“I’m not sure that I can figure out how to do that”: Pursuit of work among people with mental illnesses leaving jail

Abstract

Restoring people with mental illnesses to community life after detention in jail is fraught with significant challenges. Many of these challenges mirror those faced by anyone else who has been detained in jail. Among these are the particular challenge of seeking gainful employment and financial support for day-to-day life. This challenge is intensified when individuals return from jail to impoverished communities where employment prospects are already limited for residents, and where either a criminal record or a mental illness creates still additional barriers to work. To understand these barriers more fully, this study examined the process of seeking employment among people with mental illnesses leaving jail. Seventeen individuals with a history of mental health problems and with recent jail incarcerations were recruited from either a community based employment program or a mental health service setting. The informants were interviewed using life history interview techniques. Results show that connections to the paid workforce were tenuous at best for these respondents, both before and after their jail detention. While psychiatric symptoms, addiction, and the lack of productive social connections were individual-level factors that affected employment, the most pernicious impediments were rooted in policy, community structures, stigma and other social and economic realities.. If employment interventions are to have any traction at all in these settings, interventionists need to dig for innovative ways to address these factors, which are not complications, but bedrock realities that undergird all else.

Employment is often seen as a cornerstone of successful reintegration into the community after incarceration (Petersilia, 2003; Uggen, 1999; Visher, Winterfield, & Coggeshall, 2005). Indeed, parole decisions often hinge on the availability of a job in the community, in part because the structure that employment gives to day-to-day life is associated with reduced risk of arrest recidivism. While the instrumental goals of employment have been touted in both criminal justice and psychiatric rehabilitation, intervention research on employment rarely addresses the broader context of employment as marking meaningful aspects of community integration (Anthony, Rogers, & Farkas, 2003). Too few studies have explicitly examined the role of employment as a factor in promoting either psychiatric recovery or community reentry. Unfortunately, research in both areas have focused intensely on individuals and their employment, but rarely on the concrete interplay of these aspirations with social and economic poverty factors.. The labor force participation rate (i.e., working or looking for work) for persons with a psychiatric disability has remained around 25% for a number of decades (Mulkern & Manderscheid, 1989; Trupin, Sebesta, Yelin, & al:, 1997), the lowest rate among all disability groups. Even so, almost everyone with a mental illness has worked at some point in their lives (Baron & Salzer, 2002), 70% of those currently unemployed in one survey reported that they wanted to work (Rogers, Danley, & Anthony, 1992), work has been associated with numerous positive psychosocial outcomes, and interventions such as supported employment, have been shown to be effective (Burns, T. et al, 2007). However, the extent to which current state-of-the-art interventions have enabled persons with serious mental illnesses to achieve a long-term attachment to the labor force and financial independence has been negligible. For example, studies of Individual Placement and Support (IPS), a form of supported employment, find that fewer than 45% of persons in these programs eventually are employed at any point in time over an 18–24 month period (Drake, Becker, Clark, & Mueser, 1999; Lehman et al., 2002). The average job tenure reported in one study was only 16.5 weeks (Drake et al., 1999). Further, supported employment programs rarely bring individuals out of poverty. Draine et al. (Draine, Salzer, Culhane, & Hadley, 2002) pointed out the need to examine contextual factors, such as poverty, transportation, and normative factors that disproportionally affect persons with mental illnesses, rather than exclusively focusing on illness and other individual capacity factors, when examining the criminal, housing, and work lives of persons with mental illnesses. In regards to work, a greater understanding of the labor market liabilities and interventions in these areas may augment and extend employment outcomes achieved through current intervention technologies (Baron & Salzer, 2002). Involvement in the criminal justice system is one of these important labor market liabilities that would be expected to impact the work life of an individual with a mental illness, just as it impacts anyone else.

