1. Stuck in the mud Experiences of access to employment in northeastern Ontario for persons with serious mental illness. 1Karen Rebeiro Gruhl, Laurentian University June 2010

2. Objectives for today  To share how people with SMI are doing in the area of employment in NEO  To offer an explanation of why consumers are stuck in the mud regarding employment, and how this happens  To share community based solutions and next steps 2Karen Rebeiro Gruhl, Laurentian University 2010

3. Research design quan Providers Persons with SMI Decision makers Case Study QUAL Community Based Partners 3Karen Rebeiro Gruhl, Laurentian University 2010

4. Final participant sample SettingSudbury Manitoulin DistrictCochrane-Timiskaming DistrictTotals Sampling Sub-groupUrbanRuralUrbanRural Persons with SMI3251020 Providers1303218 Decision makers538 Totals212111246 4Karen Rebeiro Gruhl, Laurentian University 2010

5. Data Collection techniques QUALitativeQuantitative  Interviews:  Individual  Focus groups  Field notes  Conceptual notes  Methods notes  Pertinent documents  Brochures (local)  Community socio-demographic data (LHIN) (Regional)  Policy (Provincial )  Primary data source: Participant demographic questionnaire  SMI, PR, DM  Empirically driven variables  Secondary data source: (MCSS)  Empirical and study generated variables  Regional and local contexts 5Karen Rebeiro Gruhl, Laurentian University 2010

6. Data analysis  Inductive analysis of QUAL data  Iterative, inductive back and forth process between field notes, transcript data, documents, analytic memos  Deductive analysis of quan data  Theory driven, drawn from empirical literature  Within and between case analyses  Yielded a unifying conceptualization of access to employment for people with SMI in northeastern Ontario 6Karen Rebeiro Gruhl, Laurentian University 2010

7. Quantitative results Does place matter?  Primary data  Secondary data 7Karen Rebeiro Gruhl, Laurentian University 2010

8. Consumer Participant Characteristics Age Age of Onset Education level Income Source 1=16-24 years 9 = <20Some HS=7ODSP=14 5=25-35 years 8 = 20-30HS=5CPP=3 7=36-45 years 3 = >30Some College =2Other=2 7=46-64 years College or U=6Work=1 8Karen Rebeiro Gruhl, Laurentian University 2010

9. Primary data source findings Participant Employment successReported employment Rurality & Employment NEO # Reporting employment Prior work experience NorthSouthUrbanRural YesNoYesNo Sudbury Manitoulin 2/55/524448 Cochrane Timiskaming 6/1515/156 Totals Participant Sample 8/2020/20624448 9Karen Rebeiro Gruhl, Laurentian University 2010

10. Secondary data tables: Northeastern Ontario Employment successRecipients on ES Adult ODSP Recipients with SMI Total # ODSP Recipients with SMI # Reporting earned income % Reporting Earnings Total # reported earnings URBAN %Total # reported earnings RURAL % Sudbury Manitoulin 2515219 8.7% 4391.548.51 Cochrane Timiskaming 1597139 8.7% 1976624 Totals NEO4112358 8.7% 6286.11013.8 10Karen Rebeiro Gruhl, Laurentian University 2010

11. Quan sample n=4112 Cochrane Timiskaming n=1597 Sudbury Manitoulin n=2515 Northeastern Ontario # employed 139 219358 (8.7%) # Met 13 week target 20 4767 (18.7%) Tenure: How long are people working? < 1-6 month 11 2536 (53%) 6 -12 month 9 2231 (47%) >12 months 0 00 Reported earnings How much are people making? 0.01 – 750.00 72% 750.01 – 2000.00 23.8% >2000.00 4.2% Self-sufficiency Are people leaving income support systems? *Income precludes or in excess 1 Year period3.0% 6 year period8.1% 11Karen Rebeiro Gruhl, Laurentian University 2010

12. Does place matter?  People with SMI in NEO are not faring well in employment  8.7% reported employment earnings  Earn < $750.00  Few reaching the target of 13 weeks (2%)  No one is sustaining employment > 1 year  Few exit income support systems  Urban Individuals are doing better than rural cohorts  WHY? 12Karen Rebeiro Gruhl, Laurentian University 2010

13. Qualitative results  Stuck in the mud  Raising the bar and the expectations “People with mental illnesses are stuck (SM02)…We are stuck in the mud” (CT02). 13Karen Rebeiro Gruhl, Laurentian University 2010

14. STUCK IN THE MUD INFLUENCE OF THE DOMINANT DISCOURSE SYSTEMIC AND LOCAL TENSIONS THE NEED TO RAISE THE BAR AND THE EXPECTATIONS Ideological and interest-based tensions Painting everybody with the same brush Northern and Rural Tensions Jurisdictional Tensions s Funding Tensions Organizational Tensions SETTLING FOR LESS BUILD COMMUNITY CAPACITY BUILD CONSUMER CAPACITY CHANGE THE THINKING ABOUT CAPACITY 14Karen Rebeiro Gruhl, Laurentian University 2010

