Running head: IPS MODEL

IPS Model and Severe Mental Illness

Tanner King
Professor Smith
ENGL 111-67F
17 November 2015(Word Count: 2,131)

King 1

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ABSTRACT
The Social Security Administration was created in the beginning
to help a group of people that were never supposed to be able to
reenter the workforce. But now the number of people that are
eligible for these benefits has increased dramatically. But at
the same time the number of employment opportunities has
increased at the same rate. Through Medicare and Medicaid people
receive money to help them live and this includes people of
severe mental illness. In an article by Drake and Whitley (2014)
at this current time the employment rate of people with severe
mental illness is 20% (p.236). When people of severe mental
illness want to try and pursue a job they are not able to. Even
if they use the IPS model and find a way to become successful.
This is because the way the current system is set up when a
person that is on either Medicare or Medicaid and that individual
begins to earn above a certain income they will be taken off the
benefits. Current policies provide no short term disability
benefit. The Act that funds the Medicare and Medicaid programs is
called The Federal Insurance Contributions Act (FICA) provides
for roughly 1.45% employee and 1.45% employer tax contribution to
fund Medicare and Medicaid programs. In some way a funding method
needs to be put in place in the long term to cover costs and to
help pay the government when training companies how to train

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organizations on the IPS method and how to make it most

effective.
IPS Model and Severe Mental Illness
According to an article by Drake and Whitley (2014) the
employment rate of people with severe mental illness has declined
to 20% (p.236). This is in comparison to the employment rate of
all workers being on average 95% in the year 2014 for people aged
25 and older provided by a study conducted by the Bureau of Labor
Statistics (2015). This is not a promising trend and if the issue
is continued to be ignored people with severe mental illness will
continue to struggle and not receive the help they need. Inside
the Legislative Branch in the part known as Congress, there must
be an attempt needs to create and put into place a new set of
policies and guidelines for how to do them for large corporations
and normal businesses to develop a single supported employment
method. This single supported employment method should be the
Individual Placement and Support Model.

Once all of these

policies and guidelines are in place and start to be used

effectively The Department of Health and Human Services, which is
part of the Executive Branch of the U.S. government, has to start
developing a way to provide funding for the long term to allow
people to receive their mental healthcare benefits even as they
attempt to reenter the job market.

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As of now many people with a more severe mental illness are

not employed and no longer have the option to go out and actively
search for a job because at this time they are relying on
Medicare and Medicaid. This specific group of people were
identified by Frank (2013) as being known as the duals which
currently cost a good amount of money to take care of in the
current system alone (p.47). Also stated by Frank is that 50% of
this group of beneficiaries live below the poverty level and
account for 39% of all Medicaid spending and also account for 29%
of all Medicare spending. This is costing the government much
more money than it would if the system would not take away both
systems when someone with severe mental illness acquires work and
joins the labor force. The current system almost acts as a sort
of deterrent to keep these people from wanting to actively search
for employment and become independent. The funding approach will
need to be established in collaboration with the Social Security
Administration, since the Medicaid budget is established through
employee and employer taxes. The Federal Insurance Contributions
Act (FICA) provides for roughly 1.45% employee and 1.45% employer
tax contribution to fund Medicare and Medicaid programs. The
funding support in the long term is needed to cover direct costs
that are associated with mental illness and is also needed for
providing government resources to train various groups on how to
effectively put into place the IPS method. According to Drake,

