Noble J H
National Catholic School of Social Service at the Catholic University of America, Washington, DC 20064, USA.
Psychiatr Serv. 1998 Jun;49(6):775-81. doi: 10.1176/ps.49.6.775.
Recent evaluations by the U.S. General Accounting Office and the National Alliance for the Mentally Ill of reemployment efforts of the federal-state vocational rehabilitation program found that services offered by state vocational rehabilitation agencies do not produce long-term earnings for clients with emotional or physical disabilities. This paper examines reasons for these poor outcomes and the implications of recent policy reform recommendations. Congress must decide whether to take action at the federal level to upgrade programs affecting persons with severe mental illnesses or to continue to rely on state decision making. The federal-state program largely wastes an estimated $490 million annually on time-limited services to consumers with mental illnesses. Rechanneled into a variety of innovative and more appropriate integrated services models, the money could buy stable annual vocational rehabilitation funding for 62,000 to 90,000 consumers with severe mental illnesses. Larger macrosystem problems involve the dynamics of the labor market that limit job opportunities and the powerful work disincentives for consumers with severe disabilities now inherent in Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid.
美国总审计局和全国精神疾病联盟近期对联邦-州职业康复计划的再就业工作进行了评估，结果发现，州职业康复机构提供的服务并未给有情感或身体残疾的客户带来长期收入。本文探讨了这些糟糕结果的原因以及近期政策改革建议的影响。国会必须决定是在联邦层面采取行动，升级影响重度精神疾病患者的项目，还是继续依赖州政府的决策。联邦-州计划每年在为患有精神疾病的消费者提供限时服务上大约浪费4.9亿美元。如果将这笔钱重新用于各种创新且更合适的综合服务模式，那么这笔资金可以为6.2万至9万名重度精神疾病消费者购买稳定的年度职业康复资金。更大的宏观系统问题涉及劳动力市场的动态变化，这种变化限制了就业机会，以及目前社会保障残疾保险、补充保障收入、医疗保险和医疗补助计划中存在的对重度残疾消费者强有力的工作抑制因素。
