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Changing Job Markets and Serious Mental Illness

By Elizabeth Hancq, Director of Research at the Treatment Advocacy Center.

Having a meaningful job that gives one a sense of purpose, regardless of what that job may be, is something most people want. Work, especially work which one finds productive and fulfilling, promotes better well-being and higher quality of life. This is especially true for people with serious mental illness. Previous research has shown that work plays a large role in community integration and quality of life and can improve mental illness symptoms.

However, there is an extremely high unemployment rate in individuals with serious mental illness. One estimate suggests that as few as 12% of people with schizophrenia in the public mental health system are employed. There are multiple barriers to obtaining employment for people with serious mental illness that stem from impairments due to the illness itself as well as the way employment is structured in our society. These barriers may be evolving due to the shift in the labor market in the United States in the past 20 years.

There is no question that labor markets are changing at a rapid pace, especially due to new technology. This evolution has also shifted the skills necessary for employment opportunities as automations and artificial intelligence have made entire job sectors obsolete. Questions remain about how this shift in the labor market may disadvantage people with serious mental illness.

New research published this month in Psychiatric Services, led by Harvard Medical School health policy expert Richard Frank, attempts to answer some of the questions around how the shift in labor markets may impact people with serious mental illness. Specifically, the study authors sought to address whether people with serious mental illness are likely to work in job classes that are declining compared to those that may be growing.

The authors used data from the National Health Interview Survey as well as the Occupational Information Network database to examine changes in patterns of employment for people with mental illness from 1997 to 2017. They grouped occupations by the broad types of skills required and examples of job classes that fall into those categories: 1) routine cognitive (filing clerks, bookkeepers), routine manual (warehouse packing), nonroutine analytical (computer coding, engineering), nonroutine interpersonal (nursing), and nonroutine manual (certified nursing assistant). The authors predict that the routine job classes, which are most prone for automation, will continue to decline, whereas the demand for nonroutine job classes will increase.

People with serious mental illness were much less likely to work in any capacity compared to the rest of the population, with more than two-thirds of people not working during 2015-2017, according to their results. For individuals with serious mental illness who did work, they were much more likely to be in the routine job classes, with 12.1% working in routine cognitive jobs in 2015-2017.

The proportion of people with serious mental illness who were not working increased 10.4% over the 20-year period. Much of the declines in employment were in job sectors that are in decline overall, with little offset by increases in employment in the other job markets. This suggests “a large segment of people with mental health conditions has been and continues to be employed in jobs that have been vanishing and are projected to continue to disappear,” the authors write.

Instead of shifting toward job classes that are growing, a larger proportion of people with serious mental illness are not working at all. The authors suggest that supported employment programs may need to adapt their programs due to the changing labor market so that people with severe mental illness have the skills necessary for the jobs that are available. The authors also suggest that new adaptations for workplace accommodations in the Americans with Disabilities Act could promote continued employment for people with mental illness.

Frank, R. G., et al. (2021, February). Jobs for people with mental health conditions: Trends and prospects. Psychiatric Services.

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