Career counseling with clients who have a severe mental illness

Posted by Justin | July 28, 2007 .

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People who have a severe mental illness continue to be stigmatized and neglected because of numerous myths about this population. For example, it is widely believed that people with a mental illness are a danger to society and that they are incapable of maintaining a job. These myths persist in spite of evidence suggesting that people who have a mental illness are no more likely than individuals in the general public to commit violent crimes and that people with mental illnesses can be productive members of society, especially when they receive supportive services (Tenety & Kiselica, 2000).

The stigma of mental illness is only one of many barriers encountered by people who have been diagnosed with a serious psychiatric condition. The purpose of this article is to discuss these barriers and to describe a developmental approach to career counseling that is designed to help people who have been diagnosed with a chronic mental illness make a successful transition back into the community. We begin this article with an overview of barriers that reduce the chances of people with serious mental illness from obtaining gainful employment and independent and semi-independent functioning. We then suggest practical strategies that counselors can use to enhance the career development of this population, including recommendations regarding career-oriented intake interviews, assessments, and counseling.

Barriers Impeding the Career Development of Clients Who Have a Severe Mental Illness

People who have a serious mental illness represent the second largest category of individuals with a disability served by state vocational rehabilitation systems, yet vocational rehabilitation programs have demonstrated limited success with this population (Garske & Stewart, 1999). Although most psychiatric personnel claim that fostering the career development of this population is an important therapeutic goal, the unemployment rate for people with a major psychiatric illness has been estimated to be as high as 85% (Garske & Stewart, 1999).

The dismal record in the United States of addressing the career needs of clients who have received a diagnosis of a serious psychiatric condition is tied to a number of barriers that impede the career development of this population. For example, Bond and McDonel (1991) noted that negative attitudes about individuals who have been diagnosed with a mental illness pervade all levels of society. Consequently, many professionals, consumers, employers, and even relatives of these individuals view them as inappropriate candidates for employment (Herr & Cramer, 1996). When clients do receive career assistance, pertinent services tend to be focused on assessment and prevocational skills rather than on competitive employment. To make matters worse, the policies of many social insurance programs (e.g., Supplemental Security Income [SSI], Social Security Disability Insurance [SSDI], Medicaid, Medicare) and other federal programs fail to cover the career needs of persons with serious psychiatric illnesses adequately, or they create confusing circumstances that discourage many people in this population from seeking work. For instance, criteria differ for persons receiving SSDI or SSI and often involve calculating and maintaining accurate records of earnings and knowledge of a multitude of inclusionary/exclusionary criteria to determine the amount of an individual’s benefits. Some of the criteria that are considered include substantial gainful activity amount ($780 per month), impairment-related work expenses, continued payments under a vocational rehabilitation program, trial work period, and continued Medicare/Medicaid benefits. In addition, a new position called the employment support representative (ESR) was recently established by the Social Security Administration to help beneficiaries make transitions to work/careers, adding another layer to this already overwhelming system (Social Security Administration Office of Employment Support Programs, 2002). The disinclination to risk losing assured benefits, which individuals who have a mental illness regard as essential to their sustenance, is understandable (Rutman, 1994).