Mental Health and Self-Employment
Kim Cordingly, Ph.D., Lead Consultant
Lead Consultant, Self-Employment Team
and
Melanie Whetzel, M.A., Lead Consultant
Lead Consultant, Cognitive/Neurological Team
JAN is a service of the U.S. Department of Labor’s
Office of Disability Employment Policy.
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Mental Health
Presentation Overview
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Overview of common mental health impairments
Mental health – accommodation overview
Research on mental health and employment
Self-employment; microenterprise; customized
self-employment
Benefits and challenges of self-employment
Overview of the business development process
Case examples from JAN’s customers
Questions and answers
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Mental Health
Overview – Entrepreneurship Team
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Accessible by toll free phone/TTY, chat, Email, JAN
on Demand
Comprehensive intake process
Individualized consulting and resource
materials
Provide local, state and national resources
Ongoing electronic and telephone access
and support – not case management
JAN entrepreneurship Website access
For-profit, non-profit,
customized self-employment,
home-based business, independent contracting
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Mental Health
Defining Mental Health
“Mental health includes our emotional, psychological,
and social well being. It affects how we think, feel, and
act. It also helps determine how we handle stress, relate
to others, and make choices…Over the course of your
life, if you experience mental health problems, your
thinking, mood, and behavior could be affected. Many
factors contribute to mental health problems including:
biological factors, such as genes and brain chemistry;
life experience, such as trauma and abuse; and family
history of mental health problems.”
From MentalHealth.gov
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Mental Health
Common Mental Health Impairments
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Anxiety
Bipolar Disorder
Major Depression
Obsessive Compulsive Disorder (OCD)
Panic Disorder
Post-Traumatic Stress Disorder (PTSD)
Seasonal Affective Disorder (SAD)
Schizophrenia
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Mental Health
Limitations that may affect self-employment or small
business ownership include:
 Social Interaction
 Concentration
 Emotions
 Fatigue
 Memory
 Organization
 Panic Attacks
 Sleep Disturbances
 Stress
 Communication Issues
 Response to triggers
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Mental Health
General Accommodation Overview
 Social Interaction
 Concentration
 Emotions
 Fatigue
 Memory
 Organization
 Panic Attacks
 Sleep Disturbances
 Stress
 Communication Issues
 Response to triggers
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Mental Health
Mental Health Data
 Mental health impairments can affect persons of any age, race,
religion, or income level
 One in five American adults experience a mental health issue
(MentalHealth.gov)
 In 2012, there were an estimated 9.6 million adults aged 18 or
older in the U.S. who experienced a serious mental illness in the
past year (NIH)
 For many people with mental health impairments, the stigma can
be worse than the condition
 60-80 percent of people who live with mental illness are
unemployed; for those with a severe mental illness, the
unemployment rate may be as high as 90 percent (NAMI)
 An estimated 1/3 to 1/2 of people with severe mental illness live
at or near the federal poverty level (NAMI)
 Half a million people with mental illness are homeless or in jail
(NAMI)
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Mental Health
Employment – What Research Says Works
 Work needs to be part of a holistic recovery plan
 Approach is individualized, customized -- effective
supported employment and self-employment
programs
 Integrated services – multidisciplinary team
approach
 Employment First
 Knowledgeable support to navigate public benefits
and work incentives
 Individualized long term supports
 Importance of creative approaches and ways to
make it work
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Mental Health
Employment – What Research Says About
Challenges
 Lack of access to integrated supported
employment (and self-employment) programs
(Individual Placement and Support – IPS)
 Work disincentives and fear of losing benefits
 Service delivery and support not long term
 Services are disjointed and not integrated
 Stalling employment or self-employment through
training or waiting for “recovery”
 Program design not planning for episodic nature of
many mental health impairments
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Mental Health
“Success generally stems from the love of one’s
labors, the critical match between personal
characteristics and preferences, and the
environment in which one works.”
-Cary Griffin, et al.
