Dr. Kwame McKenzie
I count myself lucky. When I arrived in Canada four years ago, I had a job and it helped me find community, colleagues and friends. Work helped me connect with Toronto.
Most of my clients are not so lucky. Living with the stigma and symptoms of a severe mental health problem is challenging enough. But they have to add to that the social isolation that comes with being jobless. Many people with schizophrenia and other serious mental illnesses do not work, and many have been told they cannot work. Yet an interesting thing happens when they do find employment — their health improves.
Study after study has confirmed that a good job is good for their health. Their quality of life goes way up. Their use of health services goes way down.
Almost half of provincial government resources are spent on health care. When we find a proven formula for improving health and reducing use of health-care services, we should be doing everything possible to implement it. But this is not what we are doing. We are not doing enough to find jobs for people with serious mental health problems and we penalize those who battle prejudice and actually succeed in finding jobs for themselves.
Many of my clients depend on social assistance, often the Ontario Disability Support Program. The programs are understandably worried about fraud. But the big picture is that this means they may not provide the right support for people on low incomes.
If you have a mental health problem, you are on ODSP and you may lose so many benefits that it is simply not worth your while financially to work. You actually lose money by going to work. That is enough to put most people off. This is a shame because a job is more than the money — it is a link to the rest of the community and it is good for your health.
The Dream Team, Houselink Community Homes and CAMH have been working together on recommendations that take a different approach. ODSP could balance its administrative imperatives with a determined focus on supporting people to work. This would make a significant difference in the lives of the people I treat.
There is no single solution to this problem. But we know some of the things that need to change. Programs need to be better coordinated so that nobody on ODSP loses money when they work. We would explore innovations that allow people who work to keep more of their earned income, and evaluate how this strengthens workforce attachment. We would make the process of calculating social assistance easier for people with earned income, and less threatening. We would enrich the benefit received by all recipients who choose to work.
There is much more to do. We need to decrease discrimination against people with mental illness in the workplace and we need to develop jobs that are better for our health. But in the meantime, the small step of making our benefits system support those who want to work rather than deterring them from working could be helpful.
Work helps us all put food on the table. It is part of our contribution to society and is one way we are connected to each other. For those with mental
health disabilities, welfare systems can act as an enabler or be a barrier to inclusion. Employment must be recognized as a key element of recovery and
inclusion; changes to social assistance policies can help us get there.
Dr. Kwame McKenzie is a senior scientist within the Social Equity and Health Research section at CAMH.