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An estimated 40 million people in the United States have psychiatric impairments; and of this number, 4 to 5 million adults are considered seriously mentally ill. Despite their strong desire to work, functional competencies, and educational qualifications, many of those who have severe and persistent emotional problems have no long-term attachment to the labor market. While there is a consensus among rehabilitation professionals that employment is an important part of life, for persons with mental illness (VandenBoom & Lustig, 1997), estimates of unemployment are at a rate of 85 percent for the working-age members of this population (National Institute on Disability and Rehabilitation Services, 1993). Due to the severity of impairment in many persons with serious mental illness, psychiatric rehabilitation programs face a challenging task. Even when persons with serious psychiatric disability seek vocational services, they have success rates only about half of those persons with physical disabilities (Marshak, Bostick, & Turton, 1990). Emphasis on community-based treatment, along with the development of effective antipsychotic medications, has resulted in a major shift in treatment patterns and has put significant stress on an as yet not fully developed outpatient system. Since the 1950s, state mental health institutions have been radically depopulated, resulting in a greater number of individuals with severe psychiatric disability in the community (Rogers, Anthony, & Jansen, 1991). There are more than twice as many people with schizophrenia and manic depressive psychoses in public shelters and on the streets than are in mental hospitals (Torrey, Erdman, Wolfe, & Flynn, 1990). Along with other human service workers, rehabilitation counselors are being challenged by the large number of people with severe and life-long mental disorders. Mental Health Service Changes In the early 1960s, the education of the public on mental illnesses and their treatment was more widespread. The public's awareness stimulated the community's involvement in raising the standards of treatment for mental disorders. The passage of the Mental Health Centers Act of 1963 (P.L. 88-164) mandated a major change in the care of people with severe psychiatric disabilities. This legislation was amended in 1975 (P.L. 94-63) to further define the mental health services that each center was required to provide (Peterson, et al., 1996). The intent of this legislation was to initiate the development of a decentralized community-based treatment system as opposed to state hospital care. The deinstitutionalization effort of the 1960s and 1970s resulted in the discharge of many thousands of people with severe psychiatric difficulties into communities that were neither prepared nor willing to accept them (Gerhart, 1990). More recently, many young adults with severe psychiatric difficulties are found with a similar dilemma. While not hospitalized for a long period of time, these young adults also struggle with life in the community due to their functional limitations and with a community mental health service system due to its often inadequate services. Similar to out-patient mental health workers, many rehabilitation counselors are overwhelmed because of the increased referrals and complexities of clients with a primary disability of a mental or emotional nature (Garske, 1992). According to McDonald-Wilson, Revell, Jr., Nguyen, and Peterson (1991), vocational rehabilitation programs have demonstrated limited success for people with psychiatric disability, considering that this population represents the next-to-the-largest category of disability served by the state-federal vocational rehabilitation (VR) system. In spite of the wide range of educational backgrounds, intelligence levels, career aspirations, and previous work history, people with severe psychiatric disability typically have unemployment rates as high as 85 percent or higher. …
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