Outcomes of employment discrimination charges filed under the Americans With Disabilities Act.

OBJECTIVE: The outcomes of employment discrimination charges filed under the Americans With Disabilities Act (ADA) by individuals with psychiatric disabilities and those with other disabilities were compared. METHODS: Data obtained from the Equal Employment Opportunity Commission (EEOC) consisted of all ADA employment claims closed as of March 31, 1998. Charges were categorized by whether they were investigated by the EEOC or by a Fair Employment Practice Agency (FEPA). RESULTS: Of the 175,226 charges filed, 83.2 percent were closed by March 31, 1998. Of these, 15.7 percent brought some kind of benefit to charging parties, although only 1.7 percent resulted in new hires or reinstatements. Of charges investigated by FEPAs, 23.3 percent led to some benefit, compared with 11.5 percent of charges investigated by the EEOC. Of charges investigated by the EEOC, the median actual monetary benefit was $5,646, compared with $2,400 for charges investigated by FEPAs. A total of 13.6 percent of charges filed by individuals with psychiatric disabilities resulted in benefits, compared with a benefit rate of 16 percent for persons with other disabilities. The median actual monetary benefit received by persons with psychiatric disabilities was $5,000, compared with $3,500 for those with nonpsychiatric disabilities. Individuals whose charges were investigated in the first three years of ADA implementation were more likely to receive benefits than individuals whose charges were investigated more recently. CONCLUSIONS: Most employment discrimination charges filed under the ADA do not result in benefits or a finding of reasonable cause. Outcomes for people with psychiatric disabilities do not differ substantially from those for people with other disabilities.     

Effect of benefits counseling services on employment outcomes for people with psychiatric disabilities

OBJECTIVE: This study examined the impact of specialized benefits counseling services on levels of competitive employment for people with psychiatric disabilities receiving Social Security Administration (SSA) disability benefits in Vermont. METHODS: Beneficiaries who had a psychiatric disability and who received specialized benefits counseling (N = 364) were compared with matched contemporaneous and historical control participants over four years, two years before and two years after the initiation of the intervention. Study participants were consumers of vocational rehabilitation services, and the outcome measure was quarterly earnings from state unemployment insurance program records. Benefits counseling included general education regarding SSA disability programs, the various work incentives available under those programs, and other federal and state public benefits; individualized research and counseling regarding enrollees' current benefits packages; assistance in managing benefits through the transition to employment; and provision of information to supporting professionals. RESULTS: Participants who received specialized benefits counseling achieved significantly greater improvements in earnings. The benefits counseling group increased its adjusted average earnings by 1,256 dollars per year in comparison with the two control groups. CONCLUSIONS: Specialized benefits counseling appears to be an important employment support for Social Security Administration disability beneficiaries who have psychiatric disabilities.     

Mediation of employment discrimination disputes involving persons with psychiatric disabilities

OBJECTIVE: This study sought to determine whether persons with psychiatric disabilities who filed employment discrimination complaints with the Equal Employment Opportunity Commission (EEOC) under the Americans With Disabilities Act (ADA) were referred to the EEOC's mediation program with the same frequency as ADA claimants with other disabilities. The extent to which employers agreed to engage in mediation with claimants and the extent to which claimants benefited from participating in the mediation program were also examined. METHODS: The data included all 23,759 ADA charges filed with the EEOC from January 1, 1999, through June 30, 2000, and closed as of September 30, 2000. Percentages of mediation rates were computed, and chi square tests were conducted to test for differences between categories. RESULTS: Individuals with employment discrimination complaints based on psychiatric disabilities were slightly but significantly less likely to be referred by the EEOC to mediation than were individuals with other types of disabilities. Moreover, employers were significantly less willing to mediate with claimants who had psychiatric disabilities than with those who had nonpsychiatric disabilities. Once employers agreed to participate in mediation, however, the majority of cases were settled. No significant differences in settlement rates were found between cases with claimants who had psychiatric disabilities and cases with claimants who had other types of disabilities. CONCLUSIONS: The EEOC's mediation program has been a remarkably successful development and has the potential to provide effective case resolution services to thousands of EEOC claimants. However, the agency should educate employers and EEOC investigators alike that many people with psychiatric disabilities can work productively and participate in mediation successfully.     

