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Making It Work Guide

This guide highlights and describes various “return-to-work” strategies and provides practical tips for implementing them most effectively. It has been designed as a practical resource tool for mental health providers/ program planners, vocational rehabilitation counselors, occupational therapists or anyone else, whether on a personal or professional level, who is involved in supporting consumers to find and keep meaningful work and overcome their barriers to employment.

People with serious mental illness, like all other people, find themselves affected by a number of influences when trying to find and keep meaningful employment. Some of these influences are in their control, but many are not. In this guide, these different influences are understood as operating at the individual, local community and broader societal levels. Searching for competitive employment is an individualized process, yet individuals do not operate in a social vacuum. They become linked to the broader culture at the community and societal levels.


Focusing on the Individual
Connecting With The Community
Advocating For Systemic Changes

A. Focusing on the Individual

“Individual” refers to the characteristics and experiences of individual persons that impact on their employability. Previous employment, volunteer and educational experience can greatly influence future work prospects. Personal attitudes, motivation, level of self-esteem, skills and abilities are also critical factors in finding and keeping work.

Each individual who arrives at your agency door seeking employment-related assistance is a unique person with his/her own desires, skills, strengths and experiences. Recognizing the uniqueness of each individual is the first step towards developing a mutually respectful relationship.

We have found that you can be most effective in supporting consumers to reach their desired employment goals if you adopt a participant-centred, holistic and incremental approach.

Adopt a Participant-Centred Approach

No two people who experience a mental illness are the same, and as a result there is not one single recipe for achieving successful employment.

This highlights the need for a flexible job search process which is tailored to meet the unique and individual traits, experiences and needs of each consumer. Prepackaged programs that are time-limited and rigid in structure may be easier to administer but have shown poor results due to their inability to truly address individual needs. Just as an optometrist prescribes customized lenses for each patient, employment support workers need to recognize that the type and level of support provided will vary from person to person, and will likely fluctuate over time in response to changing needs. Given the cyclical nature of mental illness, someone who may have been requiring very little support over the past several months, might suddenly need more. Ongoing and flexible support needs to be viewed as healthy, and not as a dysfunctional need.

Adopt a Holistic Approach

Providing effective employment support means considering all aspects of a person’s life, because employment is only one piece of a person’s “life puzzle.” People need support that understands this holistic view of life. Searching for a job is more than simply developing a resume or practicing interviewing skills, although these are important steps. It is also about understanding how employment will affect other aspects of a person’s life such as his/her disability pension or drug benefits.

From a holistic perspective, factors such as housing, income, medication and support networks all influence an individual’s level of emotional stability, which in turn impact on his/her ability to focus on finding and keeping a job. For example, during their job search, people may need support while adjusting to new medications or help in finding affordable stable housing. Once work is found, people may need support in managing their finances, finding child care or accessing transportation to get to work.

Adopt an Incremental Approach

Individuals who have been out of work for some time, or who have never worked in the past, face many barriers on both an individual and systemic level. Research and experience have shown us that finding meaningful work is likely to be a long term process that may require a combination of different strategies over a period of time. By adopting an incremental approach towards achieving long term work goals, you can actually “set people up” for success and minimize some of the societal pressures placed on them to “get off welfare” and find any job. If people understand at the beginning of your relationship with them that they may need to go through a number of stages in order to prepare themselves to meet their long-term employment goals, then they may not feel as discouraged if success is not met immediately.

