Work As A Priority
A Resource for Employing People Who Have Serious Mental Illness and Who Are Homeless

This guidebook is intended to provide both a conceptual and practical framework to increase employment among people who are homeless and who also have serious mental illnesses. It was developed to inform the work of service providers, policymakers and stakeholders, as well as program managers, case managers and employment specialists. Sweeping changes in American society have taken place as welfare reform moved many Americans to enter the workforce. When this guidebook was produced, nearly 90 percent of people with serious mental illness were unemployed and an estimated 200,000 of the mentally ill were homeless.

The following guidebook is provided courtesy of the Substance Abuse and Mental Health Services Administration (SAMHSA).

Table of Contents


What Do We Know about Employment for People Who Have Serious Mental Illnesses and Are Homeless?

  • Background
  • What We Know So Far
  • Employment Outcomes
  • Urban vs. Rural Employment Program Considerations

A Recovery-based Foundation for Employment Services

  • Worker Role Recovery
  • Conceptual Framework for Providing Employment Services
  • Cultural and Environmental Considerations

Approaches to Employment for People with Serious Mental Illnesses

  • Transitional Employment
  • Supported Employment
  • The PACT Vocational Model
  • Individual Placement and Support
  • Social Enterprises and Affirmative Businesses
  • Self-Employment
  • A Note about Supported Education

The Impact of Homelessness on People with Serious Mental Illnesses who Are Seeking Employment

  • Personal-Level Challenges
  • Program and Services Provider-Level Challenges
  • Addressing Challenges In Service Systems

Helping People Who are Homeless and Have Serious Mental Illnesses Obtain Work

  • Underlying Principles
  • Key Services and Supports

Working with the State Vocational Rehabilitation Agency

  • Purpose and Scope of VR Services
  • Effectiveness of the VR System for People with Mental Illnesses
  • Best Practices for People with Serious Mental Illnesses who are Homeless
  • Future Challenges in Building Successful VR/MH Partnerships

The Right to Work

  • Rehabilitation Act of 1973
  • Rehabilitation Act Amendments of 1998
  • The Americans with Disabilities Act
  • Workforce Investment Act of 1998
  • Ticket to Work/Work Incentives Improvement Act of 1999


See PDF:
Work As A Priority [PDF, 1.17MB]

Work As A Priority: A Resource for Employing People Who Have Serious Mental Illness and Who Are Homeless. HHS/SAMHSA/Center for Substance Abuse Prevention. 2003. English. [PDF, 1.17MB].

Last Reviewed: June 2009

Last Updated: January 10, 2013