Influencing the disability trajectory for workers with serious mental illness: Lessons from Minnesota's Demonstration to Maintain Independence and Employment

Abstract

Without access to needed health and employment support services, working individuals with serious mental illness risk developing long term dependence on federal disability programs. Minnesota's DMIE intervention aimed to prevent or delay the disability progression by providing working persons with mental illness a comprehensive set of health, behavioral health, and employment support services, coordinated through a navigator. Potentially eligible study participants were identified through analyses of the Minnesota MMIS using an algorithm targeting mental health service and pharmacy utilization. The eligible sample was stratified and randomly assigned to the intervention (n = 1,257) or control (n = 300) group. Data sources included MMIS, other administrative data, and navigator encounter data to capture utilization of health, mental health, employment support services, and other public services, as well as annual earnings. Participants also completed an annual survey. Multivariate analyses found that individuals in the intervention group had greater access to health and mental health services, greater improvements in functioning, and were significantly less likely to report applying for SSDI at the end of 12 months of enrollment. Multivariate analyses focusing only on individuals in the intervention group demonstrated that participants who engaged with their navigator had better mental health status and were significantly less inclined to apply for SSDI after 12 months of the intervention. Study findings are important because SSDI beneficiaries with psychiatric disabilities are the fastest-growing, largest, and most costly disability group in the SSDI program.

Navigation delivery models and roles of navigators in primary care: a scoping literature review

“…Health Systems Issues were addressed by navigators in 13 papers. Navigators assist with fragmentation of health and social health care system through various methods, including communication [ 10 – 12 , 14 ], access to care [ 10 , 13 , 14 ], navigating the system and services [ 13 , 15 , 16 ], health insurance [ 12 , 33 , 36 ], inappropriate care delivery [ 33 , 37 , 38 ], clients without permanent providers [ 10 ], and the need for better transitions [ 39 ]. In eight papers, Disease Specific Issues were addressed.…”

“…Examples include mental illness [ 11 , 14 , 16 , 37 , 40 ], substance abuse [ 14 , 40 ], cancer [ 14 , 33 ], chronic disease [ 41 ] and comorbidities [ 12 ]. Navigators address issues related to the social determinants of health and these were identified in eight papers including housing concerns [ 14 , 36 , 42 ], food insecurity [ 8 , 14 , 40 ], legal issues [ 36 , 40 ], employment issues [ 36 , 37 ], financial difficulties [ 12 , 40 ], racism [ 40 ], and lack of social support [ 12 ]. Patient Related Issues included lack of basic needs [ 40 ], patient fears and beliefs [ 12 ], self-management [ 11 ], adherence [ 36 ], and appointment compliance [ 11 ].…”

“…Five major categories of patient populations were described, but many programs defined their populations by more than one of these categories, including: a) individuals with specific diseases; b) ethno-cultural groups; c) individuals experiencing economic barriers; d) age groups; e) vulnerable populations, and f) underserved populations. Individuals with specific diseases included those with chronic diseases [ 8 , 11 , 16 , 27 , 41 , 43 – 47 ], mental illness and addictions [ 27 , 37 , 39 , 43 , 48 , 49 ], cancer [ 12 , 36 , 50 , 51 ], diabetes [ 38 , 42 , 47 ], HIV-AIDs [ 15 , 52 , 53 ], pediatric asthma [ 38 ], and obesity [ 38 ]. Ethno-cultural groups included Hispanics [ 16 , 38 , 42 , 51 ], racial-ethnic minorities [ 33 , 54 ], African-Americans [ 55 ], refugees and immigrants [ 38 ], and rural Americans [ 56 ].…”

“…Ethno-cultural groups included Hispanics [ 16 , 38 , 42 , 51 ], racial-ethnic minorities [ 33 , 54 ], African-Americans [ 55 ], refugees and immigrants [ 38 ], and rural Americans [ 56 ]. Individuals experiencing economic barriers included those identified as low income [ 11 , 16 , 33 , 37 , 40 , 43 , 53 , 54 ] and uninsured patients [ 11 , 13 , 43 , 54 ]. Populations were also described according to age group including older adults [ 44 – 46 , 56 , 57 ], parents or guardians of young children [ 58 ], children [ 38 , 58 ], and adolescents [ 58 ].…”

“…CHWs worked with populations with chronic diseases [ 41 ] and newly diagnosed cancer [ 50 ]. Other models described navigators with specific skill sets including legal assistance expertise [ 36 ], financial practices [ 54 ], and vocational rehabilitation [ 37 ].…”