(Second Edition, 2014)
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Mental Health
Competitive Versus Self-Employment
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Mental Health
Self-Employment and Disability
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The Rehabilitation Act Amendments of 1998 includes two
references to self-employment as a valid employment outcome
State VR agencies develop guidelines for SE in state plans
ODEP has funded numerous demonstration projects and
programs supporting self-employment/customized employment
models and goals
START/UP USA Report (2013) – documents research exploring
diverse approaches, national technical assistance, and
expertise
Systems change – customized employment/Employment First
Restructuring of economy – more part-time, flexible, freelance
work
Location of work more dispersed and mobile
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Mental Health
Substantial Benefits
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Customized and individualized approach
Social Security & Medicaid advantages
Accommodation opportunities
Community integration
Customized job creation
Resolve transportation issues (rural)
Autonomy and ownership
Increased flexibility
Economic development (e.g., hiring others with
disabilities)
 Fulfills a dream and lifelong interests
 Enables continuation in one’s chosen field of work
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Mental Health
Potential Challenges
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General risks of starting a business (often overstated)
Inadequate or inaccurate information
Family issues
Financial concerns related to interaction with benefits
Funding and credit challenges
Health insurance and coverage issues
Proper supports and agency cooperation
Health challenges
Lack of appropriate supports
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Mental Health
Many challenges can be overcome
with proper planning and supports!
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Mental Health
Team Approach – Who Can Help?
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Service and employment professionals (case
management)
Family members and friends
Small business counselors (SBDC, SCORE, WBC)
Social Security benefits specialists (WIPA)
Other business owners in the community
Microfinance specialists
Asset development providers
Economic and community development consultants
Local, state and federal agency partners
Professional organizations – field specific
Disability-related service organizations
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Mental Health
Defining Entrepreneurial Strategies
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Self-employment
Small business
Microenterprise
Customized employment/self-employment
Independent contractor
Home-based business
Freelancer
Business within a business
Family business
Non-profit organizations
& social enterprise
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Mental Health
Keys to Success
 A really good business idea
 Knowledgeable support team
 Individualized process – no one is the
same
 Building on abilities and interests
 Appropriate support system throughout
the process
 Family support
 Mentorship in one’s field
 A business/self-employment plan
 Financing options
 Assistance with benefits planning
 Accommodations built into the design of
business
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Mental Health
Self-Employment Ingredients – Process
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Discovery, information gathering, and initial
feasibility
Benefits planning (e.g., Social Security,
unemployment, public benefit programs)
Business planning
Networks, mentors, and communities
of support
Trial run
Financing
Ongoing support - sustainability
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Mental Health
Social Security Benefits Analysis and Work
Incentives
 Work Incentive Planning and Assistance projects
(WIPA) - http://choosework.net
 Identify skilled benefits planner with self-employment
training
 SSI and SSDI – different programs and incentives
 Plan to Achieve Self-Support (PASS Plan)
 Property Essential to Self-Support (PESS)
 SE advantages and disadvantages with both
 Griffin et al. – Chapter 6 in Making Self-Employment
Work…
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Mental Health
Business Planning
 David and his business Racecar Waterboy - MicroEnterprise 25-Step Business Plan Workbook
 Funding sources and work incentives often require it
 Sources of assistance include SBDC, WBC,
microenterprise organizations, mentors, VR, CRPs,
and so on
 Helps set framework for detailed planning and works
well in conjunction with a benefits plan
 Is an evolving document – not set in stone
 Careful planning avoids later problems with what is
needed to sustain the business
 Helps establish the mission and start-up costs
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Mental Health
Financing Options
 Disability specific programs (e.g., CRPs, VR)
 Blended and braiding funding (e.g., agencies
collaborate to combine resources)
 Microloans
 Asset development programs – individual
development accounts (IDAs)
 Social Security work incentives (e.g., PASS Plan)
 Economic development funds
 Personal and family savings
 Resource ownership
 One Stop funding – individual training accounts
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Mental Health
Social Media – Low Cost Marketing
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Mental Health
JAN Profiles
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Mental Health
“Karen”
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Alternative therapy health practitioner
Wellness practice
Anxiety and depression
Very intelligent and well educated
Difficulty working within disability “systems”
Limited family and agency support
Concern about losing benefits
Challenges with organization
Accommodations
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Mental Health
Accommodation Ideas - Organization
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Color coded system – use of folders, paper clips,
sticky notes in same colors (finance and insurance)
Importance of choosing system and sticking to it so
paperwork, etc. doesn’t build up again
Use of one planner at all times – maybe a wall
calendar but no more than two
Uses multiple notebooks to write down ideas –
suggested one notebook with dividers by colors
Put color key on wall so won’t be forgotten
Elicit assistance for organizing home and workspace
Locate coach or mentor to provide support with
business and personal issues
Prioritize issues – personal and professional
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Mental Health