Chinese cultural dynamics of unemployability of male adults with psychiatric disabilities in Hong Kong

Work and employment has long been regarded as crucial for the mental health of human beings. Unemployment may lead to deterioration of physical and mental health. Nevertheless, for adults with psychiatric disabilities, discontinuity of employment is common. They may have various reasons to discontinue their employment. In Hong Kong, only 2.5% of people with psychiatric disabilities discharged from sheltered workshops are able to seek open employment. By means of illustration, the authors will show that traditional Chinese work culture tends to reinforce the discontinuity of employment of adult males with psychiatric disabilities. In Chinese culture, work is a means to occupy time, control misbehavior, show consistency of words and deeds, and to glorify parents and ancestors. All these factors contribute to the fulfillment of an adult male role and identity in traditional Chinese culture. In this case history, instead of finding realistic employment, a male adult with psychiatric disability tried to indulge himself in what he felt was his ideal job to fulfill all requirement as an adult male in Chinese culture. The imaginative ideal job gave him excuses to discontinue open employment. Its implications to vocational rehabilitation with male adults with psychiatric disability are also discussed.     

Can SSDI and SSI beneficiaries with mental illness benefit from evidence-based supported employment?

OBJECTIVE: Individuals with psychiatric disabilities are the fastest-growing subgroup of Social Security Administration disability beneficiaries and have negligible rates of return to competitive employment. Nevertheless, a new approach to vocational rehabilitation, termed supported employment, has increased the optimism regarding employment for this population. METHODS: Aggregating data from four randomized controlled trials of evidence-based supported employment for persons with severe mental illness, the investigators compared 546 Social Security Administration disability beneficiaries with 131 nonbeneficiaries. Three employment measures were examined: job acquisition, weeks worked, and job tenure. RESULTS: Beneficiaries receiving supported employment had better employment outcomes than those receiving other vocational services. Similar results were found for nonbeneficiaries. Overall, nonbeneficiaries had better employment outcomes than beneficiaries. However, the effect sizes measuring the improved outcomes with supported employment were similar for beneficiaries (d=.52-1.10) and nonbeneficiaries (d=.78-.89). CONCLUSIONS: Evidence-based supported employment could enable many Social Security Administration beneficiaries with psychiatric disabilities to attain competitive employment even though receipt of disability benefits operates as a barrier to employment.     

Employment equity and mental disability

PURPOSE OF REVIEW: Recent research on the civil rights issue of employment equity for people with psychiatric disabilities is reviewed. RECENT FINDINGS: Mental disorders, particularly depression, are the most frequent source of occupational disability worldwide and are expected to grow. Employers are increasingly aware of the productivity costs associated with mental disorders and the importance of fostering a mentally healthy workforce. Few firms, however, have explicit policies to include disabled people in their workforce, and many employers continue to express prejudicial views toward people with mental disabilities which would exclude them from competitive work. At the same time, disability legislation has not offered the hoped-for protection for people with mental disorders. Employers have expressed concerns over the costs of making workplace accommodations and have successfully battled for a legal definition of disability that excludes many individuals with mental disorders. CONCLUSION: In the absence of antistigma efforts directed toward the business community, one wonders if the growing awareness of the productivity costs associated with mental disability will foster greater employment equity, or fuel more subtle forms of employment discrimination. Low employment levels among people with disabilities remain a major determinant of the social disparities they face.     

