Federal and state vocational rehabilitation systems for people with severe mental illness are a failure, says the National Alliance on Mental Illness (NAMI).

The federal-state vocational rehabilitation system has, for the most part, "been an abject failure as a viable source of vocational rehabilitation services for people with severe mental illness," NAMI concludes in its report, "A Legacy of Failure: The Inability of the Federal-State Vocational Rehabilitation System to Serve People With Severe Mental Illness."

"Moreover, as it is currently structured, the federal-state vocational rehabilitation system is unlikely to ever be an effective source of services for people with these brain disorders," NAMI concludes.

The report is drawn from surveys of employment programs and practices for people with severe mental illness, with particular emphasis on the following areas: the federal-state vocational rehabilitation system and its effectiveness in providing services to people with severe mental illness; state mental health systems and their effectiveness in providing and/or financing vocational services for people with severe mental illness; community-based psychiatric rehabilitation programs and their effectiveness in providing vocational services for people with severe mental illnesses; and state protection and advocacy programs and their effectiveness in advocating for vocational services and income supports for people with severe mental illness.

Results of the survey were scathing, and NAMI's recommendations amount to rebuilding the system of vocational rehabilitation for the severely mentally ill from scratch (see story below for recommendations).

"Studies show that the federal-state vocational rehabilitation system has achieved dismal outcomes in serving people with severe mental illnesses," NAMI concludes. "It achieves a lower rate of closure into meaningful jobs as compared to others with physical disabilities or mental retardation. More than for any other type of disability, people with severe mental illnesses are `closed out' of state vocational rehabilitation systems as `failures.' "

NAMI noted that none of the states surveyed was able to provide basic information regarding how many people with severe mental illnesses are expected to be served in the coming year, how much money would be spent on services for that population, and what the expected outcomes are.

"The need for federal oversight of the vocational rehabilitation system is illustrated by the resistance we encountered when trying to obtain copies of vocational rehabilitation plans in certain states," NAMI reports. "Although these plans are legally a matter of public record, NAMI was forced to file Freedom of Information Act requests or seek intercessions by the governors to obtain this information from the following states: Arkansas, Colorado, District of Columbia, Florida, Idaho, Maryland, Michigan, Missouri, Mississippi, Nebraska, New Hampshire, New Jersey, New Mexico, Nevada, North Dakota, Oklahoma, Virginia, West Virginia, and Wyoming."

NAMI offered the following summary of failures in the vocational rehabilitation system:

• Services are time limited and predicated on the idea that once people obtain employment, they no longer require services and supports from the vocational rehabilitation system. This is "entirely contrary to the realities of severe brain disorders."



• State vocational rehabilitation agencies have perpetuated a system that rewards counselors for putting their greatest efforts and resources into those individuals who are easiest to place in employment and most likely to retain employment after placement.



• A large proportion of resources goes into administrative functions, rather than direct services for people with disabilities.



• Many state vocational rehabilitation administrators and counselors lack knowledge about severe mental illnesses and the characteristics and needs of people who suffer from these brain disorders.



• Diagnostic codes used by the federal Rehabilitation Services Administration are "hopelessly outdated," NAMI says. "These categories--'psychotic disorders' and 'psychoneurotic disorders'--have not been used in the field of psychiatry for many years. The ongoing use of these terms by the federal-state vocational rehabilitation system speaks to the lack of interest and commitment on the part of this system to providing effective services to this population."



• State vocational rehabilitation agencies have done "a very poor job" of working cooperatively with mental health agencies to meet the needs of the severely mentally ill.



• Artificial, time-limited funding and durational limitations established by state vocational rehabilitation agencies serve as disincentives for community-based providers to contract with these agencies.

Copies of the report are available for $5 by writing to NAMI, RDS, Item #134,
NAMI (National Alliance on Mental Illness)
Colonial Place Three
2107 Wilson Blvd. - Suite 300
(703) 524-7600
(703) 524-9094 (fax)
NAMI HelpLine: 1-800-950-NAMI (6264).

Suggested Fix

The estimated $490 million currently spent on "ineffective" vocational rehabilitation services should be spent on a broader array of long-term or intermittent vocational and psychosocial services and supports that do appear to work better for people with severe mental illness.

That was the first of several far-reaching recommendations put forward by the National Alliance on Mental Illness in its report, "A Legacy of Failure: The Inability of the Federal-State Vocational Rehabilitation System to Serve People with Severe Mental Illnesses."

These are the other recommendations:

• Psychiatric rehabilitation programs and other potential recipients of vocational rehabilitation monies must meet minimal service standards.



• Mechanisms must be developed to monitor the performance and accountability of programs that provide vocational rehabilitation services to individuals with severe mental illness.



• The Supplemental Security Income and Supplemental Security and Disability Income programs should adopt changes that encourage people with severe disabilities to reenter the work force without fear of losing access to benefits should they relapse.



• Federal and state laws must be adopted prohibiting discrimination against people with severe mental illnesses in private health insurance plans.



• The scope and specificity of reports issued by the U.S. General Accounting Office or other oversight agencies must be increased to provide information about short- and long-term employment outcomes achieved by individuals who receive federally funded vocational and psychiatric rehabilitation services.

(Psychiatric News, April 4, 1997)