Supported postsecondary education for people with mental illness.

For most Americans, postsecondary education remains part of the "American Dream", the process by which a career is chosen and launched, the route to upward mobility. It is the major channel in our society, for young and old alike, through which we can change and enhance life goals. But, for people with psychiatric disabilities, this resource has been largely unavailable.

Although people with psychiatric disabilities often attempt college, they are frequently unable to complete their course work or course of study because of the nature of their illness and its treatment. Other disability groups, such as people with physical disabilities, learning disabilities or acquired brain injury, have been recognized as needing additional services in order to have access to and to be successful in the postsecondary environment. Student services for people with these disabilities are available on most campuses, while people with psychiatric disabilities have not been included in these services. In the last 5 years, this lack of services has been recognized, and a change is beginning to occur.

Public Law 93-112, the Rehabilitation Act (1973), and, more specifically, Section 504, included "chronic mental illness" among those conditions that are protected from discrimination and require accommodation. Colleges, universities and other postsecondary training settings, such as technical schools, are becoming increasingly aware of this population and the legal and moral mandate to provide equal access and special programs.

Programs that serve people with psychiatric disabilities in a postsecondary educational setting have been described in the literature (Beardsle et al, 1984, Ryglewicz, 1987, Lamb, 1976, Heffner & Gill, 1982, Unger et al, 1987). These progrmas have taken many forms, but all acknowledge that the college or post-secondary education environment is an appropriate setting for people with psychiatric disabilities and that to be successful these students may need special programs and additional support. This concept of serving people with psychiatric disabilities in an educational environment has been called "supported education" because it shares many of the same goals and values of supported employment. To further explain and elaborate on the concept of supported education, a definition and descriptions of various models may be instructive.

Definition of Supported Education

The definition of supported education is based on the definition of supported employment. The 1986 Rehabilitation Act Amendments define supported employment as: "Competitive work in integrated settings--(a) for individuals with severe handicaps for whom competitive employment has not traditionally occurred, or (b) for whom competitive employment has been interrupted or intermittent as a result of severe disability, and who, because of their handicap, need ongoing support services to perform such work."

Using this definition as a model, supported education could be defined as: "Education in integrated settings for people with severe psychiatric disabilities for whom postsecondary education has not traditionally occured or for people for whom postsecondary education has been interrupted or intermittent as result of a severe psychiatric disability and who, because of their handicap, need ongoing support services to be successful in the education environment.

Supported Education Prototypes

A number of programs that meet the definition of supported education have emerged in various forms over the past several years. They represent different approaches to providing services to this population in a postsecondary environment. In examining the characteristics of 10 programs identified, they seem to divide themselves into distinct program models or prototypes.

Supported education can be categorized into three prototypes on the basis of two variables. The variables are level of integration and where the support is provided. The three prototypes are self-contained classrooms, onsite support and mobile support. Following is a brief overview of each supported education prototype.

Self-contained classroom. Students attend classes on a postsecondary site with other students who are also characterized as people with psychiatric disabilities. The curriculum is set, and students receive the same instruction in the same classroom. The students are not initially integrated into regular classes, but they may participate in the activities and use the resources of the institution. However, support is available from program staff for students as they progress and move on to regular classes. Program staff may be from the sponsoring program and/or the academic institution.

Onsite support. Students attend regular classes at the postsecondary site for which they are matriculated and receive credit. Support is provided by staff from the postsecondary site. The settings from which services are provided are Disabled Student Services or Mental Health/Counseling Services at the postsecondary site.

Mobile support. This model is the same as the onsite support model with the exception that the support is provided by staff from community-based mental health services, they are members are housed at the community mental health services, they are available to provide support to the students onsite at a variety of postscondary institutions.

Examples of Existing Supported

Education Prototypes

Examples of the three prototypes follow. Each example currently exists. In addition to providing program information about these prototypes, other similar programs of the same prototype are identified.

