Let’s Talk Employment
A Guide for Family Members of Individuals in Mental Health Recovery
What Families Can Do to Help Job Seekers Overcome Vocational Barriers
What Questions Should I Ask?
- What are some barriers we might expect?
- What should I do if my family member does not want my help?
What You Should Know
As mentioned in other sections of this Guide, being a role model and providing a positive attitude toward employment are perhaps two of the most important ways that families can support the process of vocational recovery. If families can promote persistence, hope, optimism, resilience, and confidence (without nagging), it is extremely beneficial to the job seeker. Filling the position of “role model” does not mean that you are expected to be a perfect person; it simply means that you try to show enthusiasm for your own work whether it is in a job outside or inside the home. It is really the effort to help that counts, even if it does not seem successful at first. If you don’t know exactly how to help, remember it is the willingness to be supportive that matters, not always knowing the right thing to say.
It is important not to oversimplify the process or to underestimate the barriers that one has to overcome in order to get and keep employment. Advice is not always the best way to motivate someone to go to work, especially if the person does not think any of these options are good or simple.
You still can support your family member, even if you do not agree with their decisions about employment; you can listen, provide positive comments when deserved, and offer tangible supports that your family member wants or needs. You also can borrow some of the practices that Employment Specialists use from Motivational Interviewing. Some short version principles:
- Resist telling the person what to do. Avoid telling, directing, or convincing the person what to do.
- Understand the person’s motivation; his or her values, needs, abilities, barriers to change, and what is important.
- Listen with empathy; be active listeners with more attention to the individual’s motivation than yours.
- Empower the person to set his or her own goals and identify ways to overcome barriers.
Consider how you would respond to these barriers:
- Disincentives in the public benefits (Social Security, Medicaid etc.) The structure of public benefits is often a chief deterrent to working and is seen as a barrier, typically by the person in recovery, but also by the families who may have worked very hard over a long period of time to obtain the benefits. With the right information and benefits counseling by very knowledgeable specialists, job seekers may be able to come up with a plan which enables them to net more money than with benefits alone. Using work incentives provided by Social Security can be helpful in increasing income.Using resources that help to stretch dollars, such as housing subsidies, thrift shops, clipping coupons, and food stamps (SNAP) also can make employment worthwhile. Misinformation or insufficient information can get in the way of persons in recovery achieving employment. As for health benefits, they have to be carefully researched so that the employer, Medicaid, Medicare, and/or other federal/state resources dedicated to health benefits are accessed by the “employee.”With the right information, the fear of losing benefits can be reduced. It is critical to get: Benefits Specialists to help find the way through the maze of policies.
- Attitudes, expectations of others, and the culture of unemployment. Professional and family expectations can encourage or discourage people in recovery from considering or pursuing employment. Clinicians, family, or friends may feel that employment is either not possible or not in their best interests. Because of the extremely high percentage of people with psychiatric disabilities who are unemployed (about 85%), potential job seekers may feel that unemployment is the norm for a reason; thus unemployment becomes part of their culture.Social views of mental health conditions contribute to the generally low expectations for employment. Clinicians and families can be supportive and encourage employment while avoiding placing pressure on the job seeker to choose specific employment goals.
- Fear of too much stress or fear of relapse. You or your family member may think that work will cause too much stress or even trigger a relapse. As with people who do not have disabilities, high stress at work may be a result of the wrong match – either the work environment may not be right or the job itself is not right. People in recovery can be taught how to manage stress at work and adopt wellness activities that can be utilized to prevent or reduce stress. Should someone have a relapse, it may be short term, enabling a return to work. If the employee has to leave a job, benefits can generally be reinstated on an emergency basis, until benefits are re-determined or the person goes back to work in a different job.
- Lack of confidence. This can occur when someone has no work history or a problematic work history. It even can occur when someone has had a good work history, but now is dealing with a mental health condition. In any situation, a person can be lacking in confidence to such a degree that they will not consider working or postpones actions that could lead to employment. Families can assist in helping to restore confidence or get through a series of small accomplishments. A family member might also volunteer to take the job seeker to a Job Fair or Resource Fair.
- Inability to fluently communicate in English. Family members can assist the individual in finding English classes, if they are open to the idea. An employment specialist or any other resource person could practice essential phrases and questions with the job seeker. The individual also can seek employment in environments where fluent English is not as important.
- Discrimination (all forms). There are many types of discrimination (mental health conditions, racial, ethnic, gender identity, religion, etc.), so people in recovery may experience it on more than one front. Employment specialists, clinicians, and families all can be helpful in teaching how to deflect discrimination and stigma, whether it is subtle or more obvious. Sometimes if the employee receives accommodations, there may be resentment by coworkers, which is a little different than discrimination due to disability itself. Being prepared for these different types of aggressions with awareness and skills will help the employee to maintain employment and reduce the stress that might occur.
- Worrying about losing the job. This is another expression of the lack of confidence in employment. An Employment Specialist or Job Coach can assist the employee with boosting confidence and reducing anxiety.
- Insufficient access to effective vocational services. Although we know through research that there are some effective approaches to psychiatric vocational rehabilitation, those effective models often are missing from many communities. This may be due to insufficient funding or lack of priority in the service system. Employment Specialists and families sometimes can find resources that are a good fit for the job seeker or help to transport the job seeker to another area where the vocational services are available. Families can be a tremendous force in advocating for the development of vocational services. Only around 2% of those in need of supported employment services receive them.
- Insufficient clinical services. Clinical services that are suited to one’s culture, language, values, and beliefs may be unavailable in your community or may only exist in a very limited way. It is still worth searching for clinical services in your community or in another community that your family member can reach. Alternative or complimentary health practices also should be easily accessible to maintain a good health/mental health balance.
- Insufficient job protection. See Section 12 for the policies and legislation around job protection. While helpful to many, sometimes these policies and legislation are not enough to assist in helping someone to save their job when it is in jeopardy. The Americans with Disabilities Act (ADA or ADAA), for example, does not always have “strong teeth.” Although it was a hard-fought victory to pass the ADA, it is not uniformly or assertively enforced. Refer to the next page for locations for ADA Centers that offer some legal advice.
Should your family member not want your help, ask them how you can be most supportive. You might give some examples of how that might work by using a friend to provide an informational interview (practice interview), by helping to get a bus pass, or by providing another specific support. If your family member still does not want you to do anything, just remain available.
Cook, J. Subcommittee on Employment and Income Supports of the President’s New Freedom Commission on Mental Health. (Oct. 1, 2006). Employment barriers for persons with psychiatric disabilities: Update of a report for the President’s Commission. Psychiatric Services. http://ps.psychiatryonline.org/doi/full/10.1176/ps.2006.57.10.1391
Henry, A., & Lucca, A. (2004). Facilitators and barriers to employment: The perspectives of people with psychiatric disabilities and employment service providers. Work, 22(3):169-82.
Abstract at: https://www.ncbi.nlm.nih.gov/pubmed/15156083
Moss, K., & Burris, S. (2007). The Employment Discrimination Provisions of the Americans with Disabilities Act: Implementation and Impact. The Future of Disability in America. National Academy of Sciences.
ADA CENTERS– national network throughout the U.S. can offer consultation and advice (cannot represent clients legally).
Bond, G. (2016). Evidence for the Effectiveness of Individual Placement and Support Model of Supported Employment. https://ipsworks.org/index.php/library/