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Massachusetts Rehabilitation Commission
Research, Evaluation and Development Department
CONSUMERS WITH PSYCHIATRIC DISABILITIES
CASES CLOSED IN FFY 2007
January 25, 2008
The following report describes the demographic characteristics and rehabilitation
experience of MRC consumers whose cases were closed with primary psychiatric
disabilities in 2007. We look at who they are, how they come to the MRC, the services
they receive, and the outcome of their VR experience including jobs and wages.
Comparisons to consumers with other types of disabilities are presented for comparison.
This report follows the “Psychiatric and Substance Abuse Report” of 2005 (which is also
available on this website). That report, on the rehabilitation experience of consumers
with psychiatric and substance abuse disabilities at the MRC, was prepared by the
Research, Evaluation and Development Department. It found that, consistent with
national research, MRC consumers with psychiatric disabilities achieved competitive
employment at a lower rate than the MRC population as a whole. They were also less
likely to be employed in better paying professional jobs. Regardless of occupation, they
generally earned less than people with other disabilities.
After the Psychiatric and Substance Abuse Report of 2005, discussions on the topic of
best practices arose among counselors, which led to open forums and eventually to the
development of the MRC Mental Health Liaisons. These representatives cover the state,
working to develop meetings and trainings which respond to treatment challenges,
marshal resources, and generally develop effective practices for MRC counselors
working with consumers with psychiatric and substance abuse disabilities to help them
set and reach their employment goals.
BACKGROUND
Comprising more than one-third (36%) of the entire closed case population, consumers
with psychiatric disabilities are the largest disability group at the MRC (N=4456). This
is true for psychiatric disabilities coded as either primary (36%) or secondary (36.3%).
Nearly 14% of the closed case population was in ‘double jeopardy’ from mental illness,
having two different illnesses with psychiatric sequels, such as major depression and
panic disorder, coded as primary and secondary disabilities.
Primary Disability 2007
40
35
30
Percent
25
20
15
10 1
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Primary Disability %
Psychiatric 36
Substance Abuse 14.1
Visual 0.5
Hearing 5.3
Orthopedic 9.8
TBI 3.1
Medical 7.8
Neurological 4.4
LD/ADHD 14.6
MR 4.4
In terms of demographics, consumers with psychiatric disabilities were significantly
more likely to be women (53.7 % vs. 41.2%), and European American (83.3% vs. 81.2%).
Significantly fewer consumers with psychiatric disabilities were African American
(14.5% vs. 16.7%). But the proportions were reversed in the case of other minority
groups. For example, 9.9% of the psychiatric consumers were Hispanic compared with
9.1% of the others, and 2.2% of the psychiatric consumers were Asian compared to 1.9%
of the others.
Looking at age, consumers with psychiatric disabilities who came to the MRC did so a
few years later in life. Their average age was 37.4 years compared to 35.9 years among
other consumers.
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DEMOGRAPHICS
Characteristic Psychiatric Non-psychiatric
Age 37.4 35.9
African-American 14.5% 16.7%
European American 83.3% 81.2%
Hispanic 9.9% 9.1%
Asian 2.2% 1.9%
Male 46.3% 58.3%
Female 53.7% 41.2%
Prior work experience 11.2% 17.3%
Weekly wage prior work $234 $280
Public Asst./mo. Referral $762 $720
Consumers with psychiatric disabilities came to the MRC with both substantial
advantages and disadvantages for employment. Consistent with other research,
consumers with psychiatric disabilities were less likely to have prior work experience.
This was also the case in 2005. On the other hand, consumers with psychiatric
disabilities were among the best educated groups. Over one-third (36.4%) of consumers
with psychiatric disabilities attended college or vocational school. At the same time,
they made good use of the MRC’s educational services. Consumers with psychiatric
disabilities made significant improvements in reducing their numbers who had less than
a high school education and in increasing their numbers pursued a college or graduate
school education while they were with MRC.
