People with mental illness who are homeless often realize that having a job would improve their lives dramatically, and most service providers know that finding employment for them is a crucial step in their journey from lives of dependency and despair to lives of independence and hope.

Day to day, however, individuals who are homeless often are derailed by the debilitating effects of their mental illness, and service providers are faced with ongoing challenges to find adequate resources.

To help, SAMHSA has published a new guidebook that provides a blueprint for increasing employment possibilities. Work as a Priority: A Resource for Employing People Who Have Serious Mental Illnesses and Who Are Homeless is designed to help service providers, as well as policymakers, program managers, case managers, and employment specialists, make informed decisions as they guide people who are homeless and have mental illnesses into employment. This new guide offers practical guidance for assisting individuals in finding jobs through employment service programs.

In preparation for this guidebook, providers of services for mental health and homelessness across the Nation were surveyed. Text includes summaries of innovative programs that readers can use as models to create new programs. One example is New York City-based Project Renewal, a program committed to showing people who are homeless and who have serious mental illnesses how to make the transition. The organization's Culinary Arts Training Program, a 6-month tutorial in commercial food preparation, has graduated 40 people since it opened its doors in 1995. The program's job placement rate is 85 percent.

In addition to its culinary program, Project Renewal provides clients with a variety of tailored employment services and training in life skills necessary for getting and keeping a job.

Another program, Life Link in Santa Fe, NM, created its own business advisory committee to stay attuned to the training and hiring needs of local businesses and to facilitate employer-employee match-ups. LAMP, Inc., a homeless services agency in the Skid Row district of Los Angeles, has made a commitment to hiring graduates of its programs to work within the agency. Approximately one-third of staff members are former guests of LAMP.

First-person testimonials illustrate how important work is to individuals with serious mental illnesses. One woman writes, "The thought of employment seemed far-fetched and out of the question for me. But my mind was changed by seeing other tenants working at various jobs within the building. I thought to myself, I can do that."

The guidebook includes a review of the relevant literature, a summary of promising employment programs, and a discussion of policies and laws addressing continued on page 20

continued from page 19
employment support services for people
who are homeless and have serious
mental illnesses.

The information is presented in seven chapters:

1. What We Know So Far

This chapter contains a brief review of writings and research studies on employment for people who have serious mental illnesses and are homeless. Findings presented in this chapter demonstrate that mental health recovery and homelessness reduction are directly linked to an individual's ability to obtain and retain a job. This chapter also outlines the critical elements of successful employment programs, with case studies provided as examples.

2. A Recovery-based Foundation

Many people who are mentally ill and homeless view employment as crucial to their recovery. This chapter presents a framework for providing recoverybased employment and outlines specific program elements that work. Cultural and environmental factors are also discussed in this chapter. Health practitioners are encouraged to build their awareness of cultural differences among the individuals they serve.

3. Employment Approaches

For the past two decades, a number of best practices have been developed to increase employment success for people with serious mental illnesses. This chapter summarizes a variety of proven employment models. The evidence supports that "long-term worker role recovery" happens through employment that provides work at competitive wages, offers the opportunity to work with non-disabled co-workers, and offers long-term, post-placement support. Information in this chapter can help service providers plan and establish programs that are designed to facilitate recovery, provide marketable skills, and expand opportunities needed for successful employment.

4. The Impact of Homelessness

Many housing programs are not equipped to provide job training and assistance for people with serious mental illnesses. This chapter addresses personal, program, and system-level challenges to employment. Case studies provide examples of how to meet these challenges. 5. Joining the Workforce

Service providers cannot use a "one-size-fits-all" approach to meet the employment needs of people who are homeless and have serious mental illnesses.

This chapter highlights agencies across the Nation that use flexible and innovative programs to coordinate employment services. The chapter also describes how collaboration with area businesses and public housing authorities can help service providers expand and enhance the employment opportunities they provide. Key factors for developing successful employment services are also included.

6. The State Office of Vocational Rehabilitation

State departments of vocational rehabilitation (VRS) can be powerful allies in the effort to find employment for people with mental illnesses who are also homeless. This chapter provides an overview of VR services, discusses their effectiveness in meeting the employment needs of people with mental illnesses, and considers ways to create collaborations between mental health and VR systems. The chapter describes how selected VRS are working with people who are homeless and who have serious mental illnesses, as well as recent VR/mental health integration efforts.

7. The Right to Work

Several Federal statutes provide a foundation to help people with disabilities find jobs. This chapter highlights those statutes, including the Americans with Disabilities Act, the Workforce Investment Act, and the Ticket to Work/Work Incentives Improvement Act.

For a print copy of Work as a Priority: A Resource for Employing People Who Have Serious Mental Illnesses and Who Are Homeless, contact the National Mental Health Information Center at P.O. Box 42490, Washington, DC 20015. Telephone: 1 (800) 789-2647 or 1 (866) 889-2647 (TTY). Online, the publication is available through SAMHSA's National Resource Center on Homelessness and Mental Illness at www.mentalhealth.samhsa.gov. For more information on homelessness, visit www.samhsa.gov.▸

-By Jon Bowen

Treatment Admissions

for Painkillers

Between 1992 and 2002, treatment admission rates for abuse of narcotic pain medications more than doubled, according to a new report based on information reported to TEDS in 2002. The proportion of new users those entering treatment within 3 years of beginning use-increased from 26 percent in 1997 to 39 percent in 2002. The median duration of use before first seeking treatment decreased from 9 years of use in 1992 to 7 years in 1997 to 4 years in 2002.

