NWX-SAMHSA CMHS

Moderator: Jane Tobler
February 28, 2012
2:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants are in a listen-only mode until the question-and-answer session.

Today’s conference is being recorded. If anyone has any objections, you may disconnect at this time. I would now like to turn the call over to Ms. Jane Tobler. Thank you. You may begin.

Jane Tobler: Hello and welcome to Breaking the Poverty Cycle Creating Social and Economic Opportunities. Today’s webinar is sponsored by the Substance Abuse and Mental Health Services Administration Resource Center to promote acceptance, dignity, and social inclusion associated with mental health also known as the ADS Center.

SAMHSA is the lead federal agency on mental health and substance abuse and is located in the U.S. Department of Health and Human Services. Please join the ADS Center listserv to learn more about social inclusion, including upcoming webinars, new resources, and events.

This webinar will be recorded. The presentation audio recording and a written transcript will be posted to SAMHSA’s ADS Center Web site at promoteacceptance.samhsa.gov in late March.

The views expressed in this training do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.

Our presentation today will take place during the first hour and will be followed by a 30-minute question-and-answer session. At that time, you’ll press star 1 on your telephone to ask a question, enter a queue, and be invited to ask your question in the order in which it is received.

The social determinants of health and well-being involve complex and dynamic processes that involve social structures and economic systems. These social and economic systems are responsible for most of the health inequities in the United States.

Addressing these inequities particularly poverty, discrimination, and the entitlement trust is a social economic and health imperative. People with behavioral health problems are disproportionately affected by poverty. When economic stressors and other social determinants of health such as trauma, social isolation and discrimination intersect individuals and families are trapped in a cycle of poverty.

It is critical that we begin to acknowledge these impacts and accept responsibility as a community for creating social and economic opportunities to support people in recovery in their efforts to exit poverty.

Our speaks today will examine this important issue including the importance of community support, financial tools, cross agency collaboration, and other innovative resources that are assisting people with behavioral health problems to achieve financial health, wellness, and community integration.

Our first speaker is Dr. Crystal Blyler, a Researcher at Mathematica Policy Research where she works on projects related to health, mental health, and disability.

Before joining Mathematica, Dr. Blyler spent 12 years as a Social Science Analyst with the Community Support Program’s branch on SAMHSA’s Center for Mental Health Services where she collaborated with other federal agencies including the Social Security Administration, the U.S. Department of Labor, the Centers for Medicare and Medicaid Services, and the U.S. Department of Education.

She also served on a number of committees including the Interagency Council on Disability Research’s Subcommittee on Employee and the Federal Partners for Mental Health Transformation’s Employment Work Group.

Today Dr. Blyler will discuss how the safety net can lead to unintended negative consequences. Thanks for joining us Dr. Blyler.

Dr. Crystal Blyler: Good afternoon. Thank you for inviting me. I appreciate the opportunity to talk to you today about this important topic.

In economics the cycle of poverty is defined as the set of factors or events by which poverty once started is likely to continue unless there is outside intervention.

I want to talk to you today about how the very safety nets that we’ve established to help people with the most serious mental illnesses can end up relegating them to a life of poverty.

Before I start, I want to acknowledge my colleagues at Mathematica who have been researching and writing about this topic for many years and providing much of the material for this presentation. In particular I thank Bonnie O’Day, Gina Livermore, and David Stapleton. You’ll see some of their work included among the resources listed at the end of the presentation.

Decades of research have consistently documented a clear association between mental illness and lower income and poverty. The research shows that it’s people with the more severe illnesses who are particularly likely to live in low-income households while the average income of people with moderate disorders is only slightly less than that for the general population. The income of people with severe disorders is reduced by a third. In the U.S. almost half of people with severe mental disorders live in low-income households.

So why would poverty be particularly associated with severe mental illness? Well most people in the U.S. get most of their income from working. People with mental disorders however, especially those with severe disorders are much less likely to be employed while the percent of people with moderate disorders who work as close to the rate in the general population. Only 45% of people with severe disorders are employed.

So if you aren’t working where else would you get your money? The safety net that we’ve established to provide income to people who can’t work due to mental health problems hinges on the Social Security Administration’s disability benefit programs: SSI and SSDI.

Unfortunately while these programs can be life savers for people who need them, they themselves are linked to poverty. For people with severe mental disorders receiving disability benefits triples the risk of living in a low-income household not receiving a benefit therefore. In other words working would seem to be the best strategy to tackle poverty.

So how do people enter this poverty trap in the first place? We start at the lower left-hand corner with an episode of mental illness. Of course episodes vary in their severity and oftentimes people are able to continue working despite the symptoms.

Other times however the illness disrupts the person’s ability to work. Oftentimes the inability to work will be short lived and people will be able to return to their job or obtain a new job that suits them better. In some cases however the inability to work results in the loss of a job. Sometimes in these cases the person will be able to obtain a new job.

If however they continue to be without a job and they’ll eventually find themselves without income and the ability to pay for the healthcare that might help them to recover, this is the point at which the safety net kicks in to protect people against the diarist outcomes of homelessness, starvation, and death.

So once you’ve been caught in the safety net what can you expect? Well the maximum income you can receive from SSI is $674 a month well below the federal poverty level. The average SSDI check is about $1,000 a month which is above the poverty level, but still considered to be very low income. Consequently 50% of beneficiaries live in poverty.

How far does the Social Security check go? Well the national average rent for a studio efficiency which is the smallest housing unit available is $695 a month. So you can that that’s—the cost of an apartment alone exceeds the maximum SSI benefit. So while serving as a kind of insurance against other destitution, disability benefits don’t prevent poverty. Moreover once on the roll people rarely leave. Receipt of Social Security benefits therefore too often result in a lifetime of poverty.

Unfortunately life in the safety net is not lonely. Almost 1 out of 20 working age Americans receives SSDI. Among people in mental disorders 1 out of 5 receive either SSI or SSDI. And despite the income support provided by the safety net over 800,000 people with disabilities are homeless or living in group homes and another 400,000 are living in nursing homes or public mental health institutions.

So let’s take a look at how one might get out of this trap starting in the upper left-hand corner. The first thing that has to happen is that your illness has to give you a break.

We know that mental illnesses tend to wax and wane in severity over time, that most people do have periods even after a prolonged or severe illness in which they’re ready and able to work.

