MODELS OF PSYCHOSOCIAL REHABILITATION AND PLACEMENT/EMPLOYMENT

The unemployment rate for persons with severe mental illness is 85%.  Of the persons that are employed some may be in a sheltered workshop, some competitively employed in a full-time or part-time job, others involved in time-limited transitional employment, and still others in a supported employment program.

 

Sheltered Workshop   

 

At some point in their lives, persons with severe mental illness may have been a participant in a Sheltered Workshops or Community Rehabilitation Programs (CRP).  Especially older persons with severe mental illness that were part of the deinstitutionalization movement in the middle 1960s may have worked in such a setting.   As a participant in a sheltered workshop consumers are placed in an array of different programs.  These programs may include; psychosocial rehabilitation programs to learn community living skills (i.e., community sign recognition, safety, money usage, etc.), work adjustment skills, job readiness skills, and various vocational tasks.  The consumer may be a participant in a  work program on premises or at a distant job site.  Ideally, participants would learn skills needed to become competitively employed and then move into a community employment.  This is not always the case.  Sometimes it may take a very long time to move into community employment.  A problem may exist with the discrepancy between learning a job in the sheltered workshop environment and transferring that ability to a community job site. 

 

Competitive Placement

 Competitive employment means work that is performed on a full-time basis or on a part time basis, averaging at least 20 hours per week for each pay period, and compensated in accordance with the Fair Labor Standards Act.   Of the roughly 15% of persons severe mental illness that are employed, only around 5% of that 15% are in competitive employment. 

 

Transitional Employment   

These are structured programs offering services to an individual seeking to  enter competitive employment, but who are not at the point where competitive employment is feasible.  An example of a transitional employment program is Fountain House.  In this program members can stay with the program as long as they choose.  Job related skills are aimed at placement.  Supported employment may be used.  Another well known transitional employment program is Thresholds.  Thresholds is a more structured than Fountain House.  Participants sequence through the programs with a target date for completion of services.  A typical sequence would be sheltered employment to job training to supported employment and then to competitive employment.    Other models of transitional employment could be described as intensive case management.  These programs seek to maintain the individual with severe mental illness in their community,  and prevent the need for further psychiatric hospitalizations.  The consumer is a member of their treatment team and may receive daily contact from other members to monitor efforts to cope with employment and community life.

 

Supported Employment

Historically, supported employment was developed for persons with mental retardation.  However, it has evolved into a program used with other disabilities.  With the presence and support of the job coach, supported employment has proven to be a successful model when used with persons with mental illness.  There are four models of supported employment; individual jobs, enclaves in industry, work crew/mobile work crew, and small business.  Single jobs in businesses is the individual jobs model.  The person will obtain and retain the job by using supported employment services. The person receives on-the-job training by the job coach.  This model is used extensively in the service industry.  There is a 1:1 ratio between the person and the job coach.  Persons in this model generally make the highest wages and have the highest occurrence of social interactions with the public and coworkers.  A second model of supported employment is enclaves in industry.  These jobs tend to be in industrial or manufacturing settings.  This model is sometimes referred to as a “workshop without walls.”  Persons working in this model work as a unit with other supported employment consumers, although a non-disabled worker may be a part of the work unit. 

 

Closely resembling an enclave is the work crew or mobile work crew.  Supported employment consumers travel to a work site usually to do janitorial or grounds keeping.  Frequently, persons with mental illness are placed in this model.   The mobile work crews usually do their work after the business has closed, therefore, interaction with the general public or other non-disabled workers is minimal or nonexistent.  The final model of supported employment is the bench-work model.  In this model a small group of supported employment consumers, usually six persons along with one job coach, will start a small business.  The business may be a bakery, print shop, cleaning service, restaurant, green house, etc.  The persons will run the business, taking only small wages from the profits, if any, of the business.