While many factors may contribute to community reintegration of people leaving jail or prison (Graffam, Shinkfield, Lavelle, & McPherson, 2004), former prisoners’ ability to secure legitimate employment with sustainable wages has been regarded as a critical element in this regard (Finn, 1998; Fletcher, Shaver, & Moon, 1993; Harer, 1994; Harrison & Schehr, 2004; Kerley & Copes, 2004; Needels, 1996; Sampson & Laub, 1993; Uggen, 1999). Stable employment - characterized as having a full-time position over a period of time or the ability to remain employed regardless of job change (Kachnowski, 2005; Kerley & Copes, 2004) - relates to positive economic and health outcomes, as it may serve to increase social functioning, promote self-efficacy, and reduce isolation (Parsons & Warner-Robbins, 2002; Richie, 2001). However, many individuals leaving prison fail to find and retain legal employment due to factors such as low educational attainment, drug addiction, social stigma, and legal restrictions (Pager, 2007; Pogorzelski, Wolff, Pan, & Blitz, 2005).

Systematic evidence does not provide support for the effectiveness of most employment based programs in reducing recidivism (Visher et al., 2005). Current models may be limited by the quality of jobs and the low perceived value of reentry programs by clients of those programs (Marlowe, 2006; Uggen, 1999). Uggen argues that employment programs need to address the social attainment value associated with employment, and that this may be the factor that leads to reductions in criminal recidivism (Uggen, 1999). This is a much higher bar than simply attaining a job, as aspiring to improve one’s social position is a direct challenge to the mechanisms of the economy that act to keep poor people, including those of us with mental illnesses, out of the primary labor market (Peck & Theodore, 2008).

We conducted an in-depth interview study with people who know these experiences first hand – individuals with mental illnesses who have recently been released from jail. Our aim was to explore their employment experiences and to understand the interaction of individual resources and community context in seeking employment.

Methods

Participants

A self-referred sample was recruited from employment programs serving individuals who have jail histories and mental health agencies also serving those with jail histories, all located in a large northeastern city. We purposely selected individuals who met the following criteria: 1) those who self-reported as having a mental illness, 2) those recently released from jail, and 3) those who represented varied experiences of reentry and help with reentry (i.e., use of vocational or other reentry supports) after jail release.

Procedures

The primary source of data was unstructured interviews using a phenomenological, life history technique (Rich et al., 2001; Starks & Trinidad, 2007). The interviews were conducted between June and November 2009 by the first two authors, who began each interview with the following prompt: “Tell me about your experiences of finding work or employment after you left jail this last time. Take as long as you like, and tell me whatever you think is important.” Interviewers probed for more detail in topical areas that seemed particularly relevant to the research aims. Demographic and background information were also gathered from participants after they provided their narrative. This included information about both their employment histories and perceived work prospects following their incarceration.

All interviews were recorded, and conducted in a manner that did not elicit identifying information on the recording. Recordings were then transcribed. The interview lengths were an average of 23 minutes (SD=4.72) in length, with a range from 16 to 30 minutes. The first two authors read and/or listened to recordings of all interviews. Using a grounded theory approach, they met a series of times to develop and refine themes of relevance to the research questions. After agreeing on the basic themes they conducted a second review of the data to reach consensus and final results. This research was approved by the IRB’s of the University of Pennsylvania, Temple University, and the City of Philadelphia Department of Public Health, as well as the research review board of Horizon House, Inc.

Results and Discussion

Participant Characteristics

A total of seventeen individuals were interviewed. They ranged in age from 25 to 55 years (mean = 41.82, SD = 9.10). Eleven (65%) were male and six (35%) were female. They predominantly identified as African-American (n = 15, 88%) with the remaining two identifying as white or Caucasian (12%). None were currently married, with 12 describing themselves as single (70%), three divorced (18%), and two widowed (12%). Six had not completed high school or GED at the time of the interview (35%), four had a high school education (24%) and seven had education beyond high school (41%). None of the participants had completed a four-year college degree. Twelve (71%) had experienced psychiatric hospitalization at some point in their life.

Regarding criminal justice involvement characteristics, the average age at first arrest was 23.30 years (SD = 7.66), with a range from 12 years to 39 years. Five of the 17 (29%) were first arrested at an age younger than 18 years. The number of months since incarceration ranged from 1 to 48, with five (29%) having been in jail within the previous year and 16 (94%) having been in jail within the past two years. One person had been out of jail for four years.