Self-Contained Classroom

Prototype

The Continuing Education Program at Sargent College of Allied Health Professions, Boston University, is sponsored by the university's Center for Psychiatric Rehabilitation. The goal of the program is to assist students in choosing a career goal and in developing and implementing a career plan so they may enter, or reenter, the work force in the occupation of their choice, with the level of support they need to be successful (Unger et al, 1987). Students learn career development skills while they attend class for 3 semesters, 3 days per week for 2 and 1/2 hours, for Continuing Education Credit.

Students learn to develop a vocational profile of themselves and to match that profile with appropriate occupations. Short- and long-term goals are determined so students can develop a plan to realize their career aspirations. During an optional fourth semester, many students begin the first steps of their goal by attending other postsecondary programs or by working. Staff provides individual and small group instruction, supervision and support. The level of integration of this prototype is determined by the closed classroom located within Sargent College. Opportunities for integration occur as students mainstream into campus activities or attend other college classes, with support as needed.

Ten to thirteen students participate in each class and receive Continuing Education Credits. Students are referred to the program by self-referral, by parents or by mental health or rehabilitation service providers. Program staff provide support and advocacy services and needed. The program is staffed by instructors from the Center for Psychiatric Rehabilitation and graduate students from Boston University. For therapeutic support, students have separate service providers in the community.

Other Similar Prototype Programs

Other programs that occur in closed classrooms on college campuses are: Project CHANGE, Rockland Community College, Pamona, New York, sponsored by the Rockland County Community Mental Health Center; the Redirection through Education Program at George Brown College, Toronto, Canada, co-sponsored by the Ministry of Colleges and Universities and the Ministry of Health; and the Education Intervention Program at Buffalo State College, sponsored by the Buffalo Psychiatric Center in Buffalo, New York.

Project CHANGE provides a varied curriculum for its students, including vocational assessment, fitness for life, psychology, speech, creative problem solving, and ceramics. This is a two semester program offering six credits per semester for regular college credit. The goal of the program is to engage students for several semesters by offering special supports and "stress control" for as long as necessary as students pursue their educational and vocational goals. Opportunities for mainstreaming, with Project CHANGE staff support, occur as students register for other courses.

In this program all students are clients in treatment programs at Rockland County Community Mental Health Center (RCCMHC); clients/students are referred to the RCCMHC coordinator by treatment staff, case managers, staff of community residences, or by other workers; and referrals are screened by the clinician, the RCCMHC coordinator and other members of RCCMHC's Project CHANGE committee (Ryglewicz, 1987).

The Redirection Through Education Program, located at George Brown Community College, is primarily a mental health program that uses education as treatment. Students participate in a three-phase program to help them become integrated into the community. During the first phase, students learn math, English, communication skills, assertiveness, and computer skills. Although classes are taught by both program and college staff, students do not receive college credit. The second phase provides a work opportunity to learn prevocational skills in an enclave in a restaurant. The third phase builds on the experience of both previous phases to help students refine their communication skills related to the work environment and to develop resumes and work opportunities in the community. Students are referred to the program by community human service personnel.

The major variation in this program is that it is viewed as an educationally oriented, day treatment program on a college campus. Community integration occurs as students go on to other training programs or work (L. Mellanby, personal communication, May 15, 1989).

A program just begun is the Education Intervention Program at Buffalo State College. It provides remediation in reading, writing and math and teaches career development skills modeled after the Continuing Education Program at Boston University. The goal of the program is to help students return to school or work. Staff are provided by the Buffalo Psychiatric Center. Referrals are received from both community mental health centers and the Buffalo Psychiatric Center. Integration occurs as students work and go to school part time (Carolyn Jankowski, Patricia Wahl, personal communication, May 15, 1989).

Onsite Support Prototype

The Supported Learning Project at Quinsigamond Community College in Worcester, Massachusetts, is sponsored by the Center for Psychiatric Rehabilitation at Boston University and funded by the Massachusetts Department of Mental Health. The goal of this program is to help students with severe psychiatric disabilities achieve their educational aspirations by participating in normal education in an integrated setting with whatever supports that are needed (Walsh, 1989). Students enroll in regular college classes and receive support and assistance from project staff, who are located in the college counseling office.

