Schizophrenia is one of the most disabling illnesses in the world. The disease wreaks havoc on everyday functioning, affecting the ability to live independently, engage in productive activities and social interactions, and attain/maintain employment. Common symptoms include delusions, hallucinations and inner voices (psychosis); emotional flatness or lack of expression; diminished ability to begin and sustain planned activities; social withdrawal and apathy; and cognitive deficits impacting memory and attention. Schizophrenia symptoms typically emerge during prime career-building years, therefore treatment often incorporates vocational counseling, life balancing and independent living skills training. Depending on the extent of illness, a person may not be able to perform the most basic functions (e.g., bathing and brushing teeth) or more involved activities (e.g., financial and medication management, community mobility, shopping, housework and job skills). Moreover, poor physical health is pervasive in schizophrenia because individuals tend to not take care of themselves through a healthy diet. A vicious cycle of physical impairment and low activity levels, exacerbated by symptomatic and cognitive deficits, may play a significant role in impeding daily functioning. Clinical remission is much more common than functional recovery, although some people experience occasional relapses even with proper treatment adherence.
Working With Schizophrenia
Current statistics indicate as many as 70% of people with schizophrenia would prefer to work, however, a mere 14.5-17.2% work in the U.S. “The truth is that the majority of people with schizophrenia are willing and able to thrive in the workplace if they find a job that fits their interests, works with their strengths and talents, and offers them some accommodations,” said Sita Diehl, director of state policy and advocacy for the National Alliance on Mental Illness (NAMI). The challenge of keeping symptoms under control at work is often compounded by how the condition is perceived, both in the workplace and in the mental health community. Although work offers hope, meaning, value and social connections, all of which are essential for recovery, a one-stop solution does not exist to help people with schizophrenia attain employment. Schizophrenia affects each person differently. Some people may be distracted by delusions, which can present on-the-job dangers, while others struggle with disorganized thinking or social anxieties, which presents other challenges. Less than 2% of those who are able and willing to work receive the job support they need to succeed. The best-case scenario is working with a job coach who recognizes and incorporates each individual’s unique weaknesses, strengths, passions and triggers into attaining gainful employment. For example, someone who suffers from severe anxiety when answering phones would not apply for a job as a receptionist.
Research Analyzing Employment Outcomes in People with Schizophrenia
A meta-analysis of 25 randomized trials conducted between 1986-2015 yielded key insights. Due to the significant impact of schizophrenia on several areas of daily functioning, researchers concluded that participation in employment-specific rehabilitation treatment was insufficient to ensure job stability. Similar to previous findings, a supported employment approach combined with therapeutic interventions (neurocognitive therapy) and job-related social skills training, appeared to be the most effective method for ensuring job retention. Coordinated, comprehensive treatment is necessary to address functional deficits contributing to the high unemployment rates and job performance issues in people with schizophrenia. The treatment plan should incorporate vocational rehabilitation, health care, employment assistance and social services.
Driving with Schizophrenia
Every state has slightly different rules governing driving privileges for individuals with physical impairments or mental illness. In some states, a person with any diagnosed mental illness must disclose this and any associated medications when applying for or renewing a driver’s license. In other states you may not have to disclose this, however, getting in an accident or being hospitalized may result in a driver’s license being revoked. A letter from the treating doctor may be required stating the person is capable of driving safely. An additional challenge is that a physician’s-office-based assessment of a person’s driving skills correlates only minimally with scores on standardized road tests. It’s important to keep in mind schizophrenia drugs like clozapine can impair driving skills and if a person hears voices when driving, this could endanger them and others.
Is Schizophrenia Classified as a Disability?
People with schizophrenia experience a range of impairments affecting various aspects of daily functioning, including the ability to work. In the U.S., the principal sources of public disability insurance are the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs. People with schizophrenia spectrum and other psychotic disorders fall under the category Schizophrenia/Paranoid Functional Disorders. For all mental disorders, claimants must submit evidence supporting a medical cause of disability and meet specific criteria relating to impairment in at least two out of four domains of functioning. For schizophrenia, claimants may meet an additional set of criteria related to chronic disorder-related impairment, instead of or in addition to the second disability criteria. The SSDI allowance rate typically exceeds 80% in applicants with schizophrenia. Many unsuccessful applicants are not denied, rather they are simply unable to manage the appeals process after an initial denial. Advocates suggest applicants work with a Social Security disability attorney with experience dealing with clients with mental disorders. Although living with schizophrenia presents significant challenges, comprehensive treatment including medication management can help many people work, drive and be productive members of society.