Employment and Disability

To the Editor: The article by Dr. John Noble (1) entitled "Policy Reform Dilemmas in Promoting Employment of Persons With Severe Mental Illnesses" in the June 1998 issue was well researched and captured many of the essential issues in the current psychiatric vocational services world, where I have worked for more than 24 years. However, the author failed to address the fact that many people with severe mental illness would prefer to work part time and continue to collect some disability payments.

Their preference for part-time employment is due to numerous factors: the stressful nature of full-time employment, difficulty focusing on work for extended periods of time, difficulty meeting the higher interpersonal demands of the workplace for long stretches, and fear of losing benefits when their mental illness is still periodically cycling or symptomatic.

The Supplemental Security Income (SSI) program allows a gradual increase in earnings and a concomitant decrease in SSI benefits. However, the Social Security Disability Insurance program has a strict cut-off point of $500 for earnings from substantial gainful activity once the nine-month trial work period is over. This limit on earnings creates what consumers call the "cliff effect": if you start working and inch over the $500 mark, you immediately lose your whole disability check, thus dropping your monthly income dramatically.

Part-time employment still affords the non-income benefits of employment alluded to by Dr. Noble: reduction in hospitalizations, increased self-esteem, decreased symptomatology, structure, social contact, and normalization. These benefits are worth a lot, even if the work is not substantial enough to permit total discontinuation of disability benefits (often the only measure by which success is defined by government program evaluators.)

Federal legislation (H.R. 464 and S.B. 1054) has been proposed to increase the level of earnings from substantial gainful activity from $500 to $1,050 (the current level for blind persons only). This change would right an inequity that has existed for many years, as the level of earnings for nonblind persons with disabilities has not increased since 1990. This legislation preceded and is completely separate from the proposed legislation for a major revision of the Social Security disability system, which will likely face more hurdles because of its complexity.