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Skinner, Bond, and Goldman (2009) generally, the funding approach

should focus on the redistribution of dollars to minimize the
number of individuals that use disability benefits versus
actively gaining meaningful employment using the IPS model
(p.762). In other words, focus on a prevention approach instead
of reaction after individuals are forced into making disability
claims. As stated by Drake et al., (2009) research consistently
shows that roughly 50 70 percent of individuals struggling with
severe mental illness would prefer employment opportunities
versus disability claims (p.763).
The companies must understand that they must do more than
just create a certain policy but must know that they have to
provide data that the plan is being implemented, is being
monitored, and is being successful. The government cannot just
sit back and expect the companies to comply with the new sets of
rules on the IPS method so it is important that the government
works closely with the places using the method. Supportive
employment is defined as paid competitive employment in an
integrated setting with ongoing supports. Also stated by Bond
(1998) the Individual Placement and Support method is made up of
six elements that include: Competitive employment is the goal,
rapid job search, integration of rehabilitation and mental
health, attention to consumer preferences, continuous and
comprehensive assessment, and time-unlimited support (p.12). At

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this time many different organizations like the Veterans Affairs

use many different strategies when providing assistance to people
with mental illness. The Legislative Branch must watch over the
businesses and make sure that the laws are being followed.
Through watching over the companies using the method and by the
increased funding supports the Individual Placement and Support
method can be perfected.
The ways the mentally ill are being helped right now is
through funding provided by the Social Security Administration in
the form of Social Security Disability Insurance (SSDI) and
Supplemental Security Income (SSI). The SSDI and SSI offer
support when the individuals are impacted initially from
unemployment. If we look at the numbers, the individuals with
mental illness represent the majority of people receiving Social
Security benefits in the form of SSDI or SSI benefits. According
to Bond, Drake, and Xie (2007) in recent years, policy makers at
the Social Security Administration (SSA) have become increasingly
concerned by the rising number of beneficiaries with psychiatric
disabilities of working age (1864 years) in its two disability
programs (p.1416). As the population receiving these benefits
represent a younger generation, the drain on Social Security
distributions will become a problem that cannot be overcome with
the current funding model. The focus should be on the prevention
aspect of the mental health issues and subsequent benefits

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provided for treatments which possibly keep these individuals out

of the workforce. A 2011 report issued by the federal government
concluded that Medicaid is the most common source for ongoing
support of supported employment service. Some states allow for
components of supported employment related to case management
support but other states adhere strictly to covering medically
necessary services. This inconsistency in approaches would need
to be guided by adjustments at a Federal legislative level. Most
of this cost has been put onto the general public to pay for
through taxes. The Substance Abuse and Mental Health
Administration estimated that the U.S. national expense for
mental health care was $147 billion in 2009 as referenced in a
government article issued by the National Institute of Mental
Health wrote by Thomas Insel (2015).

The article also provided

projections from the World Economic Forum for global cost

estimates for mental disorders estimated at $6 trillion by 2030.
These are direct healthcare costs and does not include the cost
of disability insurance payments and any costs that has a
financial impact to employers from someone not being able to go
to work. In addition to the healthcare costs as previously
stated, there is a significant difference in the employment rate
of people with severe mental illness when using different
methods. When someone with a mental illness gets a job, the
benefits they are receiving through the government get taken

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away. This makes it even more important to use a plan that will
make a person successful in the long run with continuing mental
health benefits and employment. Continuing the benefits after
employment is obtained, is a reason that longer term funding
needs will be critical to the success of an IPS employment model.
The cycle will continue as people leave the workforce in order to
maintain Medicaid benefits.
The IPS model is more successful due to the six elements of
the service. One major reason for the success is the timeunlimited approach, which differs from most federal services.
Bond (1998) stated that most of the funding to help many
receiving services is stopped after 90 days but this is not the
case with the Individual Placement and Support method. The brief
time that funding is allowed through the Vocational
Rehabilitation program is unworkable and ineffective (p.19).
Through a study conducted in Washington D.C. adults with severe
mental illness were examined, and the IPS method was compared to
an approach relying on a group of agencies offering other methods
like sheltered work and set-aside jobs. Bond (1998) concluded
that paid employment was higher in the comparison group but the
people in the IPS group were 10 times more likely to acquire work
in an integrated setting. A study of people receiving supported
employment compared to people receiving help through the day
treatment model showed that the IPS model was more effective in

