On-The-Job Therapy

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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.

Dr. Judith Cook, a professor of psychiatry at the University of Illinois at Chicago, headed one the largest studies on the topic, which was released this year in the Archives of American Psychiatry. Cook followed 1,300 people with mental illness in seven cities over two years and found that up to 64% of them worked — several times the norm. There were no reports of anyone being violent or disruptive at work.

Cook also noted that participants in the study earned a total of $4.7 million during the two-year period.

Currently, even though many get government support, 70% of the mentally ill live on less than $20,000 a year, according to the National Alliance on Mental Illness. The majority of those who receive state and federal disability assistance — typically $800 to $900 a month — are allowed to earn only a minimal amount of additional money. If they earn more, they risk losing both their payments and the equally important health insurance provided under Medicaid.

On the career track

Under the new treatment approach, anyone who wants to work is encouraged to find a career that interests them and fits their skill set.

Depending on the severity of their illness, some are pursuing careers they abandoned when they got sick and are going back to work as teachers or flight attendants. Others are finding entry-level jobs in fast-food restaurants or as salespeople in department stores. Still, it's not easy to match up clients with jobs, said Paul Barry, associate director of the Village, a mental health center in Long Beach that finds housing and work for people with mental illness.

"Our biggest obstacle for our folks is not their mental illness, but the fact they may be 35 years old but vocationally act more like they're 16," he said.

Signs of schizophrenia and bipolar disorder typically appear in the late teens or early 20s, leaving many people unable to finish school or begin a career. As a result, many aren't attuned to how to act on the job, keep a schedule or deal with delicate office politics.

Barry said many clients got the hang of it after a few years but often switched jobs several times in the process.

It's illegal for employers to ask job applicants about their medical history, and experts say a significant number of mentally ill workers don't inform their employer about their illness.

The Village, like a growing number of mental health clinics, has its own job placement agency. It advertises as a general employment service and doesn't necessarily inform its clients that their workers have a mental illness.

But the counselors often go a step beyond those at a regular employment agency. The counselor from Merriman's clinic, for instance, drove him around to look for openings. (Merriman is an avid cyclist, but does not drive.) She helped him fill out the application at Lowe's. She sat in with him during his interview and later gave him advice about what to wear on his first day of work.

Once someone is hired, the state may provide a stipend for clothes and transportation. Workers typically talk with counselors weekly — in person or over the phone — to sort through any problems that pop up.

Until 2004, Harvey Cochran of Long Beach was serially unemployed. Cochran, 40, who suffers from bipolar disorder, understands why he was repeatedly fired. He showed up late. He forgot to show up at all. During bouts of depression, he often didn't leave his room.

Cochran now works at a movie theater as an usher and behind the concession stand 15 hours a week. His job counselor has helped him better manage his schedule, as well as his relationships with bosses and co-workers. He recently got a raise from $6.75 to $7.15 an hour; and he has saved $1,000 in the last year.

Cochran also says he's more outgoing, and he likes being able to buy things he wasn't able to afford. For his recent 40th birthday, he bought himself a 36-inch television and a DVD set of the "Karate Kid" movies. "They're my favorite," he said.

Corporate aid

Employers are embracing the concept rather easily. The majority of clinics place individual clients with local businesses, but a number of larger companies also are signing on. Among them: Best Buy, Johnson & Johnson and Trader Joe's. All are hiring applicants with histories of mental illness as long as doctors say they are able to work.

In certain cases, employers are seeking out a small number of mentally ill workers as part of an overall effort to support the mentally ill.

Merriman's manager at Lowe's, Koko Ingram, says he is a "great employee." Lowe's uses anonymous shoppers to judge how often workers greet customers and how well they answer questions. "The last time, we got extra points because of how well Steven did," Ingram said.

Mental health advocates hope the public will become more sensitive and more comfortable around people with mental illness as they move into the mainstream workforce.

Mental health professionals also are encouraging more of their clients to go to college, hopeful that they will find long-term careers. Brenda Lee Riley, a 47-year-old Long Beach resident who suffers from paranoid schizophrenia, has finished six semesters at Cal State Long Beach. For years, Riley hardly left her apartment. Like many people with mental illness, she also battles a drinking problem. But her self-confidence has soared since enrolling in college.

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One of the things she most likes about being on campus is the conversation. "People in college talk about things other people don't talk about," she said. "They talk about that DeLay guy getting arrested. They talk about politics and what's going on around the world."

She takes three classes a semester and has earned a 4.0 grade point average. Riley hopes to become an English professor.

Her main goal, in the meantime, is to stay focused.

"I understand it will be several years before I become a college professor," she said. But "I want to use my head. I want to help people and I want to work. I want to contribute."

Last updated: 11/05

Source: LA Times

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