Supported Employment for people with severe mental illness

Supported Employment for people with severe mental illness

United States
Organization type: 
nonprofit/ngo/citizen sector
$1 million - $5 million
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.





Researchers at Dartmouth College developed the Supported Employment model for people with severe mental illness in the early 1990's. Thresholds was among the first service-providers to implement the program, and the impact was immediate. Our agency has put thousands of people to work.


About Project

Problem: What problem is this project trying to address?

The unemployment rate for people with severe mental illness hovers around 90% nationally, despite the fact that the vast majority of this population desperately want to work. Research shows the power of work in terms of aiding one’s recovery from mental illness. Yes, we said recovery, in the form of decreased hospitalization, symptom reduction, and increased confidence and self-esteem. This vulnerable population often lacks the necessary educational background, ongoing support, and the kinds of employable skills to make that job a possibility. Spread out over a nation, that’s hundreds of thousands of people ready but unable to work, relying on Social Security Disability Income for their survival.
About You
Section 1: About You
First Name


Last Name


Section 2: About Your Organization
Organization Name


Organization Phone


Organization Address

4101 N. Ravenswood Ave.

Organization Country
Your idea
Country your work focuses on
What makes your idea unique?

Supported Employment is a highly-effective, proven concept that reverses course from the antiquated vocational rehab concepts of sheltered employment and industry-specific job training programs that have been utilized by the psychosocial rehabilitation field for decades.

Do you have a patent for this idea?

What impact have you had?

Supported employment has been a critical ingredient for consumers in their recovery journey. Speaking of the importance of employment in their life, one consumer noted, “Working has given me a sense of responsibility. I am proud of my work and it makes me feel good about myself.” An additional consumer of Thresholds SE services encouraged others to join the employment program by stating, “Never give up on being employed with a disability. It takes strength, and you are taking a step forward. I would say that if someone feels like they were at a point in life that they want to live a decent life-style and overcome mental illness and disability that they should look into the employment program.”


Created by Dartmouth researchers and applied by Thresholds throughout the diverse setting of Chicago, Supported Employment has transformed job creation for people with severe mental illness. Our agency's team of Supported Employment Specialists (SES) work with any member who wishes to work by providing a comprehensive assessment of work skills and preferences, assisting in the job search and application process, networking with area employers to find suitable fits, and maintaining on-the-job support if needed. One SES can assist up to 20 job-seekers at a time. Thresholds has a network of nearly 150 companies who understand the benefits of hiring motivate employees, such as Banana Republic, Federal Express, Walgreens, Kohls, etc.


Based on agency intake statistics, an estimated 96% of individuals are unemployed at entry to Thresholds, roughly 50% have no work history, and 5% come to the agency homeless. Of the roughly 3,500 individuals served by the agency last year, 914 received supported employment services. Competitive employment rates for the agency’s SE teams ranged from 18 to 63%, with a total of 283 consumers working at 366 competitive jobs at over 120 businesses in the Chicagoland area. Average wages earned was $9.04 an hour, and the average number of hours worked per week was 22.9

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

Again, we believe we're already experiencing success, albeit on a smaller scale. Plans to grow the program - and increase the number of people transitioned from disability income to independent working status - are focused around a Supported Employment Research and Training Center. The three-year plan is broken into separate stages: Research, Cultivation, and Solicitation. It is as follows:
FY2010 - Finalize the Center's goals and budget, followed by a feasability study;
FY2011 - Roll out silent capital stage, with major funders, committees, and institutional partners; and
FY2012 - Unveil challenge matches and solicit second- and third-tier donors.

What would prevent your project from being a success?

There are challenges to implementing our Supported Employment on a greater scale, both within Thresholds and throughout the mental health field. The truth is, changes in practices in this field come slowly, with estimates placing a near 15-year lag between the identification of an evidence-based practice and its implementation. (There remains less than a 5-year gap within traditional medicine). Also, there's the always looming question of funding, particularly daunting given the State of Illinois' current budget concerns. Without proper funding, the Supported Employment will always be a small revolutionary in terms of finding people jobs and not the industry mainstay it could and should be. For every Supported Employment Specialist we hire, we can work with up to 20 potential job-seekers.

