- People with severe mental illness and mood disorders have higher unemployment rates than the general population. Prior research found that within the Veterans Health Administration (VHA), patients with psychiatric diagnoses of schizophrenia, bipolar disorder, PTSD, and substance use disorders were more likely to be unemployed, retired, or disabled than patients without psychiatric diagnoses. The VHA provides vocational rehabilitation through the Therapeutic and Supported Employment Service (TSES) program to help veterans with psychiatric diagnoses obtain employment through four predominant service models: supported employment, transitional work, incentive therapy, and vocational assistance. The current study investigated the extent to which the VHA employment services reach the population of VHA patients with psychiatric diagnoses within one year.
- Key findings include that about four percent (4.2%) of VHA users with psychiatric diagnoses accessed employment services in a given year. VHA patients with a psychiatric diagnosis of schizophrenia had a higher odds of accessing employment services relative to VHA users with other psychiatric diagnoses, including PTSD, depression, and other anxiety disorders. Among VHA patients with psychiatric diagnoses, veterans who were homeless, African American, or had a substance use disorder were more likely to receive employment services, but less likely to receive supported employment. VHA users with a service-connected disability of 50 percent or higher were less likely to access employment services.
- Findings indicate that the reach of VHA employment services to veterans with psychiatric diagnoses is fairly limited. The VHA might expand the availability of its employment services, especially supported employment, given that supported employment is evidence-based for people with severe mental illnesses. More research is needed to understand the employment-related needs and preferences of veterans with depression and anxiety disorders.
“This study examined the population-based reach of Veteran Health Administration (VHA) employment services to VHA patients with psychiatric diagnoses. Reach of services includes the percentage and characteristics of people who accessed services compared with those who did not. Using clinical administrative data, we identified patients with a psychiatric diagnosis among a random sample of all patients who received VHA services in 1 yr. Among VHA patients with psychiatric diagnoses, we examined their likelihood of receiving any VHA employment services and specific types of employment services, including supported employment, transitional work, incentive therapy, and vocational assistance. We identified clinical and demographic characteristics associated with receiving employment services. Results indicated that 4.2% of VHA patients with a psychiatric diagnosis received employment services. After adjusting for clinical and demographic characteristics, VHA patients with schizophrenia and bipolar disorders were more likely to receive any employment services and to receive supported employment than were patients with depression, PTSD, or other anxiety disorders. VHA patients with depression and PTSD were more likely to receive transitional work and vocational assistance than patients with schizophrenia. Future studies should examine system-level barriers to receiving employment services and identify types of employment services most appropriate for Veteran with different psychiatric diagnoses.”
Veterans who have psychiatric diagnoses and use the VHA should be aware that employment services are available as part of their mental health care. VHA users with psychiatric diagnoses who have a service-connected disability of 50% or higher could consider utilizing VHA employment services to assist them in obtaining employment. Veterans should be aware that receiving VHA employment services should not affect VA benefits and should discuss their medical and financial benefits with benefits advisors and other appropriate advisors. Benefits advisors should be aware of that VHA employment services are considered part of health care. Since employment is known to provide a sense of meaning and recovery for people with psychiatric diagnoses, clinicians should encourage their patients to seek employment. While VHA patients with schizophrenia or bipolar disorder may require intensive employment services, like supported employment, it is vital that clinicians also recommend employment services for veterans with diagnoses of PTSD, depression, or other anxiety disorders. VHA clinicians should consider referring veterans to Therapeutic and Supported Employment Services (TSES). Clinicians outside the VHA should consider referring veterans with psychiatric diagnoses to VHA mental health care (which includes employment services) or other vocational rehabilitation programs. Family members should encourage their veteran with psychiatric diagnoses to seek employment and employment services.
Currently, the VHA’s Therapeutic and Supported Employment Services (TSES) Programs reach a limited number of veterans in a given year. The VHA might expand the availability of its employment services to Veterans with all psychiatric diagnoses. Although veterans with schizophrenia and bipolar disorder are receiving proportionally more services than veterans with other psychiatric diagnoses, previous research suggests that even these Veterans are underserved by VHA employment services, and would benefit from employment services expansion. Policymakers could consider allocating funds to further study the efficacy and effectiveness of various employment services provided by the VHA, particularly for veterans with PTSD, depression, and other anxiety disorders. Allocating funds to support research on the implementation of employment services may be especially pertinent to help facilitate the translation of research findings into clinical practice. Given that veterans may be disincentivized to access employment services because of misinformation on how VA benefits work, the VA and VHA might ensure that veterans with a service-connected disability of 50% or higher understand that there is to be no loss of VA benefits when VHA employment services are accessed. Together, VHA, Veterans Benefits Administration (VBA), and the Department of Defense (DoD) might collaborate to ensure the availability of employment services for veterans with different psychiatric diagnoses. To better understand the need for employment services across the VHA system, the VHA might consider systematically measuring veterans’ employment status and desire for work.
For Future Research
This study’s findings should be understood in the context ofits limitations. The study relied on VHA administrative data for clinical information and utilization of employment services, so the authors were unable to assess veterans’ current employment status, their motivation or desire for employment, and their use of employment services outside of the VHA–each of which might impact a veteran’s use of VHA employment services. The researchers studied receipt of employment services over the course of one year. Given that receipt of services can change overtime, future studies should use longitudinal data to investigate the receipt of employment services over several years. The sample used in this study was representative of the VHA patient population in that it included mostly middle-aged Caucasian men. Studies that oversample female veterans, veterans of diverse ethnic and racial backgrounds, and younger veterans are needed to better understand the unique employment-related needs of veterans with different demographic characteristics. While supported employment is an evidence-based employment service for people with severe mental illnesses, the effectiveness of the other types of employment services described in this study has not been assessed. Future researchers should investigate the types of employment services that will be most effective for veterans with PTSD, depression, and other anxiety disorders.