At this point in order to escape one must look for a job. Obtaining a job of any kind at this point poses a number of challenges due to the time passed out of the workforce.

First the triggering illness episode may have disrupted your education. If you’re receiving disability benefits, it’s likely that you’ve been out of the workforce for at least a few years given the length of time it takes to obtain benefits in the first place. Therefore any skills you have obtained may be at least rusty or in some fields obsolete.

Second, you now have gaps in your résumé that may be difficult to explain in interviews. If you’re not able to obtain a job for these reasons, you continue to have the safety net protections. But of course there’s some significant negative consequences of not working not only for your income, but also for your mental health and social well-being.

If you do manage to find a job you don’t necessarily lose your disability benefits, but you’re also not guaranteed an escape from poverty. If you earn less than the amount that Social Security calls substantial gainful activity then you get some of the benefits of work without jeopardizing your benefits. This is the option chosen most by people on disability benefits who want to work.

The disadvantages that the income that you’re allowed to earn while still receiving benefits is quite limited, so you may still be subject to a lifetime of low income or poverty.

As a stepping stone however this can be a good temporary option. As you develop workplace skills, experience, and confidence you may be able to parlay an initial job into a better one in the future.

If the job you attain pays above the substantial gainful activity level, you’ll eventually lose your benefits although it may be years before this happens as the next speaker will explain.

Depending on the job, you may end up therefore among the working poor and you could possibly end up without healthcare insurance although health reform is working to remedy this.

Not having health insurance can make it difficult to pay for the health that’s enabled you to work in the first place thereby putting you at increased risk of losing your job due to any future mental illness episodes and restarting the cycle.

Nevertheless, you still reap the benefits of work including increased self-esteem, social inclusion, and growing work skills that might help you to find better jobs in the future.

This happy yellow circle in the middle is the American dream. You find a job that pays well and includes benefits and you’re on your way. You’ve escaped from poverty. So you see from this slide that escape certainly is possible, but there are many challenges to achieving this.

I’ve shown that employment is key to escaping poverty. Unfortunately however the employment rate of people with disabilities is heading in the wrong direction having fallen from 24% in 1981 to 16% in 2010. Yet federal spending on employment and education supports has decreased to a new low of only 1% of disability funding.

SAMHSA’s Block Grant data show that 80% of people receiving services from state mental health authorities are out of work—80%. Yet only 2% of them receive evidence-based supported employment services.

While employment rates have been decreasing rents have been increasing to the point that today there’s not a single one of the nation’s 2500 housing markets in which an SSI disability beneficiary can afford to rent a modest house without a permanent rental subsidy.

The percentage of SSDI awards made the people with mental disorders has been growing since 1989 even though the prevalence of mental disorders in the U.S. has remained unchanged during the same time period. Growth in the Social Security roles is pushing federal disability spending to the limits.

You may or may not be aware that SSDI benefits are paid for out of payroll taxes that are set aside in a trust fund that is separate from the rest of the federal budget.

With benefits rising faster than revenue, the Congressional Budget Office estimates that the trust fund will run out of money in about five years. In order to protect people who rely on these benefits something’s got to give.

Given the overall federal budget crisis, the disability system will be reformed over the next few years either through active attempts to make it solvent or passively through its demise.

Here’s a quick overview of some of the reforms being proposed. First through health reform people with disabilities will be able to obtain health insurance without having to be enrolled in SSI or SSDI.

Second in the modern era, people with disabilities increasingly can and want to work. Making people prove that they can’t work in order to receive needed benefits therefore discourages them from working when they otherwise would.

My colleagues at Mathematica have put forth a proposal to consolidate federal disability funding streams and create a unified program that focuses on preventing people with disabilities from losing their jobs and entering the disability roles in the first place and providing needed supports to help people on the roles return to work all while preserving protections for people who can’t work.

Others have proposed an experience rating approach to encourage employers to do whatever they can to keep existing employees with disabilities working. Similar to what’s done in the unemployment insurance system this approach would tax businesses for every former employee who enters the disability roles.

Another business approach would be to offer employers a tax credit for every individual that they hire off of the roles.

And finally to feel comfortable earning enough money to leave the roles, people need to know that if their illness once against prevents them from providing for their basic needs the safety net will catch them before they fall into destitution.

That’s a quick summary of disability reforms currently being considered. Here are some references where you can learn more and I particularly invite you to enter into the discussion about these proposals through the Hills Congress blog listed in the fourth bulletin.

Thank you for your attention. I look forward to hearing your thoughts during the question-and-answer period.

Jane Tobler: Dr. Blyler, thank you so much for helping us better understand of the economic and policy issues related to poverty and mental illness and how people can find a path to community integration and social inclusion.

Our next speaker is Oscar Jimenez Solomon, a public health professional and advocate with over 12 years experience in program development and applied research in health, disability, and economic development issues.

He holds a Master’s of Public Health from Columbia University and leads a consulting firm which helps mental health, substance addiction, and developmental disability services improve their outcomes through evidence-based program design, monitoring and evaluation, and quality improvement systems.

Oscar is developing a program to offer matched savings for people in recovery with the goal of starting a small business or pursuing further education. Oscar will tell us about successful community-based and statewide interventions including innovative cross agency collaborations in New York State as well as important readily accessible financial tools that can help people with mental illness build a path out of poverty and toward self-sufficiency. Thanks for joining us today Oscar.

Oscar Jimenez Solomon: Good afternoon—good afternoon everyone. My name is Oscar Jimenez Solomon. Thank you for the introductions. I want to thank first of all the ADS Center at SAMHSA for the invitation to speak to all of you and offer an overview of a few interventions that providers, community-based organizations, and states can consider in assisting individuals in recovery to build a path out of poverty into a self-sufficiency.

Poverty and mental health disability are intimately linked and the first part of my presentation will offer another perspective to the one that was already shared at the beginning of this presentation. And this perspective and based upon research that has really been built during the last few decades tell us that people who live in poverty have lower mental health status than their wealthier counterparts.

For several decades now studies have found a prevalence of psychiatric conditions and addiction that ranges between two and nine times higher among people in low-income communities.

