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.