In 1875, when California officials opened Napa State Hospital to treat the mentally ill and indigent, the massive four-story, Gothic-style mental hospital was staffed with all the necessary doctors, staff, and equipment needed to care for the state’s most vulnerable. But the facility was also built on the belief that working more than 2,000 acres of the state’s lushest land was its own therapy.
The hospital’s dairy and poultry ranches, vegetable gardens, and other farming operations gave the mentally ill skills that would be valuable in the agrarian area, and also helped make the facility financially self-sufficient. At the hospital's peak in 1960, five thousand patients worked the lands around it.
Yet in recent years, the state’s overcrowded prison systems have flooded such facilities with mentally ill inmates after a federal mandate said they were being ignored, leading to more of a locked-down facility and less space to help those who become wards of the state.
Nowadays, the mentally ill and homeless aimlessly line many streets in Northern California—just one page in the story of the national breakdown in America’s mental health system, which has been whittled down to near nothingness as the need for help has only increased.
That helps explain the unsurprising and grim truth that emerged this week. More than 80 percent of people with serious mental illnesses are unemployed, according to a new report from the National Alliance on Mental Illness. That’s despite nearly $4 billion spent annually in federal funds to support employment for the mentally ill and improve those rates.
Employment rates for people with mental illness were already “abysmal,” but they have continued to decline over the last decade, the report says, because of a confluence of factors—from negative stereotypes of the mentally ill to the reduction of assistive services across the country.
“We knew that mental health services really took it on the chin during the recession. Employment rates had already been dismal to begin with, and when the supports were eroded, people with mental illness lost support and lost jobs,” Sita Diehl, author of the report, told the Washington Post.
Job provisions that help people with disabilities or mental illness find and keep work can come in the form of a job modification, added work training, or special accommodations on-site to make the position more accessible for an employee with a mental illness.
Of the more than 7 million people across the country who are receiving public mental health services, more than half want to work—but they aren’t getting the support services they need. Debbie Plotnick, senior director of state policy for Mental Health America, said the extremely high unemployment rate is old hat for this sector of the public.
“It’s absolutely not surprising, nor is it news,” she said.
Most funding for mental health programs comes at the state level, said Plotnick, but since the recession hit in 2008, billions of dollars were slashed from these budgets across the country.
Maine, West Virginia, Hawaii, Pennsylvania, and California are the five states with the highest unemployment rates for people with mental illness, according to the NAMI report. Recently though, California has made great strides in setting aside state money for mental health prevention and intervention, said Plotnick. Under Proposition 63, sometimes referred to as the millionaire’s tax, California puts 20 percent of this income toward helping kids with mental health issues and working with adults before their condition escalates to a crisis, such as a suicide attempt.
However, California is the exception, not the rule. When state mental health budgets get cut, it is typically the crisis services that remain and preventive measures that go, Plotnick said. This decision is penny wise, pound foolish, because it allows mental health issues to go untreated until they escalate into extreme or emergency situations.
“If these are the only services you have left, people will become sicker; they’ll become more disabled,” Plotnick said. “Unfortunately, in this country we wait until people have an extreme condition...until we intervene.”
It’s like waiting until someone has stage IV cancer to address the illness, she said, and states will see the biggest return on their financial investment in mental health if they focus on early intervention and community support. Otherwise, those dollars saved may be spent in future health care or the criminal justice system.
Most major mental health conditions manifest in late adolescence and early adulthood, said Plotnick, and this can interrupt schooling, making it difficult to land higher-level jobs without additional support. Some people with mental illness take a slew of medications, which can interfere with their ability to work or make them too tired to keep a normal schedule.
Even for those who are ready and willing to work, policy disincentives encourage people to stay on social security or disability insurance instead of getting a job. When a person becomes employed, he often loses Medicaid or Medicare benefits and is instead left with subpar health insurance through the new employer. In fear of relapsing because they can’t get the help or medicine they need, many drop out from the labor force altogether, according to the report.
Although the Affordable Care Act has the potential to be a huge help for those with mental illness, advocates say there needs to be system-wide improvement. Lowering the unemployment rate is not only positive for the economy—it’s crucial to the recovery of those with mental illnesses.
“Work is tied to a person’s sense of identity, dignity, and worth in our society,” said NAMI Executive Director Mary Giliberti. “Even during the recession, the national unemployment rate paled next to what people in the public mental health system routinely experience. We must do better.”