Employment Support Services in Japan

Although some people with psychiatric disabilities have a desire to gain employment in Japan, the employment situation is not conducive for people with such disabilities. Nonetheless some efforts have been made to improve the situation within the country through the introduction of new employment measures and enhancement of employment supports for people with psychiatric disabilities. This article provides an overview of policies, employment support services, and actual employment situation for people with psychiatric disabilities in Japan. It also indicates some of the progress within each area. Even though the process to promote employment for people with psychiatric disabilities has been slow, the number of people with psychiatric disabilities calculated in the actual employment rate has grown at a faster rate than before. This progress brings a sense of hope to people with psychiatric disabilities who want to work.     

Vocational rehabilitation in psychiatry: a re-evaluation

OBJECTIVE: To highlight the vocational gap in the provision of psychiatric rehabilitation, to outline the goals and conceptual framework of psychiatric rehabilitation, and to discuss rehabilitation interventions with specific reference to vocational rehabilitation and the evidence base for supported employment. CONCLUSIONS AND SERVICE IMPLICATIONS: Vocational psychiatric rehabilitation has been a neglected area of practice in Australian psychiatry. Psychiatric treatment needs to adopt a more balanced approach in the provision of a range of services, including vocational rehabilitation, in order to improve long-term outcomes for people suffering from psychiatric disability. A vocational focus should be included in psychiatric rehabilitation and better integration between mental health services and vocational services needs to take place. Supported employment is an evidence-based practice that is designed to help people with psychiatric disabilities participate as much as possible in the competitive job market.     

An update on affirmative businesses or social firms for people with mental illness

Social firms, or "affirmative businesses" as they are known in North America, are businesses created to employ people with disabilities and to provide a needed product or service. This Open Forum offers an overview of the development and status of social firms. The model was developed in Italy in the 1970s for people with psychiatric disabilities and has gained prominence in Europe. Principles include that over a third of employees are people with a disability or labor market disadvantage, every worker is paid a fair-market wage, and the business operates without subsidy. Independent of European influence, affirmative businesses also have developed in Canada, the United States, Japan, and elsewhere. The success of individual social firms is enhanced by locating the right market niche, selecting labor-intensive products, having a public orientation for the business, and having links with treatment services. The growth of the social firm movement is aided by legislation that supports the businesses, policies that favor employment of people with disabilities, and support entities that facilitate technology transfer. Social firms can empower individual employees, foster a sense of community in the workplace, and enhance worker commitment through the organization's social mission.     

Enriching the process of "good science" through participation of people with psychiatric disabilities in all aspects of research

The purpose of this study is to describe the experiences of researchers with a psychiatric disability participating in a project evaluating the services of Community Mental Health Centers (CMHCs) and to identify strategies for researchers with a psychiatric disability in mental health. A project coordinator and four researchers who were people with psychiatric disabilities were interviewed. The rationale for researchers with a psychiatric disability is discussed, and the facilitators of and barriers to them are described. People with psychiatric disabilities should be involved in formulating research questions, data collection, interpreting the results, identifying implications, and presenting the results to stakeholders. People with psychiatric disabilities' participation in CMHC program evaluation can promote service innovation and enhance people with psychiatric disabilities'satisfaction.     

Choose-get-keep: a psychiatric rehabilitation approach to supported employment.

Increasing numbers of people with psychiatric disabilities are residing in communities rather than in inpatient settings. They are also becoming more aware of the benefits of working and of their legal right to employment with accommodations. Traditional work preparation programs have failed to result in employment for many people with psychiatric disabilities. However, supported employment, when modified to reflect the basic principles and practices of effective psychiatric rehabilitation, has been shown to result in employment benefits for participants at a reasonable cost to providers. With supported employment methodologies such as the choose-get-keep approach, providers can do much to help people with psychiatric disabilities reap the many social and financial benefits of employment and achieve their community living goals.     

Mental illness and changing definitions of disability under the Americans With Disabilities Act

The Americans With Disabilities Act (ADA) prohibits employment discrimination on the basis of disability. Originally, an assessment of whether a person had a disability and thus was protected by the ADA examined the person's impairment in its uncorrected state. Thus it was comparatively easy for people with mental illness to meet the threshold requirement for having a disability. However, in 1999 the U.S. Supreme Court issued three decisions holding that, for the purposes of the ADA, disability had to be assessed in its corrected state. Since those decisions were issued, the courts have increased the burden on individuals, including people with mental illness, to prove that they have a disability. In several cases, courts ruled that people with serious mental illnesses do not have a disability and are not protected by the ADA. This article discusses these cases and their implications for people with mental illness and for practitioners.     