Findings

The individuals who were interviewed have made little progress in stabilizing their incomes or finding steady jobs in the weeks, months, and in some cases years since their release. None of those interviewed appeared to have settled into a long-term, even minimally financially rewarding role in the region’s competitive labor market. Much of what the respondents talked about when asked to share their experiences with work and money since their release was not encouraging with regard to their prospects for attaining employment stability. In fact, what is noticeable about the tone and content of responses was the lack of surprise or immediate frustration about the process. While this level of economic instability is unsettling with regard to its economic and social implications, it was also an ordinary part of life for these respondents.. The ten themes that emerged –described in greater detail below – suggest the multiple barriers that stand between these individuals and the productive and financially self-sustaining work roles they indicate they want for themselves.

Finding #1: Entry-level jobs dominated both the work histories and work goals reported on by the respondents, and few expressed more ambitious career goals

Almost none of the respondents had held a full-time semi-skilled, skilled, or professional position, either before or after incarceration. While entry-level work and occasional jobs are nothing to be ashamed about, particularly in the contemporary labor market, in today’s world they offer neither financial stability nor a reliable platform for future career growth. In part, the respondents’ work histories and goals are likely an artifact of the recruitment sites – urban neighborhoods served by publicly-funded agencies primarily serving the poor,. Both the human and social capital of the respondents was considerably limited. Even before incarceration, respondents had worked primarily at low-wage, low-to-no-benefit jobs with demanding schedules and high rates of turnover, establishing a vocational pattern that was playing itself out for these interviewees in the post-incarceration period as well. There was little aspiration for ‘better jobs,’ as though such a job constituted an unknown or unreachable ambition that was too unrealistic a goal to merit mention. Almost no one talked about pursuing an educational program beyond achieving basic literacy or gaining a high school equivalency diploma, nor were more than one or two of the respondents exploring or participating in semi-skilled or skilled training programs. Respondents set their job sights quite low, and the vocational programs they had participated in thus far had not substantially altered their fundamental notions of the kinds of jobs they could expect to get. The below response was fairly typical in regards to this finding:

I’ve done all kinds of work: I’ve cleaned up in a dentist’s office; I’ve done fast food restaurants; I’ve done recreation center clean up: I do housekeeping – self-employed housekeeping – etc. I actually have an associate’s degree in computers, but even though I have that education, my background messes everything up. (Interview 103)

Finding #2: Respondents reported that the community programs they had turned to for job training and placement after incarceration were only mildly responsive to their needs

Because each of the respondents in the sample was already attending a community program with a specific employment focus, everyone we spoke to was nominally in some form of vocationally oriented programming. However, respondents – while grateful for the structure, support, and financial assistance offered by the agencies – still found the programs less vigorous than they had hoped, and less helpful to them in landing a job. Some respondents were in traditional vocational rehabilitation programs, designed to help individuals develop a resume, practice responses to tough job interview questions, sort through the help wanted section of the newspaper, etc. Others were in education programs, including basic literacy classes and high school equivalency diploma classes. Many respondents in their current educational or training programs reported that their progress was agonizingly slow. It should be mentioned, however, that a few respondents did aggressively pursue job opportunities – regularly checking for job announcements, attending job fairs, and showing up for job interviewees. Even so, these respondents did not indicate that their actions in this regard were directly the result of their programs, which were described by them as relatively weak and passive, leading us to conclude that interviewees’ actions instead reflected on their individual motivation. The respondents did report that the programs were better than nothing, but still were viewed as lacking in effectiveness. A typical response was:

I haven’t got much help with work – other than a little here and there – and I mean no one in my family, no one in prison, no one in the probation department – has much asked me about work and what I’d like to do and how they could help. I wouldn’t mind going back to nursing school – given that I’ve done a lot of that already, but I’m not sure that I can figure out how to do that. (Interview 107)