Education of Consumers with Psychiatric Disabilities
Grade Referral Closure
<High school 25.9% 14.9%
High school graduate 38.8% 34.2%
Some college 28.1% 35.5%
College graduate 10.5% 13.6%
SERVICES RECEIVED
There are a number of sources of referral to the MRC coded by the counselor, but the
most commonly reported is “self referral”. Consequently, we found little conclusive
information about the sources of referral for consumers with psychiatric disabilities.
They were most often self-referrals, followed by a few referrals from health care
providers, primary and secondary schools, Community Rehabilitation Providers or
“other” sources. The only small difference between psychiatric and non-psychiatric
consumers was a slight increase in self-referrals among consumers with psychiatric
disabilities.
Regardless of type of referral, consumers with psychiatric disabilities had a slightly
better chance of becoming MRC consumers. They were not more likely to be accepted
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as eligible for MRC services (status 08), but they were more likely to receive SSI or SSDI
benefits which is presumed eligibility for MRC services. Over half (52.5%) of the
consumers with psychiatric disabilities were receiving SSI/SSDI upon referral to the
MRC and would be presumed eligible. 92.9% of all consumers with psychiatric
disabilities were coded as having met the criteria of having the most significant
disabilities necessary for the MRC’s services. Among those consumers who went on to
employment, the percentage with the most significant disabilities was as high as 99.9%.
Of the 4,456 closed cases with psychiatric disabilities in 2007, about half (2,568 or
57.6%) received services. The others left before services were delivered or were deemed
ineligible. Service information was available for these 2,568 cases.
There were practically no differences between the psychiatric and non-psychiatric
groups of consumers in the types of services received at the MRC. The most common
services among those that were coded by the counselor (data entry in this area is not
always consistent) were: counseling, diagnosis and treatment, assessment, job
placement, college or university education, on the job support, transportation, job
readiness, “miscellaneous” and “other”.
Services Provided to Consumers with Psychiatric Disabilities
Service Psychiatric Non-Psychiatric
Counseling 56% 56%
Diagnosis and Treatment 52% 48%
Assessment 44% 43%
Job Placement 37% 37%
College/University 16% 16%
On the Job Support 13% 13%
Transportation 13% 12%
Job Readiness 10% 9%
Miscellaneous 16% 14%
Other 25% 25%
The average per case cost was lower for consumers with psychiatric disabilities, which is
difficult to explain since the percent receiving service in the table above is so similar.
The average cost per case for consumers with psychiatric disabilities was $1045 overall
and $2096 for those who went on to employment. For consumers with other types of
disabilities, the average case cost was $1575, and $3137 for those who went on to
employment.
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OUTCOME
The literature on employment outcomes among consumers with psychiatric disabilities
frequently describes unemployment, underemployment, low wages, and limited success
for these job seekers (as did our 2005 report); so it would seem at first glance among
MRC consumers in 2007. The rehabilitation rate (the number of consumers employed
divided by number of consumers served) among MRC consumers with psychiatric
disabilities was much lower than among the rest of the case closures in FFY 2007
(46.9% vs. 55.6%). The proportion of unsuccessful closures was somewhat higher for
the psychiatric group (59.8% vs. 51.6%).
Looked at another way, however, we can say that in spite of their lack of work
experience, nearly half of all consumers with severe psychiatric disabilities improved
their education when necessary and found and maintained employment in a wide range
of types of jobs, including professional jobs, for a minimum of 90 days at the MRC.
Status by Disability 2007
40
35
30
Percent
25
20
15
10
5
0
8 26 28 30
Outcome Psychiatric
Non-Psychiatric Status
Outcome Status
Status Non-Psychiatric Psychiatric
8 15 12.9
26 33.4 27.4
28 26.7 31.1
30 24.9 28.7
PUBLIC BENEFITS
The comparative decline in the rehabilitation rate among consumers with psychiatric
disabilities might be related to the high proportion of consumers that derive income
from some type of public assistance. More than three-quarters (77.3%) of consumers
with psychiatric disabilities compared to 61.0% of others received some type of public
assistance while at the MRC. These payments came largely from SSI or SSDI among
consumers with (65.4%) or without (47.6%) psychiatric disabilities.
When they first came to the MRC, consumers with psychiatric disabilities were receiving
somewhat more than others in terms of the average amount of monthly public
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assistance. Their benefits averaged $762, compared to $720 among those without
psychiatric disabilities.