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finding competitive employment (p.13). According to Bond (1998)

the people in the IPS model had a 38% success rate in finding
competitive employment compared to the 15% success rate through
the other methods (p.14).
Additional laws should be developed and existing laws
enforced to require an IPS approach because case studies and
research support the positive results of an IPS approach and
increasing employment rates short term and long term for people
with mental illness. When individuals are employed and provided
the ongoing support structure this will reduce healthcare
expenses from disability claims and lost work days. The
government would have to work with Community Mental Health
Centers (CMHC) to have them put the IPS strategy into effect
nationwide. The federal government would have to set up grant
options for the CMHCs to develop their IPS approach and grant
money would be withheld from CMHCs that did not offer up an IPS
approach. The government could provide support in developing
guidelines, procedures, and necessary measurement tools to
develop a successful IPS strategy. According to Becker, Torrey,
Toscano, Wyzik, and Fox (1998) in most cases CMHCs took at least
one year to put IPS into place. This is usually the minimum
amount of time needed for staff workers to acquire the necessary
skills to use the program, remove the barriers to change, and
become a mature program (p.52).

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In conclusion, the effectiveness of the Individual Placement

Support model to increase employment rates for individuals
struggling with severe mental illness has been proven through
various research studies for many years and needs the help of the
Social Security Administration to figure out the Medicaid and
Medicare situation to make the plan succeed. As with any
research, there needs to be a solid plan in order to implement
the actions as proven in a monitored research study. The proposed
action for long term funding plans to cover cost not currently
supported by Medicaid after employment is maintained over a
period of time will need to be addressed by modifying or adding
new legislation related to Medicaid payment policies.

Creative

approaches to grants and other funding options will require joint

efforts between legislative areas, private, and public sectors.
Without funding options being addressed, the implementation of an
IPS model will not be feasible or sustained long term.

The

success of the IPS model will be achieved by Legislative guidance

to decrease the complexity of the interactions of agencies
involved in the monitoring process and define
guidance/requirements for maintaining the IPS model. Any program
is only successful as the ongoing maintenance and tracking of
progress.

This is another aspect of Legislative

guidance/requirements for organizations to provide meaningful

statistics on employment data of individuals with mental illness,

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documentation of procedures and processes to support the IPS

model, and how further improvements are being made to encourage
hiring practices for individuals with mental illness.

References Page
Becker, D., Torrey, W., Toscano, R., Wyzik, P., & Fox, T. (1998).
Building recovery-oriented services: Lessons from
implementing individual placement and support (IPS) in

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community mental health centers. Psychiatric Rehabilitation

Journal, 22(1), 51-54. ProQuest Research Library.
Bond, G. (1998). Principles of the individual placement and
support model: Empirical support. Psychiatric
Rehabilitation Journal, 22(1), 11-23., ProQuest Research
Library.
Bond, G., Xie, H., & Drake, Robert E. (2007). Can SSDI and SSI
beneficiaries with mental illness benefit from evidencebased supported employment? Psychiatric Services, 58(11),
1412-20. ProQuest Research Library.
Bureau of Labor Statistics. (2015) Earnings and unemployment
rates by educational attainment.
Drake, Robert, & Whitley, R. (2014). Recovery and severe mental
illness: Description and analysis. Canadian Journal of
Psychiatry, 59(5), 236-42., ProQuest Research Library.
Drake, R. E., Skinner, J. S., Bond, G. R., & Goldman, H. (2009).
Social security and mental illness: Reducing disability with
supported employment. Health Affairs, 28(3), 761-70.
ProQuest Nursing and Allied Health Source ProQuest Research
Library.
Frank, R. G. (2013). Mental illness and a duals dilemma.
Generations, 37(2), 47-53. ProQuest Research Library.

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National Institute of Mental Health. (2015). Directors Blog:

Mental Health Awareness Month: By the Numbers.