Complete integration is achieved in this program which utilizes existing college and community services to provide support to participating students. Project staff coordinate student service needs, develop peer support groups and provide a supportive environment where students can meet with staff or other students. Informal skill-based classes are provided by project staff as student needs are identified. Staff also provide support and consultation to college staff and faculty.

Referrals to the project are made by the students themselves, by college staff or by faculty. To meet students' mental health service needs, referrals are made to community agencies. This prototype is modeled after the disabled students' services programs located on many college and university campuses.

Other Similar Prototype Programs

The Disabled Students Services Office of Mott Community College in Flint, Michigan, provides services to people with psychiatric disabilities in the same manner that they provide services to those with other disabilities. The major difference between this service and the Supported Learning Project is that no particular person is assigned a caseload of students with psychiatric disabilities (D. Williams, personal communication, May 16, 1989).

Laguardia Community College in New York City supported a program which recruited students with psychiatric disabilities to enroll in an academic program that trained mental health workers. The major difference is that students were enrolled in one particular program: Mental Health Worker Training. They were supported by one faculty member/counselor in that program (Long, 1983).

Mobile Support Prototype

The Community Scholars Program sponsored by Thresholds in Chicago, Illinois, provides support to students in many secondary environments from a central Thresholds site. The program seeks to help people with psychiatric disabilities fulfill their education goals. Students begin the program with preparatory and remedial classes in a closed classroom. Then they are supported as they enroll in secondary sites in the Chicago area.

There are six components in the Community Scholars Program:

* mobile support units, which provide support to students as they attend colleges in the Chicago area;

* a preparatory class, to help students choose a college or vocational school, learn study skills and find financial aid;

* remediation classes, in math, reading and writing; tutoring is also available;

* faculty/staff awareness program;

* evaluation; and

* training and dissemination.

All students are referred to the program by caseworkers at Thresholds, have case managers and receive services from Thresholds. The mobile support staff reports to the case managers. Community integration is achieved as students participate and are supported in the postsecondary site of their choice (K. Ingstrom, personal communication, May 17, 1989).

More Examples of Similar Prototype

Programs

The Continuing Education Program sponsored by the Center for Psychiatric Rehabilitation at Boston University has a mobile Supported Learning component. One staff person provides support to former CEP students as they move on to regular college classes at Boston University or other postsecondary sites. Major activities include enrollment and financial aid assistance, time management, stress management, symptom management, study skills, tutoring, and advocacy. A student support group meets weekly so students can share experiences, assist each other and socialize.

Spruce Mountain Inn in Plainfield, Vermont, is a residential program that encourages community integration by supporting residents as they attend neighboring postsecondary sites. Initially, educational needs and abilities are assessed and then matched to the education resources. The case manager from Spruce Mountain Inn provides a network of services to support the students' community integration from the residential site.

The major variation of this program is that mobile services are provided from a residential program rather than a mental health services program (Beardsley, et al, 1984).

Characteristics of Supported

Education

Supported education can be further defined in terms of its mission, values, policies, procedures, and funding.

Program Philosophy and Mission. To define what a program is, it is important to determine the philosophy on which it is based, including its overall mission. The mission of a supported education program is similar to that of most postsecondary colleges and universities, i.e., to provide educational services to the community. However, an additional emphasis might be placed on increased access to and retention of people with psychiatric disabilities. For example, a mission statement might read: "To provide educational and support services to people with psychiatric disabilities in a postsecondary setting so that they can have access to and successfully utilize the educational environment."

Program Values. The purpose of defining program values is to clarify the beliefs that are the basis for the program. The following values serve to clarify the philosophical and programmatic context in which supported education services are provided.

* Support. Services which the student perceives to be supportive are provided as long as they are needed.