But the question is why is this so? Some studies have concluded living in poverty makes individuals more vulnerable to experience mental health and behavioral disability due to things like financial stress, poor environmental conditions, or lower access to behavioral healthcare.

On the other hand some studies have suggested that having a mental health diagnosis makes individuals more likely to lose jobs, stop their education, accumulate debt, use social supports and therefore become further impoverished.

In our opinion both theories have merit. Poverty and mental health instability seem to create a pervasive cycle that traps individuals and reduces their quality of life and overall wellness.

However the impact that poverty has on individuals is not only limited to our emotional well-being, but really affects all areas of wellness including occupational, social, spiritual, and physical.

Poverty for instance is associated with a 25-year lower life expectancy among people with psychiatric conditions across the country. It’s really a responsibility of our public and community-based mental health and behavioral health system to break the cycle of poverty, disability, and full wellness among people in recovery.

The remaining time I’d like to share a framework and an overview of the types of interventions that can help break this cycle.

First I’d like to touch on the capital framework. The good news is that just as poverty and mental health disability create a pervasive cycle in which one feeds the other, promoting economic integration can also have a positive impact on recovery and overall wellness of individuals.

We actually maintain that it is not only income, but also assets what help people build a path out of poverty. Therefore obtaining and keeping a job is key, but assets are fundamental in order to bring financial stability.

And just to make this point, I would just invite all of us to think about times in our lives in which savings, home equity, or having retirement accounts has enabled us to sort of face some difficult financial times especially when losing jobs or going through some catastrophic illnesses.

The same thing applies for people in recovery in our experience in order to be effective economic interventions must possess three key types of capital or assets. They must help build on own human capital such as our knowledge, skills, or our financial education skills but also economic capital or real capital such as assets, savings, homeownership, and most importantly from mentally, social capital.

By social capital we mean when we refer to the social connections and links among individuals, providers, communities, and states that allow the access to information, knowledge, free sources, opportunities, and connections beyond the mental health and behavioral health systems.

In our experience successful interventions need to be grounded on the goal of building the connections between individuals from recovery and providers with other communities that have access to economic opportunities.

An important example of this is that most of the people in the real world get jobs and advancement opportunities for people that they know or through friends or acquaintances of people they know. The same thing is true for economic self-sufficiency or access in economic self-sufficiency resources.

There is an entire world out there of anti-poverty, financial asset building organizations and programs to whom our mental health and behavioral community is often not connected.

Developing those social connections or institutional connections must therefore be a foundation of building the human and economic assets of individuals that we support.

Specifically what interventions can help break the cycle of poverty and mental health disability? What are the key steps in helping to build a path out of poverty to learn about the programs that can help and then to reach out to those programs to establish connections or strengthen the connection that we have to them.

In the last part of my presentation, I will be sharing—providing a very basic overview of interventions of three levels: the provider individual level, the community-based level, and the statewide and capacity building level.

At the individual provider level one of the most important interventions we can make is to simply engage individuals in conversations about their life dreams and aspirations.

Many of us who have spent years or decades in mental health or addiction services have really stopped allowing ourselves to talk about our dreams or goals. Simply ask people what their aspirations and financial goals are. You may be surprised what you learn.

In our experience these conversations about the life dreams and goals are essential because they are what will keep people motivated as they pursue a job, save, build their credit, or take some of the difficult steps that are necessary towards achieving self-sufficiency.

The resource section at the end of this presentation you will see some links. To two tools were developed by Dr. Peggy Swarbrick and myself is sponsored by NYAPRS. And tool developed by Dr. Cook and her team at the University of Illinois in Chicago. These tools provide more concrete handouts and guidance of how to hold effective conversations with individuals about their life dreams and financial goals.

Increasing information about and access to work incentives is another key program and area that can make all the difference. Work incentives help people who are on SSI or SSDI support to keep some benefits while working and while achieving greater levels of self-sufficiency. Unfortunately there are still a lot of myths out there in our community about work incentives.

It is not true for example that someone receiving SSI or SSDI will necessarily lose all their cash benefits or health benefits. The trial work period for instance allows SSDI recipients or Social Security Disability Insurance recipients to receive their full SSDI check for at least nine months while earning any amount.

The 1619a allows SSI recipients to earn money through work and still receive a pro-rated check always making more in the end.

The Medicaid Buy-In Program which unfortunately is not available in all states but in many states allows people with disabilities to help to get or keep full Medicaid while earning much more than the regular Medicaid limits. In New York State for instance individuals can make over 55, up to $55,000 a year in earned income and still remain eligible to the Medicaid Buy-In.

One of the best kept secrets in our community is the Earned Income Tax Credit. Every year the Internal Revenue Service keeps hundreds of millions of dollars that could actually go to low-income Americans many of whom are people in recovery who do not know about the Earned Income Tax Credit and other tax credits and never file taxes.

The Earned Income Tax Credit is a refundable credit of anywhere between $600 to $7,500. The minimum requirement is to file taxes and to have earned income.

On Slides 34 and 35, you’ll find more information about the income requirements and the dollar amount that an individual and family should expect based on the income that they achieve in the prior year the good news is that the EITC is exempt for nine months from the SSI resource test.

Also on Slide 35, you’re going to find more information about the Volunteer Income Tax Assistance, V-I-T-A, VITA which provides free tax preparation assistance across the country to many people that have low moderate incomes and people with disabilities as well that have low moderate incomes.

Individual development accounts are created, were created by the federally funded dependents or A-F-I, AFI program. IDAs match the savings of an individual to start a business, buy a home, or secondary education. Start to save the IDA matches it with one, two, three…

IDAs are not as specific to people with disabilities, but are for low-income or moderate income Americans in general. There are hundreds of individual development accounts across the country.

Resource Slide number 31, we provide links to an IDA directory by state. Unfortunately it’s not a fully comprehensive IDA directory. Please find out what IDAs are available in your state or community and learn about the specific eligibility criteria and in which ways you or your organization could develop relationships to increases access of individuals that are connected to your organization to individual development accounts.

Pilot Tansy and his wife Joan from Syracuse, New York are one of the successful IDA savings stories that went out. Pilot and Joan are advocates of the mental health community in Central New York and about a year and a half ago decided to save to buy a house. With a relatively moderate income and a 4 to 1 match from the Syracuse Federal Credit Union, they were able to save over $9,000 and happily able to buy and move into a home last October.

