribute to wellbeing and concentration.
There also are structured guides to dealing with health and mental health issues as well as preventing or dealing with crises, which many help your family member feel more confident.
Wellness Recovery Action Plan is widely used in mental health programs and by self-help groups. It also has been adapted for Latinos, Veterans, Families, Addiction, Kids and People with Developmental Disabilities. Copeland, M. Wellness Recovery Action Plan (WRAP). http://psychcentral.com/library/id239.html
There are many resources your family member can use for building concentration and focus, such as simple games, crossword puzzles, Sudoku, and other online games. There may be programs or services that also can help with building readiness, and we will consider them in a later section.
Boston University, Center for Psychiatric Rehabilitation on Readiness: Assessing and Developing Readiness for Rehabilitation (includes work or any personally developed goal.)
Online games at: http://www.ibraining.com/
Whole Health Action Management. WHAM is a training program and peer support group model developed to increase resiliency, wellness, and self-management among people with mental health conditions and substance use disorders.
Swarbrick, M. (2010). Peer wellness coaching supervisor manual. Freehold, NJ: Collaborative Support Programs of New Jersey, Institute for Wellness and Recovery Initiatives. Wellness Coaching is a training manual to help coach individuals on the dimensions of wellness.
C. Do I know how to find the right vocational professional?
A vocational professional can be the most important support your family member will need. Some vocational professionals are in programs where their role is very obvious, such as the state Vocational Rehabilitation Agency Counselor or the America’s Job Center Employment Specialist. Supported Employment Programs, which are excellent at rapid job placement, may not be quite so easy to find as they may be listed on the Internet under a Community Mental Health or other agency. It is a matter of finding the right agency for you family member’s specific needs. Benefits Specialists also can be invaluable to potential job seekers by translating the maze of information on benefits and employment. See links on the next page for how to find a vocational professional.
What you should know:
Each possible resource for employment services is likely to have criteria that your family member has to meet in order to get help. For example, your family member might have to live in a certain area, be in a specific age range, be part of another agency like the Department of Mental Health, be involved with a certain treatment team, or have particular diagnoses.
Some possible doors your family member can try to enter for vocational support include:
You can do an Internet search of supported employment programs in your state. If this doesn’t work, contact the state Dept. of Mental Health in your area or search the Internet for your state’s directory of local offices.
State Mental Health agencies Administrative Offices
State Vocational Rehab Agencies Admin Office They can help to assess the individual, develop a vocational plan and provide or coordinate the services necessary to attain the goal
Rehabilitation Clubhouses in 46 states (in-house volunteering; transitional employment paid, part time- employment in own job with supports; independent employment.
Vocational Professionals through Ticket to Work A benefit of the Social Security Administration for Persons on SSI.
Programs of Assertiveness Treatment Free downloads. Not all programs have strong employment focus so explore in advance.
These are services generally open to all citizens (not restricted to people with disabilities) but they are supposed to serve persons with mental health or physical/ developmental disabilities as well:
Workforce Innovation & Opportunity Act (WIOA) – find resources.
D. Do I really understand how earnings will interact with benefits such as Social Security, veterans, medical, housing, or whatever benefits might be relevant to me?
What you should know:
The relationship between benefits and work can is not always clear. There tends to be much misinformation or incomplete information. People often make choices not to work or to remain in part-time entry-level work because someone has told them that this is the best option when it is not the whole story. What happens to benefits when my family member starts to work? This has a complex answer and we strongly recommend you read this carefully.
Benefits and Employment How it Works. You may want to go over it with your family member/job seeker.
For veterans this may be helpful, and consult a Veterans Employment Specialist Veterans Benefits and Work:
VA Fact Sheet:
Here is a GLOSSARY OF BENEFITS TERMS
The questions related to benefits and work should be asked very early on in the “thinking about work” phase of the process so that any chances of misinformation or partial information can be minimized. The best approach is to have Benefits Specialists, who guide you through the maze of benefits and earnings and answers all your questions. However, not all states or all communities provide access to such a person. If this is the case, an Employment Specialist may be your interpreter of the benefits – earnings issues.
In addition to cash benefits and concerns about work, an equally important factor to look at is medical benefits and what will happen when someone works. If your family member retains even one dollar of SSI cash benefit, medical benefits will be retained. If your family member has been on SSDI for two years or more and goes to work, they retain their Medicare as long as they are still on SSDI, such as through a trial work period. Many employers will pick up health care benefits often for full time workers. There is a way for working disabled persons who have any SSI benefit to retain Medicaid while working. Certain criteria are necessary under 1619 b section of Social Security. It works as long as the worker is still considered “disabled” until income reaches a level determined by the state.
Persons with disabilities in selective states also can benefit from the Medicaid Buy-In if they meet the eligibility criteria. It allows those who would not be able to continue Medicaid while working to purchase Medicaid at a lower rate, similar to buying private insurance. Forty one states participate, and you can learn more by contacting your social security administration local office.
Some of the Medicaid benefits and other federally-subsidized health benefits (e.g., Affordable Health Care Act or its replacement) vary from state-to-state as some of the states offer different subsidies. Medications often are very expensive, and if your family member does not have sufficient coverage through health benefits, some pharmaceutical companies will provide medications at no cost. For those on Medicare who have limited income for premiums, deductibles, and copayments of their Medicare Part D prescription drug plan Social Security has a program called Extra Help.
With the right information and using the incentives provided by the Social Security Administration, a job seeker with a disability almost always will end up with a total of more money. The next goal is to make the dollars s-t-r-e-t-c-h.
Learn the basics of how work and benefits interact. Get the right information and keep up to date.
Another important strategy is to make the dollars stretch. In many areas of the U.S., housing and related costs are so high that a large portion of a person’s income is spent for housing and related costs. The amount of money coming into the household is not the only thing that affects the quality of life. Some of the ways you can help your family member make the dollars stretch include: applying for housing subsidies (probably the most helpful), food stamps (SNAP), using food banks, clipping coupons, and shopping at thrift shops or second-hand stores both traditional and online stores.
You can assist your family member by locating professionals who can help maneuver the world of health related benefits. You could start with your local Department of Mental Health or state Vocational Rehabilitation agency. If your family member is working with a Supported Employment program, there should be Benefits Specialists who can help.