Recognizing the significance of employment in the recovery journey, supported and transitional employment have emerged as crucial tools to empower those facing mental illnesses. Services for the UnderServed (S:US) has implemented these innovative approaches through evidence-based programming, such as Assisted Competitive Employment (ACE) Services and the Brooklyn Clubhouse, that fosters independence and a sense of purpose.
Mental health challenges affect millions of individuals worldwide, impacting their daily lives, including their ability to work and contribute to society. According to the United States Department of Labor, around 1 in 5 adults in New York experiences a mental health disorder each year. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that approximately 16.5% of the US population aged 12 or older has a substance use disorder. The unemployment rate for individuals with mental health conditions in New York is higher than the general population, at above 80% (Mental Health America, 2023).
Individuals living with serious mental illness and co-occurring substance use disorders have continuously been stigmatized and subjected to discrimination in the workforce. This is a population that has often been overlooked, excluded, and discouraged from working due to their disability (Mental Health America, 2023).
At S:US, we are dedicated to implementing scalable solutions that bring about transformative changes in the lives of people with disabilities, those facing poverty, and individuals experiencing homelessness. Our mission is aligned with rectifying societal imbalances, envisioning a city where everyone has shelter, good health, productivity, and the ability to enjoy meaningful social connections.
Supported Employment is a model designed to assist individuals with mental health conditions obtain and maintain competitive employment. At S:US, the ACE program is designed to support individuals living with serious mental illness (SMI) towards their employment goals. The key principle is individualized support, tailoring assistance to meet each person’s unique needs and aspirations. Employment Specialists work closely with individuals to identify suitable job opportunities, provide on-the-job coaching, and facilitate communication between the employee and the employer. Regular check-ins and open communication help the Employment Specialist understand the individual’s progress and address any challenges that may arise during the employment journey. ACE receives referrals from psychiatric settings, such as hospitals and clinics, and shelters and housing programs. In particular, ACE collaborates with S:US behavioral health housing, an important referral source. This partnership illustrates the importance of housing stability in relation to job retention. Oftentimes, individuals who are unstably housed are unsure of where they will find housing and, therefore, are hesitant to find a job and build roots in one particular area. The individuals we serve prefer to work in close proximity to their housing location, which minimizes transportation costs and additional job-related stressors. ACE has placed individuals in local retail stores, laundromats, hotels, security positions, and roles within S:US as residential aides and peer specialists. On average, these participants could retain employment for up to 18 months at a time.
Benefits of Supported Employment to Participants’ Recovery
- Increased Self-Esteem: Employment Specialists collaborate with participants to set achievable employment goals, breaking them down into manageable steps. Celebrating small milestones and recognizing achievements during the job search or in the workplace enhances their self-esteem. Participants have also reported that obtaining and maintaining employment has provided them with a sense of accomplishment and purpose.
- Community Integration: Staff conduct social skills workshops to help participants feel more comfortable in social settings. Additionally, staff assist participants in building a professional network by introducing them to local community events, job fairs, and/or industry-related gatherings. By actively participating in the workforce, they were able to break the cycle of social isolation. They also reported feeling a sense of belonging and community within their work sites and amongst their peers.
- Financial Independence: Staff supports participants in developing budgeting skills, emphasizing the financial benefits of employment. Together, they create a budget that considers the participant’s income, expenses, and savings goals, thereby promoting financial independence. Participants have reported that employment contributed to their financial stability, reducing reliance on external support systems and promoting independence. They were also experiencing food insecurity and were able to sustain themselves while working.
- Skill Development: Employment Specialists provide on-the-job coaching that helps participants develop and refine their skills, enhancing their professional growth and adaptability. Some of our participants began at the part-time level and, as they developed their skills, were promoted to full-time positions.