At both referral and closure counselors determined the major source of income of
consumers with psychiatric disabilities was public benefits, while consumers with other
disabilities were most likely to rely on personal income at closure or some other non-
public type of income at referral.
Even though they were more likely to come to the MRC while receiving public benefits,
consumers with psychiatric disabilities were not more likely to start receiving SSI or
SSDI payments while at the MRC. Consumers with and without psychiatric disabilities
reported an increase in SSI/SSDI enrollment at the same rate. The proportion of
consumers with and without psychiatric disabilities who received SSI or SSDI at closure
increased slowly and at the same rate.
While consumers did increase their reliance on public benefits while at the MRC,
preparation for employment among consumers with all types of disabilities apparently
placed some limit on their ties to public assistance. Just slightly more than half (54%) of
the successfully rehabilitated consumers with psychiatric disabilities and 68% of
unsuccessful closures received SSI/SSDI at closure. Among rehabilitants, the average
public benefit received for consumers with psychiatric disabilities decreased from $781
to $749 between referral and closure. Among consumers with other disabilities the
average public benefit actually increased, from $720 to $746.
Considering all public benefits received by consumers with psychiatric disabilities, there
would be an overall decrease in benefits from $2,221,672 to $1,884,620 in the year
following completion of the MRC program.
Receipt of Public Assistance
Characteristic Psychiatric Non-Psychiatric
Rely public assistance referral 62.2% 42.2%
Rely public assistance closure 57.0% 38.6%
Rely earnings referral 9.8% 16.9%
Rely earnings closure 28.9% 41.1%
Avg. Amount benefit/mo referral $762 $720
Avg. Amount benefit/mo closure $704 $702
Receive SSI/DI referral 52.5% 33.7%
Receive SSI/DI closure 62.1% 43.6%
Receive SSI/DI anytime 65.4% 47.6%
Receive Public Assistance anytime 77.3% 61.0%
EMPLOYMENT
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Of the 4,156 consumers with a severe psychiatric disability, 1,206 or 99.6% were
competitively employed at or above the minimum wage in an average of 24 months.
These consumers earned an average of $11.61 an hour, well above the national average
of $9.97, but below the $12 target wage the MRC holds for its outcome standards for the
general VR program, and below the average of $12.06 earned by consumers with other
disabilities.
Consumers with psychiatric disabilities work an average of 26.5 hours per week, slightly
less than the 28 hour standard the MRC holds for the general population.
Perhaps surprisingly, a majority of consumers with psychiatric disabilities (56%) earned
over the SGA (Substantial Gainful Activity) which could have disqualified them for SSA
benefits (SSI or SSDI).
On a yearly basis, consumers with psychiatric disabilities earned between $413 and
$107,482 per year, or an average of $16,299. Individually, their MRC experience
benefited them considerably, raising their income an average of $15,883 a year.
Socially, as a group, these rehabilitants would bring a combined earned income of
$19,155,085 back to their local economy at the end of a year.
OCCUPATION AND HOURLY WAGE
Psychiatric Non-Psychiatric
Occupation % Average % Average
Wage/hr Wage/hr
Management 1.7 15.16 2.3 16.45
Business & Financial 1.5 14.69 1.5 16.30
Computer & Math 1.6 20.75 1.9 16.58
Community & Social Service 6.3 12.48 5.7 12.53
Education 4.6 14.69 3.6 15.03
Arts & Entertainment 2.0 17.32 2.2 14.14
Healthcare Practitioner 2.5 16.65 3.1 20.44
Healthcare Support 7.4 11.69 5.5 13.04
Protective Services 2.0 10.15 1.6 11.27
Food Preparation or Serving 9.5 9.10 9.7 9.15
Building & Grounds 6.8 9.61 7.4 10.08
Personal Care & Service 7.1 11.59 5.5 10.65
Sales 12.3 9.68 11.6 9.67
Office & Administrative Support 16.5 11.00 13.3 11.28
Construction 2.2 13.60 3.8 14.95
Installation & Repair 2.4 11.15 2.8 13.90
Production 4.7 10.85 5.4 10.66
Transportation 7.4 11.29 11.0 11.41
The types of occupations most commonly held by consumers with psychiatric
disabilities included: Community and Social Services, Education, Healthcare Support,
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Food Preparation, Personal Care and Service, Sales, Office and Administrative Support
and Transportation. This is a wide variety of types of occupations, reflecting various
interests and skills. Approximately 30% of the rehabilitants with psychiatric diagnoses
earned an hourly wage above the $11.61 average for the group. However, with a few
exceptions, average pay grades in the left hand column of the table above do not reflect
the high proportion of college educated consumers with psychiatric disabilities.
