Poor physical health a barrier for job seekers with serious mental illness

People with serious mental illness believe their physical health problems rather than psychological health make it difficult for them to find jobs, according to a Rutgers study.

"The study underscores the urgent need for integrated mental health and physical health care for people with serious mental illness, especially those with long-term, chronic conditions," said lead author Ni Gao, an associate professor at Rutgers School of Health Professions.

"Without addressing physical health problems, people with serious mental illness will continue to experience more health problems and diseases and do not seek employment that could improve their quality of life."

About 11.4 million U.S. adults have a serious mental illness—such as schizophrenia, anxiety, major depression and bipolar disorder—and up to 90 percent are unemployed, with about three million that are dependent on public assistance, including Supplemental Security Income and Social Security Disability Insurance.

Chronic unemployment is a major concern since it can exasperate stress, anxiety, depression and cardiovascular disease and reduce access to the care they need to manage their physical and mental conditions.

The goal of the Rutgers study, published in The Journal of Vocational Rehabilitation, was to better understand how a person's perception of their mental and physical health affects job seeking. The study was funded by a grant by the National Institute on Disability, Independent Living and Rehabilitation Research of the U.S. Department of Health and Human Services.

Researchers met over one year with 162 people with serious mental illness living in supportive housing programs. At each meeting, they assessed the participants' physical health and employment-related activities, such as the number of applications submitted, interviews they had gone to, job offers that were made and what these individuals identified as their barrier to getting a job.

Almost half of the participants had a high school diploma and 27 percent were college-educated. About 60 percent had not been employed during the previous five years, but all expressed a desire to seek employment when enrolled in the study.

In each of the monthly check-ins, 11 to 26 percent of the participants reported that their long-term physical health conditions—such as diabetes, chronic pain and obesity—prevented them from job seeking versus zero to 2 percent who reported barriers due to long-term mental illness, such as lack of energy in job seeking due to depression or anxiety symptoms.

According to Gao, people with serious mental illness often do not receive the same physical care as the general public for many reasons, such as lack access to high-quality and affordable health care, and physical health problems of this population often being under-recognized and under-treated by health care providers.

"Studies have shown that the life expectancy of people with serious mental illness may be reduced by up to 25 years compared with the general population, but that employment may be one of key elements to improving and maintaining both their mental health and physical health. Employment increases their resources for better living conditions and access to quality health care, promotes positive self-identity and peer respect," said Gao. "These are people who are unemployed despite having a desire to work."

Therefore, the integration of mental health, physical health and vocational rehabilitation for this underserved group deserve public attention, she said.