15. STUCK IN THE MUD INFLUENCE OF THE DOMINANT DISCOURSE SYSTEMIC AND LOCAL TENSIONS THE NEED TO RAISE THE BAR AND THE EXPECTATIONS Ideological and interest-based tensions Painting everybody with the same brush Northern and Rural Tensions Jurisdictional Tensions s Funding Tensions Organizational Tensions SETTLING FOR LESS BUILD COMMUNITY CAPACITY BUILD CONSUMER CAPACITY CHANGE THE THINKING ABOUT CAPACITY 15Karen Rebeiro Gruhl, Laurentian University 2010

16. STUCK IN THE MUD INFLUENCE OF THE DOMINANT DISCOURSE SYSTEMIC AND LOCAL TENSIONS THE NEED TO RAISE THE BAR AND THE EXPECTATIONS Ideological and interest-based tensions Painting everybody with the same brush Northern and Rural Tensions Jurisdictional Tensions s Funding Tensions Organizational Tensions SETTLING FOR LESS BUILD COMMUNITY CAPACITY BUILD CONSUMER CAPACITY CHANGE THE THINKING ABOUT CAPACITY 16Karen Rebeiro Gruhl, Laurentian University 2010

17. Rise in unemployment rates from 5.5% to 10.5% during study period. Few employment specialists to cover a large geography. Few service providers willing to provide vocational services in rural or remote areas Service providers must travel large distance Few designated vocational workers on mental health teams, and if so, dedicate <25% Service providers do not collaborate due to limited resources, and distance SYSTEMIC AND LOCAL TENSIONS Northern and Rural Tensions Jurisdictional Tensions Funding Tensions Organizational Tensions Figure 8: Systemic and local tensions contributing to being stuck in the mud 17Karen Rebeiro Gruhl, Laurentian University 2010

18. STUCK IN THE MUD INFLUENCE OF THE DOMINANT DISCOURSE SYSTEMIC AND LOCAL TENSIONS THE NEED TO RAISE THE BAR AND THE EXPECTATIONS Ideological and interest-based tensions Painting everybody with the same brush Northern and Rural Tensions Jurisdictional Tensions s Funding Tensions Organizational Tensions SETTLING FOR LESS BUILD COMMUNITY CAPACITY BUILD CONSUMER CAPACITY CHANGE THE THINKING ABOUT CAPACITY 18Karen Rebeiro Gruhl, Laurentian University 2010

19. STUCK IN THE MUD INFLUENCE OF THE DOMINANT DISCOURSE SYSTEMIC AND LOCAL TENSIONS THE NEED TO RAISE THE BAR AND THE EXPECTATIONS Ideological and interest-based tensions Painting everybody with the same brush Northern and Rural Tensions Jurisdictional Tensions s Funding Tensions Organizational Tensions SETTLING FOR LESS BUILD COMMUNITY CAPACITY BUILD CONSUMER CAPACITY CHANGE THE THINKING ABOUT CAPACITY 19Karen Rebeiro Gruhl, Laurentian University 2010

20. Building community capacity  Fostering best practice employment services  Fostering collaboration and integration of services for persons with SMI  Creating opportunity for employment through creative community and cross sectoral partnerships 20Karen Rebeiro Gruhl, Laurentian University 2010

21. Building consumer capacity  Widely promoting the benefits of work for all  Greater focus on education and training  Providing a variety of evidence based supports as long as needed 21Karen Rebeiro Gruhl, Laurentian University 2010

22. Changing the THINKING about capacity  Inclusive thinking about mental “health” care  Shifting the paradigm beyond illness to include social determinants of health  Making employment more of a priority within mental health systems in NEO 22Karen Rebeiro Gruhl, Laurentian University 2010

23. Town Hall forums & Next steps  Employment Advisory  Building community capacity:  Train vocational service providers & mental health providers in IPS ES  Advocacy for implementing best practice models and ways to collaborate  Sponsor a workshop 23Karen Rebeiro Gruhl, Laurentian University 2010

24. Building consumer capacity Karen Rebeiro Gruhl, Laurentian University 2010 24  Advocacy for supported education and access to training dollars to bridge the education-work gap  Actively promoting work, education and other rights of citizenship within mental health care continuum

25. Changing the thinking about capacity Karen Rebeiro Gruhl, Laurentian University 2010 25  Influence the discourse by demonstrating successful outcomes  Raise the profile of employment for persons with SMI with local employers and decision makers within our communities  Celebrate employers who make a difference

26. Questions? 26