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Autumn 2009 | Vol 13 No 1

A view from CAMH

Dr. Kwame McKenzie

Some argue that during these pressured economic times focusing on employment for people with mental illness is unrealistic. Classically, during a recession, women, minority groups, older people and people with disabilities are disproportionately affected by economic downturns. Employers have an ever-growing pool of people desperate for jobs. Unemployment among those with a diagnosis of mental illness would be expected to increase.

Clinicians at CAMH have taken a different position, which is that employment schemes are even more needed during a recession, where jobs are scarce and less available to people at the fringes of the employment market. This position is in tune with the welcome focus on health equity being pioneered by local health planners in Toronto and is based on increasing evidence of the effectiveness of employment schemes. For instance, in a recent study, individual placement and support, a model that has been developed for the first episode psychosis program at CAMH, was compared to standard rehabilitation and vocational support programs geared towards improving work skills. Both approaches improved levels of employment, but in this international randomized controlled trial, individual placement and support was better for people with severe mental health issues.

The impact of employment in promoting recovery and keeping people with mental health challenges out of hospital, off social assistance as economically productive members of society compares well with most biological interventions. In a recession we should be thinking more than ever about the importance of employment for people with mental health and addiction issues.

Kwame McKenzie, MD, MRCPSYCH (UK)
Executive Editor, CrossCurrents;
Senior Scientist, Social Equity and Health Research Section, CAMH;
Deputy Director, Schizophrenia Program, CAMH;
Professor of Psychiatry, University of Toronto