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According to the US National Library of Medicine, the importance of employment is that it delivers financial security, identity, and participation in society. Employment is also a basic right in many nations and is essential in maintaining one’s mental health. Being included or excluded from the workforce is considered a “social determinant of health“. According to the World Health Organization and the National Institute of Mental Health, “access to the social determinants of health are far more important to mental health than access to health care alone“.
These social determinants include:
Reasonable access to educational opportunities
Reasonable access to job opportunities
Community inclusion — a feeling of acceptance within a larger peer group or community.
Between 1987 and 2007, the number of people who qualified for Social Security Disability Income (SSDI) or Supplemental Security Income (SSI) due to mental illness increased by 250% (Angell, 2011). By 2012, there were an estimated 43.7 million adults in the US living with at least one mental illness, which was nearly 20% of the US adult population (NIMH, 2014).
SSA expects disability claims (including SSI and SSDI) to increase by nearly 300,000 in the second half of fiscal year 2021, and over 700,000 in fiscal year 2022, compared to fiscal year 2020
“Most SSDI recipients receive between $800 and $1,800 per month. However, if you are receiving disability payments from other sources, your payment may be reduced. For 2017, you can work and collect your disability benefits as long as your earnings don’t exceed $1,170 per month, or $1,950 if you’re blind.” 
The problem with SSDI and SSI is that while providing meager benefits, it also often acts as a deterrent for many people trying to enter the workforce. People on disability benefits are penalized for making an income, as there are income limits for those receiving benefits. Blind recipients are allowed to have 80% more income than recipients of benefits for mental illness. This creates a lot of complications and obstacles to employment.
Additionally, those making over a certain amount are penalized by half a dollar for every dollar earned.
“You can begin to work and continue to receive SSI benefits as long as your wages and other resources do not exceed the SSA’s income limit for SSI; however, your monthly benefit amount will be reduced in proportion to your income.” 
It should be no surprise that if you are receiving benefits while accruing a steady monthly income, this reasonably ensures that you will not go homeless. To find gainful employment, however, this means risking your health benefits in addition to your SSI or SSDI benefits which means you will be trapped in a cycle of poverty.
The real harm occurs because it becomes a deterrent to seeking employment. It is a vicious cycle, and it’s an institutional barrier.
Individuals living with mental illness make up a significant portion of the global workforce. They are also the majority of mental health consumers seeking professional assistance from counselors, psychiatrists, and social workers.
According to The Health & Safety Executive (2005) and Watson Wyatt Worldwide (2010), mental illness is among the top reasons for absenteeism in the workplace. They also make up the majority of individuals receiving disability benefits (Mental Health Foundation, 2009). Lauber and Bowen (2010) identify one of the most significant issues as getting employees with mental illness to return to work after taking a leave of absence. Fear of returning, strained relationships with co-workers and supervisors and fear of job loss are a few identified factors shown to influence employees with mental illness in their decision whether to return to work after a prolonged absence (Lauber & Bowen, 2010).
There are also organizational elements that influence the decisions of employees living with mental illness whether or not to return to work.
Organizational characteristics that are conducive to returning employees are the accessibility of health services and a supportive environment among colleagues. Characteristics of an organization that discourages employees from returning to work are limited resources, poor communication, health care barriers, poor colleague support, and a line manager’s inability to monitor the well-being of employees (Lauber & Bowen, 2010).
According to the National Center for Biotechnology Information, “Half the respondents to a survey said they would not work with, associate with, or have a family member marry someone with a mental illness.” 
Adults labeled with mental illness are at especially “high risk for limited participation in meaningful activities, having few opportunities for emotional fulfillment and personal growth, and experiencing social marginalization”.
According to the Journal of Community Psychology:
Societal and internalized stigmas provoke feelings of low self-esteem, shame, and depression, and inhibit social interactions, recovery, job opportunities, adequate health coverage, and overall quality of life (Chronister, Chou, & Liao, 2010). The literature consistently supports the existence of such negative impacts of this kind of stigma on people living with mental illness.
Let’s say this again, to quote the World Health Organization:
“Access to the social determinants of health are far more important to mental health than access to health care alone“.
According to the WHO declaration, mental health is defined as:
A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.
According to the American Journal of Occupational Therapy:
“Human beings define their lives, cultures, values, and worth through activities. It is the interactions of everyday life, rather than particular interventions in mental health settings that are the primary medium through which recovery occurs”
Any model of recovery from mental illness needs to be a multi-disciplinary one. As mental illness is a multi-faceted problem, it can’t be explained on the basis of genetics or chemical imbalances alone, any more than saying that bad people are that way due to biochemical interactions in the brain that cause such behaviors.
It’s not sufficient to say that the core problem is the low access to treatment or the lack of affordable access to it. While it’s true that health care, in general, is expensive, and unaffordable to many, it doesn’t explain the reason that for those able to afford treatment, relapses are too common. Despite the soaring numbers of Americans taking anti-depressants this year, the rising suicide statistics remain the same, and in some cases, increased.
Mental illness is as much a social problem as it is biological or a matter of inadequate policy. Such issues to be addressed in its entirety can only be adequately addressed as a community-based approach tackling the causes of homelessness, incarceration, isolation, and the social stigma that surrounds it. This doesn’t include some things even more basic, such as the need to be meaningfully occupied and engaged in meaningful activity, which undeniably is essential to mental health, something that clinical intervention alone cannot provide.
Clinical, client-centered approaches to treatment, whether it be psychiatric drugs or psychotherapy, must exist alongside interventions on a community level.
Any complete recovery model requires a path to re-entry or re-integration into the community. This means the patient must not only be adequately housed but also given access to community services and treatment providers. Preventive approaches that end the cycle of poverty, homelessness and jail recidivism that too often coexist with mental health challenges must invariably include things not commonly associated with mental health treatment.
This means: finding training and employment opportunities and is something that community-based programs and social programs can implement.
These issues, taken together highlight a gap in the system and a need in a society where social workers and non-governmental organizations may have the necessary expertise and collective will to uncover a solution; one which is likely to lead to significant reductions in jail recidivism, suicide statistics, and opioid addiction or relapses.
Ken Cohen is a psychology intern at Painted Brain and student at Antioch University.
Are you interested in the Medi-Cal Peer Support Specialist Certification Training? New Classes begin October 24. Space is limited.