ER Visits for Club Drugs

Emergency room visits related to abuse of club drugs-GHB, ketamine, LSD, and Ecstasy-remained stable or declined in 2002, according to a new DAWN report. Visits associated with GHB decreased by one-third between 2000 and 2002, and visits involving LSD declined rapidly between 1999 and 2002. Ecstasy-related visits remained steady at 2001 levels, while ketamine-related visits remained at the lowest levels seen since 1998.

Criminal Justice Referrals

The Nation's criminal justice system was the principal source of referral for 36 percent of all substance abuse treatment admissions in 2002, according to new data compiled from TEDS. The report also notes that admissions referred by the criminal justice system were more likely to report alcohol as the primary substance of abuse compared to all other admissions (45 percent vs. 42 percent).

Youths aged 12 to 17 who

had run away from home in the past 12 months were more likely to be malo (56 percent) than female, and nearly hat (46 percent) were aged 16 or 17 Youths aged 12 to 17 who

had run away from home in

the past 12 months were
have used
more ikely

alcohol maruana or an
cit drug other than
marijuana in the past year
than youths who had not
nun away

Alcohol use was higher
among female youths who
had run away (55 percent)
than male youths who had
nun away (46 percent)

Substance
Use among
Youths Who

Had Run
Away from
Home

Drug and Alcohol Use
Among Runaways

Young people age 12 to 17 who had run away from home in the prior 12 months were more likely to have used alcohol, marijuana, or an illicit drug other than marijuana in the past year than those who had not run away, according to the 2002 NSDUH Report. Although runaways were more likely to be male (55 percent), alcohol use was higher among female youth (55 percent) who had run away compared to males (46 percent).

ER Data on Oxycodone and Hydrocodone Abuse

Of the 119,000 mentions of narcotic pain medications in emergency room visits in 2002, 40 percent involved either oxycodone or hydrocodone, according to a new DAWN report. The report found 47,594 mentions of oxycodone and hydrocodone in 42,808 emergency room visits related to drug abuse. Approximately three-quarters of these hospital visits involved other drugs in addition to oxycodone (71 percent) and hydrocodone (78 percent).

Painkiller Treatment Rates in Urban and Rural Areas

Overall, treatment admission rates for narcotic painkillers increased by 155 percent between 1992 and 2002, based on data compiled from TEDS. Increases in treatment admission rates for abuse of narcotic painkillers were evident in all urban levels, but were greatest in more rural areas. The proportions of narcotic painkiller treatment admissions taking the drugs orally or inhaling them increased, while the proportion injecting them decreased.

For a copy of these reports, contact SAMHSA'S National Clearinghouse for Alcohol and Drug Information at P.O. Box 2345, Rockville, MD 20847-2345. Telephone: 1 (800) 729-6686 (English and Spanish) or 1 (800) 487-4889 (TDD). Online, these and other publications are available at www.oas.samhsa.gov.

IN BRIEF.......

Building Bridges

SAMHSA'S Center for Mental Health Services (CMHS) recently published Building Bridges: Mental Health Consumers and Members of Faith-Based and Community Organizations in Dialogue. The 29page booklet summarizes the findings and recommendations of a CMHS-sponsored dialogue between mental health consumers and members of diverse faith traditions and community organizations.

Two dozen invited participants attended the 2-day meeting, held in Baltimore in October 2002, to explore the roles of faithbased and community organizations in recovery for people with mental disorders. The dialogue themes and findings presented address factors that promote recovery,

Mental Health Publication

SAMHSA'S Center for Mental Health Services Survey and Analysis Branch recently released Mental Health, United States, 2002. This 390-page resource covers the areas of good decision-making, population and insurance dynamics, the status of mental health services, and national mental health statistics. The 21 chapters include "Community Mental Health Centers at the 40-Year Mark: The Quest for Survival," "Sixteen-State Study on Mental Health Performance Measures," "Mental Heath in New York City After the September 11 Terrorist Attacks: Results from Two Population Surveys,' and "Children and Adolescents Admitted to Specialty Mental Health Care Programs in the United States, 1986 and 1997."

To order this publication (SMA 3938), contact SAMHSA's National Mental Health Information Center at P.O. Box 42490,

2003 Survey Released

SAMHSA's Office of Applied Studies released the 2003 National Survey on Drug Use and Health at the 15th annual launch of September's National Alcohol and Drug Addiction Recovery Month. The survey-the largest of its kind Government-wide-includes findings on illicit drug and alcohol use, tobacco use, trends in lifetime prevalence of substance use, trends in initiation of substance use, youth prevention-related measures, and prevalence and treatment of mental health problems across the Nation.

For a copy of the survey, contact
SAMHSA'S National Clearinghouse for
Alcohol and Drug Information at P.O.
Box 2345, Rockville, MD 20847-2345.
Telephone: 1 (800) 729-6686 (English
and Spanish) or 1 (800) 487-4889 (TDD).
Online, the publication is available at
www.oas.samhsa.gov.