* Normalization. Services are culturally normative and use non stigmatizing methods and settings. Services are integrated or generally consistent with the normal routines of life within the postsecondary environment.

* Availability and Accessibility. The program is publicized to current and prospective students so they can use the service, which is located on campus at a convenient location.

* Individualization. Services are tailored to meet the unique and changing needs of each student.

* Dignity. Services are provided in a manner and in an environment that protects privacy and enhances personal dignity.

* Self-Determination. Students retain the fullest possible control over their own lives. This means that they are the ones to set their goals and participate fully in determining the criteria for success and in evaluating progress toward meeting these goals.

* Indefinite Duration. Services are available for as long as students need and/or want such support.

* Flexibility. Services are evaluated on an ongoing basis so they can be revised, as needed, to keep them responsive to student needs.

* Coordination. The resources of the educational setting and the resources in the community are brought together to work for the benefit of the students.

* Hope. Students are treated as developing persons, capable of growth and positive change.

The Population to be Served

Entry criteria for a postsecondary education environment generally include two elements: an age limit and some reference to academic potential. There is usually a lower age limit, often 18. Academic criteria, depending on the educational setting, may range from very high academic standards to being able to benefit from the instructional programs of the education institution.

Entry criteria for determining the appropriateness of a student for supported education may include (Adapted from California Community College Task Force Report, DRAFT, 1989):

* Written verification of psychological disability diagnosed by a licensed mental health professional (for funding purposes).

* Able to meet the educational admission and retention standards.

* Eighteen years of age or over and able to benefit from the instructional programs in an educational setting if supported education services are provided.

* Able to complete the necessary admission and matriculation processes.

* Is not currently an imminent danger to themselves or others.

* Behavior is appropriate to the interview setting. The person acts in a manner appropriate to the intake process and appears to be able to provide informed consent regarding service provision policies and the educational institution's code of student conduct.

* Expresses willingness to use supported education services.

Referral Process

A supported education program is designed to serve students who are currently enrolled or who are potentially appropriate candidates for postsecondary training or education. Referrals to the program may be made by the students themselves, by mental health or rehabilitation services staff or by faculty or staff who may suspect or recognize mental illness in currently enrolled students. Soliciting referrals of students from mental health service providers or organizations may be determined by the recruitment policies of the postsecondary setting. However, services to people with psychiatric disabilities should be described and advertised as another service offered by that postsecondary site.

Interagency Collaboration

It is important to develop interagency collaboration with mental health and other community service agencies that work with people with psychiatric disabilities so as to supplement the support services of the postsecondary setting. Although some postsecondary educational settings provide mental health services, they are usually not equipped to handle the long-term service needs of people with severe psychiatric disabilities. Developing liaisons with community agencies would help to keep separate the long-term mental health needs of the person from the supported education needs of students while they are on the grounds of the educational site.

Public Funding 

Funding, as in other support programs for disabled students, should come from usual and stable funding channels of the local, state and national governments channelled through the education institutions. Although pilot and demonstration projects may be funded to further test the prototypes, stable and continuous financial support must be available over time.

A Caveat About What Supported

Education Is and What It Is Not

The purpose of a supported education program is to improve access to and retention of postsecondary educational environments through appropriate accommodations for people with psychiatric disabilities. The primary goal is to assist them, as members of the community, to appropriately utilize the education environment.

The education environment is not a treatment setting, nor is a supported education program a treatment program. Treatment is the role of the mental health system; education the role of the postsecondary education site. However, as part of their education mandate, many settings have additional support services to help students mainstream into the regular routine. Providing such support to people with psychiatric disabilities, as well as offering additional classes to teach people with psychiatric disabilities the skills to participate successfully at postsecondary sites, is an appropriate role for a supported education program.

Supported education is defined by where it is provided, i.e., the postsecondary site. Programs which do not meet the definition of supported education are those that utilize postsecondary academic staff to provide instruction in a mental health setting or deliver "education" services at the mental health site. While such programs emphasize the importance of education in the rehabilitation process, because of their location they are not, by definition, supported education.

