Predictors of Labor Force Status in a Random Sample of Consumers with Serious Mental Illness

  • Carol CarstensEmail author
  • Richard Massatti


Employment among persons with severe mental illness has been challenging. Supported employment programs have had some success; however, much remains to be understood about client motivations for employment. A labor force participation study was mailed to persons receiving services in a Midwestern state’s publicly funded behavioral health system, and a random sample of participants resulted in 964 valid surveys. Analysis showed significant differences between Medicaid coverage program and labor force status, with some programs likely to have higher percentages of employed persons. A multinomial logistic regression model explored the odds of employment and unemployment to not being in the labor force. Perception of incentives to employment greatly increased the odds, while age and perception of barriers to employment decreased the odds for both groups when compared to those not in the labor force. Findings have implications for the design of employment programs and coverage benefits.


Serious mental illness Incentives and barriers to employment Medicaid MHSIP Consumer surveys 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.


  1. 1.
    Goldstrom ID, Manderscheid RW. The Chronically Mentally Ill: A Descriptive Analysis from the Uniform Client Data Instrument. Community Support Service Journal. 1982;23:4–9.Google Scholar
  2. 2.
    Mulkern VM, Manderschied RW. Characteristics of Community Support Program Clients in 1980 and 1984. Hospital and Community Psychiatry. 1989;40(2):165–172.PubMedGoogle Scholar
  3. 3.
    Anthony WS, Jansen M. Predicting the Vocational Capacity of the Chronically Mentally Ill. American Psychologist. 1984;39:537–544.CrossRefGoogle Scholar
  4. 4.
    Uttaro T, Mechanic D. The NAMI Consumer Survey Analysis of Unmet Needs. Psychiatric Services. 1994;45(4):273–374.CrossRefGoogle Scholar
  5. 5.
    Roth D, Crane-Ross D, Hannon MJ, et al. Toward Best Practices: Top Ten Findings from the Longitudinal Consumer Outcomes Study. Columbus Ohio Department of Mental Health, Office of Program Evaluation & Research, 1999.Google Scholar
  6. 6.
    Bonnie RJ, Monahan J. Mental Disorder, Work Disability, and the Law. Chicago: University of Chicago Press, 1997.Google Scholar
  7. 7.
    Estroff SE, Zimmer C, Lachicotte WE, et al. Pathways to Disability Income Application among Persons with Severe Persistent Mental Illness. The Millbank Quarterly. 1997;75(4),495.CrossRefGoogle Scholar
  8. 8.
    Substance Abuse and Mental Health Services Administration. Achieving the Promise: Transforming Mental Health Care in America, Final Report. HHS Publication No. SMA 03–3832, Rockville: Department of Health and Human Services, 2003.Google Scholar
  9. 9.
    Cook JA. Employment Barriers for Persons with Psychiatric Disabilities: Update of a Report for the President’s Commission. Psychiatric Services. 2006;57(20):1391–1405.CrossRefGoogle Scholar
  10. 10.
    Cook JA. One-Year Follow-Up of Illinois State Vocational Rehabilitation Clients with Psychiatric Disabilities Following Successful Closure into Community Employment. Journal of Vocational Rehabilitation. 2003;18:25–32.Google Scholar
  11. 11.
    Drake RE, Skinner JS, Bond GR et al. Social Security and Mental Illness: Reducing Disability with Supported Employment. Health Affairs. 2009;28(3),761–770.CrossRefGoogle Scholar
  12. 12.
    Lehman AF. Vocational Rehabilitation in Schizophrenia. Schizophrenia Bulletin. 1995;21:645–656.CrossRefGoogle Scholar
  13. 13.
    Bond GR, Drake RE. Predictors of Competitive Employment among Patients with Schizophrenia. Current Opinion in Psychiatry. 2008;21(4):362–269.CrossRefGoogle Scholar