Strategies for Finding Meaningful Work

Strategies for helping consumers to find meaningful work may take place within your agency, out in the community or directly on the job. Some strategies will require providing one-to-one support, while others can be carried out in a group setting. In this guide, these strategies are grouped together in the following way:

Type of Strategy Location Strategy includes
Pre-employment Within your agency i. Pre-employment assessment and counseling (prerequisite for other strategies)
ii. Employment preparation and job search support
Pre-employment Out in the community i. Skills development training*
ii. Educational upgrading
iii. Volunteering
Unpaid work experience In an integrated workplace setting i. Job trials
Paid work experience In an integrated workplace setting i. Transitional employment
ii. Supported employment

B. Connecting with the Community

As an employment support worker, your roles and responsibilities bring you in direct contact with many organizations and businesses in your community. Whether you are exploring training options for someone, setting up a job trial, finding a transitional employment placement or contacting social services on behalf of a participant, you are in constant communication with individuals outside of your organization. Building or strengthening interagency partnerships and developing linkages to the local business community are both central to the process of creating employment opportunities for consumers in the mainstream workforce.

Building Strong Interagency Partnerships

Choose to partner with agencies that provide services which complement those of your own organization.

For instance, your agency’s mandate may be to offer only pre-employment assessment and counseling services to consumers. Once the assessment is complete, an individual may discover that his/her lack of training in a chosen occupational field is one of his/her barriers to finding work in this area. As an employment support worker, you need to be aware of the various community programs that offer specific training (e.g. clerical, computer, carpentry) in order to link individuals up to the appropriate training and help them to reach the next step in their job search plan. Networking with other community programs and services can happen in a number of different ways, such as initiating a personal connection, joining an existing network of vocational agencies or attending professional development workshops and seminars offered in your community.

Establishing Partnerships with Local Businesses

As an employment support worker, you will discover that there are many benefits to building strong connections with your local business community. These include:

    becoming more aware of local labor market trends, the types of jobs available in your community (e.g. service industry, manufacturing, retail, information technology, etc.) and the employment opportunities within each sector; this allows you to connect the interests, experiences and skills of consumers to the supply and demand realities of the market place;
    gaining an increased understanding of employers’ current attitudes towards persons with serious mental illness and finding out what their past experiences (if any) have been with respect to employing consumers in their workplace;
    being able to educate employers/ business associations about mental illness and about the types of workplace accommodations that are effective with this population; and
    being able to directly create employment opportunities for consumers by educating employers about the value of including workers with disabilities in their workplace and presenting participants’ specific abilities in the best possible light.

The term “job development” is used to describe all of the above activities. Job development involves going out into the community and selling your employment program to employers as a way of convincing them to hire consumers in their workplace. Well done “job development” can serve to educate the community and reduce the stigma associated with mental illness as well as to identify specific job opportunities.

Have you considered networking with local business and service groups, of hosting an open house reception or of establishing a “Business Advisory Committee”?

The Value of Informal Support Networks

Informal supports refer to those people who “naturally” surround individuals and who are able to provide them with social support, encouragement and guidance. An individual’s support network could include family members, friends, other consumer peers or people that s/he has met through community affiliations (e.g. church groups, community clubs, etc.).

Informal supports can help a person to cope with both the emotional as well as financial stressors associated with being unemployed and looking for work. Through a person’s “natural” support network, s/he might learn of possible job leads in the hidden job market which have not been formally advertised in the newspaper or on the Internet. The old adage, “it’s who you know” seems to still ring true in today’s job market.

Conversely, we have found that individuals who have minimal support from family or friends tend to be less successful at finding work. Social isolation has been identified as a definite barrier to finding a job. Yet, many consumers tell us that peer support groups and peer mentoring have helped them to overcome their social isolation.

Joining a Peer Support Group

Self-help groups are a valuable way of connecting people who share common experiences. Over the past decade, the self-help movement has flourished in communities across the country. Self-help groups are now recognized as a complement or even alternative to the formal service system. These groups can give people a sense of belonging, the power to control and make informed choices about their lives and the understanding that can only come through someone else who has been through the same experience.

In the context of searching for work, these groups can provide members with opportunities for exchanging “job hunting and keeping tips” and for helping one another to realize that they are not alone in their struggles against a host of “systemic” barriers to employment. Consumers who are presently working can share their success stories with the group. It can be both encouraging and motivational to hear from someone who has faced similar obstacles and has succeeded in achieving his/her goals.