“Jenny”
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Real estate – property management – Internet business
PTSD
Working with vocational rehabilitation with selfemployment as work goal
Inquired about supported self-employment and was told
didn’t apply to her, only those with DD/ID
Feels she will need ongoing support beyond when her
case is closed
Has anxiety and stress intolerance
At times difficulty controlling anger/emotions
Self-employment enables autonomy and independence
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Mental Health
Accommodation Ideas – Stress Intolerance
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Work on stress management skills with counselor,
coach or mentor; rehearse skills in work scenarios
Have a checklist of reminders to do when triggered
Plan for situations (or alternatives) in which triggers
are more likely (e.g., use email versus in person
conversation)
Business training to build up confidence and reduce
anxiety
Outsource certain tasks such as accounting
Include a mentor, family member, or friend in a
meeting for extra support (e.g., bank) and to help
keep topics on track
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Mental Health
“Bill”
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Engineer in private sector
Left job due to high anxiety in work
setting (has dual diagnosis)
Independent contracting
Government contracts
Financial loss (e.g., home foreclosure, limited
financial resources)
In process of applying for SSDI
Believed flexibility and increasing control over
workload would make continuation in his field
possible
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Mental Health
Accommodation Ideas – Reducing Sensory
Overload and Anxiety
 Use noise cancelling headphones, choose a quiet
workspace, or use a white noise machine
 Use calendar or time management program to plan
and organize workload levels and deadlines – limit
procrastination
 Reduce clutter in any workspace and maintain
organization
 Schedule meetings in locations with low noise levels
 Know anxiety triggers and have strategies in place
should they occur
 Use a coach, mentor, or counselor for support and to
prepare for potentially problematic situations
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Mental Health
“Mary”
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Freelance paralegal
Bipolar disorder, anxiety
History of losing competitive employment
Working with vocational rehabilitation with selfemployment as goal
Receiving unemployment benefits
Unfamiliar with small business resources and
process
Good knowledge of her market
Accommodation issues – being productive when
mood changes and depression affect her
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Mental Health
Accommodation Ideas – on “bad days”
distracted, anxious, and fatigued
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Use a daily list to prioritize activities - have realistic
expectations
Opt for digital communication when possible if inperson interaction causes greater anxiety
Seek support from coach, counselor or mentor and
use stress management techniques
Build in time for rest breaks
Work from home on “bad” days
Design schedule so work is project based and can be
done on most productive days
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Mental Health
“Allen”
 Horticulture; plant product development
 Schizophrenia and depression
 Lives in rural area with few resources
 Ownership – home and land
 Experience in the greenhouse business
 Family and caregiving issues – other family members
with disabilities
 Limited transportation options
 Accommodation issues – anxious when
communicating with agencies; literacy issues; side
effects of medication especially fatigue
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Mental Health
Accommodation Ideas – Communication and
Anxiety
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When contacting organizations, write out questions
ahead of time and keep notes of conversations
Schedule counseling sessions at home or over
computer
Use familiar professional contacts in the field
whenever possible for assistance/mentors
Practice social interaction in different environments –
computer, telephone, Email, and social media
Manage time outside when less heat to limit side of
effects of medication
Involve family members to provide additional
supports
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Mental Health
“Marilyn”
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Sell handmade
knitwear and crafts
Major depression, chronic
fatigue, and hearing loss
No experience with sales
Not working with employment or vocational programs
SSDI
Concerns about health insurance and medical costs
In transition phase back to work
Accommodation issues – work from home; hearing
aids; screen enlargement
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Mental Health
Accommodation Ideas – Work from home
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Biggest accommodation was being able to work from
home
Needed updated computer and training
Shared online venues for selling goods (e.g., Etsy)
Allowed her to work when able and “stockpile” items
for holiday season, etc.
Manage work time with rest when necessary
Increase support circle – familiarize her with
business organizations and funding sources
Possibly outsource accounting
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Mental Health
“Ken”
 Buy real estate – rehab property to sell
 Partnership with his mother
 Post 9/11 veteran with PTSD
 Receives VA benefits
 Business development assistance available to
veterans
 Project based
 Family support
 Interest in community
development
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Mental Health
Accommodation Ideas – Autonomy and
Family Support
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Business is project based so can work autonomously
Flexibility to work when most productive
Family support to step in when helpful
Counselor/mentor to provide support when triggers
arise
Mother will assist with business tasks such as
accounting
Ability to leave for doctor appointments
Increase participation with other veteran business
owners
Consider the presence of a support animal
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Mental Health
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Mental Health
Contact
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(800)526-7234 (V) & (877)781-9403 (TTY)
(304) 216-8189 via Text
AskJAN.org & jan@askjan.org
janconsultants via Skype
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Questions?
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Presentation Slides () - Job Accommodation Network