"What mental health practitioners need to hear," Zlatka Russinova, Ph.D., told Psychiatric Times, "is that people with serious mental illness do have the capacity to go back to work." Russinova is senior research associate at Boston University's Center for Psychiatric Rehabilitation and has specialized in researching the connections between mental illness and employment.

"I'll give you one example. I had a colleague who is a postdoctoral fellow and who has been conducting interviews for our study. She has been so amazed that, as a clinician, she never believed that people with serious mental illness could do this or think clearly about serious economic decision making. She said to me, 'There probably are so many other mental health professionals out there who think the way I thought.'"

Where occupational therapy was once seen as a treatment tool, the ability to work and earn a living is now recognized as a realistic outcome for many patients. In one study of workers with serious mental illness, Russinova and her colleagues found that 74% of the 687 participants had held the same job for 24 months or longer. In that group, 28% suffered from major depression, 17% had schizophrenia or schizoaffective disorder, 42% had been diagnosed with bipolar disorder, and 11% had posttraumatic stress disorder or other dissociative disorder.

Across the country, programs are going beyond just training people with mental illnesses for jobs and helping them find employment opportunities. They are creating businesses in which workers who are mentally ill take an active part in running the enterprise, dealing with customers and sharing in the economic fruits of their labor.

"We've seen this happening around the country," said Ron Honberg, J.D., national director for policy and legal affairs at the National Alliance for the Mentally Ill. He told PT, "A lot of times they are food establishments. That's a successful model, but it's not widespread. It's a very cool approach, involving people in all aspects of the enterprise, giving them a stake in how it does. It's a progressive approach to addressing a need that is very profound for people with mental illness." Examples can be seen in the Table.

Eloise Newell runs Restoration Project Inc., a vocational rehabilitation program that trains people who are mentally ill in furniture upholstery and refinishing in Acton, Mass. "We do an annual survey of our graduates," she told PT. "Over the 10 years we've been in existence, more than 70% of them remain employed. Their recovery appears to be permanent."

Newell was a university-level physics instructor when her own son was diagnosed with schizophrenia as a college sophomore. "Sixteen years ago, programs weren't geared toward recovery," she said. "He was always ambitious and had a strong work ethic. He said he knew if he could work he would be better."