Peer mentoring

Peer mentoring is an effective strategy whereby a consumer who has succeeded in finding and keeping meaningful employment acts as a role model for another consumer who is still working towards this goal. Peer mentors can model, or lead by example, and show someone what it means to “set realistic goals” or “maintain wellness.”
Peer support can add value to existing employment support programs at virtually no financial cost!

C. Advocating for System Changes

People with serious mental illness must not only deal with the stressors of unemployment shared by other members of society (e.g. poverty, low self-worth), but also overcome barriers to employment that are associated with their mental health struggles. In communities across the country, from large urban multicultural centers to small rural towns, consumers have consistently identified the following two systemic barriers to employment:

      the stigma associated with mental illness
      current income support/ disability pension back-to-work legislation

As an employment support worker, it is critical that you have an understanding of the broader social, political and economic factors that influence consumer participation in the mainstream workplace.

Social Stigma: The Need for Attitudinal Change

Psychiatric disabilities are unique because the label of “serious mental illness” itself creates a barrier for people returning to work. Perhaps more than any other label in our society, having a serious mental illness indicates to the person and those around that s/he will never be capable of work. The general public, including employers, often understand mental illness through the eyes of the popular media. According to The No Force Coalition, a group of individuals and organizations against force in psychiatry, 4 out of 5 Canadians believe people labeled mentally ill are irrational, dangerous and violent. In fact, almost half the media stories we read on mental illness involve crime. The real fact is that people with serious mental illness are responsible for four percent of all violence in society. In other words, if those serious mental illnesses could be cured tomorrow, 96 percent of all violence in society would remain. Such context should appear in all stories linking violence with mental illness, but it does not.

Public perceptions, as shaped through the media, clearly influence social attitudes towards people with a serious mental illness. The result is that many employers resist hiring consumers due to an inaccurate belief and fear that they cannot work effectively or that meeting their needs will cost a great deal. Employees with psychiatric disabilities also continue to experience fewer opportunities for promotion and training, since employers tend to focus on their disabilities rather than their capabilities. This helps to explain why so many consumers are earning low wages that keep them below poverty existence.

Financial Disincentives: The Need for Legislative Changes

Aside from the emotional struggles involved in recovering from mental illness, consumers often face some tough practical decisions as to whether to return to work or not. Many consumers who have been out of the workforce for some time have come to rely on income support or disability pension to meet their basic survival needs. In their current state, many of these support programs adopt an “all or nothing” approach to providing financial assistance. Individuals are either classified as fully capable of working, and therefore ineligible for income/ disability support, or as incapable of working at all.

As a result, the current system discourages consumers from seeking out part-time, occasional or even volunteer work, as they fear jeopardizing their income support or disability pension. Yet, these are the very strategies that have been identified throughout Making it Work! A Resource Guide as being helpful to consumers who do not yet feel ready to enter the workforce on a permanent and full-time basis.

Furthermore, existing income support and disability pension programs make it very difficult for consumers to move from these programs into employment for the following reasons:

  • Employee benefits, such as drug and dental plans, sick leave, pension plans and long term disability, are sometimes denied or only available at a much higher cost to people who have a “pre-existing health condition.” As a result, consumers may not be able to afford to lose the benefits that they receive through provincial income support programs
  • Consumers have to pay back most of their earned income while on social assistance (this varies across provinces) or pension benefits.
  • Given the cyclical nature of mental illnesses, it is impossible to predict what the impact of returning to a full-time job might be for those who have not worked in recent months or years in terms of both their physical and mental health. Indeed, there are serious “financial” risks involved in returning to work on a full-time basis should this situation prove to be too stressful
  • CMHA National has released a Position Paper on Federal Income Security Programs . This report provides insight into the barriers faced by consumers in their efforts to access programs like CPP – Disability and Employment Insurance.

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