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Autumn 2009 | Vol 13 No 1

The last word

Poor access to disability supports perpetuates cycle of poverty

By Ruth-Anne Craig

In the summer 2009 issue of CrossCurrents, Dr. Richard Warner argues that disability benefits create disincentives to employment. He makes some valid points about his study comparing disability earnings and employment income in the United States. He also makes good points about the importance of high-quality vocational rehabilitation programs for people with mental illness whose goals are employment-related. However, his argument oversimplifies the complex problems associated with mental health and employment.

While it is true that disability policy requires restructuring as a whole, the situation in Canada is extremely tenuous for people with a mental illness disability. The problem lies mainly in access to disability initiatives, which ultimately creates dependence on provincial assistance programs. Provincial welfare has commonly been referred to as the program of last resort, and was originally conceived as a temporary income replacement. Approximately 70 per cent of unemployed individuals with a psychiatric disability subsist on social assistance payments and live in poverty. According to the National Council on Welfare, in the 10 provinces, the yearly income of an individual with a disability can be as low as $7,851. All welfare incomes in the provinces were below two-thirds of the low income cut-off line. The poverty gap for individuals with a disability was larger than the amount of income they received in each of the provinces. This cycle of poverty, combined with the overwhelming stigma attached to mental illness and lack of accommodation in the workplace, creates the biggest barriers for people with mental illness and reduces opportunities for quality employment.

Yet research indicates that most people with a psychiatric disability want to work, and since mental illness affects people from all occupations, why is it that so many highly qualified individuals never realize their former earning potential in the competitive labour market after being diagnosed with mental health problems? The answer lies in our nation’s deficit approach to mental health and mental illness and our lack of a comprehensive recovery and strengths-based mental health initiative that considers the complex and unique needs of people with mental illness. Our income support programs are not designed for this disability population.

In Canada, there are three federal income security programs connected to disability – the Canada Pension Plan Disability (CPP-D), Employment Insurance (EI) and the Disability Tax Credit (DTC). All these programs are contributory, which means that individuals who have been employed for a specific period of time have contributed or are eligible for credit when filing their income tax returns. Only those who have had steady employment are eligible for Canada Pension Plan disability benefits or Employment Insurance sickness benefits. This poses a problem for people with mental illness, who often have sporadic or cyclical patterns of employment. Mental illnesses like schizophrenia or mood disorders often arise in late adolescence or early adulthood, interrupting education, with lifelong effects on occupational success. More than 50 per cent of CPP applications are denied benefits because of insufficient earnings.

Applying for EI poses the same dilemma. There are no safeguards to help those who have entered the labour market to maintain their attachment to work when periods of unemployment occur due to problematic mental health symptoms. But initiatives could be developed to alleviate the problems with EI and EI eligibility. The duration of EI sickness benefits could be extended. The current 15 weeks do not always allow sufficient time and opportunity for rehabilitation. Like CPP-D, the qualifying period for EI eligibility needs to be modified. Returning EI to its pre-1996 status by readopting a 360-hour qualifying period for benefit eligibility will assist many people whose disabilities are cyclical in nature, as well as those for whom part-time work is the only alternative because of mental health symptoms and medication side-effects.

Accessing disability income support programs has become a major problem for people with mental illness because the eligibility criteria and definition of disability are not framed within a recovery perspective. This means that a person must be permanently unemployable and unable to pursue any employment to qualify. But many people with mental illness have the potential to work. Because of this, medical professionals are often reluctant to fill out forms for CPP-D or the Disability Tax Credit Assessment form. Unable to access these programs, people with mental illness are forced to apply for provincial assistance programs. Once in this system, it is extremely difficult to escape the cycle of poverty and demoralization offered by this meager subsistence.

Many more people with mental illness could be employed given appropriate workplace accommodation. The federal government has acknowledged its responsibility for a national mental health strategy by creating the Mental Health Commission of Canada. This strategy should include a substantial fund to work with provinces and territories to expand supported education and training programs, supported employment programs that help people achieve success in the competitive labour market, and training and resources for employers to implement workplace accommodations. These supports would greatly enhance the opportunity for people experiencing mental illness who have steady employment, as well as those who wish to enter the labour market. Stigma associated with mental illness, one of the biggest barriers to employment, can be addressed through workplace health education regarding the extent and impact of mental illness and workplace stress.

Meaningful work is important to people with mental health issues. Being employed has implications that reach much further than economic security. Employment is a determinant of health, opening the door of recovery for many people struggling with mental illness. We must do whatever we can to keep the door unlocked, so that more people have the opportunity to pass through it.

Ruth-Anne Craig is executive director of the Canadian Mental Health Association, Manitoba Division.

Editorials do not necessarily reflect the views of CAMH.