Absence of conflict of interest.
The study’s objective was to examine the long-term impact of the Mental Health Treatment Study (MHTS) demonstration on employment, earnings, and Social Security disability benefit receipt outcomes for people with schizophrenia or affective disorder receiving Social Security Disability Insurance (SSDI). The MHTS tested an integrated individual placement and support (IPS) model of supported employment. Supported employment interventions provide a combination of health services and employment supports to improve employment, health, and other outcomes.
The study was a randomized controlled trial conducted in 23 sites nationwide that participated in the Mental Health Treatment Study (MHTS). The authors compared public benefit, employment, and earnings outcomes among SSDI beneficiaries randomly assigned to the supported employment intervention or control group that did not. The authors drew on the Social Security Administration’s administrative records on employment, earnings, and disability benefits to assess outcomes for up to 7 years after random assignment.
The study found that, across the sites, the supported employment treatment group the intervention led to a statistically significant increase on any earnings and the amount of earnings between the treatment group and the control group, but no significant effect on SSI/SSDI benefits suspension.
The study receives a high evidence rating. This means we are confident that the estimated effects are attributable to the intervention, and not to other factors.
Individual Placement and Support (IPS) model of supported employment
Features of the Intervention
People with serious mental illness, such as mood or psychotic disorders, have historically had a low rate of workforce participation. People with mental disability who are unable to engage in substantial paid work are eligible to receive cash assistance from the Social Security Administration (SSA). These benefits can be reduced or suspended if recipients are able to work above the “substantial gainful activity level” for more than 9 months in a 60-month period.
The current study utilized a multi-component intervention that included individual placement and support (IPS), medication management and care coordination, behavioral health services, and fully-paid health insurance coverage. IPS helps individuals secure competitive employment through quick job searches, intense vocational services, and benefits management. Health insurance coverage was provided for 3 years and was fully paid for by the Social Security Administration and Medicare. This included covering premiums, copays for behavioral health services and out-of-pocket expenses, and not requiring medical disability reviews. Behavioral health services such as substance abuse treatment or family education and support were provided as needed.
The program serves unemployed individuals 18 to 55 years old with a psychiatric disorder that receive Social Security Disability Insurance (SSDI).
Features of the Study
The study used a randomized control design to examine the impact of the intervention on earnings and benefit in SSDI recipients who experience serious mental health illness.
SSDI recipients that met inclusion criteria and lived within 30 miles of a site were randomly assigned to the treatment group (IPS and other services) or the control group (which could access other services available in the community). 2,160 individuals with psychiatric disorders receiving SSDI benefits were included in the study. 1,062 received the intervention and 1,098 were in the control group. The sample was primarily female (53 percent) and White (62 percent), with an average age of 47 years old and at least a high school degree (62 percent). The primary psychiatric diagnoses were schizophrenia (29 percent) or affective disorder (71 percent).
The treatment group received the intervention over a two-year period. The comparison group were provided with a list of resources for people with psychiatric disorders and continued with services as usual.
Data was collected from SSA’s Master Earning File and Disability Analysis Files. The Master Earnings Files includes earnings information reported annually by employers. The Disability Analysis file includes monthly benefits information from SSDI and SSI administrative data. Baseline demographic data was collected in the original study from 2006 until 2010. Follow-up outcomes used SSA administrative data from 2011 to 2015. The authors conducted generalized linear mixed-effects regression models. The models included time fixed effects, and analyses were adjusted for repeated measures of an individual over time as well as missing data at random.
Earnings and Wages
The study found that treatment group participants were statistically significantly more likely to have any earnings than the control group (41% vs. 37%).
Participants in the treatment group also had statistically significant total higher earnings than those in the control group; earning $5,073 more, on average, over the follow-up period. Among only those that worked, the treatment group earned on average, $7,468 more than the control group.
In the first year after the intervention ended, the study found that the treatment group was 2.6 times more likely to have any earnings than those in the control group (statistically significant), earning $737 more in the first year.
Public benefits receipt
The study found no statistically significant effect between the intervention and SSI/SSDI benefits ever suspended or terminated for work; total number of months with SSI/SSDI benefits suspended or terminated for work; the total SSI/SSDI benefits forgone for work; or the total cash payments from SSDI and SSI.
Considerations for Interpreting the Findings
Participants were enrolled in the study on a rolling basis, so the follow-up time period is not the same for all participants. For treatment group participants, the time between completing the intervention and the start of the follow-up period varied from less than a year up to 3 years.
Benefits and earnings values are not adjusted for inflation.
Causal Evidence Rating
The study received high evidence rating because it was a well-implemented randomized controlled trial. This means we can be confident that any estimated effects would be attributable to the intervention and not to other factors.