Transitional Employment (TE) programs act as a bridge between rehabilitation and competitive employment. At S:US, the Brooklyn Clubhouse is a community-based center that provides a supportive environment where individuals facing mental health challenges can engage in meaningful activities, socialize, and contribute to the daily operations of the Clubhouse. The Clubhouse TE program provides temporary, supportive work experiences in a structured environment. Individuals gain valuable skills and build confidence while working towards transitioning into mainstream employment. We currently have four TE positions as front desk receptionists within four different S:US housing sites and two urban farmer positions at one of our rooftop urban gardens. In addition, we have two maintenance positions at a local cleaning company. Our goal is to add more employers within the community to offer a variety of entry-level positions suitable to our members.
Person-Centered Skill Building Key Features of Transitional Employment
- Structured Learning Environment: Transitional employment provides a structured and supportive setting where participants can learn and practice work-related skills. Participants work 12-20 hours per week for 6-9 months, so they are able to enter the workforce without fully committing to it. This has been helpful in building skills and resumes while navigating employment interests for those who lack experience as they maintain a work-life balance.
- Gradual Transition: Participants gradually move from supervised work in a supportive setting to less supervised roles, preparing them for the demands of competitive employment. Several participants graduate from TE positions and feel ready for supportive or independent employment.
- Personalized Support: Similar to supported employment, transitional employment programs such as the Clubhouse offer personalized support, acknowledging the unique challenges and strengths of each participant. Staff actively train participants to provide on-site support and coverage when they are unable to work. Participants have shared that TE support allows them to not feel the same level of pressure when experiencing mental health challenges or lack motivation from time to time.
- Skill Building Opportunities: Participants engage in meaningful work that aligns with their abilities, fostering skill development and confidence. The units of the Clubhouse are designed to simulate the work-day experience while developing skills specific to each unit. The Clubhouse currently has a culinary unit, where individuals learn cooking, maintenance, and horticulture skills, and a business unit, where they learn administrative and clerical skills, data entry, computer skills, media, and communication skills.
Challenges and Future Direction
While these employment models offer numerous advantages, persistent challenges such as stigma, limited employer awareness, and funding constraints remain. To overcome these obstacles and encourage widespread adoption, it is essential to focus on advocacy, education, and de-stigmatization efforts.
Combining supported and transitional employment can create a comprehensive approach to mental health recovery through employment. Initially starting with a transitional employment program to build foundational skills, individuals can then transition into supported employment, where ongoing assistance is provided as they navigate mainstream job opportunities. Several participants have become Clubhouse members. They developed vocational skills, received their first transitional employment position, and eventually obtained independent competitive employment while still receiving support within various S:US programs. The individuals we serve have access to ACE Employment Services, the Brooklyn Clubhouse, and an array of services within the larger S:US network.
Looking ahead, sustained research, policy development, and collaboration among mental health professionals, employers, and communities will play a pivotal role in refining and expanding the impact of supported and transitional employment. Recognizing the unique potential within each individual and providing tailored support can collectively contribute to fostering a society where mental health is prioritized and everyone has the opportunity to lead fulfilling, meaningful lives through gainful employment.
For more information on S:US’ Brooklyn Clubhouse, Assisted Competitive Employment, and Transitional Employment, please visit sus.org/our-services/behavioral-health/.
Gayle Parker-Wright, LCSW-R, LSW, is the Recovery & Treatment Services Regional Director, and Angela Gralian, LCSW, is the Brooklyn Clubhouse & ACE Employment Services Program Director at Services for the UnderServed.
(n.d.). Mental Health: The Importance of a Mental Health Friendly Work Culture. U.S. Department of Labor. www.dol.gov/agencies/odep/program-areas/mental-health
(2023). Position Statement 31: Development of Employment Services for Adults in Recovery from Mental Health and Substance Use Conditions. Mental Health America. mhanational.org/issues/position-statement-31-development-employment-services-adults-recovery-mental-health-and
(2023). SAMHSA Announces National Survey on Drug Use and Health (NSDUH) Results Detailing Mental Illness and Substance Use Levels in 2021. Substance Use and Mental Health Services Administration (SAMHSA). www.samhsa.gov/newsroom/press-announcements/20230104/samhsa-announces-nsduh-results-detailing-mental-illness-substance-use-levels-2021