Finding #3: Non-vocational treatment and supports were viewed as minimally effective, further undermining employment prospects

While many respondents received a degree of behavioral health treatment, residential services, or financial support, these programs were seen by most of the respondents as only mildly responsive to their needs. A number of respondents were residents of ‘recovery houses’ – a local and largely unregulated network of residential supports for individuals who need structured residential support while attempting to leave their criminal (and often drug-related) lifestyles behind (Fairbanks, 2009). Respondents were often very critical of the recovery houses, which took their money, restricted their movement, and offered little else but shelter. Respondents wanted to leave the recovery houses as quickly as they could, even for the vagaries of street life or the emotionally complicated assistance of families, particularly inasmuch as most recovery houses restrict the ability of residents to work during the initial weeks of orientation to their new residential environment. Almost every respondent received financial assistance, although the amount of money received was minimal and barely sustained the respondents’ impoverished lifestyles. Every respondent to the survey could be characterized as currently being poor. Although a few could claim lower middle class origins, most came from quite poor or lower working class backgrounds, and all currently lived at the subsistence level within impoverished communities. Even if they had the additional support of family members, who were themselves poor, poverty was the defining characteristic of their lives – both past and present, as well as what they anticipated for their futures. The residential and financial resources available to them were viewed by the respondents as too insubstantial to dramatically affect their circumstances. Some respondents concluded that it was up to them to make their way in the post-incarceration period on their own, as best they could.

My probation started in May 2007, and I’ve not gotten much help with employment. I try to ask them about it, but they are so busy down there at probation that they pretty much get you in and out: ‘how are things going at home, have you found employment?’ – they pretty much rush you in and out. (Interview 103)

Finding #4: The sustained recession at the time the interviews were conducted was of little concern to the respondents

In the summer of 2009, as these interviews began, the national economy was in a severe recession, with a loss of jobs in virtually every sector of the economy and the growing numbers of the jobless a topic of national attention. A recent report form the Heldrich Cetner for Workforce Development (Horn, et al, 2012) captures the impact of the recession on recent high school graduates, who report a 54% unemployment rate and very pessimistic expectations for their future. Yet the respondents to our study – with two exceptions – did not identify the state of the economy as the source of their inability to find jobs for themselves. It was unclear to the interviewers the degree to which the respondents were aware of the national and local unemployment crisis or, if they were, connected it to the employment challenges they faced and with the harsh reality of looking for work in a recession.

Finding #5: Many respondents had been able to get jobs since their release from incarceration, but job tenure was limited

Approximately half of the respondents had found jobs since their release, primarily in the secondary labor market, but had subsequently lost those positions. It was unclear to the interviewers the degree to which the ubiquity of job loss was a result of the respondents’ underlying psychiatric disabilities and/or their substance abuse, or was the result of the usual ebb flow of the secondary job market, particularly during a recession. Further, the interviewers did not pursue whether each job loss was a result of lay-offs, firings, or decisions on the part of the respondent to quit a job he or she found tiring, demanding, or minimally rewarding financially. But few of these jobs lasted very long. The secondary labor market, and often the part-time jobs, that respondents found themselves in has been described by labor researchers as neither providing the financial rewards to enhance job tenure nor adequately preparing people for career enhancement (Ehrenreich, B., 2001). Here again, the money and work experiences of the interviewees since their release were not significantly different than their pre-incarceration work experiences.

Finding #6: Psychiatric disabilities and substance abuse were still troubling issues in the lives of the respondents, and were offered as explanations for their problems in moving more rapidly toward steady jobs

Respondents frequently mentioned their psychiatric illnesses and their struggles with substance abuse, in one or more of three ways. First, some respondents felt that their psychiatric illness and/or substance abuse is what led them to jail in the first place. Second, most respondents felt strongly that employer prejudices about psychiatric disabilities and substance abuse often resulted in their being easily overlooked or rapidly rejected by potential employers, and a few of the respondents spoke about this with some bitterness. Third, a number of the respondents believe that their ongoing behavioral problems continued to limit their work abilities and was the reason they had lost the entry-level positions they had held since incarceration: “I’m too slow,” “I get too upset,” and “I got too depressed to go in” were all common themes with regard to their failure to keep the job they had initially found for themselves. There was very little mention of the available interventions that mainstream vocational agencies in the area offer to sustain people with psychiatric disabilities at work, despite the fact that there is a vast network of mental health and substance abuse programs in their city that offers treatment, vocational counseling, supported employment, social connections and emergency services. Respondents believed that for the most part they were on their own in meeting the various demands of work and had little sense that the programs they were in – or other programs to which they might have been referred –could help them succeed at work.