Another important area of programming that I would like to encourage services and community-based organizations across the country to provide is financial education and empowerment. Many of us often excluded from banking services or even the ability to control our own finances through programs like representative payee ships have really little or no skills around areas like budgeting, taxes, and credit.

On Slide 30, you will find some links to a couple of financial empowerment tools that have been specially designed for people in recovery and for providers that support them.

As we said at the beginning of the presentation effective interventions must go beyond improving information and skills and also build the social capital of individuals, organizations, and communities.

One excellent example of an intervention across the country are the United Way sponsored CASH Coalitions. CASH stands for creating assets, savings, and hope. These are coalitions of communities, social, faith-based, financial, and government organizations dedicated to promoting asset building and financial stability.

They are across the country and in many instances these coalitions have helped people with disabilities access free tax preparation assistance, access individual development accounts and other asset building resources.

I’d like to encourage all of you to find out if there are any cash coalitions in your area. One of the benefits of participating in these coalitions for you or your organization is that you may not have to reinvent the wheel and necessarily create new programs for people in recovery. There are already many programs out there to which we can simply refer the individuals that we support.

Peer support is one of the most effective interventions to assist individuals in building and sustain a path out of poverty. On Slide 31, you will find a link to a report that we developed in New York State which outlines the principles of effective peer support for promoting employment and economic self-sufficiency. This report is called the Building a Cross-Disability Peer Employment Support Model. In that paper you will also find specific examples of peer run programs that have successfully helped individuals achieve their economic goals.

At the state level campaigns like the We Can Work and We Can Save campaigns, these are campaigns that NYAPRS—the New York Association of Psychiatric Rehabilitation Services implemented with the support of the New York State Office of Mental Health. The last few years the goal of those campaigns was to affect a cultural shift so that people in recovery would feel more hopeful, obtain information, and develop connections for employment and economic self-sufficiency. Slide 32 provides a link to those campaigns, their hope building, and educational tools in print, video, and PowerPoints.

Another level of intervention is the statewide capacity building. During the last three years New York State implemented—thanks to the Center for Medicare and Medicaid Services—a comprehensive Medicaid infrastructure grant entitled New York Makes Work Pay. This is a cross agency and cross sector intervention created which created a number of improvements to the state systems to support employment and economic self-sufficiency.

One of its most significant achievements in my opinion was establishment of the New York State Employment Services system. This is a multi-agency computer system built upon the U.S. Department of Labor one stop online system that allows job seekers and providers to coordinate services and use a very sophisticated job matching technology.

Well I hope that all has been helpful to all of you. I really want to commend SAMHSA and especially the ADS Center for your leadership to ensure that this topic takes the forefront of our programming, advocacy and policy agenda and as well as mental health and addiction services across the country. Please don’t hesitate to contact me if you have any questions or comments about the presentation of some of the resources that we have shared here with you today. And again thank you so much and good afternoon. I look forward to hearing any questions that you might have.

Jane Tobler: Thank you Oscar. And we’re going and show some of the resources and appendices you have that people can take a look at. And we also thank you for sharing with us this information and the importance of social capital and asset building as well as the innovative programs working in New York especially with Pilot and Joan and their house. It’s important that others around the country can see that they can bring programs like these into their communities as well.

Our final speaker today is Maura Kelley, Director of Mental Health Peer Connections—one of the family of agencies of Western New York Independent Living.

In 1990 Maura was homeless, had experienced 13 psychiatric hospitalizations, was dependent on social services and Social Security, and was eventually housed in a federal housing program.

In 1995 she began working with Independent Living first as a Peer Advocate, then as Assistant Advocate, and now as Program Director employing 20 peers to increase community living, decrease institutionalization, and increase employment for people labeled with mental illness.

Since she started working in 1995, she had not been psychiatrically hospitalized. She is now a homeowner and has received numerous awards for advocating for the rights of people with mental illness.

Maura will share her transformative journey from poverty to community inclusion, why her story is not unique, and how we can help create other successes and stories like hers in our community.

Maura thank you so much for joining us today.

Maura Kelley: Thank you Jane and thank you SAMHSA ADS Center for allowing me to speak today. Crystal and Oscar covered much of my story.

Basically what Crystal was saying, I was in college and I experienced my first psychiatric hospitalization and it was very traumatic for me. I felt very ashamed of that and it gave me very low self-esteem and I was ashamed of having a mental illness and being hospitalized. But I did graduate from college and I got into the human services field and I continued to have psychiatric problems.

And I worked in the human services field for six years. I went to a couple of psychiatric hospitalizations during that time and then it got to a point where I become totally disabled and was not able to work because of my psychiatric disability and because of that I got on Social Security Disability.

I was fearful that people were out to kill me and I left my house—my apartment and took to the streets of Buffalo and lived in my car. And this is a car that’s sort of held by duct tape. I don’t have it anymore, but it’s a hatchback and that’s what I lived in for a while until I went to the Independent Living Center in Buffalo in 1990 and asked them for help to get housing.

And at that point I was in federal housing, I was in federal housing where I had a studio apartment. I lived with other disability people and the elderly in a federal housing building. I had a bathroom, but the kitchen was in the bedroom. In the bathroom there was only a bathtub. There was no shower. I had a little refrigerator and I went to food pantries and lived in poverty. It was very stressful paying rent. I was on Medicaid, I got food stamps, and it felt very— I felt very hopeless and I had no thinking of what the future held for me. That wasn’t even a process.

And in fact in one hospital the group that I was in was to develop your goals and my goal was to have a goal and that’s where I was at. And in 1995 after I got out of a psychiatric hospital, I went to an Independent Living advocacy and empowerment training and at that point people that had psychiatric disabilities were training other people with psychiatric disabilities on how to be empowered and how to advocate for oneself.

And that idea was just brand new to me because the hospital system was very disempowering and very difficult to deal with and I was told what to do. In here I was hearing these peers saying, “Look it, you can empower yourself. You can advocate for yourself. You can have hopes and dreams.” And they were getting paid to do this.

And I applied for a job at the Independent Living Center and I got that job. And why I applied—I was afraid of working—but why I applied is because other peers said, “You can apply and you can get this benefit” and the benefit was the trial work period and they were doing it. And they said, “You won’t lose your health insurance” and that was key to me because taking medication, I knew if I stayed on my medication I’d be okay and the health insurance covered that.