Among professional level jobs, the only instances where consumers with psychiatric
disabilities earned more than or the same as rehabilitants with other disabilities were in
the fields of Computing and Math, the Arts, and Community and Social Services. Jobs
dealing with computers or mathematical skills brought in an hourly wage about $4 more
an hour for consumers with psychiatric disabilities. Unfortunately there were few
rehabilitants in this job category.
There were more employees with psychiatric disabilities in less skilled, lower paying
occupations, such as the Personal Care and Service occupations. In this case, those with
psychiatric disabilities earned about $1 more per hour. On the other hand, there were
also proportionately more consumers with psychiatric disabilities with occupations in
Healthcare Support, but here their earnings averaged about $1.50 less per hour than
consumers with other disabilities.
Looking over this table we can see that, despite their high educational levels, most
rehabilitants with psychiatric disabilities earn less per hour than consumers with other
disabilities. Discrimination and a lack of work experience are both potential
explanations. In addressing the needs of this special population group, the combined
issue of wage inequality and employment in occupations where they earn competitively
seem the most urgent.
CONCLUSIONS/RECOMMENDATIONS
o The findings presented here and in 2005 are consistent with national data. They
suggest that people with psychiatric disabilities need additional job supports to
deal with issues of under- and unemployment and adequate wages. Since 2005
the MRC has taken several steps in this direction. The MRC Mental Health
Liaisons work to develop best practices for the agency in developing this support.
The Annual Prevailing Wage Report furnishes counselors with current hourly and
annual wages by job title for cities and towns across the state. Specially trained
Placement Specialists are at work in the field, contacting employers and teaching
them about the realities involved in hiring people with psychiatric disabilities.
Developing and strengthening extended services is another way to support
employment of consumers with psychiatric disabilities. As outlined below, giving
support over a longer period of time would enable job development, preparation
to meet qualifications, and job coaching to help consumers adjust to a workplace
that may not always be accommodating and work that demands skill, flexibility
and change.
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o The high proportion (59.8%) of consumers who leave prematurely, either before
or while services are being delivered, should be investigated. It might be that
some people with psychiatric disabilities are coming to the MRC before they are
ready for employment, have second thoughts about jeopardizing their SSA
benefits, or doubt they will be able to negotiate the accommodations they will
need when the time comes. If some of these issues could be identified and dealt
with in orientation, it might save service cost and counselor time.
o A great deal of research has been conducted on the needs of people with
psychiatric disabilities in employment and the needs of employers in our job
market. There are local research institutes that specialize in these areas who
might be interested in investigating some of these issues with us. For example,
the needs of the marketplace and the types of jobs that are available are
constantly changing. Former appeals to employers, based on employee values of
past jobs, may no longer be relevant. Our Placement Specialists must continue to
receive ongoing training on promoting persons with psychiatric disabilities as
skilled, flexible and adaptable employees in the 2008 job market.
o It might be worth examining the way employers decide on the amount of work
experience they require for a particular position. Placement Specialists could
broker with employers around this job requirement, understanding the
requirement and getting leads for eventual interviews. Extended services could
be provided to the consumer who would develop a two stage employment goal.
The first stage would be to seek employment for a specified period of time to
meet the experience requirement. The second goal would be the professional
position itself. The consumer could move on to achieve his or her goals with
extended services consisting of psychiatric support from DMH, and job support
from the MRC in negotiating work experience, carve outs, accommodations and
ongoing interpersonal issues that develop in the course of a modern employment
situation.
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