Employment of persons with mental illness

We all place a certain amount of importance on work and employment. It isn't just a source of income, but also gives us a sense of purpose, an opportunity to learn, and to work with others. But what about the employability of persons with mental illness? 

Most mental illnesses usually manifest in the age group of 15-35 years. Some mental illnesses have long-term implications which may affect the most productive years of an individual’s life. Persons with mental illnesses such as clinical depression and anxiety-related disorders may be able to resume working after a brief period. However, if the person has a severe mental illness such as schizophrenia or bipolar disorder, their social skills, cognitive abilities, and their ability to take medication regularly may be affected. An illness can interfere with either the person's ability to learn new skills, or in gaining employment to utilize the skills that the person acquired prior to the illness. 

How can persons with mental illness begin or resume working?

Vocational rehabilitation is a process that runs parallel to the treatment and rehabilitation of persons with mental illness. It is a systematic and individualized program that involves vocational counseling, assessment of vocational skills, job skills training, vocational guidance, job placement, job retention and maintenance. As part of the rehabilitation process, persons are assessed, trained and placed according to the individual’s and family’s resources, needs and requirements.

A job helps people maintain a sense of self esteem and can be an important motivator. It can offer a sense of hope which in turn may aid recovery from mental illness. Broadly, when persons with mental illness are trained in a vocation:

  • Their attention is diverted from their symptoms to the work being done
  • They learn to work in groups, reducing the possibilty of their islotaing themselves. 
  • Their cognitive functions of attention, focus and memory while working on a task are increased
  • They develop a work habit while repeatedly doing a task 
  • They feel motivated when a financial remuneration is given 
  • The self-confidence of the person goes up; they feel useful and valued 
  • Their overall level of functioning improves 

Dr Aarti Jagannathan, assistant professor, department of psychiatric social work, NIMHANS, says, "In India, until recently, the concept of vocational rehabilitation for persons with mental illness meant keeping them engaged or occupied through activities or tasks. From the past one year, mental health hospitals and psychiatric rehabilitation centers have begun to focus on the need to train persons with mental illness with specific skills for employment. On these lines, NIMHANS has developed a VocationalProforma known as UDYOG (Unique Database of Youth for Gainful-employment) which is undergoing the process of standardization.” 

“However, the individual’s interest, ability and readiness for employment needs to be assessed by mental health experts prior to training them in any vocation. Also, considering the dynamic nature of the illness, a continued follow-up is essential after training and placing the individual.” she adds. The UDYOG Proforma is currently administered to persons with mental illness being treated at NIMHANS. 

Through the rehabilitation readiness assessment, mental health experts decide on one of three outcomes:

  • If the individual continues to show symptoms they are asked to come for a follow-up
  • If the individual is not yet ready for vocational rehabilitation, they are referred to a day-care center that caters to persons with psychiatric disabilities
  • When the individual is ready for vocational rehabilitation, they are recommended for vocational counseling, trained in job skills required and placed suitably

Employability of persons with mental illness

The kind of employment for persons with mental illness varies from person to person. Whether they are suitable for a competitive employment, a sheltered workshop such as a vocational centre, can be self-employed, do home-based work, or work in a cooperative, can be decided based on their functional profiling. 

Functional profiling of individuals includes assessing their job requirements based on the nature and duration of the illness, the dosage of medication and medication adherence, self-care, communication skills, social skills, time of work suitable and the ability to:

  • travel independently
  • understand instructions
  • use discretion 
  • manage one's own money

With her own experience of training persons with mental illness, Vidya H R, Program Coordinator, Enable India shares, "Many a time, I have observed that it's not that the person is not capable of doing a job, it is either due to the effects of the mental illness or the side effects of the medication, that they find it difficult to work. We at Enable India firmly believe that persons with disabilities do not need sympathy - they need a supportive environment to grow and fulfill their needs, potential and dreams."