And people told me before that that there are all these work incentives and I didn’t understand them and I didn’t trust them. I trusted other peers that had been through it. And also at that time a government agency told me I was unemployable. They said, “You’ve had too many psychiatric hospitalizations. We don’t think you can be employed.” And I believe that still goes on in some parts of the country today that because of the severity and the constant going in and out of hospitals, people think that we can’t work.

But I’m here to say we can work. I’m not unique. I am a homeowner. And as Crystal was talking about the average rent a person pays of $695 a month, I pay less than that owning a home with my home loan, my home insurance, and my taxes because New York State has a Home of Your Own Program that gives low interest financing to people with mental illness. So that’s another incentive. It’s important to look in your state what state incentives there are for people to get out of poverty.

Since I’ve started working, I’ve had no psychiatric hospitalizations and I became the Director of Mental Health Peer Connection which is a peer driven program out of the Western New York Independent Living. And I’m also part of the Weekend Work Campaign where I share my story to other peers in the community and other providers.

And it’s important to note that a lot of people say, “Oh, I’m unique. Oh, I’m special. This is a once in a lifetime story.” But I’m here to say I’m not unique. I’m not, you know, just a fluke. I’m not saying that people—I’m unique in the job I have and how I moved up the ladder and I have a good income, but I’m not unique as far as getting employment, staying out of hospitals, getting out poverty. I see that everyday. People doing that at my agency which is part of the Western New York Independent Living.

The key to my success and people I know success is the positive peer role modeling, support from people like me, hope from others who are in recovery, and learning from others experience. I don’t have a lifetime of time to learn from all the mistakes I have. I can learn from the mistakes of my fellow brothers and sisters.

And then the Independent Living recovery model helped me tremendously in accepting myself as a person with a disability, but I’m not flawed. I’m not a degenerate or odd in the community. I can live in the community despite my disability. I’m not ashamed of it today. It’s part of me. I don’t think people that get cancer are ashamed of it and that’s how I look at people with mental illness. It’s a disease. We didn’t ask for it, we didn’t cause, and it should be treated just like any other disease and I’ve learned that through the Independent Living model and that it is possible to live a normal life.

And at the Independent Living people work with all different kinds of disabilities and what I’ve learned in the past 17 years of working here is that it doesn’t matter what the disability is, it matters whether you can do the work or not and that’s the key is what we can do.

And working has given me hopes, dreams, and aspirations that I never thought I’d have before. And peers helped me do that because peers provided—they have their own hopes, dreams, and aspirations and that gave me the hope—the courage to have dreams as well.

The large scale benefits is peer support is a successful intervention and proof of that is our West New York Independent Living Mental Health Peer Connection Job Club.

We’ve served over 1000 people since 19, 2008 and over 450 people that we’ve served with serious mental illness have gotten employment for three months or longer. Some of the employment they’ve gotten are not just food, filth, filing, and flowers. We assisted someone becoming a nurse, truck driving, mechanics.

We provide poverty, we provide things that being poor you can’t get to get employed like identification, heel toe boots, uniforms, application fees, background checks. When you’re poor you can’t afraid to get those things and many employers ask for those documents or those materials or equipment to start work and we supply that.

But we also have a very successful networking group. We have dinner every Thursday night where people come in from work or looking for work and to get support from one another. And I think that networking group is how we’ve maintained success in getting people with serious mental illness. We recruit from homeless shelters, from soup kitchens, and they have obtained employment and many of them are on their way to self-sufficiency.

And the Independent Living philosophy works. Last year in getting people out of institutions and in the community, our agency saved over $25 million of taxpayer money.

I’ve received many professional recognitions and I think that’s because of my passion and where I came from. Being institutionalized 13 times gives me—I feel for the people that are still institutionalized still struggling and I have passion and desire to help them help themselves get out of poverty.

And it’s much more stressful living in poverty than it is to live working. It’s stressful budgeting, it’s stressful going grocery shopping, being treated poorly because you’re on food stamps, it’s stressful dealing with the government agencies in getting public assistance, Social Security. And with working, I don’t have any of those stresses.

In fact one of the things I do is I don’t save receipts because I don’t have to report it to the government and that’s one of the largest rewards I have because I remember I had to save all of my receipts, all my utility bills receipts and I don’t have to do that anymore so.

But one of the biggest rewards that I have is being a homeowner and being successful are my two Greyhounds. I have two Greyhounds. I had one that just passed away—Ollie and Otis. And that’s a pure luxury I’ve had because of employment and sometimes I bring my Greyhound to work and people see that hey, you know, maybe if I get a job and home I can have a dog too. And having a dog gets me out in the community, it makes me walk every day, it opens a whole different social arena than I’ve ever had and it’s not the mental health system. So that’s one of the best rewards I have.

But I guess my message is people with mental illness in poverty can get out of poverty just as I have. So I guess that’s all I have to say. So thank you very much.

Jane Tobler: Thank you Maura. Thank you for sharing your personal and professional story. It’s a true inspiration.

Before we open up the lines to our callers, we’re going to hear a little bit more from our speakers on their vision. So Crystal could you please start and tell us your vision?

Dr. Crystal Blyler: Sure. My vision is that service providers will spend as much time helping people get back to work as they do helping them to get on disability. I envision that everyone with serious mental illness will be offered employment support services as long as they need them.

Research has shown that inclusion in the workforce empowers individuals and improves their mental health and that the best way to overcome prejudice and stigma is to work alongside people with mental illnesses.

And finally working will provide people with mental illnesses with the money and status needed to increase their influence in the political process. After all at least in Washington, we all know that money talks.

Jane Tobler: Thank you. Oscar?

Oscar Jimenez Solomon: Yes. I’m really happy to have the opportunity to share a broader vision with all of you. And my vision is perhaps a bit of a bigger picture which we all enjoy a country and that means a number of systems, community-based organizations, communities, and relationships in which every person can enjoy wellness in every single area including not only emotional and occupational wellness but also financial wellness, environmental wellness regardless of our experience, our backgrounds and in which really each individual is supported to dream.

Dream beyond the confines of our mental health services, our mental health system, and is allowed to get connected to the communities that we either all were a part of at some point or that we are all meant to be whether those are social, spiritual or financial.

