Recovery From Schizophrenia: Psychiatry And Political Economy

264 WORKavailability of guaranteed jobs through the cooperative for mentally ill workers;without this, the unemployed would have no means of support.To achieve the same effect, we could (a) limit disability pensions to the mostdisabled; (b) guarantee jobs for the remainder of the disabled in private industry,in sheltered workshops or in social firms and (c) pay a wage subsidy that coversthe difference between the worker’s productive capacity and the minimum wage.Regulations governing benefits, such as SSI and SSDI, could be waived to allowpayments to be diverted into a wage subsidy scheme. The employer orcooperative would be reimbursed the difference between the worker’s rate ofproduction and his or her rate of pay.Sustained full employment is not feasible in modern capitalist economies, butinnovations in social policy—in the design of disability pensions, job programs,wages, and health care funding—could create dramatic improvements in thequality of life and integration of people with mental illness in our society.SUMMARY• Modern vocational rehabilitation methods are successful in getting people withserious mental illness back to work.• There is little evidence that working leads to an improvement in thesymptoms of psychosis in the short term, but there is no evidence available onthe long-term impact of work on symptoms and functioning.• Fewer than 15 per cent of the seriously mentally ill in the US are employed,and fewer than 25 per cent receive any type of vocational assistance• More than half of those with schizophrenia can be in paid employment whenappropriate vocational services are provided.• Supported employment is a successful vocational approach for people withserious mental illness.• Modernized sheltered workshops are valuable for the most disabled peoplewith mental illness.• Social firms successfully employ large numbers of people with serious mentalillness in Italy and other European countries.• Both sheltered work and social firms become less viable as the economydeclines.• Social firms can gain a market advantage by contracting to provide services topublic agencies or to the consumer group.• A consumer-employing, consumer-oriented pharmacy for the mentally ill is aviable social enterprise.• Mentally disabled people encounter economic disincentives to work that maybe alleviated by raising the amount an individual is allowed to earn before thedisability pension is reduced.• Wage subsidies encourage the employment of people with mental illness andmight pay for themselves by a reduction in treatment costs.