It’s a struggle. I have more against me in my life than a lot of people have. I have to fight my addictions. I have to stay level with my mental health. I have a felony against me. Those three things make it hard to have a job, let alone control what happens with depression and anxiety. My job – my job is balancing everything – is a little bit, maybe a lot, harder than most people’s. (Interview 103)

I wish I could work but it’s too stressful for me. I can’t handle a lot of stress. With people snapping at you and bringing their problems from home onto the job. When I get upset I can turn violent, so I have to program myself to make sure I don’t feed into any conversations or arguments. (Interview 201)

Finding #7: Many respondents felt that their criminal backgrounds, more than any other issue, closed many employment opportunities to them

A few of the respondents talked about the legal and regulatory barriers that closed many job opportunities to them, and indeed, the state legislature in Pennsylvania (as elsewhere in the country), continues to close additional job categories to people with criminal backgrounds. Others felt that employer prejudices in this regard were quite strong even in the absence of state regulations. Many talked about having very positive interviews but never getting a call back, or knowing they were well qualified for a job but were told directly or indirectly that the job would not be offered to them because of their criminal background. And some spoke of the way in which their multiple disadvantages - a mental illness or a history of drug and alcohol abuse along with a criminal background - made employers especially wary. Despite respondents’ general acceptance of their circumstances, the systematic limitations on their employment opportunities evoked strong feelings about a system that seemed to offer no ‘second chances.’

Each day I come here or I go to different job fairs and I pound the pavement day after day. A lot of times it is hard to even get a callback. I went to one bar that’s pretty popular and I had just filled out the application and I had the interview. They sat me down and looked at my application and told me I couldn’t go any further than this, and ‘you have to leave right now.’ I’ve had a few like that. (Interview 102)

Well, I did get an interview at one place. So I go out there and I have an interview. Everything was going fine, so towards the end of the interview he asked about a criminal background check. I wanted to lie and say “I don’t have a criminal background,” but what’s the point, because if they hire me and they find out, that makes me look like a liar and a criminal. I told the truth and stuff like that. He told me he appreciated my honesty, but because of the jobs that he was filling – were like factory jobs and being around a lot of people – and having an assault charge with a felony, he said that he wouldn‘t see those people hiring me so he was not going to waste his time. Every time I find a job and I go interview and stuff, it’s the criminal background check that messes me up. (Interview 103)

Finding #8: There was little systematic focus – either while incarcerated or while in the reentry process – on employment

There was a pervasive sense among most of those interviewed that the systems in which they found themselves were disinterested in their work futures. While a few respondents talked about participating in educational programs in prison, including ABE and GED classes, and a limited number of prison-based skills training programs, most indicated that there had been very little encouragement or counseling while in prison about their work prospects upon release. These respondents had found their way to the three programs facilitating this study’s interviews largely by accident rather than through any sort of systematic work-focused reentry planning and referral process. While finding work was frequently foremost in the minds of those we interviewed, the post-incarceration systems in which they were enmeshed were far less focused on this goal. Treatment programs sometimes purposely delayed job searchers for what they saw as clinically sound reasons or simply anticipated that some other system would provide vocational direction. A few of those who relied upon an SSI/SSDI support check were advised against working at all. While there is a vague systemic expectation that those leaving prisons and jails, with or without psychiatric disabilities, will ultimately return to work, no systemic plan exists to help insure this.

