Supported education for individuals with psychiatric disabilities: Long-term outcomes from an experimental study

Research indicates that many individuals with psychiatric disabilities often experience the onset of mental illness in young adulthood. This fact, as well as educational discrimination, unmet needs for support, personal fears of failure, and the cyclical nature of their illness causes many of these individuals not to pursue higher education, despite their intellectual qualifications. Supported education programs have arisen as psychosocial rehabilitation interventions in response to these circumstances. The Michigan Supported Education Research project was unique in using open enrollment for eligible participants from a large urban area and testing the intervention with a true experimental design. The article discusses the appropriateness of supported education as a social work intervention. Key words: mental health services research; mental illness; postsecondary education; students with disabilities Higher education increasingly is recognized as social capital, a necessity for achieving occupational mobility or even maintaining economic status in the United States today. Postsecondary institutions are enrolling a more and more diverse student population (Arnstein, 1995; Fairweather & Shaver, 1990; Kiracofe, 1993). Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112) opened access to college campuses for many individuals with disabilities, and recent passage of the Americans with Disabilities Act of 1990 (P.L. 101-336) further guaranteed the rights of these students. Disabled or special student services offices exist in most community colleges and four-year institutions of higher education. However, individuals with psychiatric disabilities have not benefited from these initiatives and remain largely disenfranchised from higher education (Anthony & Unger, 1991; Unger, 1994; Unger, Anthony, Sciarappa, & Rogers, 1991). This fact should be of concern to social workers because of the profession's emphasis on prevention and early intervention and its recognition of the empowering potential of education. Wintersteen (cited in Shera, 1996) argued that social work is the profession optimally positioned for leadership in providing services to people with serious mental illness. The exclusion of individuals with psychiatric disabilities from postsecondary settings is particularly unfortunate given the fact that mental illness often is experienced first in late adolescence and early adulthood (the mean age of onset for schizophrenia is 21; Beiser, Erickson, Fleming, & Iacona, 1993; and the 30 day prevalence of depression is highest in the age group 15 to 24; Blazer, Kessler, McGonagle, & Swartz, 1994). Many individuals obtain higher education and formulate career plans during the years of young adulthood. Psychiatric symptoms and discriminatory treatment by others can start young people with mental illness on a downward course of educational underachievement or failure, underemployment or unemployment, and consequent lifelong disabilities (Jayakody, Danziger, & Kessler, 1996). That individuals who experience mental illness have educational potential is substantiated by repeated findings that their median educational level is over 12 years and that 20 percent to 50 percent have some college experience (usually before the onset of their psychiatric problems) (Hazel, Herman, & Mowbray, 1991; Tessler & Goldman, 1982; Unger & Anthony, 1984). That individuals with mental illness need postsecondary education and training may be implied by the rather mediocre success levels of initiatives for vocational rehabilitation. That is, innovative service models appear to have improved substantially vocational outcomes for individuals with psychiatric disabilities--the example, recent multisite and experimental studies found postintervention employment rates to be 46 percent (McFarlane et al., 1995), 53 percent (Rogers, Anthony, Toole, & Brown, 1991), 56 percent (Bond, Drake, Mueser, & Becker, 1997), 76 percent (Gervey & Bedell, 1994), and 78 percent (Drake, McHugh, Becker, Anthony,& Clark, 1996); these data compare to an earlier summary of descriptive studies (Anthony & Blanch, 1987) that reported that only S percent to 1 S percent of people with long-term, serious mental illness were employed. …