Stigmatic and Mythical Thinking: Barriers to Vocational Rehabilitation Services for Persons with Severe Mental Illness

Abstract

More than 40 million people in the United States have psychiatric impairments; and of that number, 4 to 5 million adults are considered seriously (SMI; 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. 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, 1999). Competitive work is increasingly a goal for persons with severe mental illness. Like other Americans, people with psychiatric impairments wish to lead normal lives and view work as a signifier of normal adult life (Becker & Drake, 1994). Vocational rehabilitation for people with serious mental illness was not an issue prior to deinstitutionalization. People with mental illness spent much of their lives in back wards at state hospitals or in back rooms at home. Thus, the concept or possibility of rehabilitation was never considered. However, when antipsychotic medications became available to control some of the symptoms of these illnesses and patients were emptied out of the hospitals, it became apparent that many people with even very serious mental illnesses can learn work skills and seek and retain jobs (Torrey, Erdman, Wolfe, & Flynn, 1990). 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. Vocational disability is frequently associated with psychiatric disorders and constitutes a significant element in the diagnostic criteria for many mental disorders (American Psychiatric Association, 1994: p. xxi). 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 consists of the second largest category of disability reported to be served by the state-federal vocational rehabilitation (VR) system. While there is a consensus among rehabilitation professionals that employment is an important part of life for persons with mental illness (VandenBoom & Lustig, 1997), the employment success rate of persons with serious psychiatric disabilities is only about half of the rate experienced by persons with physical disabilities (Marshak, Bostick, & Turton, 1990). Moreover, individuals with severe mental disorders are notorious for having the worst employment outcomes of the various disability groups served by the state-federal rehabilitation programs. Issues of dysfunction, disability, and disadvantage are more often more difficult than the actual impairments. An inability to perform valued tasks and roles and the resultant loss of self-esteem are significant barriers to recovery. The barriers caused by being categorized as mentally ill can be overwhelming (Anthony, Cohen, & Farkas, 1990). The barriers to employment for people with severe mental disorders include societal stigmatic attitudes of professionals, family members, consumers, and employers; economic incentives of social insurance programs (e.g., Supplemental Security Income, Social Security Disability Insurance, Medicaid, and Medicare); lack of access to vocational services; and services that emphasize assessment and prevocational goals rather than competitive employment and following supports (Bond & McDonel, 1991). Effects of Stigma People with SMI have a long history of being stigmatized, reviled, shunned, shut away and, in previous eras, killed. Before the development of effective medications and psychosocial treatments, communities often found the behavior of such people too bizarre and unpredictable to tolerate in their midst. …

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