Jane Tobler: Thank you Oscar. And finally Maura?

Maura Kelley: Yes. I envision a country that does not stigmatize people with all disabilities, with all disabilities and specifically people with mental disabilities that have internal stigma. I envision a country that has the same expectations for people with disabilities as it does for people without disabilities and expectations such as community integration, higher education, employment, and homeownership. I think that should be expected and a dream of everyone in this country.

And I envision that this vision can become a reality through empowering people with disabilities, educating the community on disability awareness, and treating all people equally.

Jane Tobler: Thank you. Our speakers provided some great resources at the end of their presentations and on Slide 53 through 57 there are additional resources for you to learn more about breaking the poverty cycle.

We will now go to questions from callers. To ask a question, please dial star 1 on your telephone to be placed into the queue and tell the operator your name. If you do not wish your full name to be announced, please only state your first name. Because our time is limited, please limit yourself to just one question.

After the conference operator announces your name, your may ask your question. Once you’ve asked your question, your line will be muted so the presenters may respond.

So I’m going to go our operator. Leigh can you let us know if there’s a question in the queue?

Coordinator: Yes, we have two questions. Our first question comes from Obie Johnson.

Jane Tobler: Obie?

Obie Johnson: Yes. Great, great presentation guys. I really enjoyed it. My question is how do you respond to opposers or what are some of the barriers that you have encountered in trying to carry this message of hope to the various communities?

Obie, so your question was—we just missed one word of that—how do we respond to…

Obie Johnson: Opposers of this view…

Jane Tobler: Opposers.

Obie Johnson: …or not opposers—I wouldn’t say that was the proper word or how do you—what are some of the barriers that you encounter in carrying this message of hope? Because this was very inspirational for me and particularly some of the people that I work with. So how do you respond to those who oppose this message of hope that you have?

Jane Tobler: Excellent, thank you. Thank you Obie. Oscar, can you talk a little bit about how you do that? How you take the message of hope out there and how you deal with the barriers?

Oscar Jimenez Solomon: Sure. I can put it in very simple terms and basically to say that probably the most important and the most powerful tool that we have is the tool of our own stories of recovery and economic success. You know, today you heard one story. You heard about Maura Kelley’s who shared a little vignette about some of our colleagues also here in New York and we know that there are thousands and thousands of people across the country.

So one of the most powerful things that in my experience has really intruded to create a cultural shift in the work that we’ve done in New York State has been to really put the stories—our personal stories—at the forefront into ways that are hope building, that change the narrative, change the message we can’t or they can’t to yes we can to it is possible.

And then also engage people in ways that are more effective by not simply just, you know, sharing the sub part of our stories but also sharing the specific pathways that we utilized such as the specific programs that people utilized, whether it was a homeownership program, whether it was employment, whether it was a training, whether it was a vocational rehabilitation program, or whatever specific tools.

That combination of both the human aspect and the stories really has had an impact in my opinion not only on people in the past, but also on providers. What I can share is that in the experience that I had the chance to be a part of New York State, we created some tools with really the main purpose of promoting hope among individuals but certainly what ended up happening is that they ended up becoming really important, very important training tools and tools to shift culture which is really that’s ultimately the business that we’re in. We’re in the business of changing the cultural perspective on what is possible for people in recovery.

Jane Tobler: Excellent. Thank you so much Oscar. Maura, did you want to add anything on dealing with barriers, taking the message of hope, and dealing with barriers?

Maura Kelley: Yes. I’m a firm believer that if you put expectations on people, they will meet those expectations. So what I’ve seen is a lot of family members, providers, people in the mental health system don’t expect people with mental illness to work. And I think we need to do a huge educational campaign to say yes people can work, yes people can come out of poverty, come out of their houses and their group homes and work. And that starts with educating people who come in contact with these people with mental illness that don’t have the hopes, dreams, and aspirations that they really can have.

Jane Tobler: Crystal, did you want to add anything?

Dr. Crystal Blyler: Yea. I think on the policy side the biggest barrier is that employment for people with mental illness doesn’t seem to be anybody’s responsibility. Nobody will take ownership for it and make it their cause. And the people on the employment side will say, "Well no that’s mental health’s responsibility." And people on the mental health side will say, "No that’s not our business. It’s the employment," you know, "Department of Labor’s job." And really it should be everybody’s job.

So the approach that I’m trying to take and we’re trying to take here at Mathematica is to really join forces with the larger disability community because these issues are not specific to mental health. They apply across all disabilities and only by joining together actively with the disability community can we have a greater influence by really being proactive and going and proposing policy changes ourselves that we want to see and not just waiting for some nice person in Congress to think of it on their own.

Jane Tobler: Thank you. Here’s a question we received via email. Maura, if you can address this. Say more about the impact of work and peer support in enhancing emotional health, developing courage, and becoming a strong advocate. So this person is just looking for a little more information on the impact of work and peer support in emotional health, developing/encouraging, and becoming a strong advocate. Maura?

Maura Kelley: I can’t hear—there’s a lot of garbling. It’s hard to hear the question. I don’t understand it.

Jane Tobler: Okay let me read it again. I hope that other people are not having that as well. One of the email questions we received was regarding the impact of work, having a job, and peer support in helping and enhancing emotional health and becoming a strong advocate.

Maura Kelley: I’m sorry, I can’t hear. Everything’s goobly gook. I’m really sorry.

Jane Tobler: Jane Tobler: Okay. Well you know what? We’ll see if we can fix that with the operator. Oscar were you able to hear the question?

Oscar Jimenez Solomon: I was, I was and I, you know, hear—I’m going to sort of cross over and talk about not only my professional experience but also my personal experience.

I can say that peer support has been absolute fundamental in my own path of becoming a stronger advocate and maintaining my hope and conviction that it is possible to have not only a job, but also a career. That it is possible to advance economically.

One of the things that I had shared in the presentation is—and I would encourage everyone to actually take a look at it—there is a paper posted in—you can access it to one of the links. It’s called Building a Cross-Disability Peer Employment Support Model and that was the result of work that we did to identify exactly the ways in which peer support helps individuals achieve, implement economic goals.

And, you know, it’s hard to summarize it but I guess I’ll just mention it in 15 seconds that what we found is that peer support is helpful to individuals in a number of ways.