The EEOC charge priority policy and claimants with psychiatric disabilities

OBJECTIVE: In June 1995 the U.S. Equal Employment Opportunity Commission (EEOC) instituted a new charge priority policy. Under the new policy, charges are classified as one of three priority levels during or immediately after intake. Only charges assigned a high priority receive a full investigation. This paper examines the effect of the charge priority policy on individuals with psychiatric disabilities who filed Americans With Disabilities Act (ADA) charges with the EEOC. METHODS: Using data extracted from the EEOC's charge data system, the authors analyzed all 66,298 ADA claims prioritized and closed between June 1995 and March 1998. The z test for difference in proportions and the generalized estimating equations procedure were used. The primary outcome measure was the priority assignment received by ADA claimants. RESULTS: Charges that received a high priority assignment were more likely to result in benefits for claimants. Charges filed by claimants with psychiatric disabilities were significantly less likely to be assigned a high priority than charges filed by other claimants. Claimants with psychiatric disabilities were also significantly less likely to benefit from their claims. CONCLUSIONS: The strong relationship between being assigned high priority and receiving benefits as a result of filing a charge demonstrates the importance of accurate priority categorization. The finding that people with psychiatric disabilities are less likely than others to benefit from their claims is cause for concern, particularly given the fact that the accuracy of the charge prioritization system has not been validated.     

Strategies for Assisting People with Psychiatric Disabilities to Assert Their ADA Rights and Arrange Job Accommodations

Abstract

Psychiatric rehabilitation programs that continue to ‘make job placements” need to assess the impact that such a caretaker approach has on the long term abilities of people with psychiatric disabilities to find their own jobs and then communicate independently with employers. Following a national survey of job coaches and job developers, the authors suggest a teaching approach to providing employment support services: job developers and job coaches should teach the ADA and workplace communication skills, so that individuals can develop the ability to negotiate with employers on their own behalf. Practitioners can also enhance this teaching approach to provision of employment support services through the development of employment peer support groups.     

Support in Housing: A Comparison Between People with Psychiatric Disabilities and People with Intellectual Disabilities

The primary objective of this study was to compare type of housing and support in housing in two groups (people with psychiatric disabilities and people with intellectual disabilities) typically dependent on support in everyday life. A second objective was to examine whether type of housing and support in housing were related to gender within the two groups. Information was obtained by available questionnaire reports provided by staff members. The results indicate unequal accessibility of support in housing in relation to the two groups. Moreover, the findings suggest that type of disability is a more determining factor than gender regarding support in housing.     

Creating job opportunities for people with psychiatric disabilities at a university-based research center

The consumer empowerment movement has led to an increase in opportunities for people with psychiatric disabilities to take on roles in the development and delivery of mental health services. However, to date there has been less involvement of people with psychiatric disabilities in services research. In this paper, we describe our experiences creating employment opportunities for people with psychiatric disabilities in a university-based mental health services research center. Working with two local clubhouse programs we developed research assistant positions using both transitional and supported employment approaches. We describe the development of the jobs, employee characteristics, the orientation and training provided to new employees, job characteristics and typical responsibilities, supports and accommodations provided to employees, boundary issues we encountered, and the perspectives of employees on rewards and challenges of the jobs. We offer recommendations to mental health researchers wishing to create these types of opportunities for people with psychiatric disabilities.     