After I got out of jail in ’07, I went to work at a place I worked at before I went to jail, but I only worked there for about two weeks because the SSI people told me that they were going to review my case to put me on SSI, and so I discontinued work to make sure I qualified: they told me if I was working they would automatically disqualify me, so I haven’t been working since ’07. (Interview 506)

The problem I faced, of course, is that I’m on SSI and I really can’t afford to work more than twenty hours a week without losing my SSI and medical benefits, so I’m not really sure how to proceed. (Interview 108)

Finding #9: Social capital and connections to employment networks is in short supply

Those interviewed reported few other family or neighborhood resources that could provide financial assistance or job leads. Most interviewees seemed to have little or no social capital on which they could rely for assistance or direction. While this is not surprising – those with behavioral health issues sometimes exhaust family and friend support systems over the years – what this meant for those we interviewed is that they had even fewer informal sources of connection to competitive jobs than others in similar limited socioeconomic circumstances. This meant fewer job leads and substantially less emotional and practical supports that people rely upon when starting a new difficult job.

You asked whether there is anyone who has helped me to look for work, and I’d have to say, ‘yeah, myself.’ I would say myself, because I’m the one really having to be the one to make my mind up and find a job. (Interview 104)

My family had moved me out. They had their own problems with supporting a home and supporting meals for themselves, and naturally I wanted to be able to be on my own. When I need them, I couldn’t stay with my parents or my relatives anymore because they weren’t going to tolerate me any longer. (Interview 202)

Finding #10: Despite their circumscribed vocational prospects, there was little complaint

One of the unsettling themes that emerged from these interviews was the respondents’ lack of vigorous complaint about their circumstances. Most did not seem particularly surprised by the difficulties they were facing in finding work, nor did they rail against the jails they had been in for failing to provide appropriate vocational training, nor were they surprised by the ineffectiveness of the vocational interventions they had finally located. There was an atmosphere of resignation that seemed to suggest that they hadn’t really expected much, and had these expectations confirmed by their experiences. Their current lives were not that much different, in most regards, from the lives they had been leading for the five or ten years leading up to incarceration. There was little money, but they had for the most part grown up in economically difficult circumstances; and while finding and holding a good job was proving more difficult than they had anticipated, their careers before incarceration had been no cake walk either.

My friend takes me around almost every day. We go to a lot of different places where there’s a lot of stores and just ask if they are hiring, but they don’t have much to offer. I tried to get a job at K-Mart: I deserve better than that, but I guess with what’s going on with my criminal stuff, I can’t get it. I tired Kids-R-Us, I went to job fairs, but before I even wasted my time I would ask ‘do you hire ex-offenders’ and although they would say ‘yes’ they would also say ‘well, it depends on the situations’ and I would fill out an application but I never hear anything back. One man was opening a business and needed a secretary and I told him that I do that kind of work: people talk a great game but it’s following through that counts. I even went to the zoo and filled out an application and had an interview, but they sent me a letter saying I’m not qualified for the job they had. You might as well give up, that’s how I look at it: you know, if you’re not going to use me now, why would you use me later. (interview 103)

Implications

This study does have limitations worth noting. The sample size is relatively small and involved a self-referred group of individuals. The sample also consists exclusively of those residing in urban settings and the findings may not be fully applicable to those in suburban or rural settings. These issues should be considered when considering the findings, and conclusions, and proposed implications that are offered.

Nonetheless, based on these findings we are left to ask how the re-entry experiences of people with psychiatric disabilities returning to community life following incarceration could be reinvented to provide them with a reasonable opportunity to obtain and maintain self-sustaining employment. These interviews force a recognition that the individuals most in need of help are not those whose normative career trajectories – whether working class or middle class - have been interrupted by unexpected behavioral problems and/or isolated acts of illegality. Instead, it is clear that many, just like others in the labor market without behavioral health issues, have never managed previously to establish a long-term attachment to the primary and legal competitive labor market. The degree to which respondents have experienced only the secondary labor market in their pre-incarceration years, and the way in which these experiences with entry-level, low-wage, and short-term employment roles has shaped their perceptions of the types of jobs they are best suited for in the future, requires a refocusing of both individual and program work goals if they are to contribute to reducing criminal recidivism.

