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In the Wall Street Journal this morning, I read about Corrie Strasse, 14-year-old daughter of Senator Ben Strasse (Nebraska). Corrie has spent the last month working as a farmhand on a cattle ranch. Almost every day, she texts messages back to her father to tell him about the work: learning to drive a manual-shift tractor, getting up at midnight to feed the cows, watching the birth of a stillborn calf. Why did the Senator and his wife send their daughter to the ranch? Because, he says, "At the end of the day, a certain level of consumption is necessary to sustain life, but production, and doing things that benefit your neighbor, they’re what give life meaning."
Voters know this too. In the exit polls following yesterday’s primaries in Wisconsin, voters indicated that their uppermost concern in this election year is the economy. The economy (i.e. jobs) is a greater concern than immigration, terrorism, or the healthcare system. The presidential candidates acknowledge this concern, so they all talk about their plans to create jobs and "get America back to work again." Jobs matter – to the public, to politicians, and to people recovering from a serious mental illness.
For persons with schizophrenia or other serious mental illness, a good job is far more than a source of income and self-sufficiency. A job helps restore self-esteem, provides a source of accomplishment and achievement, and supports the process of recovery. Indeed, many persons with SMI say getting a job is their most important recovery goal. It is disheartening, therefore, that fewer than 30 percent of persons with schizophrenia or other serious mental illness are working.
Why don’t we care that this group has such abysmally low employment rates? I believe there are two reasons. First, we don’t expect persons with serious mental illness to work. Second, we don’t want them to work – around us.
We don’t expect persons with schizophrenia to work because the stereotype of a person with serious mental illness is someone who is confused, incompetent, and incapable of holding anything but a menial job. That stereotype would be wrong. John Nash was a brilliant mathematician and Princeton graduate who won the Nobel Prize in economics in 1994. Elyn Saks is an Associate Dean and Professor of Law at the University of Southern California. Both were diagnosed with schizophrenia. Dr. William Minor worked for years as a contributor to the original Oxford English Dictionary, all the while experiencing symptoms of paranoid schizophrenia. There are thousands of other examples of people, with even the most serious mental illness, who are successfully employed in mainstream jobs. Many others are capable of working in such jobs. Do we want them in the workplace?
No. We don’t want them to work with us because another stereotype of a person with serious mental illness is someone who is difficult, unpredictable, and perhaps even dangerous. That stereotype engenders stigma, which triggers an avoidance mechanism. We’d rather keep away from such a person because they make us uncomfortable and afraid. But that stereotype would also be misleading. Persons with serious mental illness whose symptoms are in remission are no more unpredictable or dangerous than other persons. In fact, they look and act pretty much like anyone else, and they are more likely to be the victims of crime than the perpetrators.
But the low expectations, together with the intense stigma against mental illness, have led to employment policies that are paternalistic and jobs that are (to be kind) less than challenging to an intelligent person who happens to have a serious mental illness. Here is an example: Despite his diagnosis of schizophrenia, my son managed to complete his Bachelor’s degree at a prestigious southern university. Several years later, a vocational counselor with the state mental health services system suggested that he could have a job collecting coins from vending machines. There is nothing wrong with such a job – as Carrie Strasse is learning, all work is meaningful. There is, however, something wrong with a mental health services system which believes that such a job is all that a person with serious mental illness can do.
The low expectations and stereotypical thinking about persons with serious mental illness are more entrenched in our mental health services system than we would like to believe. The very best vocational programs we have for persons with serious mental illness typically place clients in low-paid, short-term jobs. Indeed, an essential component of the programs is to provide counseling to ensure that a client’s income does not exceed the threshold that would disqualify them from Social Security Disability Insurance. In other words, there is no expectation that a person with serious mental illness will obtain a well-paid job with sufficient earnings to provide for themselves.
The prevailing attitude that persons with schizophrenia or other serious mental illness must be dependent on others for support is not only demeaning, but outdated. Science has given us near-miracle drugs that can alleviate the most acute symptoms of serious mental illness for a large proportion of patients. The drugs make it possible for many persons, with even the most serious mental illness, to work in well-paid jobs that provide financial independence and security. Yet our mental health services system seems stuck in a holding pattern, providing medications, counseling, and access to disability benefits until science finds a cure. While we wait for scientists to find a cure for schizophrenia, shouldn’t we work to ensure that people suffering from the disease today have the best possible quality of life? For many, that includes meaningful and rewarding employment. Persons with serious mental illness, like all of us, need to know the pride and satisfaction that comes from productive work.