Implications

People with psychiatric disabilities have often been thwarted as they have strived to gain or regain a legitimate role in the community. Traditional service settings often overlook those people who are capable of and committed to an occupation that uses their intellectual potential (Unger and Anthony, 1984). Relegated to day treatment programs that are not rehabilitation oriented, or sheltered workshops that are far below their abilities, people with psychiatric disabilities are both frustrated by the mental health system and frustrating to staff of the mental health system. Yet, programs that have identified their needs and goals have served them successfully, with students not only moving on to work, but reporting improved interpersonal relationships with friends and family and improved self-esteem (Unger, 1987). Supported education provides people with psychiatric disabilities an opportunity, not only to participate more fully in their own rehabilitation, but to do so in an environment that is normal and nonstigmatizing. It offers hope that people with psychiatric disabilities can use postsecondary sites as other members of the community do. There is the possibility that, with hard work and support, dreams can be realized.

Summary

Supported postsecondary education programs have these two characteristics:

* The site for student participation is a postsecondary institution.

* The program goals are designed to increase access and retention of people with psychiatric disabilities.

Supported education is emerging as another means by which people with psychiatric disabilities can more fully utilize existing community resources and be more fully integrated into the community. Although education has long been recognized as an important component of the rehabilitation process (Anthony, 1979), the emergence of the concept of supported education models provides a formal structure by which we can describe, evaluate and replicate successful programs.

Footnote 

(1) Adapted from California Community College Task Force Report, DRAFT, 1989.

Bibliography

[1] Anthony, W.A. The Principles of Psychiatric Rehabilitation. Baltimore: University Park Press, 1979.

[2] Beardsley, C., Kessler, R., and Levin, E. "Education for the Young Adult Chronic Patient." Psychosocial Rehabilitation Journal, 1984. 8 (1), 44-52.

[3] Heffner, F., and Gill, R. (1982). "The Role of Community-Based Service Providers in the Rehabilitation of De-institutionalized Psychiatric Patients: Does Education Belong in the Therapeutic Processes?" Psychosocial Rehabilitation Journal, 1982. 5 (1):5-8.

[4] Lamb, H.R. "An Education Model for Teaching Living Skill to Long-Term Patients." Hospital and Community Psychiatry, 1976. 27 (1), 875-877.

[5] Long, L. Final Report: Training Former Mental Patients as Mental Health Workers. New York, NY: La Guardia Community College, February 1983, VEA 52-82-0054.

[6] "Responding to an Emergent Need: Serving Students with Psychological Disabilities." A Chancellor's Office Task Force Report, Sacramento, CA: California Community Colleges, Student Services Division, 1988.

[7] Ryglewicz, H. "Project Change: College Helps Adults Needing Growth and Education," Tie Lines, April 1987, pp. 3-6.

[8] Unger, K., and Anthony, W. "Are Families Satisfied with Services to Young Adult Chronic Patients? A Recent Survey and a Proposed Alternative." In B. Pepper and H. Ryglewicz (Eds.). New Directions in Mental Health Source Book. San Francisco: Jossey-Bass, 1984.

[9] Unger, K. "Rehabilitation Through Education: A University-Based Continuing Education Program for Young Adults with Psychiatric Disabilities," (Doctoral dissertation, Boston University, 1986), Dissertation Abstracts International, 1987. 47A (11), p. 4060.

[10] Unger, K., Danley, K., Kohn, L., Hutchinson, D. (1987). "Rehabilitation Through Education: A Rehabilitation Program for Young Adults with Psychiatric Disabilities on a University Campus." Psychosocial Rehabilitation Journal, 1987. 10, (3):35-49.

[11] Walsh, D. (1989). "Campus Support Project: A supported Learning Program Model," Boston: Center for Psychiatric Rehabilitation, Boston University, 1989.

Dr. Unger is Director, Educational Initiatives Dissemination, Boston University Center for Psychiatric, Rehabilitation, Boston, Massachusetts.