Increasing the educational achievements of individuals with mental illnesses is a critical aspect of community inclusion: the opportunity to ‘live like everyone else’ includes the opportunity to receive and benefit from the same educational programs as everyone else. Nonetheless, data from the National Co-Morbidity Study conducted in the early 1990s indicate that the typical early-onset of a psychiatric disorder has a significant and adverse impact on educational attainment, and data from an earlier Epidemiologic Catchment Area (ECA) study conducted in the 1980s showed that persons diagnosed with schizophrenia had lower graduation rates from high school than the general population (57% versus 66%) and much lower college graduation rates (5% versus 17%).
Why is this important to community inclusion? It is in part because educational attainment is so closely linked to social and financial benefits. Those with less than a high school diploma have lower rates of participation in the labor force (44%) than those with a high school diploma (65%), some college (73%), or college graduates (78%). Education also dictates the types of jobs that can be sought, with lower educational attainment associated with entry-level jobs known for lower pay, limited benefits, rapid turnover and diminished job satisfaction.
A report issued by the Economic Mobility Project of The Pew Charitable Trusts in 2008 established a direct correlation between attending college, earning a college degree, and achieving economic success in America (Butler, et al. 2008). Researchers involved in the Pew study found that individuals who simply attend college will earn during their lifetime, on average, 16 percent higher wages than workers who only graduate from high school. Earning a degree reaps even greater financial rewards. Those persons receiving a two-year associate degree will earn on average 29 percent more than those with simply a high school diploma. Notably, individuals who graduate from college with a bachelor’s degree will make an average of 70 percent more than those with only a high school education. Further, a recent article in the Philadelphia Inquirer, referred to a forecast by the Georgetown University Center on Education and the Workforce that projected that 63 percent of all jobs over the next few years will require some type of post secondary school credential.
Over the past decade, there has been an increased recognition that people with psychiatric disabilities can be helped to return to school, at all levels. Some consumers may need to work on the fundamentals of literacy, and others are interested in obtaining a high school diploma. Others may want to pursue a community college two-year degree or a career college program preparing them for a specific career, while others a four year degree or graduate program in mind. Indeed, one study found that 62% of 300 individuals with a mental illnesse would like more education (Rogers, Walsh, Masotta, & Danley, 1991).
However, many people with psychiatric disabilities who want to return to school find that they lack both the confidence and the supports needed to successfully complete their programs. A core principle of community inclusion is that those who do want to return to school should be offered an array of supports to do so, including help in selecting a school program, help in applying to schools, and the academic, emotional, and practical assistance people often need to succeed. Studies indicate that effective support services increase students’ self-esteem, promote hope, and instill motivation. Research further demonstrates that students who receive such supports experienced a decrease in debilitating symptoms and a dramatic decrease in hospitalizations compared to students with mental illness who do not participate in support programs (Isenwater, et al. 2002). Further, the many students who enroll in college upon graduation from high school who then experience their first major psychiatric episode find that schools are unprepared and inadequately staffed to help them obtain supportive services and subsequently continue their studies with necessary supports. Dr. Richard Kadison, Director of Student Health Services at Harvard University talks about the mounting crises on college campuses in his book entitled, College of the Overwhelmed: The Campus Mental Health Crisis and What to do About It. “Many health services are often underfinanced, understaffed, and generally unequipped to handle the number of students who desperately need help. Many of these situations are hidden and never known: students suffer silently, dropout, or return home. (p.3).
A new generation of supportive programs – loosely grouped under the Supported Education title – have begun to provide these supports, and several monographs, journal articles, research studies and books review the support needs of people with psychiatric disabilities and describes the growing number of supported education programs that have been started around the country (Mowbray et al., 2002).