How many people will your project serve annually?


What is the average monthly household income in your target community, in US Dollars?

$100 ‐ 1000

Does your project seek to have an impact on public policy?


What stage is your project in?

Operating for more than 5 years

In what country?
Is your initiative connected to an established organization?


If yes, provide organization name.


How long has this organization been operating?

More than 5 years

Does your organization have a Board of Directors or an Advisory Board?


Does your organization have any non-monetary partnerships with NGOs?


Does your organization have any non-monetary partnerships with businesses?


Does your organization have any non-monetary partnerships with government?


Please tell us more about how these partnerships are critical to the success of your innovation.

Thresholds relies on partnerships to organizations and businesses, government and private funders alike. These collaborations help make us better. Specifically, we enjoy a network of more than 150 area businesses who hire our members. Our 42-person Board of Directors and 80-member Associates Board is essential in creating awareness and revenue sources. As our leading funder, the Department of Mental Health is wonderfully supportive of our recovery efforts.

What are the three most important actions needed to grow your initiative or organization?

1. We need to halt funding for institutional care. Illinois leads the nation in the practice of "warehousing" people with severe mental illness in nursing homes. At $38,000 a year in costs, this is a waste of money and the potential of every person relegated to this kind of treatment. Community-based programs, like Thresholds, find people jobs, help them go back to school, create housing, and appropriate medical interventions.
2. Create awareness that Supported Employment is successful finding people jobs, where traditional programs have failed.
3. Money. It requires one Supported Employment Specialist for every 20 consumers.

The Story
What was the defining moment that led you to this innovation?

Under the direction of executive director, Jerry Dincin, PhD (1965-2003), Thresholds became increasingly interested in the evaluation of its services for the purposes of program improvement. Studies conducted at Thresholds provided quantitative evidence of the need for effective employment services first understood intuitively by Thresholds founders in the early '60s. Analysis of data collected in the 1980s showed that the percentage of consumers employed at intake to the agency ranged from only three to seven percent. In order to assess the most effective services to address this problem, Thresholds began to conduct research studies comparing employment outcomes of members enrolled in traditional pre-vocational services with those engaged in competitive employment. As study results illustrated the effectiveness of competitive employment over other employment models, Thresholds shifted increasingly toward a “place-train” approach in which consumers obtained competitive jobs in the community and were provided with on-going supports.

Thresholds committed to evidence-based supported employment (EBSE) services beginning with a five-year research study of supported employment in 1999. This study, conducted in conjunction with Dr. Gary Bond from IUPUI and the Dartmouth Psychiatric Research Center, demonstrated the greater effectiveness of EBSE in obtaining successful employment outcomes for consumers compared to Thresholds’ previous vocational model. With the arrival of Dr. Tony Zipple as the new Chief Executive Officer in June 2003, Thresholds made a commitment to recovery-based services and to evidence-based supported employment in particular.

Tell us about the social innovator behind this idea.

Deborah R. Becker M.Ed., CRC is Assistant Research Professor of Community and Family Medicine and of Psychiatry, Dartmouth Medical School. She is a rehabilitation specialist and is the Senior Project Director at The New Hampshire-Dartmouth Psychiatric Research Center. Along with Robert E. Drake, she has described and researched the Individual Placement and Support approach to supported employment. She provides consultation and training on vocational rehabilitation and program implementation.
Robert E. Drake, MD, Ph.D. is the Andrew Thomson Professor of Psychiatry and Community and Family Medicine at Dartmouth Medical School and the Director of the New Hampshire-Dartmouth Psychiatric Research Center. He has been at Dartmouth for over 20 years, developing and evaluating community-based programs for persons with severe mental disorders. He is well known for his work in psychiatric rehabilitation and mental health services research.

How did you first hear about Changemakers?

Email from Changemakers

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