A first response to this finding is that employment programming could refocus on primary labor market jobs. As suggested earlier, jobs in the secondary labor market support millions of American families and have as much inherent nobility about them as any other. But they do not provide either financial stability or a good basis for career advancement, and many of those with a criminal background are already quite aware of the limitations of a long-term career in unskilled jobs. It may be unrealistic for many of those returning to community life to anticipate that they can readily move into or work toward well-paid and interesting careers within the middle-class, but it is demonstrably realistic to refocus individuals toward the semi-skilled and skilled jobs which constitute 50% of the U.S. primary competitive labor market. These are the types of jobs that often provide other Americans with family-sustaining wages, reasonable benefit structures, and long-term career prospects.

However, these positions often require additional educational and/or training. While many of these jobs are among the fastest growing sectors of the labor market (e.g., medical billing, home health care, etc.), they often require completion of an approved training program, apprenticeships and/or and state licensing. This should not be considered beyond the capacities of the growing cohort of unemployed men and women with behavioral health challenges and a jail or prison history – assuming that the supports these individuals need to find their way to and succeed at these preparatory programs are available, which is currently rarely the case.

If behavioral health and criminal justice systems continue to focus on preparing people for only entry-level jobs – in part because these seem to be most readily available - we are committing our systems to goals that sell short many individuals and that fail to assist them in achieving their full capabilities. Few people – with and without disabilities or criminal records – stay in such jobs very long, in part as they increasingly recognize that secondary labor market jobs are no longer a starting point for a slow and steady progress toward work in the primary labor market.

A second response is to address the contextual barriers, including the legislative and prejudicial barriers to job acquisition that are structural impediments to full inclusion in community life. There should be an easier and more reliable route to expungement of criminal records, so that more individuals can fearlessly prepare for and apply for the jobs currently unavailable by law in the semi-skilled and skilled job categories. We can reverse the trend of state legislatures to continuously broaden the number and range of job categories beyond the reach of those with criminal records. Such laws are arguably counterproductive – pushing people back into behaviors that risk arrest and are the source of tremendous anxiety for both employers and their prospective employees.

Further, the prejudices of employers, independent of legislative restrictions and other structural impediments, continue to play a major role in keeping people from productive employment (Pager, 2007). Advocacy efforts could be increased to remove questions about mental illness, substance abuse, and criminal records from job application forms. In addition, the field needs more public examples of men and women who have been able to turn their lives around, and more support for employers who are willing to play a role by offering a job to them. There are a lot of people with criminal records and behavioral problems already responsibly employed but who simply stay silent about their past in order to maintain their good fortune or enhance their prospects for an even better future. Their silence, while very understandable, maintains the status quo for many of their less fortunate peers.

People with psychiatric disabilities and criminal records who return to community life can also become a more visible and active part of the consumer self-help movement, drawing on that movement’s lessons with regard to successful policy advocacy, the ongoing push for programs that promote community inclusion rather than isolation (Kaplan, Salzer, & Brusilovskiy, 2012) and the creation of jobs within the mental health and criminal justice systems for consumers. Engagement in advocacy, community life, and social service positions has taught an emerging generation of individuals with only psychiatric disabilities about their own capacity for jobs and justice, and can do the same for this population as well. There are barriers to this route, from consumers and from professionals in both the criminal justice and mental health fields, but the ground has been prepared for them. Consumer-run programs can refocus and revitalize the re-entry process.

Third, while it sounds glib to say that an effective reentry process begins on the first day of incarceration, it is nonetheless true. These respondents were consistent in their perception that employment was either completely ignored or only minimally addressed during their months or years of incarceration. Nor was it a core aspect of their preparation for release. Prisons – given their 24-hour responsibility for the lives of these individuals – have a dramatic opportunity to re-orient prisoners around more socially acceptable mechanisms to earn money, but this opportunity is often both squandered and – if available – rarely meaningfully linked to job opportunities or further training upon the individual’s ultimate release. The use of peer specialists who help prisoners focus on employment opportunities during incarceration may be one important way to break through toward more substantial employment outcomes and reentry success. Simply focusing on ‘criminal thinking’ and refashioning the individual’s ability to anticipate the consequences of illegal activity isn’t enough if the prospects for a meaningful life less engaged in criminal thinking patterns are not so enticing themselves.