One person with a psychiatric disability cited in the Mowbray book wrote that they began to see “that my problems in completing school were not intellectual: they were the result of the lack of supports (p. 63).” Mowbray warns, particularly in reference to college, that “the consequences of this lack of support in the educational system (have) long range, long reaching, and detrimental effects. Consumers who attempted college and failed, in society’s and their own eyes, (have) their self-esteem so destroyed that they never (attempt) college again and (retreat) into a life of low-paying jobs or disability insurance (p. 29).”
Legislation and Supported Education
The legal mechanisms for supported education are grounded in The Americans with Disabilities Act and Section 504 of The Rehabilitation Act. It is essential for all students with a disability to know their rights under the law as they concern disclosure, classroom accommodations, termination, and harassment. Every college and university is required to work with students to develop reasonable academic accommodations, parallel to the requirements on employers when they hire someone with a disability. The scope of services varies greatly often based upon the size of the school. Some examples of accommodations include extended time on exams, note takers, special re-entry classes, taking exams in separate rooms with fewer distractions, or tape-recorded lectures.
Unlike special education at the secondary school level, college students must request an accommodation which requires disclosure of the disability. This raises concerns about the prejudices and discrimination that may result as administrators, teachers, and other students begin to treat these students differently. Each student has unique considerations and may benefit from connection to some type of supported education services program.
Supported Education Services
Supported Education services are currently available in only a limited number of communities, but Karen Unger, an early researcher on this topic, reports that “existing evidence indicates that programs and services that facilitate the participation of people with a psychiatric disorder in postsecondary education can produce positive outcomes.” The University of Michigan School of Social Work offers an interesting overview of supported education. This overview of supported education includes a look at the conceptual framework and values, the types of services that can be offered, and model programs. The Substance Abuse & Mental Health Services Administration (SAMHSA) has published (currently in draft form) a toolkit presenting a best practices approach that adheres to principles of psychiatric rehabilitation and community inclusion. Horizon House’s Education Plus Program, based in Philadelphia, serves 55 students each semester, who attend area colleges of their choice. This mobile approach is currently the focus of a research project being conducted by the University of Medicine and Dentistry of NJ under the auspices of the Temple University Collaborative, to establish this model as evidence-based.
Links to learn more about supported education:
Butler, Stuart, et al. (2008) “Pathways to Economic Mobility: Key Indicators, Washington, D.C., Economic Mobility Project, an initiative of The Pew Charitable Trusts.
Fishbein, Steven M. and Betty Holland (1993) “So You Want to Go to College: A Guide for Individuals Diagnosed with Severe Mental Illness Who Are Thinking About College.” Published by the Dept. of Human Services, Division of Mental Health & Hospitals, Office of Human Resource and Rehabilitation Development, Trenton NJ.
Isenwater, Wendy, (2002), Psychiatric Rehabilitation Journal, Vo. 26, No. 1
Kadison, Richard. (2004) College of the Overwhelmed: The Campus Mental Health Crisis and What to do About It. San Francisco: Jossey-Bass.
Mowbray, C.T., Brown, K.S., Furlong-Norman, D., Soydan, A.S. Eds. (2002) Supported education and psychiatric rehabilitation: Models and methods. International Association of Psychoscial Rehabilitation Services: MD.
Rogers,E. S., Walsh,D., Masotta,L. & Danley,K. (1991). Massachusetts survey of client preferences for community support services (Final report). Boston: Center for Psychiatric Rehabilitation.
Unger, Karen (2008) Supported Education Implementation Guide: Draft Version. Substance Abuse and Mental Health Services Administration.
Getzel, Elizabeth Evans and Wehman, Paul, eds. (2005) Going to College: Expanding Opportunities for People with Disabilities. Paul H. Brookes: Baltimore.
Unger, Karen (1998) Supported Education: Providing Services for Students with Psychiatric Disabilities. Paul H. Brookes: Baltimore.
Wells-Moran, Jolyn and Gilmur, Deanne. (2002) Supported Education for People with Psychiatric Disabilities: A Practical Manual. University Press of America.