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Can we as a society really boast about "successful treatment" of the seriously mentally ill as long as the majority of the population who have received treatment are either unemployed or underemployed?

David Clark
Houston, Texas

Answered by Frederick J. Frese III, Ph.D.:
This is another excellent question. It is my experience that even with "successful treatment" many of us with these conditions have difficulty sustaining full time work for long periods of time without being subject to relapse. However, many of us in this situation can work well for shorter periods of time, perhaps a few hours per day.

For this reason it is so important that the work rules for the disabled are being changed. The Federal Ticket-to-Work/Work Incentives Implementation Act was signed into law in December, 1999. The law allows disabled persons to work more than minimal hours per week without losing Medicare, Medicaid, SSI, and SSDI benefits, and if they relapse after returning to full time work they can regain their benefits much more easily. The law also establishes new Employer Networks and issues vouchers directly to consumers who can select from a variety of options to receive vocational assistance to return to work. The law is complex and allows states considerable latitude in implementing the law. Mental health advocates in all states should be trying to ensure that this law, which must be implemented in all states by 2003, is fashioned in as consumer-friendly a manner as possible. I am not sure that this issue is receiving appropriate attention in all states.

In addition to altering the disability laws so that they are more realistic for persons with serious mental illness, we also need to better attack the stigma and discrimination that keep us from being employed. Most employers understand very little about mental illness. In this regard I feel A Beautiful Mind and A Brilliant Madness can be real breakthrough events for us. We now have, for the first time really, major media portrayals of one of us that are realistic, dignified, and positive. Employers are more likely to be sympathetic to hiring someone like John Nash than they are to hiring someone like Hannibal Lecter or Norman Bates. But we need to do much more in this regard. After all, even though one of us has won the Nobel Prize, and another of us has won the MacArthur "genius" award recently (Kay Jamison), most of us have considerably less spectacular talents. Nevertheless many of us do have talents and society will benefit as it begins to more effectively tap this resource. We should not have to win a Nobel Prize or a MacArthur Prize in order to be able to be able to make contributions to society.

Unfortunately discrimination against mentally ill persons is particularly egregious in the mental health establishment and in academia. Most mental health professional schools seem to actively screen out anyone in recovery from mental illnesses. Certainly very few of them give credit for life experience if that experience includes mental illness.

The mental health establishment, including the academic centers, tend to be very pro-active in reaching out to other historically marginalized groups, e.g., ethnic minorities, women, gays and lesbians, etc. But unfortunately they "draw the line" when it comes to the mentally ill. I am afraid that until the academic, professional and government establishment entities responsible for our well-being become willing to take strong action to signal that we can be accepted to work along-side others, employers in general are unlikely to believe that they should hire us.

I have heard all the arguments about how mental health professionals do not want us to become dependent on them and their system. But as long as they will not willingly accept us, they are sending a signal that we are not worthy of being accepted. This unfortunate situation must change. We are human beings and it is time we stopped being laughed at, ostracized, marginalized, and otherwise kept out of the mainstream.

I can not believe how often I hear my fellow professionals use terms like,"nuts," "crazy," "psycho," etc. They do not seem to understand that these pejorative terms perpetuate our being excluded. We need to help them change the traditional way we are perceived.

Thank you for the question.

Frederick J. Frese III, Ph.D.

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