  14. 14.
    Bond GR, Drake RE, Becker DR. An Update on Randomized Controlled Trials of Evidence-Based Supported Employment. Psychiatric Rehabilitation Journal. 2008;31(4):280–290.CrossRefGoogle Scholar
  15. 15.
    Wewioriski JH, Fabian ES. Association between Demographic and Diagnostic Factors and Employment Outcomes for People with Psychiatric Disabilities: A Synthesis of Research. Mental Health Services Research. 2004;6(1):9–21CrossRefGoogle Scholar
  16. 16.
    Burke-Miller JK, Cook JA, Grey DD, et al. Demographic Characteristics and Employment among People with Severe Mental Illness in a Multisite Study. Community Mental Health Journal. 2006;42(2):143–159.CrossRefGoogle Scholar
  17. 17.
    Corbiere M, Mercier C, Lesage A. Perceptions of Barriers to Employment, Coping Efficacy, and Career Search Efficacy in People with Mental Illness. Journal of Career Assessment. 2004;12:460–478.CrossRefGoogle Scholar
  18. 18.
    Salyers MP, McGuire AB, Bond GR, et al. What Makes the Difference? Practitioner View of Success and Failure in Two Effective Psychiatric Rehabilitation Approaches. Journal of Vocational Rehabilitation. 2008;28:105–114.Google Scholar
  19. 19.
    Bickhard MH. An Integration of Motivation and Cognition. Development and Motivation: Joint Perspectives. 2003;41–56.Google Scholar
  20. 20.
    Beck JS. Cognitive Therapy: Basics and Beyond. New York: Guilford Press, 1995.Google Scholar
  21. 21.
    Miller WR, Rollnick S. Motivational Interviewing, Second Edition. New York: Guildford Press, 2002.Google Scholar
  22. 22.
    Ryan RM, Deci EL. Intrinsic and Extrinsic Motivations. Classic Definitions and New Directions: Contemporary Educational Psychology. 2000;25(1):54–67.CrossRefGoogle Scholar
  23. 23.
    Larson JE, Ryan CB, Wassel AK, et al. Analysis of Employment Incentives and Barriers for Individuals with Psychiatric Disabilities. Rehabilitation Psychology. 2011;56(2):145–149.CrossRefGoogle Scholar
  24. 24.
    Dantzker ML, Hunter RD. Research Methods for Criminology and Criminal Justice, Third Edition. Sudbury: Jones & Bartlett Learning, 2012.Google Scholar
  25. 25.
    Substance Abuse and Mental Health Services Administration. Combined Substance Abuse and Mental Health Treatment Episode Data Set (TEDS) State Instruction Manual with State TEDS Submission System (STSS, Version 4.0) Guide. Center for Behavioral Health Statistics and Quality. Available online at Accessed on July 2, 2015.
  26. 26.
    Bureau of Labor Statistics. BLS Handbook of Methods, Chapter 4: Measurement of Unemployment in States and Local Areas. U.S. Department of Labor. Available online at Accessed on July 2, 2015 2015.
  27. 27.
    Jerrell JM. Psychometrics of the MHSIP Adult Consumer Survey. Journal of Behavioral Health Services and Research. 2006;33(4):483–488.CrossRefGoogle Scholar
  28. 28.
    Hosmer D, Lemeshow S. Applied Logistic Regression, Second Edition. New York: Wiley, 2000.CrossRefGoogle Scholar
  29. 29.
    The Analysis Factor. How to Diagnose the Missing Data Mechanism. Statistical Resources. Available online at Accessed on July 1, 2015.
  30. 30.
    Pigott TD. A Review of Methods for Missing Data. Educational Research and Evaluation. 2001;7(4):353–383.CrossRefGoogle Scholar
  31. 31.
    Alderks CE, Lutterman T, Phelan B, et al. June 15, 2015 Webinar of the 2014 Mental Health Data Collection Results URS, MH-CLD, MH-TEDS. The Behavioral Health Services Information System. Available online at Accessed on July 14, 2015.

Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  1. 1.Ohio Department of Mental Health and Addiction ServicesColumbusUSA

Personalised recommendations