Immediately post deinstitutionalization, the highest expectation for most individuals with mental illness was staying out of the hospital and off the street. This era of "containment" has ended. We now know that many established beliefs about serious mental illness are myths-that schizophrenia is not necessarily a progressively debilitating disease with little prospect of return to normal functioning. We have examples of individuals with serious mental illness who have "come out" and serve as role models for others struggling with the recovery process. We now have more accurate diagnoses, combined with improved medications having fewer side effects, so individuals with mental illness can receive appropriate medical treatments. Further, we have improved rehabilitation methods to assess functioning, strengths and deficits, and to allow individuals to retain or regain significant family and community roles.
And what better rehabilitation tool than higher education? Education affords opportunities and identity transformation, often providing individuals a clean slate as they reintegrate into society. Advanced educational degrees are important prerequisites for most professional and skilled occupations; earnings and benefit packages are typically higher for people with education beyond h igh school. Most high-school graduates now go on to advanced education and training.
Despite the importance of higher education, people with psychiatric disabilities have typically been unable to access educational resources or maintain their involvement with educational institutions-because of stigma, discrimination, past educational failures or other problems. Based on a national sample, researchers estimate that nearly 4.29 million U.S. residents would have graduated from college if they had not experienced an early-onset, psychiatric disability (Kessler et al., 1995).
Enter supported education! Supported Education (SEd) programs arose in response to requests from consumers and family members for psychiatric rehabilitation services which could help individuals with serious mental illnesses to begin or restart higher education. The mission of SEd is to empower adults with serious mental illnesses to choose their own higher education goals and acquire necessary tools for achievement in post-secondary educational settings, attain their highest potential and succeed in their efforts. SEd seeks to achieve its mission by increasing individual skills, increasing support from the environment and maximizing the fit between the individual and his/her environment-that is, the likelihood that the individual will be able to access support and the likelihood that the environment will be able to respond positively. This involves a systems approach, with the student actively involved. A necessity for successful SEd implementation is collaboration among stakeholders: consumers and their organizations, mental health providers, families, post-secondary educational institutions and vocational rehabilitation agencies. Supported education is congruent with social work practice in its emphasis on choice, adapting the environment to meet the needs of the individual, being client-centered and focusing on strengths.
SEd services build on individuals' unique strength s. The program content utilizes a paradigm promoting individual capacities to take control over disabilities and access needed resources and environmental modifications. The program theory behind SEd is to (1 ) engage students in the program through support and reassurance; (2) provide opportunities to develop a new, positive identity as student in contrast to the stigmatized role of psychiatric patient and (3) through knowledge and skill practice, enable students to take control of their disability, their environment and their futures. Supported education programs follow the psychosocial rehabilitation model-assisting individuals to make choices on needed paths for education and training, helping them get into an appropriate education or training program, and assisting them to keep their student status within that program until their goals are achieved . While Freire (1973) recognized the importance of education for all oppressed people, education affords opportunities and an identity transformation. Furthermore, it can provide a clean slate for those seeking to reintegrate into society. SEd offers participants not just community integration but also the possibility for expanded "normalization" and improvements in future quality of life. SEd programs certainly differ, most offer these core services (Brown, 2002):
Career planning: instruction, support, counseling and assistance with vocational self-assessment, career exploration, development of an educational plan and course selection.
Academic survival skills: strengthening basic educational competencies; providing information on college/training program enrollment and time and stress management; developing social support for educational pursuits, tutoring and mentoring services; and offering opportunities for confidence building and social development within a normalized setting.
Outreach to services and resources: facilitating referrals and contacts with resources on campus (e.g., computing center) and/or relevant human service agencies, like vocational rehabilitation; providing help for the college enrollment process, education on rights and resources for people with disabilities, assistance in obtaining financial aid and in resolving past educational debts; and making available contingency funds.
Additionally, for SEd to promote "normalization" and role transformation from "psychiatric patient" to student, some significant part of the service should be located on a college campus. Usually, the professionals employed as SEd staff are educational specialists and do not provide mental health treatment; however, they do help students access services as well as coordinate with service providers and academic services (with students' permission). While SEd may advocate for students, the long-term goal is to develop students' capability and skills in advocating for themselves.
There is accumulating evidence that SEd programs effectively provide assistance to people with psychiatric disabilities in accessing and completing postsecondary education. Published reports of SEd evaluations indicate that the services are well-utilized: rates of active participation following enrollment range from 57% to 90%. Research on SEd models has provided documentation of effectiveness. Positive outcomes have been demonstrated in the domains of educational achievement, employment, self-esteem and quality of life. Supported education has been endorsed by the Center for Mental Health Services in SAMHSA and the National Mental Health Association's Partners in Care Program as an exemplary practice for treatment and rehabilitation of adults with psychiatric disabilities.
I have been involved with supported education for more than ten yearsinitially in designing the evaluation of a model program to be funded through state sources; later as the principal investigator on the first outcome study of SEd using an experimental design and testing its longer-term effectiveness. In my 25 years in the mental health field, this is undoubtedly the most positive program with which I have ever been associated.
As reported by consumers and providers alike, the benefits provided by supported education are manifold. It gives people a new identity-in contrast to the stigmatized and devalued role of psychiatric patient, they see themselves and are seen by those around them in the valued role of college student. Second , it gives them a new and normalized environment, the college campus, which accepts diversity in appearance, culture, lifestyle and behavior. Third, supported education provides a structure-{)ne that is based on choice and not forced upon them-and a routine that includes interesting variations and meaningful activities. Fourth, attaining a degree or certificate through post-secondary education or training gives people a clean slate; no longer will they have to explain downward job mobility, checkered work histories or major employment gaps. When individuals are hired for professional, paraprofessional or technical occupations, what the employer cares about is their education, training and job experiences relevant to that position. No matter what the individual's age, their resume before the relevant degree need only list some of their prior jobs, without providing a detailed chronology.
Finally, and also probably most importantly, supported education gives people hope. It gives them a possibility of a future, rather than only fading memories of their past. Seeing other individuals with psychiatric disabilities succeeding in college provides inspiration that they can and will be able to do this, too.
REFERENCES
Brown, K.S. (2002). Antecedents of psychiatric rehabilitation: The road to supported education programs. In C.T. Mowbray, K.S. Brown, K. FurlongNorman, & A.S. Sullivan-Soydan (Eds.), Supported education and psychiatric rehabilitation: Models and methods. Linthicum, MD: IAPSRS.
Freire, P. ( 1973). Education for critical consciousness. New York: Seabury.
Kessler, R., Foster, C., Saunders, W., & Stang, P. (1995). Social consequences of psychiatric disorders, I: Educational attainment. American Journal of Psychiatry, 152(7), 1026-1032.
-Carol Mowbray, professor of social work, is the director of the School's National Institute of Mental Health Social Work Research Center for Poverty, Risk, and Mental Health. She is active in state and national organizations promoting psychosocial rehabilitation, advocacy for mental health and program evaluation.