Population-level prevalence estimate and characteristics of psychiatric disability among Chinese adults

Psychiatric disability is a population health problem, and understanding its magnitude is essential to informing population health policies. This paper aims to describe the prevalence rates, causes, and severity of psychiatric disability in Chinese adults, and to explore daily activities and social functions for people with psychiatric disability. We used the second China National Sample Survey on Disability, comprising 2,526,145 persons from 771,797 households. Identification and classification for psychiatric disability was based on consensus manuals. We used standard weighting procedures to construct sample weights considering the multistage stratified cluster sampling survey scheme. Population weighted prevalence and 95% Confidence Intervals (CI) were evaluated. An estimate of 8 million adults with psychiatric disability was identified. The weighted prevalence rate of psychiatric disability was 8.14 per 1000 people (95% CI, 7.95-8.33). More rural residents suffered from psychiatric disability than their urban counterparts, and more females had psychiatric disability than males. Schizophrenia, schizotypal and delusional disorders accounted for more than half of the psychiatric disability in Chinese adults. People with psychiatric disability had more severe difficulties in most daily activities and social functions than in people with other disabilities. This study demonstrates psychiatric disability causes social burden to the Chinese communities. Strategies including case identification, treatment, and rehabilitation should be developed and countermeasures are warranted for females and rural residents to reduce the burden caused by psychiatric disability.     

A decision aid to assist decisions on disclosure of mental health status to an employer: protocol for the CORAL exploratory randomised controlled trial

ABSTRACT: BACKGROUND: The UK Equality Act 2010 makes it unlawful for employers to ask health questions before making an offer of employment except in certain circumstances. While the majority of employers would prefer applicants to disclose a mental illness at the application stage, many people either wait until they have accepted the job and then disclose to an occupational health professional, or do not do so at all due to the anticipation of discrimination or a wish for privacy. However, non disclosure precludes the ability to request reasonable adjustments in the workplace or to make a claim of direct discrimination. Disclosure to employers is therefore a difficult decision. A recent pilot study by our group of the CORAL decision aid showed that it helped mental health service users clarify their needs and values regarding disclosure and led to reduction in decisional conflict. The present proof of concept trial aims to determine whether a full scale randomised controlled trial (RCT) is justifiable and feasible, and to optimise its design. METHODS: In this single blind exploratory RCT in London, a total of 80 participants (inclusion criteria: age [GREATER-THAN OR EQUAL TO]18 years, on the caseload of a specialist employment adviser working with people with mental illness; referred to the adviser either from primary care via Improving Access to Psychological Therapies or secondary mental health service; currently seeking or interested in either paid or voluntary employment, and a Decisional Conflict Scale score of 37.5 or greater and stage of decision score 1--5) will be recruited from vocational advice services. After completing a baseline assessment, participants will be randomly assigned to one of two conditions (1) Use of the CORAL Decision Aid (DA) in addition to treatment as usual or (2) Treatment as usual. Those allocated to the DA condition will be given it to read and complete, and the researcher will be present to record the time taken and any content that causes confusion. Intervention participants may keep the decision aid but are discouraged from showing it to other service users to avoid contamination. Follow up interviews will be conducted at 3 months. Primary outcomes are: (i) stage of decision making score; (ii) decisional conflict scores and (iii) employment related outcomes. Secondary analyses will identify predictors of disclosure and qualitative analysis will explore the impact of the intervention. DISCUSSION: A reduction in decisional conflict regarding disclosure leading to more effective job seeking activity could have significant economic consequences for people with mental illness in terms of employment rates and productivity.Trial registration number: NCT01379014 (ClinicalTrials.gov Identifier).     

Participation of Older Persons With Mental Health Conditions and Psychosocial Disabilities in the Labor Market

This paper discusses the right to work as a basic human right that should be granted unrelated to chronological age, health or mental health status and disability including declining cognitive functioning. The benefits of continued employment are both at the individual level and at the organizational and societal levels. Nonetheless, there are multiple barriers that prevent older people and particularly older people with mental conditions and psychosocial disabilities from remaining in the workforce and/or from rejoining the workforce. We outline interventions at the organizational, national, and international levels to ensure the full participation of people of all ages and abilities in the workforce. Such interventions should address the intersection between disabilities and advanced age at the global, regional, and country levels.