One is through not only providing the emotional support, but also through things like helping individuals to enhance or broaden their social networks because many of us have really spent so many years in the mental health system and really have kind of stayed segregated from larger communities.

Another important aspect is this whole piece that we call the narrative change which is really the role that peer support has in shifting my own stories of now I’m never going to amount to anything or I’m always going to end up losing my job or end up going back to the hospital to reframing them to a narrative of possibilities.

And finally on a more practical note peer support is also—depending on how it is implemented and so helpful I know to me and many people that I know around very practical things like for example getting a ride when I didn’t have a car to actually apply for a job. Getting some support to navigate a system by someone sharing what they did when they were actually applying for a particular service.

And so there are a number of the spectrum of areas in which peer support can be helpful. It’s very broad and there are a number of experiences that we could share concretely the ways that that can be implemented. But I guess to start it, I would encourage everyone to take a look at our paper because it was a mapping—a scanning of a number of practices across New York State and I’m sure there are many others across the country.

Jane Tobler: Thank you Oscar. Operator, can we go our next question please?

Coordinator: Thank you. Mark, you may ask your question.

Mark: Hi. I really don’t have a question, but I would like to echo Maura’s comments. I am one of that 16% that have a job and a severe mental illness. Thirteen years ago my illness surfaced and I spent ten years on disability. I’ve slept in doorways and under bridges and now I am a mental health advocate. I lost my home, my family, and a career and I’ve gotten them all back now. So it is possible. It took a lot of work and a lot of time, but I was able to do it. Thank you.

Maura Kelley: And I’m back on the line again. I’m sorry. Something went wrong with the phone.

Jane Tobler: That’s okay. Mark, thank you so much for sharing. We really appreciate it. We are glad to hear from you and congratulations on your success.

Mark: Thank you.

Jane Tobler: Operator, do you want to go to the next call please?

Coordinator: You may ask your question.

Woman: Yes. My question is I’m on Social Security Disability, I own a charity—Christians Against Drunk Driving—and I have a lot of peer support from area churches and attending college working on substance abuse counseling and my problem is with cash. I’m still in school and these loans are building up and I find that the rent increases. I am on housing so I’m unable to receive food stamps and some of the charity money has disappeared because of loss of sit outs, you know, outreaches.

So I’ve helped to start a Christian club at the college and I want to provide support and gain the skills to help people with addiction problems. So I wanted about cash coalitions how I can, you know, partake in assistance to help, you know, the charity and my housing problems.

Jane Tobler: Okay. Oscar, can you talk about that especially the cash coalitions?

Oscar Jimenez Solomon: Sure, yes. And I can talk a little bit more about that. So just as a way of clarification, the cash coalitions so that’s cash as in C-A-S-H, right and creating assets, saving some hope C-A-S-H.

And these coalitions really have certainly the goal of helping individuals across communities to have more access or stronger access to the resources that exist in the communities. They do that basically by building bridges between organizations that otherwise are not connected.

For example, there is cash coalitions here in the capital region in New York State and the Albany, New York area and there are many others across the country where this coalition brings together federal credit unions, financial education groups, anti-poverty or social justice groups as well as disability providers and other government agencies like vocational rehabilitation agency and some other groups. Basically stay connected so that—specifically from our disability perspective or mental health providers—so that people in the mental health and disability community can learn about the services and the supports on the financial and anti-poverty community and vice versa.

I mean these coalitions are much larger. They’re not only for people with disabilities or for organizations with disabilities; they’re for the community at large. But that’s one of the strengths. That’s one of the advantages. These are sponsored by United Way across the country usually in partnership with local community-based organizations. Wherever you are if you look for your search engine United Way coalition and the name of your city or the name of your state, there’s a good chance that you will be able to get to the specific coalition that may be close to you.

So these coalitions the way that they help is by basically sharing information and helping establish either informal or formal relationships across organizations so that for example someone who is being served by a mental health provider can learn about and access for example free tax preparation assistance which otherwise they wouldn’t because many times people in our mental community don’t necessarily know anything about taxes, right? So that’s basically the way that it works. They do provide some direct services, but it’s usually through the organizations that are part of those coalitions.

So certainly I would encourage everyone to allocate providers to find your local coalition whether it’s the CASH Coalition or other coalitions similar in your state or your community and try to build those bridges. Because part of what’s really caused I believe the isolation of individuals in our communities is that our mental health and behavioral health community has remained too disconnected from the real world and we’ve created the silo of services and programs and really it has to be our responsibility. If you bring us closer to all those other organization so certainly, you know, I think that’s great. I’m really glad to hear the question and hopefully that serves as an overview.

Jane Tobler: Excellent. Thank you Oscar. Our next question comes from email. Rick Bresh of Collective Health asks—and this one I think Crystal if you wouldn’t mind answering this one—we know that social and environmental factors have a significant impact on health for example working income, housing, transportation and neighborhood condition.

What are some organizations that are doing innovative to identify the specific impact of these factors and address them in a more holistic approach to mental and physical health? So in looking at the environmental factors that have a significant impact on health, housing, transportation, neighborhood conditions what are some organizations doing innovative work to identify the specific impact of these factors and address them in a holistic approach to mental health and physical health? Crystal?

Dr. Crystal Blyler: Well this is something that is of particular interest on the world stage. I think the rest of the world has been kind of ahead of us on this and so several international organizations are really looking in to this.

The organization—I don’t have it in front of my so I always get the acronym wrong. It’s OECD, the Organization of Economic, I think it’s Cooperation and Development has just released a report like a couple of weeks ago looking across countries—not all countries. It’s mainly Scandinavian, European, and Australia, and Canada, and U.S.—but looking at different factors that are affecting this association of employment, and disability, and poverty.

There was another report, I think it was by the World Health Organization. I think it was last summer. So there’s some really good summaries of it out there right now. So it’s starting to solidify and become more of a holistic kind of approach. And as anybody looking for specific interventions, I’m not so aware of that. I don’t know if Oscar is.

Jane Tobler: Thank you. Operator, could we go to our next caller please.

Coordinator: Dwayne Loffman.

