Only Small Percentage of Veterans with Mental Illness Access VA Employment Services
Individuals with mental illness face unemployment rates higher than the general population, and Veterans with mental illness who receive VA healthcare are less likely than other VA patients to be employed. VA provides vocational rehabilitative services through the Therapeutic and Supported Employment Services (TSES) program to assist Veterans with psychiatric diagnoses in obtaining employment and experiencing the therapeutic effects of work. This study sought to assess the reach of TSES services over one year (FY10) by examining the percentage of VA healthcare users with psychiatric diagnoses that accessed any TSES services, as well as specific types of services (i.e., supported employment, transitional work, incentive therapy, and vocational assistance). The study also sought to identify clinical and demographic characteristics (e.g., homelessness status) associated with accessing at least one visit of TSES. Using VA administrative data, investigators identified VA patients with a psychiatric diagnosis (n=52,542) from a random sample of all VA patients. Among these patients, 8% had a primary diagnosis of schizophrenia, 4% bipolar disorder, 41% depression, 40% PTSD, and 8% another anxiety disorder.
- Only a small percentage of Veterans with psychiatric diagnoses that used the VA healthcare system (4%) accessed even one VA employment service in FY10.
- Among Veterans who accessed at least one visit for employment services (n = 2,178), 35% received transitional work, 30% vocational assistance, 28% supported employment (considered the gold standard, evidence-based practice), and 8% incentive therapy.
- Adjusting for clinical and demographic characteristics, Veterans with schizophrenia and bipolar disorder were more likely to receive any employment services and to receive supported employment than Veterans with depression, PTSD, or other anxiety disorders. Veterans with depression and PTSD were more likely to receive transitional work and vocational assistance than those with schizophrenia.
- Among VA patients with a psychiatric diagnosis, African Americans, those with a substance use disorder, or an indication of homelessness were more likely to receive employment services, but were less likely to receive supported employment, specifically.
- Investigators were unable to ascertain Veterans' current employment status, desire for employment or employment services, or use of employment services outside the VA healthcare system.
- Findings suggest the reach of employment services to Veterans with psychiatric diagnoses is limited, and further suggest that expansion of evidence-based services such as supported employment be considered.
Dr. Zivin's work on this study was partly funded by HSR&D (IIR 10-176) and an HSR&D Career Development Award. Drs. Abraham, Yosef, and Zivin, and Ms. Ganoczy are part of HSR&D's Center for Clinical Management Research, Ann Arbor, MI.
Abraham K, Ganoczy D, Yosef M, Resnick S, and Zivin K. Receipt of Employment Services among VA Users with Psychiatric Diagnoses. Journal of Rehabilitation Research and Development 2014;51(3):401-14.