What services help people with mental health impairment return to employment?

Challenge

The percentage of people receiving disability benefits from the Social Security Administration (SSA) for a mental health impairment is increasing. In 2005, SSA selected Westat to lead the Mental Health Treatment Study (MHTS), which found that supported employment services integrated with behavioral health treatment and systematic medication management helped disability beneficiaries with mental health impairments return to work, improve their health, and lower their hospital utilization.

About half of citizens who apply for Social Security disability benefits are denied. Many of these individuals continue to experience health issues and employment problems, and they later successfully apply for benefits. As a result, what happens to denied applicants and whether evidence-based services could help them represents a major public policy issue.

Building on the success of the MHTS, SSA chose Westat to lead the Supported Employment Demonstration. This demonstration aims to study the effects of offering the same services to people with mental impairments who were recently denied Social Security disability benefits.

Solution

Westat is implementing and evaluating the Supported Employment Demonstration using a randomized controlled trial design. We have designed the demonstration to compare the outcomes of two treatment groups and a control group among individuals with a mental impairment who applied for Social Security disability benefits and recently received a denial of benefits. Westat is enrolling 1,000 participants in each of three study arms, totaling 3,000 participants in 30 communities across the U.S. Participants randomized to the treatment groups will receive services for 3 years at local community mental health agencies selected to serve as demonstration sites.

In the Full-Service Treatment group, participants receive services from an Individual Placement and Support (IPS) employment specialist, a behavioral health specialist, a case manager, and a nurse care coordinator. In the Basic-Service Treatment group, participants receive the same services as the Full-Service group except for nurse care coordinator. In the Usual Services or Control group, participants receive a manual of national, state, and local services, which they may seek out on their own.

To evaluate the SED, we:

• Interview participants every 3 months (over the 3-year study period) by telephone about topics such as their job and health status, quality of life, use of health care services, income, and health insurance coverage
• Collect administrative data from SSA about participants’ benefits awards and award amounts, as well as data from the demonstration sites on services provided to treatment participants
• Conduct site visits involving in-person interviews and focus groups with site staff and study participants, as well as ethnographic studies of participants and those who chose not to participate

We will analyze the collected data and summarize the findings in a series of evaluation reports that we will deliver to SSA.

Results

The results of the demonstration will help SSA determine which services best support denied applicants with a mental impairment and reduce their need for Social Security disability benefits in the future.