Dwayne Loffman: Yes. I just want to fill in a particular problem, excuse me. Oh. I’d like to throw in a particular problem of my own where I’m on Social Security Disability. I earn under $1,000 a month through it. I have over $1,100 a month medication bills. If I go to work or I’m on an extra health for Part D medication plans of extra help through Medicare and if I go to work I basically lose the help with the medications or at least the extra help anyways. So I’m kind of in a spot where I don’t know where to go to find—to kind of deal with these problems so I can go to work. So I don’t know if anybody would have a suggestion as what organization would or what route would work for this type of thing.

Maura Kelley: I have a response to that. I was on about $3,000 a month medications when I started working and what happened was I had a job that had health insurance coverage. So the health insurance covered that medication and also in New York State Medicaid will cover your medication. I think Oscar knows more about this. And then you can get samples and pharmaceutical companies that will pay, give you the medication as well.

Dwayne Loffman: Can I add something to it or…

Oscar Jimenez Solomon: Actually something that might be helpful is in what state are you located, sir?

Dwayne Loffman: South Dakota.

Oscar Jimenez Solomon: Yes, if you wanted to add something I can just state just a general comment.

Dwayne Loffman: Yes, go ahead.

Oscar Jimenez Solomon: Well the general comment first of all. So you were on SSI or SSDI?

Dwayne Loffman: SSDI.

Oscar Jimenez Solomon: Okay. You said Medicare, right?

Dwayne Loffman: Yes, right.

Oscar Jimenez Solomon: Okay. I’m not aware—I personally don’t know specifically about South Dakota if your state has a Medicaid Buy-In Program. But what I would encourage you is to locate your Independent Living Center or another—work incentives planning assistance advisor that can actually give you better information about what you may have access to. Because what I can say is that New York State and many other states someone who is on SSDI and Medicare and they go back to work, they may still be eligible for Medicaid. That’s through the Medicaid Buy-In Program.

Then the other piece about it is that Medicare and there’s also a program by which people can extend their eligibility for Medicare for a number of years. So it’s not necessarily something that they will lose right away. But this is kind of one of the tricky things so far.

Today, one of the things that we always encourage people is do not make decisions just based on these kind of general statements. Individualized benefits advisement is absolutely fundamental, but I would encourage you to really keep knocking on doors and sit down with someone who is a certified benefits advisor and that can actually look at the programs that are available in your state and that can actually keep asking questions. Because there may be a way for you if your state has the Medicaid Buy-In for you to keep Medicare through an extension that actually allows many people keep Medicare for a number of years even after going back to work.

Dwayne Loffman: Can I add something there?

Jane Tobler: We’re actually almost out of time.

Dwayne Loffman: Oh okay. Go ahead. I’ll…

Jane Tobler: I do want to say that to you and to all of our callers that we have the speakers contact information, their email, and phone number as well as the ADS Center’s is available. So we have one more question we’re going to ask but then, you know, after this call we encourage you to contact the speakers and contact the ADS Center with your questions.

So the last question is for Maura—comes in for Maura via email. I understand that Independent Living Centers frequently work with people with cross disabilities. Can you share some of the innovative initiatives or success that you know about within the cross disability community?

Maura Kelley: Yes. The ones in New York Independent Living is very successful in cross disability services. Not all Independent Living centers are, but I think they’re at a learning curve.

And at our center in the 1994, ’95 they started to get money to provide services for people with mental disabilities and we had a culture change. And at the agency people with physical disabilities didn’t really know how to deal with or work with people with mental disabilities and vice versa so we had a lot of disability discussions and we found out that people with mental disabilities didn’t want to have anything, you know, they felt bad for the people with physical disabilities and the physical disabilities, you know, said, "Aw I never want to have a mental disability." And the common bond brought us together. United we stood and especially with funding and funding cuts, we can’t divide ourselves and it’s a necessity today that we work together and we do not separate ourselves from disability to disability.

The Americans with Disabilities Act almost wasn’t passed because it included people with mental disabilities and we need our brothers and sisters from all disabilities to help one another and that’s what we have to focus on is united we stand and divided we fall. So I hope that answers your question.

Dr. Crystal Blyler: Yes, this is Crystal. Can I add something?

Jane Tobler: Sure.

Dr. Crystal Blyler: At a national level the Independent Living Centers, I know people have had at times some struggles working with the Independent Living Centers because of this disconnect with mental health and physical disabilities, but I think it’s so important to link up with them as much as possible. They have a kind of a special status in the federal government because they are part of statute. They are authorized by the Rehabilitation Act.

And so when national initiatives regarding disability and employment come down often the Independent Living Centers are eligible to do a lot of the kinds of work that other service providers do and they get kind of a special status. Like they can be these work incentives, planning and assistance counselors. They can be disability navigators in the Department of Labor’s one stop system. And they have a lot of political clout as well, but also they know a lot about things that are happening at a national level that independent mental health consumer operated services might not be aware of or eligible for.

Jane Tobler: Excellent Crystal. Thank you so much. And I want to thank everyone for their questions. And just a reminder if we did not get to your question today, you can reach the speakers directly or contact the ADS Center at promoteacceptance@samhsa.hhs.gov. The contact information for the speakers is on Slide 59 and you can read more about the speakers on Slide 60, 61, and 62.

We value your feedback so within the next 24 hours, you will receive an email request to participate in a short anonymous online survey about today’s training. It will only take you about five minutes to complete so please take the survey and share your feedback with us. This information will be used to help us determine what resources and topic areas need to be addressed in future training events.

This conference has been recorded and the audio recording and transcription will be available in late March on the SAMHSA ADS Center Web site.

If you enjoyed this training, we encourage you to join the ADS Center listserv with to receive further information on recovery and social inclusion activities and resources, including information about future teleconferences.

To learn more about SAMHSA’s wellness efforts go to www.samhsa.gov/wellness.

We have come to the end of our time today. If you have more questions or would like to follow up, please do so in the information that I talked to you about earlier. And for further reference our contact information is on Slide 66.

On behalf of all of us at SAMHSA’s ADS Center, I want to extend our sincere appreciation to Crystal, Oscar, and Maura who contributed their time and expertise to help us learn more about breaking the cycle of poverty and building a path of self-sufficiency and financial independence.

Finally thanks to all of you who took time out of your afternoon to join us today. And thanks in advance for taking our survey which you’ll get in a few days. Thanks so much. Goodbye.

END