CONCLUSION

In addition to the suggestions for how extant vocational and mental health services programs can be more responsive to the need for people with psychiatric disabilities to find and keep work, there is a singular broad conclusion to be drawn from these findings that focuses on the role of psychiatric rehabilitation. As a field, psychiatric rehabilitation has a long way to go before it could be seen as responsive to the core issues of poverty among people with psychiatric disabilities, particularly those who are made more vulnerable by experiences such as jail incarceration.

This is seen in a number of the themes drawn from our interviews. The assessment of programs in general was lackluster. “Better than nothing” is one assessment under Finding 1, a classic case of ‘damning with faint praise.’ Offering inadequate and unresponsive programs to vulnerable people in seriously challenged communities is tantamount to the proverbial ice water in hell. The offer itself instills an expectation that it may be effective, but when that hope is dashed over and over in poor communities, it undercuts the legitimacy of our efforts as psychiatric rehabilitation professionals. Some of the outcomes of these dynamics are problematic in other ways. Ineffective programs may serve to replicate a passive, excluded community role for people with psychiatric disabilities and criminal justice backgrounds. We see some of this in theme 6, where serious mental illness is seen as an almost ‘obvious’ explanation for unemployment. The programs are not held accountable for their ineffectiveness, and there is resignation that the combination of perceived disability and poor communities cannot be overcome. This may explain why a focus on employment is still largely absent in either pre-release planning or mental health programs. Both consumers and providers of services may have moved toward an unconscious mutual agreement that it does not seem worth the effort, if in the end what is achieved is a reinforcement of a disempowered, exclusionary position from the economic and social flow of life. Under these circumstances, the most rational response is a new generation of innovative, aspirational enterprises, an alternative to only generating more involved service systems. Such enterprises would aspire to more humanistic outcome values, such as inclusion in the fullness of community life (including work) rather than adherence to program designs, ‘fulfillment’ of individual work aspirations rather than living ‘in spite of’ disability, and reliance upon the economic opportunities within the mainstream community rather than upon systems of care. In high risk, high need neighborhoods where conventional services are likely to be ineffective, psychiatric rehabilitation programs in particular can be challenged to live up to their own values base (Brusilovskiy & Salzer, 2012). It can also be challenged to fulfill one of its key principles, which is —to intervene for change in the environment as well as in the person. At all levels, this can alter the focus and mechanisms of change away from systems of services that reinforce economic disempowerment.

Some examples include a focus on the inclusion of people with psychiatric disability, along with everyone else, in local enterprises for the social and economic development of their communities. Health agency leaders can and ought to participate with their service consumers as stakeholders in their communities. Although psychiatric rehabilitation programs are often stigmatized within their own communities as part of a service economy, which does not have the same standing as other sectors of the healthcare system, they can work more effectively to reach out to and collaborate with local community development initiatives. At the same time, Clubhouse models can be expanded to be less, well, clubby and more inclusive of the surrounding community, and supported employment programs can be integrated into local workforce development initiatives that serve the entire community of job seekers.

Models for this work can be drawn from other fields, where organizations have adopted whole communities or section of cities in order to serve as agents of social change there. These include: The Harlem Children’s Zone in New York, serving children; the Church of the Savior in Washington DC, which has eschewed a sanctuary building in favor of providing housing and healthcare and commerce throughout the Adams Morgan Community; and The Village in Los Angeles, an aspirational model from our own field of psychiatric disability.

The call for social justice among people with psychiatric disability, who largely live in poverty and exclusion, is a call to focus more on justice rather than mere change. Psychiatric Disability needs to rehabilitate its own aspirational side, and step up to this challenge.